{
    "data": [
        {
            "src": "[doctor] hi diane , how are you ?\n[patient] i'm doing okay , how are you ?\n[doctor] i'm doin' okay . so i know the nurse told you about dax and i'd like to tell dax a little bit about you okay ?\n[patient] okay .\n[doctor] diane is a 28 year old female with a past medical history , significant for , depression and hypertension who presents for emergency room follow-up .\n[doctor] so diane what's going on ? i heard that your- your blood pressure was really high in the emergency room . what happened ?\n[patient] yeah , so i ended up going for a walk , um , yesterday 'cause it was sunny and it was really great . and i just felt really light-headed , um , and i started to fall a bit , and , um , luckily i was with my boyfriend and he caught me , um , and then we went right to the e , to the er .\n[doctor] yeah , okay . yeah , i saw that the blood pressure was pretty high , like in , like , the , almost 200 .\n[patient] yeah .\n[doctor] did you have a headache ?\n[patient] yeah i did .\n[doctor] okay , all right . have your blood pressures been running high in the past ?\n[patient] yeah , they have been . it's- it's , like , once a week , a month , it , kind of , just skyrockets .\n[doctor] okay .\n[patient] um , it usually ends up , um , being , i'm traveling a lot that week for work , so i'm not eating as well , um-\n[doctor] you're not taking your blood pressures , i take it-\n[patient] yeah .\n[doctor] . when you're traveling ?\n[patient] yeah , no , i do n't bring my cuff with me .\n[doctor] okay , but you did buy the cuff like we talked about in the past ?\n[patient] yes i did .\n[doctor] okay , all right . and are you taking your medication , are you taking the lisinopril ?\n[patient] yes i am .\n[doctor] okay , all right . um , so i think we had started you at a , kind of , a moderate dose , so we'll have to talk about that a little bit , okay ?\n[patient] okay .\n[doctor] then in terms of your depression , how are you doing ? i know that we did n't start you on medication , since you're on a bunch of other medications . what- what are your strategies for dealing with that and how are you doing ?\n[patient] so last year i started therapy and i've been going once a week and that's really helped .\n[doctor] okay , all right , great . and how is your support system ?\n[patient] really great . my boyfriend , my mom , and my brother are- are s- , amazing and they're all super close to me , so it's been , it's been good .\n[doctor] okay , well great . so i know you did a review of system sheet when you checked in and i know that you had the headache and the lightheadedness yesterday . do you have any other symptoms at this time , chest pain , shortness of breath , anything like that ?\n[patient] uh , i have a little bit of nasal congestion , but that's just from my seasonal allergies .\n[doctor] okay , all right . well i want to go ahead and do a quick physical exam , okay ?\n[patient] okay .\n[doctor] hey , dragon , show me the blood pressure .\n[doctor] so , yeah , looking at your blood pressure today here in the office , it does look a little elevated still , so we'll have to talk about that . so i'm just gon na listen to your heart and your lungs and we'll go from there okay ?\n[patient] okay .\n[doctor] so on physical examination , i- i do n't appreciate any carotid bruits in your neck . your heart on your heart exam , it does show that you have a slight two out of six systolic ejection murmur . your , there , your lung exam shows nice clear lungs bilaterally and you do have some trace pitting edema to your lower extremities bilaterally . so what that means is , you know , i- i think ultimately , uh , you know we just need to get your blood pressure under better control , okay ?\n[patient] mm-hmm .\n[doctor] um , uh , let me just go ahead , i want to take a look at some of your results , okay ?\n[patient] okay .\n[doctor] hey , dragon , show me the ecg .\n[doctor] yeah , so in reviewing the results of your ekg , it looks the same as last year . um , you do have just blood , those changes from your chronic high blood pressure that we'll address , okay ?\n[doctor] hey , dragon , show me the echocardiogram .\n[doctor] and this is just the echocardiogram from just a few months ago that just , you know , show that you have that slightly leaky heart valve , nothing to do for it , and that the heart murmur is stable , okay ?\n[patient] okay .\n[doctor] so let's just talk a little bit about , you know , my assessment and my plan for you . so , for your first problem , your high blood pressure , it's not controlled at this time , so i want to go ahead and increase the lisinopril to 40 milligrams once a day . i want you to continue to check your blood pressures and report them to me through the patient portal and we'll have to make adjustments if necessary and maybe have to add a second agent , okay ?\n[patient] okay .\n[doctor] and then for your second problem , uh , i want , you know , for your depression , i do n't think that we need to start you on any medication , it sounds like you're doing really well from that standpoint , but you know that you can contact me if you , if you need anything , okay ?\n[patient] okay .\n[doctor] do you have any questions ?\n[patient] no , not at this time .\n[doctor] okay , all right , well it's good to see you .\n[patient] good seeing you too .\n[doctor] hey , dragon , finalize the note .",
            "tgt": "CHIEF COMPLAINT\n\nEmergency room follow-up.\n\nHISTORY OF PRESENT ILLNESS\n\nMs. Diane Baker is a 28-year-old female with a past medical history significant for depression, and hypertension, who presents for emergency room follow-up.\n\nThe patient went for a walk yesterday and began to feel lightheaded. She started to fall, however she was with her boyfriend, who caught her. She presented to the emergency room after this. While in the emergency room, her blood pressure was nearly 200 and she had a headache.\n\nHer blood pressure is typically normal, however will become elevated approximately one week a month. She notes it is typically elevated because she is traveling a lot that week for work. While traveling, she is not eating as well and does not monitor her blood pressure. The patient is taking her lisinopril as prescribed.\n\nRegarding her depression, she states she is doing well. Last year she started therapy and she has been going once a week, which has helped. Her support system is great and includes her boyfriend, mom, and brother.\n\nThe patient notes she has a little bit of nasal congestion, which she attributes to her seasonal allergies. She denies chest pain and shortness of breath.\n\nREVIEW OF SYSTEMS\n\n\u2022 Ears, Nose, Mouth and Throat: Endorses nasal congestion from seasonal allergies.\n\u2022 Cardiovascular: Denies chest pain or dyspnea.\n\u2022 Respiratory: Denies shortness of breath.\n\u2022 Neurological: Endorses lightheadedness and a headache.\n\u2022 Psychiatric: Endorses depression.\n\n",
            "file": "D2N168-virtassist-subjective"
        },
        {
            "src": "[doctor] hi alan , how are you ?\n[patient] hi , good to see you .\n[doctor] good to see you as well . are you ready to get started ?\n[patient] yes i am .\n[doctor] so , alan is a 61-year-old male , here with complaints of shortness of breath .\n[doctor] so alan , what's going on ?\n[patient] so over the weekend , uh , i took a very long bike ride , about three hours or so and i got back , i was very light headed , i was short of breath and it really surprised me because i pretty much bike ride every morning and it was never an issue before so i'm a little concerned about that .\n[doctor] okay , and have you had any other symptoms ? have you had any fever-\n[patient] n-\n[doctor] . chest pain ?\n[patient] no , but i felt very light headed and , uh , i- it was hard to catch my breath afterwards , so maybe i did have a little chest pain but , uh , it , it eventually went away after about an hour .\n[doctor] okay , um , and anyone else sick in your , in your family ?\n[patient] no .\n[doctor] okay , and any cough ?\n[patient] um , i had a little bit of a cough with my first cold in the last year and a half , but that went away after about a week or so .\n[doctor] okay , all right . um , and any other symptoms ? i know you went through the review of symptoms-\n[patient] mm-hmm .\n[doctor] . with the nurse but any nausea or vomiting or abdominal pain ?\n[patient] n- no .\n[doctor] okay . all right . well , i know that i've treated you for migraines in the past . how are you doing with those ?\n[patient] that's been under control . i've , uh , taken medication , i've , uh , avoided bright lights and it's so far so good .\n[doctor] okay . all right . and i think we had you on imitrex for that . have you-\n[patient] yes , i'm still taking that .\n[doctor] all right . and then your reflux , how are you doing with that ?\n[patient] managing that as well .\n[doctor] okay and everything's working out well with the protonix ?\n[patient] yes .\n[doctor] okay . and then i know you had the cataract surgery about three months ago , your vision is okay ?\n[patient] that was about four and a half months ago and it's been actually great ever since .\n[doctor] okay , great . all right , well , we're gon na go ahead and do a quick physical exam . i wan na see your vital signs first .\n[patient] sure .\n[doctor] hey dragon , show me the vital signs .\n[doctor] okay , so looking here , everything looks quite good . your oxygenation is perfect , which is wonderful . let me just take a listen .\n[doctor] deep breath . another one . good .\n[doctor] so , on your physical exam , your neck is nice and supple . i do n't appreciate any jugular venous distension . your heart is in a regular rhythm , i do n't hear any murmur . your lungs do have a slight wheeze , expiratory wheeze , bilaterally . i can hear it every time you breathe and i see trace lower extremity edema in your lower extremities .\n[doctor] so what does all that mean ? you know , you , uh , i'm not quite sure yet but we're gon na review some of your results . hey dragon , show me the chest x-ray .\n[doctor] so looking here , this is a very normal chest x-ray . um , i do n't see any pulmonary edema , there's no pneumonia , so we're viewing your chest x-ray as , it's a norm- it's normal .\n[patient] good .\n[doctor] so , let's look at your pulmonary function test .\n[doctor] hey dragon , show me your , the pfts . and looking here again , these look quite good , i'm , i'm quite encouraged by that . that's , that's normal pulmonary function tests . hey dragon , show me the labs . and all of your labs here look quite good here as well so , i- i- i'm very pleased . so , right now my impression of you is that you may have had an asthma exacerbation from exercising and with the allergies , so at this point in time i'd like to go ahead and prescribe you some albuterol inhaler .\n[patient] mm-hmm .\n[doctor] two puffs every four hours as needed for wheezing or for shortness of breath . and , i'd like to go ahead and order a pulmonary referral for you , okay . do you have any questions about that ?\n[patient] no questions , thanks .\n[doctor] hey dragon , order a pulmonary referral . hey dragon , order albuterol inhaler , two puffs every four hours , as needed for shortness of breath .\n[doctor] and then i think from your reflux standpoint , everything seems stable and your migraines , i think that we should just continue on with the imitrex , as needed . does that sound good to you ?\n[patient] that sounds fine .\n[doctor] i wan na see you in a couple weeks and if you have this shortness of breath again , i want you to call me right away , okay ?\n[patient] you got it .\n[doctor] all right . good to see you .\n[patient] same here .\n[doctor] hey dragon , finalize the note .",
            "tgt": "CHIEF COMPLAINT\n\nShortness of breath.\n\nHISTORY OF PRESENT ILLNESS\n\nAlan Butler is a 61-year-old male presenting with complaints of shortness of breath.\n\nThe patient states that over the weekend, he took a very long bike ride for approximately 3 hours, and when he returned, he was very lightheaded and short of breath. He notes that it was difficult to catch his breath afterward. He endorses that he had mild chest pain at that time, however, it eventually went away after about an hour. He denies any fever at this time or any other symptoms at this time. No other members in his family have been sick.\n\nThe patient is currently taking Imitrex as needed for his migraines. His migraines are under control and he avoids exposure to bright lights.\n\nThe patient is currently taking Protonix for his reflux and he is doing well with this.\n\nThe patient had cataract surgery about 4.5 months ago. He notes that his vision is okay since then.\n\nREVIEW OF SYSTEMS\n\n\u2022 Constitutional: No fevers.\n\u2022 Cardiovascular: Endorses chest pain and dyspnea on exertion.\n\u2022 Respiratory: Endorses a cough. Endorses shortness of breath.\n\u2022 Gastrointestinal: Endorses reflux.\n\u2022 Neurological: Endorses migraines. Endorses lightheadedness.\n\n",
            "file": "D2N169-virtassist-subjective"
        },
        {
            "src": "[doctor] hi joyce , how are you ?\n[patient] i'm good . how are you ?\n[doctor] i'm doing well . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you when we get started , okay ?\n[patient] okay .\n[doctor] all right . so , joyce is a 50 year old female with a past medical history significant for copd , congestive heart failure who presents for follow-up to an abnormal lab finding . so , joyce , i , i got the results of your lab , uh , your labs . your hemoglobin was low . uh , so , i asked them to schedule a follow-up appointment with me . so , how are you feeling ?\n[patient] i've been feeling really tired lately . over the past couple of months , i've noticed that my energy has really gone down . i used to be really active , um , just trying to be as healthy as i can be , running, climbing . um , i at least try to do an hour or two a day . and over the past month , it's gone slowly downhill . i've just been so tired and exhausted and i have n't been able to really keep up with the way i , i was g- was going with my exercise .\n[doctor] okay . all right . um , now , have you had ... have you noticed any blood in your stools at all ?\n[patient] uh , no , not really . not , not at this time .\n[doctor] okay . and are your stools , like , dark or charry or black looking ?\n[patient] no . not that i've noticed .\n[doctor] okay . and are you spotting a lot with your periods ?\n[patient] no , i'm not .\n[doctor] okay . all right . um , and do you have any other ... i know that you are endorsing this fatigue and you feel kind of dizzy and that type of thing . do you have any other symptoms like chest pain , shortness of breath , fever , chills , body aches , anything ?\n[patient] no , nothing like that .\n[doctor] okay . any weight loss ?\n[patient] um , i've noticed a little bit , but that's because i think i've been doing really well with my exercise . um , but nothing too significant .\n[doctor] okay . all right . well , let me ask you a little bit about how's the , the copd doing . i , i know that , you know , you've stopped smoking several years ago , but , you know , you still have that em- those emphysema changes on your chest x-ray . so , how are you doing with that ? how's your breathing ?\n[patient] it's been okay . um , i have n't been smoking . i ... after i quit , i quit cold turkey and i have n't gone back since . so , that's been doing well . i think , uh , during the changes of season , it gets a little bit harder for me to breathe , but i think that's just because of my allergies .\n[doctor] okay . all right . and then from a congestive heart failure standpoint , are you watching your diet , you're watching your salt intake ?\n[patient] yeah . i've been doing really well with that . i've been staying away from the french fries , and all the other salty foods that i love to eat , uh , and everything looks great .\n[doctor] um , so , french fries are one of my favorite foods , that and fried chicken , so-\n\n[doctor] i give you a lot of credit for staying away from french fries .\n[patient] thank you .\n[doctor] um , okay . so , you ... so , no swelling in your legs or any- anything like that .\n[patient] no , not that i've noticed .\n[doctor] okay . and you feel like you have a good support system ?\n[patient] yeah . my boyfriend is , is great and i have , um , my brother right down the road .\n[doctor] okay . all right . good . i'm glad to hear that . uh , so , let's go ahead . i wan na just do a quick physical exam , okay ?\n[patient] okay .\n[doctor] hey , dragon , show me the vital signs . all right . well , your vital signs here in the office look good , so , i'm , i'm really happy to see that with the abnormal hemoglobin that we saw . um , i'm gon na just listen to your heart and lungs and press on your belly a little bit and i'll let you know if i find anything , okay ?\n[patient] okay .\n[doctor] all right . okay . all right . so , on physical exam , you know , i , i do n't appreciate anything cervical lymphadenopathy . your heart sounds really good , but i do hear a , a slight two out of six systolic heart , uh , murmur , um , systolic ejection murmur on your heart exam . your lungs sound clear . your abdomen ... you know , you did have a little tenderness to palpation in your right lower quadrant on your abdominal exam , uh , but i do n't appreciate any lower extremity edema . so , all that means it that we , you know , we hear that heart murmur , which we heard in the past , um , and your belly had some tenderness , so we'll have to talk about that a little bit , uh , going forward , okay ?\n[patient] okay .\n[doctor] let's look at some of your results , okay ?\n[patient] mm-hmm .\n[doctor] hey , dragon , show me the hemoglobin . so , here , looking at this , you know , your hemoglobin level is 8.2. somebody like you should have a hemoglobin o- of about 13 , 14 , okay ?\n[patient] okay .\n[doctor] so , we need to investigate why it's low . hey , dragon , show me the anemia labs . okay . so , looking here at your labs , uh , everything looks good from , from this standpoint . i think some of your anemia labs are still pending at this time that's part of the workup .\n[patient] mm-hmm .\n[doctor] so , let's go over a little bit about the assessment and plan for you . so , you know , your main problem , this abnormal lab , this low hemoglobin that we found , so , you're anemic and we nee- ... you know , i'm waiting for those anemia labs to come back to find out exactly , you know , what type of anemia you have . i'd like to go ahead and schedule you for an endoscopy a- and a colonoscopy just to make sure that you're not bleeding from your , inside your belly , okay ? um , and i'm ... i'll be in touch when those labs come back to see what further workup we need to do , okay ?\n[patient] mm-hmm .\n[doctor] for your next problem , the copd , i think you're doing great . you know , i , i do n't think that you , uh , need any further referrals at this time for that . i would just continue staying away from smoking . it does n't sound to be like you need any inhalers at this time . uh , for your third problem , your congestive heart failure , you know , i wan na continue you on the toprol , continue you on the lisinopril and we'll continue you on your current diuretic dosing of 20 , lasix 20 milligrams a day .\n[doctor] i'm gon na go ahead and order that referral to g- to gastroenterology . they're the ones who will do the endoscopy and the colonoscopy , okay ?\n[patient] okay .\n[doctor] hey , dragon , order the referral to gastroenterology . so , i'll be in touch . i'm gon na stay in close contact with you over the next week or so and , uh , we'll get this all sorted out , okay ?\n[patient] okay .\n[doctor] all right . take care , joyce .\n[patient] thank you .\n[doctor] hey , dragon , finalize the note .",
            "tgt": "CHIEF COMPLAINT\n\nFollow-up to an abnormal labs.\n\nHISTORY OF PRESENT ILLNESS\n\nJoyce Price is a 50-year-old female with a past medical history significant for COPD, congestive heart failure who presents for follow-up to an abnormal lab finding.\n\nThe patient reports that she has been feeling really tired lately. She reports that over the past couple of months, her energy has really gone down. She used to be really active, trying to be as healthy as she can be with running and climbing, at least an hour or two a day. Over the past month, her activity has slowly decreased. She reports that, due to her fatigue, she has not been able to keep up with her exercise. She reports that she had noticed a little weight loss, but she believes that was due to her doing really well with her exercises.\n\nThe patient reports that her COPD is doing well. She reports that she has not been smoking since she quit. She reports that during the changes of the season, it gets a little harder for her to breathe, but she believes that is because of her allergies.\n\nFrom a congestive heart failure standpoint, she reports that she has been doing really well with her diet. She reports that she has been staying away from French fries and all the other salty foods that she likes to eat. She denies any swelling in her legs.\n\nShe reports that she has a good support system with her boyfriend and her brother.\n\nShe reports that she has not noticed any blood in her stool at this time. She denies that her stools are dark or black in color. She denies that she has had any abnormal bleeding between menses. The patient denies any other symptoms such as chest pain, shortness of breath, fever, chills, or malaise.\n\nREVIEW OF SYSTEMS\n\n\u2022 Constitutional: Denies fevers, chills. Endorses weight loss. Endorses fatigue.\n\u2022 Cardiovascular: Denies chest pain or dyspnea.\n\u2022 Respiratory: \u00a0 Endorses shortness of breath with seasonal changes.\n\u2022 Gastrointestinal: Denies hematochezia, melena.\n\u2022 Genitourinary: Denies abnormal bleeding between menses.\n\u2022 Neurological: Positive for dizziness.\n\n",
            "file": "D2N170-virtassist-subjective"
        },
        {
            "src": "[doctor] hi evelyn , how are you ?\n[patient] i'm good , how are you ?\n[doctor] i'm good . it's good to see you .\n[patient] good to see you too .\n[doctor] so i know the nurse told you a little bit about dax . i'm gon na tell dax about you , okay ?\n[patient] okay .\n[doctor] so evelyn is a 56-year-old female with a past medical history significant for coronary artery disease , prior carpal tunnel release , and a herniated disc who presents for her annual exam . so evelyn it's been a little while since i've seen you , how have you been doing over the last year ?\n[patient] i've been doing okay , um , everything , um , with my herniated disc in my back has been doing really well . i have n't had any , um , back pain , or any , um , limitations in movement , so that's been doing well .\n[doctor] okay , yeah , i know that we have done a steroid injection for that , uh , a couple of month- , uh , several months ago , so that's- that's doing well ?\n[patient] yeah , it is .\n[doctor] okay , i'm glad to hear that . and then , how about your carpal tunnel issues , you had that fixed a couple of years ago , so are you having any recurrent issues , or you good , you back to work ?\n[patient] i am back to work . i have n't had any issues , and i've had full range of motion , and it's- it feels really good .\n[doctor] all right , so no numbing and tingling in your hands ?\n[patient] no .\n[doctor] okay , that's good . and then , you know , i know that you've had , uh , prior stenting in the past for your- for your heart , and your heart vessels .\n[patient] mm-hmm .\n[doctor] how are you doing from that standpoint ? have you had any chest pain , shortness of breath , nausea or vomiting ?\n[patient] over the last month i've been having a bit of chest pain , but i have n't had any of the other symptoms you mentioned .\n[doctor] okay , does the chest pain happen when you walk ?\n[patient] yeah , it does .\n[doctor] okay , and does it- does it go away if you- if you rest ?\n[patient] yeah , it does actually .\n[doctor] okay , all right . do you ever get it just sitting there at rest ?\n[patient] no i do n't .\n[doctor] okay , all right . okay , and- and can you describe it ?\n[patient] it's like a burn .\n[doctor] okay .\n[patient] it it just feels like it's burning , um , nothing terribly concerning , not enough to send me to the er , but i do notice it .\n[doctor] okay , and where exactly is it located in your chest ?\n[patient] just , um , right in the middle ...\n[doctor] okay .\n[patient] right here .\n[doctor] okay . and how often are you getting it ?\n[patient] um , probably about three- three times a week .\n[doctor] okay , all right . well i'm glad that you talked about that with me today , um , i know the nurse did a review of systems sheet with you , and , you know , you're obviously endorsing this- this chest pressure . um , have you had any other symptoms , i know the- the other ones that you have n't had , but any lower extremity edema , or muscle aches , or fever chills ?\n[patient] no , nothing like that , but i have had a little bit of congestion , um , just from allergies , because of the pollen .\n[doctor] okay , so you're endorsing some nasal congestion ?\n[patient] yeah .\n[doctor] all right , well let's go ahead and we'll do a physical exam , okay ?\n[patient] okay .\n[doctor] hey dragon ? show me the vital signs . so here your vital signs look really good , i'm- i'm happy to see that your blood pressure is under- under good control , and your oxygenation is fine , so i'm just gon na take a listen to your heart and lungs , and i'll let you know if i find anything , okay ?\n[patient] okay .\n[doctor] okay , so in physical exam your heart has a slight three out of six systolic ejection murmur , which we've heard before . your lungs are nice and clear , uh , i do n't appreciate any carotid bruits , and- and you have no lower extremity edema , you have healed , uh , surgical scars on your- on your , uh , right wrist . um , so let's go ahead , i wan na look at some of your results , okay ?\n[patient] okay .\n[doctor] hey dragon , show me the echocardiogram ? so this is the echocardiogram from last year , you know , you did have a slightly low pumping function of your heart at 45 % , but , uh , i- , you know , i suspected that will improve over time , and you did have some slight , what we call , mitral regurgitation , that's just a leaky heart valve , and that's that murmur that i heard . hey dragon , show me the ecg ? and here , you know , in reviewing your results of your e- ecg , you know , it looks stable , it just kinda reflects your prior coronary artery disease . there's no new changes , which is good , so let's talk a little bit about my assessment and plan for you .\n[doctor] so , from your first problem , you know , your carpal tunnel release , i do n't think that we need to anything further about that , 'cause you seem to be doing really well , you're back at work , if you have any recurring symptoms , just let me know , and we can take it from there . for your next problem , your herniated disc , that also sounds like your doing really well , i do n't think that we need to refer you for any further steroid injection , or physical therapy at this time . so , if you have recurrent symptoms , i want you to let me know . and finally , your last problem , the most concerning problem to me is your known coronary artery disease , and this recurrent chest pain you have .\n[doctor] so , i wan na go ahead and continue you on your asprin , and your toprol , okay ? i wan na go ahead and order a stress test for you to see if you have more blockages that could be causing this chest discomfort , okay ?\n[patient] okay .\n[doctor] and i'm gon na go ahead and get a lipid panel and , uh , start you on crestor 20 mg , once a day , okay ?\n[patient] okay .\n[doctor] hey dragon , order a cardiac stress test . do you have any questions ?\n[patient] no , that's it .\n[doctor] okay , all right . hey dragon , finalize the note . so , it was good to see you , the nurse will come in , she'll help you get your scheduled for all of those things , and i'll be in touch , okay ?\n[patient] okay .\n[doctor] take care .",
            "tgt": "CHIEF COMPLAINT\n\nAnnual exam.\n\nHISTORY OF PRESENT ILLNESS\n\nEvelyn Morris is a 56-year-old female with a past medical history significant for coronary artery disease, prior carpal tunnel release, and a herniated disc. She presents for her annual exam.\n\nThe patient states she has been doing okay with her herniated disc in her back. She has not had any back pain or any limitations in movement. She had a steroid injection for her herniated disc several months ago, which has been doing well.\n\nHer right carpal tunnel release was performed a couple of years ago and she is back to work. She has full range of motion and it feels really good. No numbness or tingling in her hands.\n\nShe has had prior stenting for her heart and heart vessels in the past. Over the last month, she reports chest pain approximately 3-4 times a week with ambulation. Her chest pain does resolve with rest. The pain is described as burning and is located in the middle of her chest. She denies pain at rest.\n\nShe has had a little bit of nasal congestion from allergies. The patient denies, shortness of breath, nausea, vomiting, or lower extremity edema.\n\nREVIEW OF SYSTEMS\n\n\u2022 Constitutional: Denies fevers, chills.\n\u2022 Ears, Nose, Mouth and Throat: Endorses nasal congestion form allergies.\n\u2022 Cardiovascular: Denies dyspnea. Endorses chest pain with exertion.\n\u2022 Respiratory: Denies shortness of breath.\n\u2022 Musculoskeletal: Denies muscle pain.\n\n",
            "file": "D2N171-virtassist-subjective"
        },
        {
            "src": "[doctor] morning roy , how are you doing ?\n[patient] hey , good to see you .\n[doctor] so , my nurse told you a little bit about dax ? so , if you do n't mind , i'm going to tell dax a little bit about you today .\n[patient] perfect .\n[doctor] great , great . so , roy is a 50-year-old male patient who comes in with a history of depression , you had some , um , high blood pressure and some hypertension .\n[doctor] so , tell me how have you been doing?\n[patient] sure . so it's been a , a pretty stressful winter and spring . and , uh , we've been onboarding a couple new employees and we have been pretty short-staffed in the meantime .\n[doctor] um , any changes in , um , weight gain or anything like that ?\n[patient] probably for the last month or so , we've been hosting some friends over vacation , and on ... you know , at the beach in the summer , so the diet is off the charts .\n[doctor] okay . okay . gotcha , gotcha .\n[patient] out the window .\n[doctor] out the window . okay . and , um , now i know you've had a history of depression . you're on zoloft , uh , 50 milligrams a day . have you been doing okay with that ?\n[patient] uh , for the most part . again , it's been kind of a challenging year-and-a-half or so .\n[doctor] sure .\n[patient] so i have my bouts . but i- it- it's under control .\n[doctor] okay . uh , sleeping okay at night ?\n[patient] mm-\n[doctor] occasionally ?\n[patient] i , i could use more sleep like everybody .\n[doctor] okay .\n[patient] but, uh, i'll, i'll usually wake up at about 5:00 in the morning .\n[doctor] okay .\n[patient] which is a little early .\n[doctor] uh , no feelings of , uh , you want to hurt yourself or anybody ?\n[patient] no , no .\n[doctor] okay , good , good . and , um , your high blood pressure , um , that's been under relatively good control recently . have you found that ? your blood pressures have been okay ?\n[patient] yes . that's why this is a little concerning to me , because of the , uh , recent , the recent readings .\n[doctor] okay , gotcha . gotcha . okay . so , um , if you do n't mind , i'm going to do a quick exam . okay ?\n[patient] sure .\n[doctor] okay . so , um , on my physical exam , your lungs are clear . your heart is , is regular . you do have a grade two systolic ejection murmur . we've had that before , so nothing new-\n[patient] mm-hmm .\n[doctor] . there . um , and not clinically relevant at all . um , your extremities are normal , no edema . um , you have put on a c- a , a little bit of weight .\n[patient] okay .\n[doctor] i want you to get back on that diet .\n[patient] okay .\n[doctor] because that's the key . right ?\n[patient] okay .\n[doctor] as far as your high blood pressure , not going to change anything there . okay ? we'll just leave you on your lisinopril 5 milligrams a day , that's good .\n[patient] okay .\n[doctor] that's also good for your kidneys , so everything , everything good ... is good there . your third problem is your depression . been a rough year . some of that's just normal reactive stuff . so i think we'll just keep you where you are at . not going to change the zoloft . do you need a refill on your zoloft ?\n[patient] uh , actually i do .\n[doctor] okay . hey dragon , order a zoloft 50 milligrams daily . we'll get that refilled for you . okay ? so , um , i'd like to see you back in about a month , an- and then in about , uh , three months\n[doctor] okay .\n[patient] a1c , if everything's getting back on track . okay ? anything else i can do for you today ?\n[doctor] no . that should do it .\n[patient] okay . come with me , we'll get you checked out . hey dragon , finalize the note .",
            "tgt": "CHIEF COMPLAINT\n\nHistory of depression.\n\nHISTORY OF PRESENT ILLNESS\n\nRoy Sanchez is a 50-year-old male who comes in with a history of depressionand high blood pressure. He presents today for abnormal labs.\n\nHe states it has been a pretty stressful winter and spring, as they have been very short-staffed at work. The patient admits to recent weight gain. He has been hosting friends over vacation and at the beach this summer so the diet is off the charts out the window.\n\nThe patient has a history of depression and is doing well. He has been consistent with utilizing his Zoloft 50 mg a day. The patient states this has been a challenging year and a half. He is sleeping okay at night, occasionally waking up at 5 a.m. Denies thoughts of self-harm or suicidal ideation\n\nHis high blood pressure has been under good control recently\n\nREVIEW OF SYSTEMS\n\n\u2022 Constitutional: Endorses weight gain.\n\u2022 Psychiatric: \u202f Endorses stress.\n\n",
            "file": "D2N172-virtassist-subjective"
        },
        {
            "src": "[doctor] hi logan , how are you ?\n[patient] hi . good to see you .\n[doctor] it's good to see you as well . so i know the nurse told you about dax . i'd like to tell dax a little bit about you . okay ?\n[patient] sure .\n[doctor] so logan is a 57-year-old male , with a past medical history significant for coronary artery bypass grafting , hyperlipidemia , and ocd , who presents with an upper respiratory infection . so , logan , what's going on ?\n[patient] so , uh , about a week ago i started to get a cold . and , in the last two or three days , it seemed to move into my chest .\n[doctor] okay . um , and , and are you having any pain in your sinuses ? or , any post nasal drip ?\n[patient] um , i had some post nasal drip for , again , for the beginning of the week . and then , uh , it , it left my , uh , my head . it went right down to my upper , uh , chest .\n[doctor] okay . and have you gotten vaccinated against covid ?\n[patient] i actually have . i've , uh , gotten both vaccines .\n[doctor] okay . all right .\n[patient] on both , both stages .\n[doctor] okay . and anyone else sick as far as you know ?\n[patient] no , not in my house . no .\n[doctor] okay . and have you had any fevers ?\n[patient] uh , i thought i had a slight fever , but no .\n[doctor] okay . and , um , any shortness of breath ?\n[patient] no .\n[doctor] okay . all right . um , so let's just talk a little bit about your high cholesterol . how are you doing with the diet ?\n[patient] i've been pretty good for the most part . uh , we did a little bit of travel over the last week or so , so the diet was n't great . but , for the most part it's been good .\n[doctor] okay , i , i know we have you on the , on the crestor 20 milligrams a day . you're doing okay with that , so tolerating it ? no muscle aches , anything like that ?\n[patient] no muscle aches .\n[doctor] okay . and i know you had the , uh , bypass grafting last year . you're doing okay ?\n[patient] it's been great .\n[doctor] no chest pain ?\n[patient] other than the congestion , no chest pain .\n[doctor] okay . all right . and you're able to exercise ?\n[patient] yes .\n[doctor] okay . before you got sick .\n[patient] that's correct .\n[patient] that's correct .\n[doctor] okay . all right . well , let's go ahead , i want to do a quick physical exam . okay ?\n[patient] you got it .\n[doctor] hey dragon , show me the vital signs . so , here it ... your vital signs look great . your oxygenation is 96 % . so that's very good . okay ? uh , i'm just going to check out your heart and lungs , and i'll let you know what i find . okay ?\n[patient] sure .\n[doctor] okay . so on exam , you do have some cervical lymphadenopathy . and your lungs have bilateral ronchi in them , um , and some wheezing . so , what that means is , you know , you have a little infection . you probably have a little bit of a cold , and you have some lymph nodes that are swollen , and some congestion in your lungs , like you said . let's go ahead and take a look at some of your results . okay ?\n[patient] mm-hmm .\n[doctor] hey dragon , show me the lipid panel . so your cholesterol , for the most part , is really good . i think you're doing a good job . uh , i do n't think you have to make any changes right now . um , hey dragon , show me the covid test . turns out you're positive for ... for covid .\n[doctor] so the results of your po- your covid test are positive .\n[patient] okay .\n[doctor] so , i know you were vaccinated . you probably have a , a , a very , um , low-level positivity . so let's talk about that . so for your first problem , uh , is your covid infection . and i think the vaccine has helped you . it seems to be very mild at this time . your oxygenation is really good . i want you to quarantine for t- for 10 days , so , uh , try to avoid your other household family members . okay ?\n[patient] okay .\n[doctor] and you're going to have to take off work . um , if your symptoms worsen , i want you to call me .\n[patient] okay .\n[doctor] it's just supportive management . uh , for your next problem , your high cholesterol , let's continue you on the crestor 20 milligrams a day , and continue to watch your ja- your , your diet and i- then i'll go ahead and order another lipid panel for six months . and , from a coronary artery bypass grafting standpoint , your coronary artery disease seems under control . you're exercising . you do n't have any chest pain . we'll do a stress test in six months as well .\n[patient] okay .\n[doctor] okay ? any questions ?\n[patient] no questions .\n[doctor] okay . it was good to see you .\n[patient] same here .\n[doctor] hey dragon , finalize the note .",
            "tgt": "CHIEF COMPLAINT\n\nUpper respiratory infection.\n\nHISTORY OF PRESENT ILLNESS\n\nLogan Harris is a 57-year-old male with a past medical history significant for coronary artery bypass grafting, hyperlipidemia, and OCD, who presents with an upper respiratory infection.\n\nThe patient reports that about a week ago he started to get a cold, which has worsened in the last 2 or 3 days. He endorses some postnasal drip for the beginning of the week, however, it has seemed to move into his chest. He denies chest pain other than his chest congestion. He was able to exercise prior to getting sick. He denies anyone else being sick in his house. He denies fever and shortness of breath.\n\nRegarding his high cholesterol, he states he has been pretty good for the most part. He did a little travel over the last week or so and his diet was not great but for the most part it is pretty good. He is on Crestor 20 mg a day and is tolerating it well. He denies any muscle aches. He had his bypass grafting last year and is doing great.\n\nThe patient is fully vaccinated for COVID-19.\n\nREVIEW OF SYSTEMS\n\n\u2022 Constitutional: Denies fevers.\n\u2022 Ears, Nose, Mouth and Throat: Endorses post nasal drip.\n\u2022 Cardiovascular: Endorses chest congestion.\n\u2022 Respiratory: Denies shortness of breath.\n\u2022 Psychiatric: Endorses obsessive compulsive disorder.\n\n",
            "file": "D2N173-virtassist-subjective"
        },
        {
            "src": "[doctor] hi , james , how are you ?\n[patient] hi , good to see you .\n[doctor] it's good to see you too . so i know the nurse told you about dax , i'd like to tell dax a little bit about you .\n[patient] sure .\n[doctor] james is a 57 year old male with a past medical history significant for coronary artery disease and lupus , who presents today with joint pain . so james , what's what's going on ?\n[patient] yeah . i've been putting a , a few more miles on the bike each day and , uh , my knees have been killing me , just more so in the last three or four days or so .\n[doctor] okay . is it one knee versus the other , or both ?\n[patient] both equally .\n[doctor] okay . and , um , does it hurt more in the morning when you wake up , or does it hurt more when you're walking around and that type of thing ?\n[patient] usually when i get up in the morning , they're pretty stiff and sore , and then by the end of the day , i start to feel that same sensation . kind of pretty much , like , uh , probably around dinner time or so .\n[doctor] okay . and any other , any other joints bothering you , your elbows , wrists , shoulders , anything like that ?\n[patient] no , it's just the knees .\n[doctor] just the knees . and have you noticed any swelling of your knees , or any redness of your knees ?\n[patient] uh , they look a little inflamed in the morning , and then in the afternoon , same but not as bad , not as noticeable .\n[doctor] okay . and do you have any other symptoms with this ? do you have any other associated fatigue or fever or anything like that ?\n[patient] no , no .\n[doctor] okay . and no injury ?\n[patient] no , no . just , uh , repetitive motion , riding the bike the everyday , it , it's part of my workout , i just probably , uh , probably doubled the miles .\n[doctor] okay , all right . well , tell me a little bit about . uh , you know , it's been a while since i've seen you . you know , in terms of your heart disease , and i know you got the stent placed last year .\n[patient] mm-hmm .\n[doctor] um , i know they took you off the plavix , are you still taking your aspirin every day ?\n[patient] i am .\n[doctor] okay . and how are you doing with your crestor ? any problems with that ?\n[patient] no , none whatsoever .\n[doctor] okay . and any chest pain or shortness of breath ?\n[patient] no .\n[doctor] no ? okay .\n[doctor] okay . all right , and in terms of your lupus , we have , you know , this is something that was kinda back in the , in the background for you , and we have n't had to do a whole lot . you know , your kidney function's been really good . um , any , any issues as far as you know ?\n[patient] no , nothing , not at least in the last year or so .\n[doctor] okay . i think we , we might have to look into it a little bit further with this knee pain that you're having .\n[patient] okay .\n[doctor] but i wan na go ahead and , um ... you know , i know that the nurse did a review of system sheet and we just covered a lot here .\n[patient] mm-hmm .\n[doctor] any other symptoms , abdominal pain , nausea , vomiting ?\n[patient] no , no .\n[doctor] no , just the knee pain ?\n[patient] mm-hmm .\n[doctor] okay . all right . well , let's go ahead and do a quick physical exam .\n[patient] okay .\n[doctor] hey , dragon , show me the vital signs . so your vital signs here in the office look really good .\n[patient] mm-hmm .\n[doctor] there's no fever , your blood pressure and your heart rate look great , so that's , that's awesome .\n[patient] mm-hmm .\n[doctor] um , i'm just gon na check out your heart and your lungs .\n[patient] sure .\n[doctor] and your knees , and i'll let you know what i find , okay ?\n[patient] okay .\n[doctor] all right . so on physical examination of your heart , you know , i do hear that's , like , two out of six systolic ejection murmur , but we've heard that in the past . your lungs sound nice and clear . and on your knee exam , i do appreciate , you know , some bilateral , uh , edema and some slight erythema , there is a slight effusion present on the right knee . does that hurt ?\n[patient] little bit .\n[doctor] all right , so pain to palpation of the right knee . um , and decreased range of motion of the knees bilaterally . so i just wan na look at some of your results , okay ?\n[patient] mm-hmm .\n[doctor] hey , dragon . show me the right knee x-ray . so this is an x-ray of your right knee and in reviewing the results of that , everything looks fine , there's no boney abnormality , there's no fracture , which is not surprising , based on the history , okay ?\n[patient] mm-hmm .\n[doctor] hey , dragon . show me the ekg . and this is your most recent ekg which we did before you came in , and that all looks really good . so , um , so no concerns from a heart standpoint . so let's talk a little bit about , you know , my assessment and my plan for you .\n[patient] mm-hmm .\n[doctor] so for your first problem , your , your knee pain , you know , i'm concerned that it might be from , you know , a flareup of your lupus , so i wan na go ahead and order and autoimmune panel to kinda see where we stand , okay ?\n[patient] sure .\n[doctor] hey , dragon . order an autoimmune panel . for your next problem , the coronary artery disease , i think you're doing really well , your ekg looks good , your vital signs look good .\n[patient] mm-hmm .\n[doctor] i'm gon na go ahead and order a lipid panel and another echocardiogram , okay ?\n[patient] okay .\n[doctor] hey , dragon . order an echocardiogram .\n[doctor] do you have any questions ?\n[patient] no questions .\n[doctor] all right , well , the nurse will be in soon and she'll get you checked out , okay ?\n[patient] you got it .\n[doctor] hey , dragon . finalize the note .",
            "tgt": "CHIEF COMPLAINT\n\nJoint pain.\n\nHISTORY OF PRESENT ILLNESS\n\nMr. James Moore is a 57-year-old male with a past medical history significant for coronary artery disease and lupus, who presents today with some joint pain.\n\nThe patient reports he has been \" putting a few more miles on the bike each day \". His bilateral knees have been sore in the last 3 to 4 days. He states his bilateral knees are equally painful. He notes stiffness and soreness in the morning and, by the end of the day, he feels the same sensation. He endorses swelling and redness in his knees which reduces in severity by the afternoon. The patient denies any other associated fatigue. He denies any injury to his knees. He denies pain in any other joints including his elbows, wrists, or shoulders.\n\nIn regards to his coronary artery disease, Mr. Moore states he is compliant with his aspirin and Crestor. He denies chest pain or shortness of breath.\n\nThe patient denies recent symptoms related to his lupus over the last year.\n\nHe denies fever, chills, abdominal pain, nausea, and vomitting.\n\nREVIEW OF SYSTEMS\n\n\u2022 Constitutional: Denies fevers.\n\u2022 Cardiovascular: Denies chest pain or dyspnea.\n\u2022 Respiratory: Denies shortness of breath.\n\u2022 Musculoskeletal: Endorses joint pain, stiffness, swelling, and erythema in bilateral knees.\n\n",
            "file": "D2N174-virtassist-subjective"
        },
        {
            "src": "[doctor] hi , natalie . how are you ?\n[patient] good . how are you ?\n[doctor] it's good to see you .\n[patient] good to see you , too .\n[doctor] i know my nurse has already told you about dax . is it okay if i tell dax a little bit about you ?\n[patient] go for it .\n[doctor] all right . so , natalie is a 39-year-old female , here today for a check-up for an abnormal lab . she's got a history of high blood pressure , diabetes , and acl repair .\n[doctor] so , tell me what's going on .\n[patient] so , uh , i got some re- routine blood work done last week and , uh , they said that my blood sugars were , were high , so that i should come in , um , and talk to you and get some more work done and , and , uh , see why that is .\n[doctor] okay . well , were you having any symptoms at all or just , we had some blood work done routinely ? uh , any chest pain , shortness of breath ? any nausea , vomiting , or diarrhea ?\n[patient] no , no symptoms . uh , so i was a little shocked when i came back high and , and elevated , so hopefully we can figure out what's going on .\n[doctor] we've been , kind of , checking on this for a while and you've been on metformin . we actually increased your dose last time-\n[patient] yup .\n[doctor] so right now you're on 100 , 1,000 milligrams a day , correct ?\n[patient] correct . yup .\n[doctor] okay . all right . no , uh , no difficulty urinating or burning when you urinate at all ?\n[patient] nope .\n[doctor] okay . all right . um , hey , dragon , show me the hemoglobin a1c . so in reviewing your , that's the lab that we checked after when i saw before i walked in . it says 8.1 , which is elevated , so i think we need to do a maybe a better job with adjusting your medication .\n[doctor] how are you doing with your diet for your diabetes ?\n[patient] my diet's been really great lately . i've been avoiding sugars , um , been really watching , uh , my weight and power walking every day , so i was a little surprised when the , the blood work came back that i- i had , um , an elevated , uh , test .\n[doctor] okay . and , uh , have you had any , uh , any other , are you checking your blood sugars in the morning or your fasting blood sugars ?\n[patient] yes , i am .\n[doctor] okay . all right . how are you doing with your high blood pressure ?\n[patient] that's been good and stable . um , i've been stable on the medication , been taking that every day . um , and i have a b- a cuff at home to , to measure it myself and that , everything's been normal .\n[doctor] okay , great . and how's your knee doing that's the other issue we've been , kind of , following ? you had some surgery done for that ?\n[patient] yeah . about five years ago , i had , um , an acl repair on my right knee and everything's been going well so far . i have n't had any , uh , issues with mobility . um , it's been great .\n[doctor] and you're pretty physically active and doing exercises ?\n[patient] yeah . i've been power walking about , at least 30 minutes every day .\n[doctor] okay . great . well , let's review , uh , some of your vital signs . hey , dragon , show me the vitals . all right . blood pressure looks good right now . your oxygen level's great . uh , your temperature's good .\n[doctor] so i know you checked in with the review of systems with my assistant before coming in . uh , anything else bothering you today except for the abnormal blood work ? no chest pain ? no shortness of breath ?\n[patient] no , nothing like that ?\n[doctor] no headaches ? no belly pain ?\n[patient] no .\n[doctor] good . great . well , let me examine you , okay ?\n[patient] okay .\n[doctor] alright . just gon na listen to your heart here .\n[doctor] no belly pain ?\n[patient] nope .\n[doctor] okay .\n[doctor] so on exam , uh , your hent or your neck exam is fine . your , uh , your eyes look fine . your lungs are clear . i do hear a systolic ejection murmur , about three over six . your belly's nice and soft . no swelling in your legs or extremities right now .\n[doctor] so let's talk about some of the issues today . all right . for the first issue , for the diabetes , since your hemoglobin a1c is is elevated , uh , and you're already on 1,000 milligrams of metformin , i think we should add , uh , jardiance , uh , 10 milligrams a day . uh , so that's a new medication . we'll start that . i do want you to , uh follow your diet pretty , uh , aggressively . i wan na see if we can get that hemoglobin a1c down the next time .\n[doctor] i'm also gon na add some labs today to see what that , to see a lipid panel and some other blood work . hey , dragon , order a cbc , cmp , and a lipid panel . and i'll go ahead and prescribe the jardiance , 10 milligrams a day . hey , dragon , prescribe , uh , order jardiance , 10 milligrams a day .\n[doctor] all right . for the high blood pressure , i think you're doing great . you're on lisinopril for that , so i think that we should continue that . uh , we'll re-check it again next time and you are monitoring that at home , correct ?\n[patient] yes , i am .\n[doctor] okay , great . and for the knee , i think you're doing great with that . you know , continue with your physical exercise , with your physical therapy , uh , uh , with your normal exercise regimen . uh , if you have any issues with that , certainly give us a call .\n[patient] okay .\n[doctor] all right . any other questions ?\n[patient] no , that's it .\n[doctor] okay . hey , dragon , finalize the note .",
            "tgt": "CHIEF COMPLAINT\n\nCheck up for abnormal labs.\n\nHISTORY OF PRESENT ILLNESS\n\nNatalie Price is a 39-year-old female here today for a check up for an abnormal labs. She has a history of high blood pressure, diabetes type 2, and right ACL repair.\n\nThe patient states she had routine blood work done last week and they said her blood sugars were high. She was instructed to follow up to get some more work done. She denies having any symptoms.\n\nRegarding her diabetes, her diet has been really great lately. She has been avoiding sugars and watching her weight. The patient is power walking 30 minutes every day. She is checking her blood sugars every morning. The patient has continued to utilize metformin 1000 mg a day, which was increased at her last visit.\n\nShe states her high blood pressure has been stable with lisinopril. The patient has a cuff at home to measure her blood pressure herself.\n\nRegarding her knee, she had an ACL repair on her right knee about 5 years ago and everything has been going well. She has not had any issues with mobility.\n\nShe denies chest pain, shortness of breath, vomiting, diarrhea, headaches, and abdominal pain. She denies any difficulty urinating or burning when she urinates.\n\nREVIEW OF SYSTEMS\n\n\u2022 Cardiovascular: Denies chest pain or dyspnea on exertion.\n\u2022 Respiratory: Denies shortness of breath.\n\u2022 Genitourinary: Denies urinary pain.\n\u2022 Neurological: Denies headaches.\n\n",
            "file": "D2N175-virtassist-subjective"
        },
        {
            "src": "[doctor] hi , alexander . how are you ?\n[patient] i'm doing really well . thank you .\n[doctor] so , i know the nurse told you a little bit about dax . i'd like to tell dax about you . okay ?\n[patient] sure .\n[doctor] so , alexander is a 62-year-old male , with a past medical history significant for reflux , who presents for follow-up of his chronic problems .\n[doctor] so , alexander , what's being going on ?\n[patient] well , i am so thankful you put me on that medicine for my , my reflux .\n[doctor] the protonix ?\n[patient] the protonix . that , i had , w- made an amazing change in my life .\n[doctor] yeah .\n[patient] i'm really comfortable now . i eat whatever i want , and i feel so much better .\n[doctor] okay , great . i'm glad to hear that . i know you were having a lot of discomfort there before , so that's good . okay . and how are you doing , kind of , managing your diet ? i know , you know , you have to do some lifestyle modifications , like cutting back on caffeine and spicy foods and alcohol . how are you doing with that ?\n[patient] i'm doing really well . i moved over from caffeine , over to green tea .\n[doctor] okay .\n[patient] and it , it is so , m- it does n't cause as much problem as it did with , when i was drinking so many energy drinks a day .\n[doctor] all right . good . i'm glad to hear that . great . all right .\n[patient] uh , i think getting that , rid of that reflux , really helped my attitude improve .\n[doctor] okay .\n[patient] uh , my job's going great . everything's phenomenal right now .\n[doctor] okay .\n[doctor] okay . and you have a , a good support system at home ? i know you have a big-\n[patient] yeah .\n[doctor] . family .\n[patient] yes . yes . all my kids-\n[doctor] okay .\n[patient] . call and check on me every day .\n[doctor] okay . great . i'm glad to hear that . now , i know you did a review of systems sheet when you checked in .\n[patient] yes .\n[doctor] i , are you having any symptoms ? any chest pain , shortness of breath , belly pain , of , nausea or vomiting ? anything like that ?\n[patient] no . no symptoms at all .\n[doctor] okay , great . um , well , let me go ahead . i wan na do a quick physical exam .\n[doctor] hey , dragon . show me the vital signs .\n[doctor] so , your vital signs here in the office look really good . so , you're doing a great job managing your , your blood pressure . your heart rate's nice and low . i'm gon na go ahead and take a listen to your heart and lungs .\n[patient] okay .\n[doctor] and i'll let you know what i find . okay ?\n[patient] okay .\n[doctor] okay . good . all right . so , on physical examination , i , i do n't hear any carotid bruits in your neck , which is really good . you know , your heart exam , i do hear a slight 2/6 systolic ejection murmur , which i've heard in the past , so that's stable . uh , your lungs are nice and clear , and you do have , you know , 1+ pitting edema bilaterally in your lower extremities .\n[patient] okay .\n[doctor] so , what does that mean ? you know , i , i think , you know , you're doing a ... it sounds like a doing a good job watching your diet . you could ... you just are retaining a little bit of fluid , maybe just from standing all day .\n[patient] okay .\n[doctor] okay ? let's take a look at some of your results . okay ?\n[patient] okay .\n[doctor] hey , dragon . show me the endoscope results .\n[doctor] so , this was the endoscopy that you had last year when you were having all that pain . it just showed that you had had some mild gastritis . so , it's good to hear that that , you know , protonix is helping you a lot . okay ?\n[patient] okay .\n[patient] i'll do a little more exercise too .\n[doctor] that sounds great . all right . so , let's talk just a little bit about , you know , my assessment and my plan for you .\n[doctor] for your reflux , i want you to continue on the protonix 40 mg a day , and continue with those lifestyle modifications with the dietary stuff-\n[patient] okay .\n[doctor] . okay ? do you have any questions ?\n[patient] no questions .\n[doctor] okay . all right . well , the nurse is gon na come in soon , and she's gon na check you , get you checked out . okay ?\n[patient] okay . thank you .\n[doctor] hey , dragon . finalize the note .",
            "tgt": "CHIEF COMPLAINT\n\nFollow-up chronic problems.\n\nHISTORY OF PRESENT ILLNESS\n\nAlexander Myers is a 62-year-old male with a past medical history significant for reflux who presents for follow-up of his chronic problems.\n\nIn regards to his reflux, he reports that he has continued to utilize Protonix 40 mg daily. He states this has helped a lot and he is really comfortable. The patient is doing really well with his diet. He reports that he has discontinued drinking energy drinks and is now drinking green tea. The patient states this change has also helped reduce his side effects.\n\nHe notes that his reflux being improved has helped his mood. The patient has a good support system at home and all of his children call to check on him daily. He also notes his job is going well.\n\nThe patient denies chest pain, shortness of breath, abdominal pain, nausea, and vomiting.\n\nREVIEW OF SYSTEMS\n\n\u2022 Cardiovascular: Denies chest pain or dyspnea on exertion.\n\u2022 Respiratory: Denies shortness of breath\n\n",
            "file": "D2N176-virtassist-subjective"
        },
        {
            "src": "[doctor] hi bruce , how are you ?\n[patient] hey , good to see you .\n[doctor] good to see you as well . uh , so i know the nurse told you a little bit about dax .\n[patient] mm-hmm .\n[doctor] i'd like to tell dax about you-\n[patient] sure .\n[doctor] okay ?\n[doctor] so bruce is a 60 year old male , with a past medical history , significant for depression , type two diabetes and hypertension , who presents for followup of his chronic problems .\n[doctor] so , bruce , i saw you a couple months ago-\n[patient] mm-hmm .\n[doctor] how are- how are you doing ?\n[patient] it's been a crazy year and a half and i think the uh the anxiety , the pressure of getting ready for thanksgiving was really starting to wear on me .\n[doctor] okay .\n[doctor] did you have a nice holiday ?\n[patient] i , i did but it was uh , it was great to see everybody after about two years but it was just a lot of work .\n[patient] a lot of stress .\n[doctor] yeah . yeah . and what do you have to look forward for like , the new year and that type of thing . are you- more gatherings like that ?\n[patient] um planning to take a vacation . so hopefully somewhere nice and warm .\n[doctor] okay . all right . um , well how are you doing in terms of your depression . i know that we've kind of talked about this in the past .\n[patient] mm-hmm .\n[doctor] and we have n't put you on medication because you're on other meds and you- you have n't really wanted to do that , so what strategies are you using ?\n[patient] yeah . over the summer we tried something new . i started going for long walks outside every morning. the weather was so nice and all the plants were in full bloom that i loved to start my day that way. on the weekends, it even encouraged me to do a little in the yard myself which was a nice way to be active and get some sun. but with the seasons changing and it getting so cold out, i have not been able to keep doing it and need to find something new to do. . i'm not ready yet to try any meds , so i think i'd like to look into some alternative options .\n[doctor] okay . so yeah . so we can talk about some therapy and-\n[patient] sure .\n[doctor] that type of thing .\n[patient] sure .\n[doctor] all right . and no ... you do n't wan na harm yourself or others ?\n[patient] no .\n[doctor] any thoughts like that .\n[patient] no .\n[doctor] no , okay . and then in terms of your diabetes , how are you doing , you know especially with the holidays managing your- your sugar intake and that type of thing ?\n[patient] uh , got through halloween okay . did n't stick to the diet too much through the thanksgiving week but it's a little bit better . so i've been trying to really monitor it .\n[doctor] okay . and are you ... you're still taking the metformin , correct ?\n[patient] yes .\n[doctor] okay . all right . and then in terms of your high blood pressure , did you buy the blood pressure cuff that i recommended ?\n[patient] yes .\n[doctor] okay . and how have they been running . i have n't received any you know notes from you in the portal .\n[patient] nothing out of the ordinary . it's been pretty moderate .\n[doctor] it's been pretty good . and you're still taking the lisinopril , no problems with that ?\n[patient] mm-hmm . correct .\n[doctor] okay . all right . i know you did a review of system sheet when you checked in .\n[patient] mm-hmm .\n[doctor] um , do you have any symptoms . chest pain , shortness of breath , belly pain-\n[patient] no .\n[doctor] blood in your stool .\n[patient] no .\n[doctor] weight loss . anything like that ?\n[patient] no .\n[doctor] okay . all right . i wan na go ahead and do a quick physical exam .\n[patient] mm-hmm .\n[doctor] hey dragon . show me the vital signs .\n[doctor] so here in the office . i agree . your blood pressure looks good . uh , i think you're doing a good job with that so keep up the good work . i'm gon na go ahead and take a listen to your heart and lungs , i'll let you know what i find .\n[patient] sure .\n[doctor] all right . so on physical examination , everything looks pretty good , so on your neck exam , i do n't appreciate any carotid bruits . on your heart exam i do appreciate a slight two out of six systolic ejection murmur heard at the left base , which we've heard in the past .\n[patient] mm-hmm .\n[doctor] your lungs are nice and clear and you do have uh one plus non-pitting edema bilaterally in your lower extremities . so what does all that mean ?\n[doctor] it just means i heard a little sound in your heart , which you know is n't anything clinically significant . we had looked into that last year .\n[patient] mm-hmm .\n[doctor] you do have a little swelling in your legs but that might just be from your your diet recently , okay .\n[patient] sure .\n[doctor] i wan na just take a look at some of your results . hey dragon , show me the ekg .\n[doctor] so i just had the nurse do an ekg on you before you came in just to make sure we were n't missing anything . you're in your 60's we have some risk factors . everything looks good .\n[patient] mm-hmm .\n[doctor] there's no evidence that i'm concerned about anything at this time . hey dragon , show me the diabetes logs .\n[doctor] so on your diabetic labs , your hemoglobin a1c is elevated . it's at eight . i'd like to see it closer to six .\n[doctor] now some of them might be having to do with the holidays that type of thing but i still think that we need to get that under better control .\n[patient] sure .\n[doctor] so lets talk a little bit about my assessment and plan for you so for your first problem of your depression i'd like to just go ahead and refer you to uh psychiatry not for medications , but just for some talk therapy that type of thing , okay ?\n[patient] that's fine .\n[doctor] um , for your second problem of your type two diabetes i'd like to go ahead and order a hemoglobin a1c in the next couple months . i want to increase the metformin to 1000 milligrams twice a day . and we're gon na go ahead and order a lipid panel , okay .\n[patient] mm-hmm .\n[doctor] uh , lastly for your third problem for your hypertension i'm gon na go ahead and order an echocardiogram just to recheck it . just that heart murmur . and i'm going to go ahead and keep the lisinopril at 20 milligrams a day . do you have any questions ?\n[patient] no questions .\n[doctor] okay the nurse will be in soon , she'll get you checked out , okay ?\n[patient] you got it .\n[doctor] hey dragon , finalize the note .",
            "tgt": "CHIEF COMPLAINT\n\nFollow up of chronic problems.\n\nHISTORY OF PRESENT ILLNESS\n\nBruce Howard is a 60-year-old male with a past medical history significant for depression, type 2 diabetes, and hypertension who presents for follow up of his chronic problems.\n\nIn regards to his depression, the patient notes that it has been a crazy year and a half. He experienced a lot of anxiety while getting ready for Thanksgiving but it is starting to resolve now. He denies suicidal and homicidal ideation. The patient and his wife began going on walks and gardening over the summer and he notes good relief of his depression from this; however, the season has changed and he needs an alterative method of management. He has preferred to avoid medications in the past.\n\nThe patient is still taking metformin for his diabetes. He notes some dietary indiscretion with Thanksgiving but he is doing better with this now.\n\nIn terms of his hypertension, he notes he is compliant with lisinopril. He did buy a blood pressure cuff and is checking his blood pressure at home. His blood pressures have reportedly been good.\n\nHe denies chest pain, dyspnea, abdominal pain, hematochezia, or weight loss.\n\nREVIEW OF SYSTEMS\n\n\u2022 Constitutional: Denies weight loss.\n\u2022 Cardiovascular: Denies chest pain or dyspnea on exertion.\n\u2022 Respiratory: Denies shortness of breath.\n\u2022 Gastrointestinal: Denies hematochezia or abdominal pain.\n\u2022 Psychiatric: Endorses anxiety and depression.\u202f Denies suicidal and homicidal ideations.\n\n",
            "file": "D2N177-virtassist-subjective"
        },
        {
            "src": "[doctor] okay . maria martin , date of birth 03/05/1946 , has been informed and consents to have this visit recorded . the patient is here for follow-up .\n[doctor] hi , maria . how have you been doing ?\n[patient] same i guess . pretty good .\n[doctor] okay , so you got my letter last time on the results . your sugars are not very well controlled .\n[patient] yeah , i got them .\n[doctor] okay . so did you increase your glimepiride ?\n[patient] did i increase it ?\n[doctor] yeah .\n[patient] i'm still taking the two milligrams .\n[doctor] yeah . so we want you to , as the letter said , from the last time , when your a1c was 9.9 , we wanted you to increase it to four milligrams twice a day , so let's start that .\n[patient] okay , sure . so you want me to take two of the pills , now twice a day ?\n[doctor] yes . uh , how much of it do you have ?\n[patient] well , i just filled it .\n[doctor] okay , good . so yeah , you can take two of them twice a day , of what you have . the new prescription will be for four milligrams twice a day .\n[patient] okay .\n[doctor] great . and are you trying to eat healthier : less sugars , less carbohydrates ?\n[patient] uh , well ...\n[doctor] not really ?\n[patient] . well , i have n't had any pasta ; i just do n't really like it , so we do n't have any in the house . we do n't often have bread , and if we do , we buy wheat bread .\n[doctor] okay . but even the wheat bread , try to cut down on the number of slices you eat per day .\n[patient] i just usually have two in the morning . i do n't care for sandwiches much ; maybe peanut butter sandwiches once in a while .\n[doctor] yeah .\n[patient] i hardly drink , drink any sodas .\n[doctor] well , that's great .\n[patient] i drink club soda .\n[doctor] okay .\n[patient] seltzer water , that's what i prefer , so that's my water . i do n't drink regular water .\n[doctor] okay , that's fine . how about your eye exams ? are they up-to-date ?\n[patient] yep . i just got new glasses .\n[doctor] okay . who do you go see ?\n[patient] i go to liberty road , the group up there .\n[doctor] okay . the , um , the optimum optometrists , right ?\n[patient] they keep changing doctors each time i go .\n[doctor] a new doc each time ?\n[patient] yeah . i got a really nice one i used to see a year ago .\n[doctor] was that dr. sanchez ?\n[patient] yeah .\n[doctor] okay . and you saw him not too long ago ?\n[patient] yeah . i just got my prescription from him . well , see , i had the iodine for my eyes .\n[doctor] cataracts , yep , okay .\n[patient] so he did that and then i had to wait for a month to get healed up and then he wrote my prescription .\n[doctor] perfect . and then you've got the high blood pressure .\n[patient] yeah . a couple of weeks ago , it was 116 on the dot .\n[doctor] okay . well , we will recheck it . you're on a combination of medications . you are on the met- met- uh , metoprolol , 50 milligrams once a day , you're on the lisinopril with hydrochlorothiazide , at 20 , with 25 milligrams once a day , and you're on the amlodipine , 10 milligram once a day . are you taking all of those ?\n[patient] well , yeah .\n[doctor] perfect . and then you've got the high cholesterol and the vascular disease in your legs . you're on atorvastatin . are you tolerating it okay ?\n[patient] yeah , but honestly , my feet feel like hell .\n[doctor] yeah .\n[patient] all the time , my legs are bugging me ; i ca n't do much walking .\n[doctor] okay . yeah , the feet i think is what we call peripheral neuropathy .\n[patient] also , i have the pain up to my hip .\n[doctor] okay . you have pain in the hips and upper legs ?\n[patient] yeah , all of it .\n[doctor] okay . so those do seem relatively stable , right ? and are you trying to get the walking in ?\n[patient] yeah .\n[doctor] okay . and you are smoking still ?\n[patient] yeah , still smoking .\n[doctor] not ready to quit ?\n[patient] no , not really .\n[doctor] it's a bad combination .\n[patient] i know . i'll think about it .\n[doctor] okay . now , let's do my review of systems . you're not having any headaches or dizziness ?\n[patient] headaches or dizziness , no .\n[doctor] okay .\n[patient] nothing , feeling totally normal .\n[doctor] good , good . and the vision is better with the cataract surgery ? that's been good ?\n[patient] yeah . not happy with this lens ; it's kinda funny . the other one is good .\n[doctor] hmm , sometimes they can go in and clean up the eye with laser , but we'll see what they say .\n[patient] okay .\n[doctor] okay . no shortness of breath or coughing ?\n[patient] i've been coughing here lately because i've been congested .\n[doctor] what does it look like when it comes up ?\n[patient] it's relatively clear .\n[doctor] no fever , chills , no shortness of breath ?\n[patient] no .\n[doctor] okay . no chest pains or pressure or tightness ?\n[patient] no .\n[doctor] nausea , vomiting , gi symptoms ?\n[patient] no .\n[doctor] okay . peeing okay ?\n[patient] not good . it's , you know , i'm old ; it takes me a little more time .\n[doctor] slower stream but stable ?\n[patient] yes , but i do pee ...\n[doctor] okay .\n[patient] . several times per day .\n[doctor] mm-hmm . how many times do you have to get up at night ?\n[patient] not too bad , just once in a while .\n[doctor] okay .\n[patient] then i have to pee by morning . i do tend to drink my drinks in the evening .\n[doctor] okay . all right , let's have a look at you .\n[patient] okay .\n[doctor] physical exam : carotids are normal , pulse is no buits . heart exam : rhythm is regular , normal rate , s1 and s2 are crisp . i do not hear any murmurs today , okay . have you lean forward for me . take some deep breaths , in and out . okay , lungs are clear . i do n't hear any rasps or wheezing today .\n[patient] my coughing got better this morning .\n[doctor] you cleared out the lungs ? all right , let me take a look at your feet .\n[patient] okay .\n[doctor] okay . extremities are without edema . pulses are palpable on the dorsalis pedis posterial tibial . she has thickened nails .\n[patient] yeah .\n[doctor] yeah . mildly dry skin , no skin breakdown . l- let me know if you can feel this .\n[patient] okay . i closed my eyes . yeah , yeah , okay .\n[doctor] mildly decreased sensation in the tips of the first and second toes . okay , we're done with your exam .\n[patient] okay .\n[doctor] okay . so again , try to keep the feet moisturized .\n[patient] yeah .\n[doctor] you do have a little bit of periphe- peripheral neuropathy . um , there is a medication we can use if they get really bad , but you're already on so many medications .\n[patient] my girl that i talk to and stuff , she uses on her feet ; she really likes it . it's , like , a foot scrub or some type of cream . i put it on when i think of it after the shower . so i could get my own instead .\n[doctor] that sounds good . so for now , your sugars , we're gon na check your ... we're going to recheck your blood work today , but the sugars last time we checked , the a1c , your blood sugar average was above nine . i really want you to increase the glimepiride . so the ones you have at home , the two milligram , take two of them twice a day .\n[patient] okay .\n[doctor] okay . watch for low sugars , weak , shaky , sweaty . if that happens , let us know , and i do n't expect it to .\n[patient] okay .\n[doctor] okay . the new prescription that i'm going to write is gon na be for the , uh , four milligram pill . so when you get the new one , just one pill twice a day . also , continue the metformin , okay ? blood pressure , when i rechecked it , i got 140 over 60 s- so the numbers at home are better , so we're gon na continue the combination of medications . we'll check kidney function today .\n[doctor] for your cholesterol though , you're on the high dose of atorvastatin or lipitor to protect the arteries , so we really wan na keep you on that .\n[patient] yeah , no problem .\n[doctor] i want you to quit smoking , but we've had this battle before .\n[patient] yeah .\n[doctor] hmm . and then , we will leave everything else the same . we'll get the labs today and we'll see you back here in four months . sound good ?\n[patient] okay .\n[doctor] great . have a good day , ma'am . take care of yourself .\n[patient] thank you . you too .\n[doctor] bye .",
            "tgt": "CHIEF COMPLAINT\n\nFollow-up for diabetes management, hypertension, hyperlipidemia, peripheral vascular disease.\n\nHISTORY OF PRESENT ILLNESS\n\nMaria Martin is a 75-year-old female who presents today for follow-up for diabetes.\n\nThe patient\u2019s blood glucose levels are poorly controlled and her most recent hemoglobin A1C is 9.9%. She denies increasing glimepiride to 4 mg twice a day as advised but confirms she is compliant with 2 mg twice a day. She mostly denies reducing sugar and carbohydrate intake, although she opts for wheat bread, she does not have pasta at home, and she does not drink much soda and instead drinks club soda or seltzer water. She reports that her diabetic eye exams are up to date and she follows with Dr. Sanchez at Optimum Optometrists. She recently underwent cataract surgery and received a new prescription for her glasses, noting improvement in her vision to one eye and displeasure with the lens in her other eye.\n\nShe confirms compliancy with her blood pressure medications of metoprolol 50 mg daily, lisinopril/hydrochlorothiazide 20/25 mg daily, and amlodipine 10 mg daily. The patient intermittently completes at home blood pressure checks and reported seeing a systolic BP of 116 a few weeks ago. She is also compliant with her atorvastatin for hyperlipidemia and reports tolerating it well.\n\nThe patient is still experiencing bilateral hip, thigh, and foot pain related to peripheral neuropathy, noting her mobility is limited but she is walking as tolerated.\n\nMs. Martin does continue to smoke cigarettes and denies interest in cessation, although she agreed to begin thinking about it.\n\nShe is currently experiencing a productive cough with clear sputum that she attributes to her recent congestion.\n\nThe patient is also experiencing a slower urine stream, but it appears stable, and she contributes her urinary symptoms to aging. She also has nocturia on occasion which she contributes to her increased fluid intake in the evenings.\n\nPAST HISTORY\n\nMedical\nType 2 diabetes mellitus.\nHypertension.\nHyperlipidemia.\nPeripheral vascular disease with neuropathy.\n\nSOCIAL HISTORY\n\nCurrent tobacco smoker.\n\nCURRENT MEDICATIONS\n\nMetoprolol 50 mg tablet. Take 1 tablet daily.\nLisinopril/hydrochlorothiazide 20/25 mg tablet. Take 1 tablet daily.\nAmlodipine 10 mg tablet. Take 1 tablet daily.\nAtorvastatin tablet.\nMetformin.\nGlimepiride 4mg tablet. Take 2 tablets by oral route 2 times per day.\n\nVITALS\n\nBlood pressure 140/60.\n\n",
            "file": "D2N178-virtscribe-subjective"
        },
        {
            "src": "[doctor] patient mrn : abc123 . date of birth : january 1st , 1960 . patient is a 60 year old , right-handed male , referred today for evaluation of numbness and tingling .\n[doctor] hello , mr. cook . how are you doing this morning ?\n[patient] hi , dr. martinez . this weekend was a bit rough . i've had this numbness and tingling for a few weeks now .\n[doctor] so it's in both of your hands ?\n[patient] yes , ever since my car wreck last december when i broke them ... well , once they healed , i mean , i noticed it more , the tingling and the numbness .\n[doctor] and you still wear the splint only on the right wrist ?\n[patient] no , i also wear the left sometimes . the right is just worse , but the splint helps . both have really gotten worse over the last month . when i broke them , my right wrist was definitely in worse shape . i've also been having some s- mild stiffness in my neck too . i hit my head during the accident , and they told me it was a contusion .\n[doctor] and where would you say the tingling and numbness is ?\n[patient] on this side , it goes from here and here up to about here . on the other side , it's from here to here .\n[doctor] i see . so on the right side , you're pointing from the middle and ring finger , all the way up the forearm . and on the left , the symptoms extend from the pinky and ring finger . and is there any pain or just tingling and numbness ?\n[patient] eh , it's mainly just sore . sometimes they throb , but overall , they feel weaker too , especially when i'm using them . the tingling happens more when they hurt , but when it goes away , the tingling is dull .\n[doctor] and when do you feel these symptoms ?\n[patient] well , really , i guess , just more so at night , and they come and go throughout the day .\n[doctor] okay . and do you experience any loss of sensation in your hands or fingers ?\n[patient] like , feeling something ? no , not that i can really think of . though , in general , they may be less sensitive than they should be , but i can still feel . they also gave me some nerve pain medicine , but i have n't been taking it like i should .\n[doctor] and are you still on the coreg for hypertension and the lexapro for anxiety ?\n[patient] yes , i'm still taking those . i had prediabetes too , but i got it under control by changing my diet .\n[doctor] and no history of thyroid issues , correct ?\n[patient] nope .\n[doctor] all right , thank you , mr. cook . okay , first , we'll go over your review of systems . correct me if i'm wrong in any of this .\n[doctor] constitutional , you have fatigue and weight gain ; gi , you have excessive appetite and bloating ; eyes have floaters ; cardiovascular shows shortness of breath and leg swelling ; endocrine , you're always hungry ; skin , you have some nail bed changes , dryness , itching ; musculoskeletal , you have gout and muscle pain . and the remainder of the review of systems is negative .\n[patient] yep , that's all correct .\n[doctor] all right , we're going to go ahead and do the neurologic examination . let's look at the right hand first . can you feel this ?\n[patient] yeah , but a little less on these two fingers .\n[doctor] sensation is normal , except pin prick sensation diminished in third and fourth fingers on the right .\n[doctor] and how about on the left ?\n[patient] um , yeah , but these two a little less .\n[doctor] sensation is decreased in the fourth and fifth fingers on the left\n[doctor] okay , let's test your reflexes now . reflexes are 1+ and symmetric ; 2+ knees ; toes are downgoing bilaterally .\n[doctor] all right , i'm going to tap on your right wrist . do you feel anything ?\n[patient] yeah , it feels like a zing up my wrist and something into my elbow too .\n[doctor] and how about the left side ?\n[patient] yeah , same on that side too .\n[doctor] tinel sign positive at both wrists and both elbows . rest of exam is normal .\n[doctor] all right , so what i am seeing today is bilateral carpal tunnel syndrome or , potentially , this could also be bilateral cubital tunnel syndrome . however , your symptom presentation suggests car- bilateral carpal syndrome , as the nerve in your wrists are aggravated by your past trauma . this is causing the pain and tingling you were describing to me .\n[patient] okay , so how do we make it better ?\n[doctor] first , i want to determine exactly where the nerve irritation is coming from . we'll need to schedule you for a nerve test , which is called an emg test . they will measure the responsiveness of your nerves to truly pinpoint where you are having your issues .\n[patient] that sounds fine to me .\n[doctor] great . after the tests are complete , you can return here for a follow-up visit . if you're still having symptoms , we can consider a referral to our hand clinic , possibly for injections or carpal tunnel release se- surgery . you could also refer ... we could also refer you to an orthopedist for the same treatment .\n[patient] sounds good , doc .\n[doctor] all right , keep wearing your splints , and i will see you after those studies .\n[patient] thank you .",
            "tgt": "CHIEF COMPLAINT\n\nNumbness and tingling of both hands.\n\nHISTORY OF PRESENT ILLNESS\n\nElijah Cook is a 60-year-old male referred today for evaluation of numbness and tingling of both hands.\n\nThe patient complains of numbness, tingling, and pain in both hands which began in 12/2019 after he broke both wrists in a motor vehicle accident and which has progressively worsened since then. He continues to wear a splint on the right wrist all the time and on the left only intermittently, which he states is because the right wrist was injured more severely in the accident. The sensation radiates from the hands into the forearms and is equal bilaterally. The 4th and 5th fingers in the left hand and 3rd and 4th on the right-hand tingle. He states that his fingers are sore with palpation and seem weaker than before. Any exertion exacerbates the tingling, and after something exacerbates the pain, the tingling seems \"dull\". The symptoms come and go and seem to occur mostly at night. He denies complete loss of sensation in any of his fingers, but states that they seem less sensitive than they should be. He reports mild stiffness in his neck. He notes that he did hit his head during the car accident and was diagnosed with a contusion. He states that he has been given \"nerve pain medicine\u201d but has not been taking it.\n\nHe currently takes Coreg for his hypertension and Lexapro for his anxiety. He reports a history of prediabetes, which he has brought under control via dietary changes. He denies any history of thyroid issues.\n\nREVIEW OF SYSTEMS\n\n\u2022 Constitutional Symptoms: Easily fatigued, weight gain.\n\u2022 Eyes: Floaters.\n\u2022 Cardiovascular: Bilateral peripheral edema.\n\u2022 Respiratory: Shortness of breath.\n\u2022 Gastrointestinal: Excessive appetite, abdominal bloating.\n\u2022 Musculoskeletal: Gout, muscle pain.\n\u2022 Integumentary: Dry itchy skin, nail bed changes.\n\u2022 Endocrine: Excessive hunger.\n\n",
            "file": "D2N179-virtscribe-subjective"
        },
        {
            "src": "[doctor] patient shirley taylor . date of birth 5/4/1961 . mrn 0000123 . patient is a 60 year old right-handed female new patient referred by dr. jacob ward for evaluation of bilateral hand numbness and tingling . please note that i personally reviewed the ct brain with and without contrasting did 2/5/21 . uh , no metastatic disease . no acute intercranial abnormalities .\n[doctor] hello ms. taylor . how are you doing this morning ?\n[patient] hi dr . lopez . this weekend was a bit rough . i've had this numbness and tingling for a few weeks now .\n[doctor] so , in both of your hands ?\n[patient] yeah . ever since my car wreck last december when i broke them . well , once they heal , i mean , i noticed it more , the , the tingling and numbness .\n[doctor] are you still wearing the splint only on your right wrist ?\n[patient] no . i wear the left one also sometimes . the right one's just worse . the splint seems to help . both have gotten worse over the last month . when i broke them though , my wrist was definitely in worse shape than it is today . i've been having some mild stiffness in my neck too . i hit my head during the accident , and they told me it was a contusion .\n[doctor] okay . and where exactly on the right side would you say the tingling and numbness is ?\n[patient] on the right , i can really notice it from my middle and ring finger all the way up to my forearm , and on my left , a bit more the pinky and the ring and not the middle .\n[doctor] all right . and , um , is there is pain or , or just tingling and numbness ?\n[patient] uh , mainly just sore . sometimes they throb , but overall , they feel weaker too , especially when i'm using them . the tingling happens some more , but when they hurt , you know , it goes away and then the tingling's just dull .\n[doctor] what kind of activities ?\n[patient] well , really , i guess , just more so at night , and then it just kind of comes and goes throughout the day .\n[doctor] okay . and do you experience any loss of sensation in your hands or fingers ?\n[patient] uh , like , like feeling something ? no , not that i can think of really . in general , they might be less sensitive than they should be , but i can still feel . they gave me some nerve pain medicine , but i have n't been taking it like i should be .\n[doctor] okay . looks like your medical history is notable for chronic kidney disease , gout , hypertension , anxiety , gerd , and diabetes .\n[patient] well , i had pre-diabetes , but i got in under control changing my diet .\n[doctor] okay . good . and are you still on the carvedilol 25 milligrams two times a day for hypertension and lexapro 10 milligrams a day for anxiety ? looks like your allergic to sulfa drugs as well . is that correct ?\n[patient] yeah , i'm still taking those and sulfa just causes me to break out in a rash .\n[doctor] and no history of thyroid issues , right ?\n[patient] nope .\n[doctor] all right . thank you ms. taylor . i'll be right back for your exam . i want to look up that medication you mentioned for your nerve pain .\n[patient] all right . thanks .\n[doctor] review of systems , please make the following changes . uh , constitutional , patient reports fatigue and weight gain . gi , um , excessive appetite and bloating . eyes , floaters . uh , cardiovascular , shortness of breath and leg swelling . endocrine , positive diabetes , always hungry . skin , nail bed trenches , dryness , itching . musculoskeletal , gout , muscle pain . neurological , parasthesia , bilateral hands .\n[doctor] um , please use the default normal neuro-physical exam with the following changes . sensations normal except pin prick sensation diminished in the third and forth fingers on the right . and the fourth and fifth fingers on the left . reflexes are one plus and symmetric , two plus knees , toes are down going bilaterally , tinel's sign positive at both wrists and both elbows .\n[doctor] let's move onto assessment and plan , bilateral carpal tunnel syndrome , question of bilateral cubital tunnel syndrome . i discussed my impression with the patient , i will schedule her for emg , ncv . if her symptoms do not resolve , we can consider hand clinic referral for possible symptomatic injections or carpal tunnel release surgery although she can pursue these uh , through her current orthopedist . i encouraged her to wear her splints , returned for emg , ncv . end of note .",
            "tgt": "CHIEF COMPLAINT\n\nUpper extremity tingling\n\nHISTORY OF PRESENT ILLNESS\n\nThe patient is a 60-year-old female referred today for evaluation of numbness and tingling.\n\nThe patient complains of numbness, tingling, and pain in both hands which began last December after she broke both wrists in an MVA and which has progressively worsened since then. She continues to wear a splint on the right wrist all the time and on the left only intermittently, which she states is because the right wrist was injured more severely in the MVA. The sensation radiates from the hands into the forearms and is equal bilaterally. The 4th and 5th fingers in the left hand and 3rd and 4th on the right-hand tingle. She states that her fingers are sore with palpation and seem weaker than before. Any exertion exacerbates the tingling, and after something exacerbates the pain, the tingling seems \"dull\". The symptoms come and go and seem to occur mostly at night. She denies complete loss of sensation in any of her fingers, but states that they seem less sensitive than they should be. she reports mild stiffness in her neck. She notes that she did hit her head during the MVA and was diagnosed with a contusion. She states that she has been given \"nerve pain medicine\u201d but has not been taking it.\n\nThe patient takes carvedilol for her hypertension and Lexapro for her anxiety. She reports a history of prediabetes, which she has brought under control via dietary changes. She denies any history of thyroid issues.\n\nREVIEW OF SYMPTOMS\n\n\u2022 Constitutional Symptoms: The patient reports increased fatigue and weight gain.\n\u2022 Eyes: Positive for floaters.\n\u2022 Cardiovascular: Positive for leg swelling.\n\u2022 Respiratory: Positive for shortness of breath.\n\u2022 Gastrointestinal: Positive for excessive hunger and bloating.\n\u2022 Musculoskeletal: Positive for gout and muscle pain.\n\u2022 Integumentary: Positive for nail bed changes, dryness, and itching.\n\u2022 Neurological: Positive for bilateral paresthesia of hands.\n\u2022 Endocrine: Positive prediabetes and excessive hunger.\n\nPAST MEDICAL HISTORY\n\nChronic kidney disease (CKD).\nPrediabetes, diet controlled.\nHypertension.\nGastric esophageal reflux disorder (GERD)\n\nCURRENT MEDICATIONS\n\nCarvedilol 25 mg twice daily.\nLexapro 10 mg daily.\n\nALLERGIES\n\nSulfa, causes rash.\n\n",
            "file": "D2N180-virtscribe-subjective"
        },
        {
            "src": "[doctor] michelle king , date of birth 01/05/1986 , mrnq27631 . new patient visit for acid reflux . past medical history of anxiety and seasonal allergies .\n[doctor] hello , are you mrs. king ?\n[patient] i am .\n[doctor] i'm dr. phillips . very nice to meet you .\n[patient] you as well .\n[doctor] how can i help you today ?\n[patient] well , my primary doctor , dr. scott , he referred me here .\n[doctor] okay .\n[patient] i've just got really bad acid reflux .\n[doctor] okay . can you tell me more about it ?\n[patient] yeah . though i mean i ... right now , i take 40 milligrams of omeprazole twice a day . some days , it is fine , but others are just really bad .\n[doctor] what do you feel ?\n[patient] it feels like burning .\n[doctor] in your chest ?\n[patient] yes , in my chest and also in my throat .\n[doctor] in your throat and chest . all right . any difficulty with swallowing ? feels like food or liquids kinda get stuck ?\n[patient] no .\n[doctor] okay . that's good . any abdominal pain ?\n[patient] no , not really .\n[doctor] nausea or vomiting , changes in bowel movements ?\n[patient] no .\n[doctor] constipation , diarrhea , rectal bleeding ?\n[patient] nope .\n[doctor] okay . very good . and how long have you had this problem ?\n[patient] i've had acid reflux since i was around 12 , but it has gotten worse over the past few years .\n[doctor] okay . and how long have you been on the omeprazole ?\n[patient] on the way , it is now i think about a year .\n[doctor] okay . do you find that it's done anything for you in the past ?\n[patient] i mean , i can tell it's helped because some days , i'll be fine , and then some days , i eat something and it feels terrible .\n[doctor] are there any things that make your symptoms worse that you can pinpoint , like food choices or stress ?\n[patient] sure . probably stress and food choices sometimes .\n[doctor] okay . what things bother you ?\n[patient] spicy foods , um , so i try not to eat them too often , but sometimes even drinking a soda can cause it .\n[doctor] we do know that caffeine and caffeinated beverages will do that , even sodas . um , even just the carbonation can cause that . how about tomato-based products or citrus products ?\n[patient] yeah , sometimes , but i still eat them .\n[doctor] okay . it's reassuring that you are n't having any difficulty swallowing , though . how's your weight been ? pretty stable ?\n[patient] i'd say pretty stable , although i have n't had much of an appetite for the past two months . i have been under a lot of work stress .\n[doctor] what do you do for work ?\n[patient] i'm a paralegal .\n[doctor] okay . and any family history of gi issues ?\n[patient] um , my grandmother had esophageal cancer .\n[doctor] on your mom or dad's side ?\n[patient] mom's side . and my mom had some issues like acid reflux , and she was taking some medication that coats the lining of your stomach .\n[doctor] okay . have you ever had an upper endoscopy ?\n[patient] i think maybe when i was younger .\n[doctor] but not in the last 10 years ?\n[patient] no .\n[doctor] have you ever tried any medication other than omeprazole ?\n[patient] um , at one point i was on omeprazole and ranititine -dine . it did help . but other than that , those are the only medications i have taken .\n[doctor] okay . have a seat here , and let me listen to your heart and lungs , and then we can talk about a plan for you .\n[patient] okay .\n[doctor] so normal physical exam per my new patient template , except for well-healed abdominal surgical scars noted . what's the surgical scar here on your abdomen from ?\n[patient] i always forget about that surgery . i had it when i was a baby . my mom said my intestines were twisted , so i had to have surgery when i was around one month old .\n[doctor] hm , gotcha . okay . so let's talk about what you have going on . from what you've told me , it sounds like you've had a several-year history of gerd , which is the medical term for acid reflux . and recently your symptoms have been poorly controlled with the omeprazole , 40 milligrams twice daily . you've been having heartburn despite taking this medication , correct ?\n[patient] yes .\n[doctor] and you've identified trigger foods like spicy foods , carbonated bev- beverages , citrus , and tomato-based foods , but you have n't cut these foods out of your diet completely yet . so the first thing i'd try is changing your diet because these foods can exacerbate your gerd , even though you're taking the ppi .\n[patient] okay , yeah , i could definitely do a better job of avoiding those foods .\n[doctor] great . so stress is another trigger that we need to address . high stress can cause worsening of your symptoms .\n[patient] yeah , stress and anxiety are definitely big problems for me .\n[doctor] so working on that may help with your gerd . additionally , we can consider trying a different ppi since the only one you've tried up to this point is omeprazole . if you're okay with this , we can switch your omeprazole to nexium .\n[patient] that's fine with me . i'm definitely open to trying whatever .\n[doctor] perfect . i will send a prescription for nexium 40 milligrams twice daily to your pharmacy on file . i'll also recommend that you have a procedure called a egd , or upper endoscopy , to look for potential causes of the gerd . we'd sedate you and then pass a small camera through your mouth , down your throat , through your stomach , and end in the small intestines . we'd look for any ulcers or signs of precancerous or cancerous conditions that we can take biopsies at the same time if we see anything .\n[patient] okay . can i schedule that today ?\n[doctor] yeah . you can get scheduled at checkout desk . i'll have you follow up with me in the office for the egd so we can discuss the results and talk about how you're doing with the dietary , stress , and medication changes . how does all of that sound ?\n[patient] that sounds good .\n[doctor] perfect . i will walk you to the checkout desk . be sure to call my office and let me know if anything changes or if you have problems before your egd and follow-up appointment .\n[doctor] please insert the procedure paragraph in the plan . i suspect that she likely has gerd with underlying functional etiology as well . reassuringly , she has no unintentional weight loss and denies any dysphagia . if her egd is normal and her symptoms pers- persist despite a trial of nexium , we can consider a trial of protonix and obtain a ph-impedance study . this will allow us to rule out abnormal acid reflux exposure and to decipher between a functional etiology and hypersensitivity .",
            "tgt": "CHIEF COMPLAINT\n\nAcid reflux.\n\nHISTORY OF PRESENT ILLNESS\n\nMichelle King is a 35 y.o. female who presents to clinic today for a new patient evaluation of acid reflux. She was referred by her primary care physician, Dr. Scott.\n\nThe patient reports severe acid reflux that has increased in severity in recent years. She explains that she has struggled with acid reflux since approximately age 12 and she describes a burning sensation in her chest that travels up her esophagus. She denies any dysphagia, abdominal pain, nausea/vomiting, changes in bowel movements, constipation, diarrhea, and rectal bleeding. She also denies any unintentional weight loss, although she admits to having a poor appetite due to her being under immense stress for the past 2 months. She has identified triggers for her symptoms, including stress, spicy foods, soda, and citrus or tomato-based products. She admits that she does still eat her trigger foods sometimes despite the exacerbation of her symptoms.\n\nMs. King has been taking omeprazole 40 mg twice daily for approximately 1 year. She believes that the use of omeprazole provides some relief of her symptoms as there are some days when she is asymptomatic. The only other medication she has tried is ranitidine which she took concurrently with omeprazole and she believes this helped. The patient denies undergoing an EGD within the last 10 years.\n\nPAST HISTORY\n\nMedical\nAnxiety.\n\nSurgical\nSurgery as an infant for \u201ctwisted intestines.\u201d\n\nProcedures\nPossible EGD in youth, but none in the last 10 years.\n\nSOCIAL HISTORY\n\nWorks as a paralegal.\n\nFAMILY HISTORY\n\nMaternal grandmother with esophageal cancer.\n\nCURRENT MEDICATIONS\n\nOmeprazole 40 mg twice daily.\n\nALLERGIES\n\nSeasonal environmental allergies.\n\nREVIEW OF SYSTEMS\n\n\u2022\u202fConstitutional Symptoms:\u202f Positive for loss of appetite.\n\u2022\u202fGastrointestinal:\u202fNegative for constipation, diarrhea, abdominal pain, difficulty swallowing, nausea, vomiting, blood in stools, unexplained change in bowel habits. Positive for heartburn.\n\u2022\u202fPsychiatric:\u202f Positive for stress and anxiety.\n\u2022\u202fAllergic/Immunologic:\u202f Positive for seasonal allergies.\n\n",
            "file": "D2N181-virtscribe-subjective"
        },
        {
            "src": "[doctor] . next patient is michelle king . date of birth : 05/07/1982 . please use toc template . she was admitted to district regional hospital on 06/29/2021 , and was discharged on 07/02/2021 . the patient is a 39-year-old female with history of quadriplegia due to , uh , prior spinal cord injury . she was experiencing increasing concerns for spasms and lightheadedness , significant constipation , and reported diaphoresis . she was evaluated in the emergency department where she was , uh , febrile and had significantly elevated white blood cell count of 23,000 . there were concerns for ongoing urinary tract infection , but she was treated with iv antibiotic therapy . she had labile blood pressure , headache , and vomiting . in the end , she slowly improved . she does have a supra-pubic catheter . cultures were obtained and reviewed . she was eventually discharged after clinical improvement of her symptoms . she presents today to follow up regarding these concerns . hi , michelle . how are you doing ?\n[patient] not too bad . and yourself ?\n[doctor] i'm good , thanks . so , it looks like you had an infection , right ?\n[patient] yeah . but you know , i really do n't think it was a uti .\n[doctor] okay .\n[patient] i told them when i went to the er ... is that your phone ?\n[doctor] it is , yeah . it listens to you and me and it does all of my documentation . it's pretty good stuff . um , tell me what's going on .\n[patient] it is , in my humble opinion , that i was just constipated and that was what was causing my blood pressure to be so high . and i hardly pooped when i was there . then when i got home i had a massive poop and i felt much better . i told them that when i was admitted , and they did x-rays and everything , but they said , \" no , \" as they did n't think that was n't ... that was it . but you know , i felt so much better when i got home and finally pooped .\n[doctor] okay . um , and the white cell count was the only thing that i think they were kind of concerned about because it was a little high .\n[patient] so i wondered if automatic dysreflexia can affect the white count ?\n[doctor] typically , it does n't .\n[patient] okay .\n[doctor] but , i mean , when i looked at the urine cultures that they checked , the cultures are not very impressive .\n[patient] yeah , that's what they said .\n[doctor] and when i go back and look , sometimes your white count is just elevated a little bit , and last year it was normal , so ...\n[patient] hm .\n[doctor] but in saying that , you know , inflammation can do that . so , yeah , you could be backed up and inflamed .\n[patient] yeah .\n[doctor] uh , they did n't do a cat scan , they just did an x-ray . but you feel like you're back to your normal self now ?\n[patient] yeah . i mean , i went in because i knew my blood pressure was out of control .\n[doctor] mm-hmm .\n[patient] it was giving me a headache and making me throw up . and i know , at that point , i'm at the loss of what i can do at home .\n[doctor] yeah , it was good that you went in .\n[patient] so i went in and they made me feel better , and then i went home , as you know .\n[doctor] well , maybe that's all it was .\n[patient] yeah .\n[doctor] so you're doing good otherwise ?\n[patient] yes , i am .\n[doctor] good . let me take a quick listen to you .\n[patient] okay .\n[doctor] all right . go ahead and take a few deep breaths . and breathe normally . now take several deep breaths . and two more . okay , good . you can relax . any pain or discomfort anywhere ?\n[patient] nope .\n[doctor] great . so here are my thoughts .\n[patient] okay .\n[doctor] you may recall it was extremely hot during that period leading up to you going to the hospital . i do n't know if you were inside for the most part ?\n[patient] yeah , it was pretty hot , was n't it ? and i go out a bit , but i do tend to stay in more when it's hot .\n[doctor] okay . well , if you do get dehydrated even just a little bit it can lead to further , um , or worsening constipation issues .\n[patient] mm-hmm .\n[doctor] i've had a lot of patients over the last couple of weeks coming in with just weird stuff , and i blame that a little bit on how hot and humid it was the last two weeks of june . so what i would do is wait a couple of weeks and then , if you could , come back in and we could do some , uh , complete blood work , uh , including your white blood cells and a full panel of cholesterol , since it's been a while .\n[patient] okay .\n[doctor] and it should normalize , but it's too soon to do it now . um , but maybe if i put some labs in you could come in in two to three weeks ?\n[patient] sure , i can do that .\n[doctor] great . so that appointment will let us kill a bird ... two birds with one stone since you're due to get blood work anyways for cholesterol .\n[patient] okay .\n[doctor] and then , i just wanted to make sure that the white count is okay , because if it remains elevated then that means there's something else going on with your bowels .\n[patient] mm-hmm .\n[doctor] i do n't think that's what we'll find , but we'll see .\n[patient] i mean , i knew going in that i had n't had a regular bowel movement in a while , even though i drink the miralax every day .\n[doctor] yeah .\n[patient] when i do n't go , i double up on that .\n[doctor] have i ever given you lactulose ? it would be a medicine you use in , um , conjunction with miralax . sort of a rescue type thing .\n[patient] is that the stuff that comes in a bottle ?\n[doctor] yes .\n[patient] then , yes . i have it . it takes about two days to work and then it's a brutal two days .\n[doctor] got it . yeah , it can be a little rough , but it works .\n[patient] yeah .\n[doctor] all right . so we have our plan . any questions ?\n[patient] yeah , well , i would like to talk to you about covid , if we can .\n[doctor] sure . so where are you at when it comes to the vaccine ?\n[patient] i am unvaccinated .\n[doctor] so what are your concerns about the vaccine ?\n[patient] well , we do n't know the side effects .\n[doctor] correct , we do n't .\n[patient] it's too soon to tell the side effects , and i'm hearing more and more reports of people getting what's now termed as \" vaccine injury \" .\n[doctor] right .\n[patient] which i had never heard of before . i do n't know if it is a new term or not , but my take on the whole thing is that i'm young and healthy enough to beat it , even if my respiratory is limited . i also take a lot of vitamin c.\n[doctor] okay .\n[patient] i also take multivitamins and i'm closely monitored . so i guess i do n't feel as though i really the vaccine .\n[doctor] well , my thoughts are that you actually should be vaccinated . i think you are high risk . if you get covid it's not going to be good for you .\n[patient] okay .\n[doctor] and i think it's safe . i mean , i understand and hear you . all of these stories out there about this , uh , regarding the vaccine . but i've seen all the bad things that could happen from covid . people have died in my practice , and i do n't disagree that if you got covid you'd probably be okay .\n[patient] yeah .\n[doctor] but i would consider you as someone that would make me a little bit concerned . i have had healthy people die from covid .\n[patient] mm-hmm .\n[doctor] i've had some people get really , really sick from it . so personally , i believe that this vaccine is completely safe . i really think that .\n[patient] all of them ?\n[doctor] yeah , i do , i do . i think there are side effects from all vaccines , so you have to go back and think about it . do you get flu shot every year ?\n[patient] no , i do n't .\n[doctor] right , well , it's hard for me to convince you because you're making a consistent viewpoint .\n[patient] well , i am open-minded to this .\n[doctor] mm-hmm . to me , it's , you know , a lot of the stuff out there is fear and most of us health providers have gotten the vaccine . we've seen what the virus can do . i also have gotten all of my kids vaccinated .\n[patient] okay .\n[doctor] so i'm not concerned about the side effects of this . i do n't think it does anything . um , and we have vaccinated 50 % of the country .\n[patient] mm-hmm .\n[doctor] the er is full of these vaccines .\n[patient] i understand .\n[doctor] so there are definitely potential side effects to the vaccine . i mean , there's guillain-barre , and all these things that could happen from the vaccine , but they're just very rare . my thing for you is i'm not convinced that there's alternative stuff or even the treatment we have , like the monoclonal antibodies , that will give help , but it's just my opinion .\n[patient] well , that's what i'm here for .\n[doctor] yeah . right now the numbers are low . even with the delta variant , when it starts mutating , it's actually good because it becomes more contagious , but less deadly .\n[patient] okay .\n[doctor] so that's what's gon na happen with covid . that's what's mo- most of the science supports and this is how most pandemics end , is that the virus starts losing its potency .\n[patient] sure .\n[doctor] but think about it , and if you have any more questions you can certainly let me know , okay ?\n[patient] will do .\n[doctor] all right . anything else we can discuss today ?\n[patient] nope . i think i'm all set . thank you .\n[doctor] you're welcome . so we'll see you in two to three weeks . have a good rest of your day .\n[patient] thanks , you too .\n[doctor] next line heading will be \" acute to chronic constipation \" . she believes her hospitalization was more likely due to her dysreflexia , from her quadriplegia that typically occurs . she did have a lot of vital signs changes , including blood pressure fluctuations . the patient feels like she has a good bowel regimen , including taking the miralax regularly as a primary treatment for constipation issues as well as lactulose for severe constipation . she feels like this was less likely a true urinary tract infection and was just related to her constipation . however , we did have a good discussion regarding her leukocytosis .\n[doctor] i would recommend just in the next three or four weeks to come back in for some updated fasting labs , and we'll repeat the cbc just to make sure her white blood cells tend downward . uh , next line and heading will be \" quadriplegia \" . um , next line and heading will be \" covid vaccine status \" . again , she's hesitant . we had a good discussion , and i recommended that the only true preventative mechanism for covid is the vaccine . i do not believe that supplements are necessarily going to help stave this off . i would be concerned if she does n't get the vaccine and i would consider her at high risk based on her quadriplegia status . she does not want to get covid . however , she needs to make these decisions . she is somewhat homeopathic .",
            "tgt": "CHIEF COMPLAINT\n\nTransition of care visit.\n\nHISTORY OF PRESENT ILLNESS\n\nMichelle King is a 39-year-old female who presents for a transition care visit. She was admitted to District Regional Hospital on 06/29/2021 and discharged on 07/02/2021.\n\nThe patient has a history quadriplegia from a prior spinal cord injury. She reported an increased concern for spasms, lightheadedness, headaches, significant constipation, and diaphoresis. Due to her uncontrolled blood pressure, headaches, and vomiting, she was evaluated in the emergency department. She was noted to be febrile, had a significantly elevated white blood cell count of 23,000, and labile blood pressure. Cultures were obtained and reviewed, with a urinary tract infection suspected. To note, the patient does require use of a suprapubic catheter. She was provided IV antibiotic therapy and was discharged after clinical improvement of her symptoms.\n\nToday, the patient states she is feeling good and claims that she does not think she had an infection. Instead, she believes she was just constipated and that was the cause of her elevated blood pressure. She states she did not have a bowel movement in the hospital and when she got home, she had a large bowel movement and felt better. She states that she told the medical team in the emergency room that she was constipated, but they did not feel that was the causative agent, although they did complete x-rays and additional tests. The patient reports taking MiraLAX consistently for her constipation and Lactulose as needed, which takes 2 days produce a bowel movement.\n\nThe patient has not received the COVID-19 vaccinations because she does not know the side effects. She reports taking vitamin C and a multivitamin and she does not feel the need for the vaccine even though her \u201crespiratory status is limited\u201d. The patient also denies receiving the flu vaccine.\n\nPAST HISTORY\n\nMedical\nQuadriplegia.\nSpinal cord injury.\nHypertension.\nChronic constipation.\nAutomatic dysreflexia.\n\nCURRENT MEDICATIONS\n\nMiraLAX as needed by mouth.\nLactulose as needed by mouth.\n\n",
            "file": "D2N182-virtscribe-subjective"
        },
        {
            "src": "[doctor] all right . this is matthew rogers . date of birth 5/24/2007 . i would like to use the acne follow-up template for him . he is here today for an acne follow-up . at the last visit on 3/3/21 he was prescribed the following : clindamycin lotion , uh , trent- tretinoin cream , 4-5 % benzoyl peroxide wash for f-face and 5-10 % for chest and back . so we're going to enter the room :\n[doctor] hi there , how are y'all today ?\n[patient] good , how are you ?\n[doctor] i'm good , thank you . uh , acne doing better ?\n[patient] yeah .\n[doctor] excellence , excellent . tell me , uh , what did you do for your skin this morning ?\n[patient] i washed it with , uh , the benzoyl peroxide and i put the antibiotic thing , and the sunscreen moisture stuff as well .\n[doctor] perfect . uh , what did you do last night ?\n[patient] uh , i washed my face with the benzol peroxide , i put , uh , the tret-tret-tretinoin cream , sh-uh sorry i do n't know how to say that , uh , for nighttime and the sunscreen moisture stuff again .\n[doctor] all right , all right , now have you had any redness , peeling , dryness , or irritation with the use of these medications at all ?\n[patient] nope . not at all .\n[doctor] excellent , excellent . and , uh , washing your chest and back with the higher strength benzoyl peroxide wash , is that right ?\n[patient] uh , no . i did n't get it .\n[doctor] okay . um , are your chest and back doing okay ?\n[patient] um , i mean , i have n't put much effort into it because it has n't' really bothered me .\n[doctor] fair enough . that's all right . um , if it bothers you , that's what , uh , that's why i recommended last time\n[patient] okay .\n[doctor] um , so as we move into the summer it may be something that you are more interested in pursuing doing that , uh , but if you feel like the acne on your face ... do you feel like the acne on your face is improving ?\n[patient] yeah . definitely .\n[doctor] all right , good . good . uh , go ahead and bring your mask down . yeah . yeah . yeah . yeah . that looks good !\n[patient] yeah . it's okay .\n[doctor] definitely . uh , this is one of the fun parts of covid for me . it's like the mask comes down for my acne patients and it's like a big reveal . this lo- this looks a lot better , like a lot better . uh , i'm just going to take a look at your back and chest real quick . um , i would n't recommend making any changes to what you're doing . uh , i'm happy with how things are going . are you- are you happy with how things are going ?\n[patient] yeah .\n[doctor] all right , yeah . if that little bit bothers you , i would use a 5-10 % benzoyl peroxide base . i think that ... i think that what i have using on your face is a 4-5 % . um , usually the back and chest can handle a little , uh , a little something stronger . um , that's the only thing i would think about changing , otherwise it think this looks great .\n[patient] sounds good .\n[doctor] all right , uh , do you have any questions for me ?\n[patient] um , i do n't . i'm just going to write that down .\n[doctor] uh , well you want me to write that down for you on your , uh , checkout sheet ?\n[patient] uh , yeah . that'd be awesome .\n[doctor] uh , the one i recommend for the chest and back is the , the PanOxyl 10 % . uh , we actually have samples of it and coupons . so i can send you home with those .\n[patient] cool . that'd be perfect .\n[doctor] all right , um , so i'm going ahead and tee up a one year prescription for you because at this point i'll want to see you once a year . i want to make sure that you have enough of your medicines , um , and these are going to walgreens on broad ?\n[patient] uh , yeah .\n[doctor] okay . um , all right . so the tretinoin , uh , usually lasts patients a couple of months . you probably have n't refilled that , right ?\n[patient] uh , yeah , we did once , i think .\n[doctor] okay . okay . so i'm going to go ahead and send in a new refill for the clindamycin with 11 refills . and then the tretinoin cream with three refills . uh , that's usually about enough for a year . uh , if you run out though , just let us know . i'm happy to send more . uh , i just need to see you back once a year for your medicine . all right ? your acne printout with steps will be at your checkout sheet . and then here are your samples and coupons .\n[patient] alrighty , thank you .\n[doctor] um , as far as the physical exam . scattered inflammatory papules and pustules across the upper back and posterior shoulders . there are less than 5 inflammatory papules on the forehead , cheeks , and chin . acne vulgaris is improved and well controlled on the face , but there is a mild flare on the back . recommend continuing current treatment plan for the face and initiation treatment with PanOxyl 10 % foaming wash to the back in the shower daily .",
            "tgt": "CHIEF COMPLAINT\n\nFollow-up acne.\n\nHISTORY OF PRESENT ILLNESS\n\nMatthew Rogers is a 14-year-old male who presents today in follow-up for acne. He is accompanied by his father.\n\nMatthew was last seen on 03/03/2021, at which time he was treatment regimen was only 4-5 % benzoyl peroxide facial wash twice a day. He was instructed to continue and was prescribed the following: clindamycin lotion to be applied topically every morning, tretinoin cream, and benzoyl peroxide 5-10 % wash to chest and back in the shower.\n\nToday, Matthew reports that his facial acne is improving. His morning facial regimen includes 4-5 % benzoyl peroxide wash, clindamycin lotion and applying sunscreen. His evening facial regimen includes 4-5 % benzoyl peroxide wash, tretinoin cream, and applying moisturizer. The patient has not been using the prescribed higher strength benzoyl peroxide wash on his chest and back. He states that he has not put much effort into treating the back and chest areas because it has not been bothersome.\n\nHe denies any redness, peeling, dryness, or irritation with use of the topical medications.\n\nCURRENT MEDICATIONS\n\n4-5 % benzoyl peroxide facial wash twice daily.\nTretinoin cream topically at night.\n\n",
            "file": "D2N183-virtscribe-subjective"
        },
        {
            "src": "[doctor] stephanie morales , medical record number 113322 . 44-year-old female that presents today six weeks status post right medial unicompartmental arthroplasty .\n[doctor] hello !\n[patient] hi , how are you doing ?\n[doctor] good , how are you ?\n[patient] i'm all right .\n[doctor] how's the knee treating you ?\n[patient] it's good .\n[doctor] good . any problems ?\n[patient] no , no problems , uh , just still the numbness on this side .\n[doctor] okay . that area of numbness will get smaller as the nerves that innervate the skin across the knee heal .\n[patient] right . okay .\n[doctor] so lem me take a look at your right knee .\n[patient] sure .\n[doctor] all right , and relax for me . good . all right , and bend . good . that looks good . um , the incision looks nice .\n[patient] mm-hmm .\n[doctor] let's look at your x-rays . uh , they look good . so here's what you got going on in there . uh , it looks good . everything's lined up nicely . um , that's looking at it from the front . and this is looking at it from the side . and then this was underneath your kneecap , but we did n't do anything there . but things looks great .\n[patient] okay . i'm so happy with how the surgery went . i have no pain .\n[doctor] yeah , you know , you're still early in your recovery , so i expect you to get even better than what you are now . um , so keep doing your pt to work on your strength , range of motion , and endurance .\n[patient] okay , will do .\n[doctor] you're probably still gon na have aches and pains occasionally . i usually tell people it's two or three months before you feel like you're back to yourself again , so you're doing really well .\n[patient] okay . that's really good to know . thank you .\n[doctor] yeah , let's plan to talk again in six weeks . so if you stop at the desk on your way out today , they're going to get you set up for a telemedicine visit . and that visit'll just be to check in and see how you're doing and make sure things are progressing okay .\n[patient] sure , okay . and can i ask you about work before i go ?\n[doctor] sure .\n[patient] well , as you know , i work for ups , and i'm not able to go back yet because of going up and down steps with the position i have . however , they're asking me to come back to work where i can sit for the shift with breaks .\n[doctor] okay . i , i do n't want you lifting greater than five or 10 pounds , and no standing or sitting longer than a half an hour . uh , usually that means you ca n't do a ups job .\n[patient] all right . so would you write a note to excuse me for another six weeks ?\n[doctor] sure . i'll have my nurse anna give it to you .\n[patient] that's great . thank you .\n[doctor] okay , so we'll talk again in six weeks , and we can discuss your job again at that time .\n[patient] sounds good .\n[doctor] yeah , those , um , are the types of , of jobs that take a good three months until you're kind of ready to get back to doing that kind of labor-intensive work .\n[patient] okay , and driving now ?\n[doctor] uh , we have plenty of data that says normal reflex time is returned at six weeks , and then your return to driving is determined by when you're ready and feel safe to be driving .\n[patient] okay .\n[doctor] yeah . so hang tight . anna will bring that note back in to you , and we'll talk in six weeks .\n[patient] all right , that sounds good .\n[doctor] uh , but keep working hard on , on pt in the meantime though .\n[patient] i definitely will . thank you .\n[doctor] all right , have a good rest of your day .\n[patient] you as well .\n[doctor] okay , this is a six-week post-op meeting exam for her . her gait was antalgic with a slight limp and decreased velocity . she's not using an assistive device . right knee focused exam has a healed surgical scar , mild swelling , tenderness- tenderness .\n[doctor] . on the area of the incision . range of motion is zero to 120 degrees . everything else normal . radiographs were three views of the right knee taken today and show implants in stable position .\n[doctor] no evidence of loosening or early complications . thanks .",
            "tgt": "CHIEF COMPLAINT\n\n6 weeks postoperative follow up.\n\nHISTORY OF PRESENT ILLNESS\n\nMs. Stephanie Morales is a 44-year-old female seen in clinic today in postoperative follow up, 6 weeks status post right medial knee unicompartmental arthroplasty.\n\nOverall, the patient reports that she is doing well but does experience some numbness on the lateral aspect of her knee. She states she participates in home physical therapy. The patient denies any pain but does not feel she is able to return to work just yet, due to her physical job requirements at UPS.\n\n",
            "file": "D2N184-virtscribe-subjective"
        },
        {
            "src": "[doctor] okay . next patient is ashley james , date of birth 12/27/2006 . ashley is a 14-year-old female , uh , who was previously healthy , now here for evaluation of abnormal renal ultrasound with an atrophic right kidney . hi . good afternoon , ashley . how are you doing ?\n[patient] i'm doing okay . how are you .\n[doctor] i'm doing well . thanks so much for asking . i'm dr. rogers . i'm one of your kidney doctors . and you guys must be mom and dad .\n[patient] yes , that's correct .\n[doctor] great . well ... all right . it's so nice to meet all of you . i wish it was under better circumstances , but we're gon na figure it all out , uh , here today . um , speaking of that , let's go ahead and review some of your past medical history , and then i'll complete an exam of her heart and lungs and kind of move from there . would that be all right with you , ashley ?\n[patient] yeah , that sounds good .\n[doctor] okay . so as i understand it , ashley was found to have a small ... kind of a small kidney on one side . tell me about when that was . um , i do also have records of everything , but i'd just like to hear the story of how it was found out and what you're doing that got us here , uh , today .\n[patient_guest] sure . so ashley came home one day sick out of nowhere , rubbing her stomach , and she said it was hurting on her right side . and it was so bad that she was bent over in pain .\n[doctor] okay .\n[patient] we automatically thought appendix .\n[doctor] sure . that makes a lot of sense .\n[patient_guest] we took her to her doctor . they treated her for a stomach virus . they get her fluids and sent her back home , and the next day she was twice as bad as the first day .\n[doctor] goodness . okay . then what happened ?\n[patient_guest] yeah . so i took her back again and they did more testing . i think they did an ultrasound or something , and that's where they found that one kidney was bigger .\n[doctor] okay .\n[patient_guest] um , then at that time they told us to followup with our primary the next day , which we did . um , but he was heading out on vacation , so he only saw her for a brief 10 minutes and then we were out the door . so she was still throwing up , in a lot of pain , so i took work off to help her .\n[doctor] wow . okay .\n[patient_guest] uh , we took her down to jacksonville , where they did see her and basically told us the same thing , that they did n't think one of her kidneys was working at all . they called it atrophic and that it was a lot smaller than the other one .\n[doctor] all right-y . then- then what happened ?\n[patient_guest] yeah . then , um , they found cysts or something on her kidney and ovaries and maybe some other places . her lymph nodes were swollen and they found some infection . um , they told us to followup with her doctor , which we figured since she was still sick .\n[doctor] okay . and then when you followed up with your doctor , what happened then ?\n[patient_guest] yeah . it did n't seem to be getting any better within a day or two , so we followed back up with her doctor , who was , of course , still out of town with no one to see her in his place . so we ended up coming to atlanta . we stayed here for about four days . um , they did see her and treated her .\n[doctor] okay . i am so sorry for all of that back and forth , but glad to know that there was some light at the end of that tunnel .\n[patient_guest] thank you . and then after they saw her , she did seem to get a little better . she has n't had any more throwing up or anything since , but she still complains about a lot of pain in her stomach .\n[doctor] mhm . okay .\n[patient_guest] yeah . and she mentions burning too , especially when she eats and stuff like that .\n[doctor] all right-y . okay . well , that was a really good review . so , ashley , before all of this , would you say that , all in all , you were a pretty healthy child ?\n[patient_guest] she is , yeah . before that , she was completely fine . uh , they said they think at some point she had a severe infection that might've affected her kidney .\n[doctor] got you . okay .\n[patient_guest] so one other thing , too , um , when she was four years old she was in the hospital three or four times , sometimes for three days at a time . i do n't think they did any tests to see what the infection was or even where it was coming from . um , they just gave her fluids and antibiotic and they would send us home .\n[doctor] hmm . okay .\n[patient_guest] yeah . and so a week or two later , she would have a fever and symptoms and basically the same thing . we went through that for a couple of months , and then it just stopped . so she had no problem since , but the doctor suspects that she's had kidney problems since then . so we just wan na see if she's all right or if she ... if it needs to be taken out maybe . we wan na do whatever needs to be done .\n[doctor] yes . absolutely . it sounds like this road has been very much so rough to navigate too , so we'll- we'll get you through for that . um , is ashley taking any medications daily right now ?\n[patient_guest] only pepcid .\n[doctor] okay .\n[patient_guest] yeah . so she takes 40 milligrams of pepcid a day and then also takes claritin for allergies .\n[doctor] all right-y . and any difficulties with your pregnancy with her or during delivery ?\n[patient_guest] no . um , renal disease does run in my family , though . my dad , aunt , and my cousins all have issues with their kidneys . i have their paperwork right here for you with their diagnoses .\n[doctor] great . i will definitely review that over . any other , uh , family history to be aware of ?\n[patient_guest] yes . my mom had breast cancer too .\n[doctor] okay . great . all right-y . so just a ... over a quick review . it does look like your- your father had a kidney transplant . is that correct ?\n[patient_guest] yes , that is correct . he did .\n[doctor] okay . so obstructive neuropathy . uh , it sounds like he was born with it and something , uh ... something made it so he could n't urinate correctly . does that sound right ?\n[patient_guest] yes , and they did n't catch it in time .\n[doctor] i'm so sorry to hear that .\n[patient_guest] yeah . he actually died at 47 of a massive heart attack .\n[doctor] my goodness . wow . i am so sorry to hear that , um , but thank you so much for ... you know , all of these bits and pieces really help knit up a story together for ashley so we can get her the best care .\n[patient_guest] you're welcome .\n[doctor] okay . so you said her aunt also has had kidney disease ?\n[patient_guest] yes . well , it was my dad's sister , so her great aunt .\n[doctor] okay . and ... okay . i'm looking here . it looks like ... do you know what the name of diagnosis ? it does n't seem to be mentioned .\n[patient_guest] um , this is what she sent me , \" end-stage renal disease . chronic kidney disease stage five , diabetes , hypertension . \" that's all i have , uh , to work on for her .\n[doctor] okay . uh , and that's ... okay . let me see . that is all when ... she was an adult when all of that happened ?\n[patient_guest] correct . yep .\n[doctor] all right-y . okay . and it also looks like ashley has seen a gi and a geneticist , where they did n't find anything sig ... clinically significant mutations on the panel that they did .\n[patient_guest] yes .\n[doctor] okay . so that's all good . so , ashley , um , a few questions for you if that's all right . how are you feeling right now ?\n[patient] i'm not feeling too bad . my stomach just hurts just a little bit . it's burning a little bit .\n[doctor] okay . and any pain when you go pee ?\n[patient] sometimes it's just hard to start , sometimes .\n[doctor] okay . and any blood in your pee ?\n[patient] no , not that i've noticed .\n[doctor] okay .\n[patient_guest] she does complain that it burns when she pees when she drinks certain drinks , um , like , soda . so she'll only drink gatorade or water .\n[doctor] okay . yeah . so we do see that some people are very sensitive when the drink certain items , especially the carbonation . um , it can make it burn a little bit when they urinate . um ... okay . so a lot of different pictures of her kidneys here , and we'll review all of that here in a moment . um-\n[patient_guest] okay .\n[doctor] all right-y . but before we review that , i wan na look through a quick exam , uh , and just see how things are doing . you'll hear me speak aloud the exam just to make sure i'm getting everything documented .\n[patient_guest] okay .\n[doctor] all right-y . please use my physical exam template . so , ashley , i'm gon na listen to your lungs and heart , if you'll just breathe normally for me . okay ?\n[patient] okay .\n[doctor] good . lungs and heart sound great . all right-y . so your physical exam , you know , everything we see up here is ... you know , you're a well-appearing female , alert and oriented , sitting comfortably on my chair today , i hope , uh , with not acute distress . exam , um , otherwise with norm ... within normal limits . okay . so where does that all leave us ? the good news is that her kidney functions do look good as- as does her blood pressure . we'll wan na keep on eye on both of those things , as she is at a higher risk for developing high blood pressure and something that we call proteinuria , which is where your kidneys do n't work as well as they should and we end of seeing protein in your pee .\n[patient_guest] okay .\n[doctor] or , excuse me , her pee . uh , her right kidney is a little bit smaller which is making her left kidney work harder , possibly causing the left to appear bigger , um , and it's something that we wan na keep an eye on but nothing for us to do with anything today .\n[patient_guest] okay . thank you .\n[doctor] i also recommend that , on an annual basis , we do kind of the following things . so i wan na have an ultrasound to monitor the size of her kidneys and their overall function , complete a urinalysis to continue to make sure that protein and blood are not in her ... in her pee , and do a blood pressure check . additionally , let's avoid non-steroidal anti-inflammatory medicines like ibuprofen and opt to use tylenol instead .\n[patient_guest] okay . that sounds good .\n[doctor] okay . and does ashley play any sports ?\n[patient_guest] yes . she is active in softball and she wants to join the drill team over the summer .\n[doctor] how fun . i used to play softball back in the day . um , so it'll be very important that during those activities she stays well-hydrated . i really wan na avoid dehydration , as it puts tremendous strain on her kidneys . so i'm gon na recommend at least two liters per day of water .\n[patient_guest] okay . great . we will work on that .\n[doctor] okay . i also recommended a healthy diet and continue her active lifestyle . this will help keep her and her kidneys healthier as an adult . so if we can start those behaviors early , we'll be in a good space as she progresses .\n[patient_guest] we can do that . we already do try to eat , uh , very well .\n[doctor] good . good . so for her next appointment , she can either meet with her primary care physician or an adult nephrologist closer to you guys at home . you do n't have come all the way out here .\n[patient_guest] okay . that sounds great .\n[doctor] okay . that was a lot . do we need any additional questions clarified or anything ? um , you can always give us or your primary a call if you think of anything or if ... certainly , if symptoms worse .\n[patient_guest] no . i do n't have any additional questions , and i'll- i'll definitely give you a- a phone call if we do . and thank you so much . this was so helpful .\n[doctor] awesome . well , thank you guys for making the trip . and , ashley , it was really nice to meet you . mom dad , you as well . and i hope you guys take care .\n[patient_guest] you too .\n[doctor] all right-y . past medical history , review of patient's grandfather's record , we see he had posterior urethral bowels valves and obstructive neur- neuropathy . uh , he developed chronic kidney disease and was on dial ... was dialysis-dependent . he had a renal transplant which subsequently failed , died of dialysis in his 40s . , wait . is that right ?\n[patient_guest] now that you've started , it does ... i do n't understand the he unless they were giving ... , the grandfather's record . but did you wan na do this on your own this recording ?\n[doctor] yeah . that's ... yeah . that'll work 'cause i'm gon na have to drop for this . but i think we're good for everything else .\n[patient] and he did die in his 40s . that's what it said in the note earlier .\n[doctor] okay . yeah . he died in his 40s , but i thought it was from a massive heart attack . died at 47 of a massive heart-\n[patient] he died ... it- it's saying that it meant ... it means he died on dia ... like , he was ... he was , um , utilizing dialysis .\n[doctor] not because of it . okay .\n[patient] yeah .\n[doctor] i see what you're saying .\n[patient] yeah .\n[doctor] got it . cool . i'm gon na stop-",
            "tgt": "CHIEF COMPLAINT\n\nEvaluation of abnormal renal ultrasound with atrophic right kidney.\n\nHISTORY OF PRESENT ILLNESS\n\nNext patient Ashley James is a 14-year-old female, previously healthy, who is here for evaluation of abnormal renal ultrasound with atrophic right kidney.\n\nThe father details a history of the patient coming home sick one day with extreme right-sided abdominal pain. Her parents brought her for evaluation, and they treated her for a stomach virus and administered fluids prior to sending her home. The next day, the patient's pain was more severe. The patient returned to the doctor's office and an ultrasound and additional testing was performed which revealed left kidney hypertrophy. At that time, they were encouraged to follow-up with her primary care physician. The patient was seen briefly by her physician the next day, which was insignificant. Ashley was still experiencing stomach pain and vomiting, her father brought her to another facility in Jacksonville. At that location, the patient's family received information that her right kidney was nonfunctioning, atrophic, and smaller than her left kidney. Additionally, cysts on her kidneys, ovaries, and other locations were found. Her lymph nodes were swollen, and she had \"a lot of infections\". The patient was sent back to follow-up with her primary care physician. The patient was unable to follow back up with her primary care physician as he was still out of town. The patient came to Atlanta, remained here for 4 days, was evaluated and treated with subsequent improvement of her symptoms. She has not vomited since.\n\nPrior to her current medical complaints, the patient was healthy. The etiology of her kidney issues is believed to have been caused by some severe infection the patient experienced, possibly as a child.\n\nWhen the patient was 4 years old, she was hospitalized 3 or 4 times, for up to 2-3 days each time. She received fluids and antibiotics, and then discharged. Her father reports that no workup was ever performed to rule out infections during these hospitalizations. A week or 2 post-discharge the fever and symptoms would return. This kept recurring for approximately 2 months and then it spontaneously resolved.\n\nThe patient is still experiencing some stomach burning. She reports hesitancy while urinating and she states she has to wait for her urinary flow to commence. She endorses occasional dysuria. Ashley denies hematuria. Some beverages are associated with dysuria, thus the patient drinks mainly water, Gatorade and V8 juice.\n\nSOCIAL HISTORY\n\nThe patient plays on softball team and is interested in joining a drill team over the summer.\n\nFAMILY HISTORY\n\nPaternal Grandfather: Deceased approximately 47. Myocardial Infarction. Posterior Urethral Valves. Obstructive Neuropathy. End Stage Chronic Kidney Disease was Dialysis dependent. Failed Renal Transplant.\nPaternal Great Aunt: End Stage Chronic Kidney Disease is Dialysis dependent. Type II Diabetes. Hypertension.\n\nNo family history of polycystic kidney disease.\n\nCURRENT MEDICATIONS\n\nPepcid 40 mg once daily.\nClaritin as needed for allergies.\n\n",
            "file": "D2N185-virtscribe-subjective"
        },
        {
            "src": "[doctor] hey sean nice to see you i heard you that you have some back pain\n[patient] yeah it's nice to see you too it's been a while\n[doctor] yeah\n[patient] yeah yeah you know i had some back surgery and for some reason i always had lower\n[doctor] left back pain when was your back surgery\n[patient] it was in november of two thousand twenty\n[doctor] was that long ago\n[patient] yes\n[doctor] wow what happened what did they do microdiscectomy my disk broke off and just wrapped around and connected to my spinal thecal sac sounds horrible it's not the poop sac though\n[patient] that's good to know what kind of symptoms did you have with that horrible pain down my leg in my back just horrible awful things that you can think of\n[doctor] horrible nerve pain it sounds like\n[patient] i think so\n[doctor] okay did they give you any meds for that they did i was highly highly dosed up on gabapentin\n[patient] was that hard to withdraw from\n[doctor] yeah it was terrible sounds like yeah there is certainly take too much of that and then stop suddenly you can definitely have some some issues okay so you have left side low back pain\n[patient] mm-hmm\n[doctor] does anything make it better or worse so my beautiful significant other always tells me to stretch and it always works\n[patient] she sounds smart\n[doctor] yeah she is so stretching helps okay what about any physical activities do they make it worse\n[patient] a lot of bending over\n[doctor] okay\n[patient] and\n[doctor] honestly it it just happens\n[patient] you know randomly\n[doctor] randomly okay so it hurt on the right side as well or just the left\n[patient] depends on the day\n[doctor] is it right around where you had surgery\n[patient] generally\n[doctor] okay did you try icing\n[patient] no\n[doctor] hmmm did you try any pain meds\n[patient] yep\n[doctor] what kind of pain meds did you\n[patient] ibuprofen eight hundred milligrams a day\n[doctor] it's quite a high dose okay let me do a quick physical exam on your back here if you bend forward does that hurt\n[patient] not right now but normally it would\n[doctor] okay so no pain with flexion how about if you stand back up\n[patient] no\n[doctor] okay no pain with extension either does it hurt while you're just standing here\n[patient] yes\n[doctor] okay so pain when you're weightbearing does it hurt when i push right here on the left side\n[patient] yes\n[doctor] pain with palpation to the left side around the l5 how about on the right side\n[patient] no\n[doctor] no pain with palpation to the right side okay i'm just gon na push down on your feet can you push back up on my hands\n[patient] yes\n[doctor] alright dorsiflexion is normal looks like that you have normal range of motion so that's good any pain down your legs\n[patient] no\n[doctor] great no nerve pain alright so we took an x-ray when you came in it looks like you do n't have any fractures or anything on the spinal bone that's good you can see where you had surgery it looks like everything has healed properly there so that's good news so what i think you did is you have a a muscle pull there from having a misalignment in your spine so what i'm gon na do is i'll prescribe some physical therapy for you you have great physical therapy here at the va so you can just come right to our physical therapist and that should help have you have you been there before\n[patient] yes\n[doctor] how do you feel about it\n[patient] i really go to the dentist\n[doctor] got it okay so i'm also gon na prescribe you some meloxicam instead of the ibuprofen that might help a little bit more with some of the pain management\n[patient] is there any chance i can get some vicodin\n[doctor] lem me check your record quick for for pain management it's kind of a strong drug for vicodin and we do n't really like to prescribe that unless it's totally necessary so why do n't we start with the meloxicam and i also write a referral to pain management and they can talk to you a little bit about some of your pain and maybe not using narcotics to manage it\n[patient] how about some demerol\n[doctor] hmmm sure i'll prescribe demerol\n[patient] thank you\n[doctor] yeah you're welcome any other problems going on today you want to talk about\n[patient] no\n[doctor] alright well it was nice to see you today\n[patient] it's always nice to see you as well\n[doctor] alright",
            "tgt": "CHIEF COMPLAINT\n\nLow back pain, left side.\n\nHISTORY OF PRESENT ILLNESS\n\nSean Phillips is a pleasant 35-year-old male who presents to the clinic today for the evaluation of left-sided low back pain.\n\nThe patient has been experiencing pain in the left side of his low back, generally localized around the surgical site of his microdiscectomy performed in 11/2020, but occasionally into the right side as well. Other than spontaneous flare-ups, his pain is worsened with excessive spinal flexion. Stretching and ibuprofen 800 mg daily are helpful, but he denies having tried icing the area.\n\nSURGICAL HISTORY\n\nThe patient is status post lumbar microdiscectomy performed in 11/2020.\n\nMEDICATIONS\n\nThe patient reports that, prior to his microdiscectomy in 2020, he was taking high-dose gabapentin for severe nerve pain through his back and lower extremities. He is currently taking ibuprofen 800 mg daily.\n\nREVIEW OF SYSTEMS\n\nMusculoskeletal: Reports left-sided low back pain.\n\n",
            "file": "D2N186-aci-subjective"
        },
        {
            "src": "[doctor] well good morning emily how are you\n[patient] good morning\n[doctor] how are you doing\n[patient] doing okay i'm okay\n[doctor] i understand you're having some sudden visual distortions and some blurring of your vision is that right\n[patient] it is yes\n[doctor] okay so what's going on\n[patient] sorry to put you off i do n't think i have that script\n[doctor] oh\n[patient] maybe a different one i wonder if patient has history of\n[doctor] macular degeneration yeah yeah i was because we do n't we do n't to do the intro anymore i was just going with that you you're coming in with sudden visual distortion and blurring of vision so i'll just you know i'll just say i'll just go ahead and go into this technician part so it looks like the technician noticed that you've been having a decrease in vision when reading and straight lines and your door frames have been looking crooked to you is that right\n[patient] it is yes\n[doctor] okay what kind of venture are we gon na go into do you do you have the the script or no it it just talks\n[patient] but it's it's not presenting like like how you're reading it like how you're talking about it is it kinda what i'm saying because like after that i'm supposed to say yeah whenever i take my husband out to like a nice restaurant i have trouble adjusting to those dim lights but i'm not really getting the question of like so what's causing it or where do you have this happening stuff like that so i'm a little confused\n[doctor] okay i mean i can just straight out follow the script just so we can kinda get it rolling so so i said so hi so it looks like the technician noticed that you've been having a decrease in vision when reading and straight lines in your door frames have been looking crooked to you\n[patient] yeah and whenever i take my husband out to a nice restaurant i have trouble adjusting to those dim lights\n[doctor] uh okay so do you have a favorite restaurant you like to go to\n[patient] i do mcdonalds is one of my favorite here in arlington\n[doctor] that sounds good what what do you what's your favorite there\n[patient] they have a great egg plant parmajon one of my favorite so i just go ahead and go with that\n[doctor] that sounds really nice very good\n[patient] it's just\n[doctor] yeah okay well so it looks like you're still smoking a pack of cigarettes a day\n[patient] yes i tried to stop smoking every now and then but it's still been hard to totally stop\n[doctor] okay and how is your blood pressure been doing are you keeping up with your medication\n[patient] i take my blood pressure when i can remember to do so\n[doctor] okay yeah it's really important to keep up with your blood pressure check that regularly i'm totally going off script and you know might want to keep a log of that as well and check your blood pressures regularly so okay well let me do a just a quick exam of your eyes if you can take off your glasses and just rest your chin on the chin rest okay so the anterior segment examination reveals posterior chamber intraocular lenses in both eyes right eye the cornea is clear no mvi pciol cup to disc is . two fundus examination of the right eye shows the retina to be attached three hundred and sixty degrees without any tears or holes or pe changes in the fovea posterior segment exam shows drusen in the macula thickening of the retina presence of subretinal fluid and exudates accumulation positive for hemorrhage left eye the cornea is clear no mvi cup to disc is . three or pe changes in the fovea no hemorrhage or subretinal fluid retina is attached okay so i reviewed the results of your diagnostic tests so for the oct so it shows drusen deposit and the retinal pigment epithelium subretinal fluid accumulation choroidal neovascular membrane can be visualized fluorescein angiography reveals focal areas of leakage in the right eye consistent with neurovascular age related macular degeneration so the diagnostic tests and the eye exam are really indicative of neovascular age related macular degeneration so this is advanced to a stage that usually leads to more severe vision loss and it really happens when those abnormal blood vessels start to grow beneath the retina and they will leak fluid and blood and hints the name wet amd and can create a large blind spot in the center of the visual field and this is really with the most common cause for severe loss of vision so my plan is to give you an injection of lucentes once a month it's injected into the vitreous portion of the eye after it's been numbed and injections are given regularly over a period of time it may slow the rate of vision decline or stop further vision loss but however the disease and loss it may also progress despite treatment do you have any questions\n[patient] i do not no that sounds great\n[doctor] okay",
            "tgt": "CHIEF COMPLAINT\n\nChanges in vision.\n\nSOCIAL HISTORY\n\nPatient smokes approximately 1 pack of cigarettes per day.\n\nREVIEW OF SYSTEMS\n\nEyes: Reports visual distortions and blurred vision.\n\n",
            "file": "D2N187-aci-subjective"
        },
        {
            "src": "[doctor] hi jaqueline how are you i heard that you injured your ankle\n[patient] yeah it's not going so great\n[doctor] what what happened to your ankle\n[patient] well i was doing something i did n't really want to be doing and i fell and now my ankle hurts\n[doctor] okay well what were you doing were you hiking or biking or what were you doing\n[patient] i was in a mountain biking messenger\n[doctor] you were in a mountain biking lesson and you fell off your bike and twisted your ankle\n[patient] yes\n[doctor] and what ankle was bothering you\n[patient] the right one\n[doctor] your right ankle okay and did it twist like did your ankle twist outward or did your ankle twist inward do you know\n[patient] my ankle twisted outward\n[doctor] your ankle twisted outward and where are you having the most pain is it is it kind of like right on your outer ankle or is it more in your foot\n[patient] outer ankle\n[doctor] it's in your outer ankle okay alright and do you have any numbing or tingling in your toes at all\n[patient] i have some tingling i have no tingling i have some numbing going on and some numbing going on in other places\n[doctor] really like where\n[patient] my heart\n[doctor] alright well i'm an orthopedic person so i ca n't talk to you about your numbing hearts okay now are you able to move your ankle\n[patient] a little bit\n[doctor] are you able to walk on your ankle\n[patient] not really\n[doctor] no\n[patient] not so great\n[doctor] are you limping\n[patient] yeah\n[doctor] you're limping okay have you taken anything for the pain\n[patient] i've taken tylenol\n[doctor] you took tylenol\n[patient] mm-hmm\n[doctor] okay did that help at all\n[patient] no\n[doctor] no it did n't help alright did you hear anything pop or anything like that when\n[patient] i heard like an like a crack crackle so\n[doctor] you heard a crack\n[patient] yeah\n[doctor] okay alright how long have you been mountain biking\n[patient] for like three years\n[doctor] three years wow\n[patient] or so\n[doctor] what where is your favorite place to go mountain biking\n[patient] i do n't remember\n[doctor] is it at north point\n[patient] no\n[doctor] no it's not at north point\n[patient] maybe i do n't know\n[doctor] do you or do you like going to colorado\n[patient] hmmm kind of a time\n[doctor] okay alright okay alright well let's go ahead and do a quick physical exam okay so i looked here at your vital signs and have you had any fever chills or anything like that since this happened\n[patient] i've had a fever it hits the pain hits\n[doctor] you've had a fever how high was your fever\n[patient] like two hundred\n[doctor] that's not a fever alright okay so lem me go ahead you looking at your vital signs you do n't have a fever now your temperature is ninety eight . six your blood pressure is fine at one eighteen over seventy seven and your heart rate looks good at seventy seven beats per minute on your right ankle exam there is some edema and erythema on the lateral malleolus on the right hand side there is associated ecchymosis and a few excoriations does it hurt when i press on it\n[patient] yes\n[doctor] there is pain to palpation of the right lateral malleolus there is decreased flexion and extension of the right ankle as well as internal and external rotation there is no apparent injury to the knee or the foot okay so what does that mean jacqueline seem awfully giggling right now so what does that mean so i took a i had the nurse do an x-ray on you before i came in and reviewing the results of your right ankle x-ray shows that you have no acute fracture or bony abnormality which is good you just have a some soft tissue injury so let's talk a little bit about my assessment and plan so for\n[patient] really\n[doctor] yeah so for your assessment and plan i do believe you have a an acute right ankle sprain i wan na go ahead and put you in an air cast we can give you some crutches i wan na go ahead and prescribe some meloxicam fifteen milligrams once a day you should ice the area for about twenty minutes five times a day and weight-bear as tolerated i am anticipating you to start feeling better in the next couple of weeks if you're not come back here and see me and we will consider physical therapy or pursuing further imaging okay\n[patient] okay bye",
            "tgt": "CHIEF COMPLAINT\n\nRight ankle injury.\n\nHISTORY OF PRESENT ILLNESS\n\nJacqueline Price is a pleasant 28-year-old female who presents to the clinic today for the evaluation of a right ankle injury. The patient sustained the injury when she fell while in mountain biking lessons. She states that her ankle twisted outward. The patient localizes the pain to her lateral aspect of her right ankle. She denies any tingling, but notes numbness in her toes. She notes that she is able to move her ankle a little bit. The patient states that she has difficulty walking. Additionally, she notes that she has a limp when she ambulates. She has taken Tylenol for the pain, but states that it was not beneficial. She denies hearing a pop, but did hear a crack when the injury happened. Ms. Price notes that she has had a fever.\n\nSOCIAL HISTORY\n\nThe patient has been mountain biking for 3 years.\n\nREVIEW OF SYSTEMS\n\nConstitutional: Reports fever.\nMusculoskeletal: Reports right ankle pain.\nNeurological: Reports numbness in the right ankle.\n\nVITALS\n\nTemperature in offce today was 98.6.\nBP: 118/77.\nHR: 77 bpm.\n\n",
            "file": "D2N188-aci-subjective"
        },
        {
            "src": "[doctor] hi betty how are you i i read in the medical records that you ended you did end up having a heart attack they ended up putting a stent in your right coronary artery how are you doing\n[patient] i'm thankful to be alive but definitely struggling and definitely scary time for me\n[doctor] yeah you know i'm i'm i'm glad that we went ahead and sent you to the emergency room now i know that you were in the hospital for about forty eight hours how are you feeling since you've been home you've been home a couple of weeks now how are you doing\n[patient] yeah they told me to really take it easy so i've just been you know doing very light work i i i do n't really do much outside of just you know sitting around and taking my medication but i would say i'm doing okay i feel like i have you know a little it i do n't feel perfect but i feel better than you know i did\n[doctor] okay and have you had any more of that chest pain since they put that stent in or is that completely gone\n[patient] i have not had any chest pain since no a little you know sore right after surgery but that doing much better now\n[doctor] okay and i know that they went through your wrist for the cardiac catheterization how is your wrist doing\n[patient] it's good i you know it was red for a while but it seems to be healing and i think there is no infection\n[doctor] okay and you're right handed correct\n[patient] correct yes right handed\n[doctor] okay alright and any shortness of breath when you walk around or move anything like that\n[patient] yeah i i would say you know i've been trying to keep my my i i'm not doing a lot of exercise but i will say that when i go up and downstairs you know i do feel like i have shortness of breath\n[doctor] okay now i know they put you on that medication the brilinta are you you're taking it correct\n[patient] yes i take it twice a day every twelve hours\n[doctor] okay great and you're still taking your aspirin correct\n[patient] i take the baby aspirin at night is that okay\n[doctor] yeah that's perfect as long as you take it once a day and you're able to afford the brilinta any issues with cost with that\n[patient] no i so far so good\n[doctor] okay alright so it's really gon na be really important for you to go ahead and continue to take these medications to prevent that stent from clogging again okay or prevent that stent from closing because we do n't want you to have another heart attack okay\n[patient] okay yeah\n[doctor] okay and how about watching your diet are you able to watch your salt intake i know that you really liked a good pizza every now and again are you\n[patient] yeah i i have eaten pizza a few times what i'm trying to do is really be diligent and eat well throughout the week and then i have had pizza a few times on the weekends is that okay\n[doctor] you can have a piece here and there you know the pumping function of your heart was pretty normal when i saw from the hospital your ejection fraction that's the pumping function of your heart was at about fifty percent which is you know low normal but not bad so that's good so okay just i would just watch your salt intake okay\n[patient] okay yeah i've been eating a lot of vegetables and and chicken without salt on it\n[doctor] okay great and then you know i i'm i'm glad that you're taking it easy now remind me this might cause you some anxiety were the denver denver nuggets swept or did they end up winning are they still in the nba playoffs i forget i know that you are a denver nuggets fan\n[patient] i am yeah they they are not sweep they were down three games but they wanted the last one so there is a there is a chance for it come back but they they play again tomorrow\n[doctor] okay yeah i'm a self expand and and we just swept the brooklyn net so i was really excited about that\n[patient] congrats that that's that's always good to sweep the nuts no one no one likes them\n[doctor] no one likes them okay well let's i wan na just go ahead and do a quick physical exam i'm just gon na be calling out some of my exam findings and i'll let you know what that means when i'm done okay so looking at your blood pressure here in the office your blood pressure looks good it's about one twenty seven over sixty which is pretty good on your neck exam i do n't appreciate any jugular venous distention there is no carotid bruits on your heart exam i do appreciate a slight three out of six systolic ejection murmur heard at the left base on your lung exam your lungs are nice and clear to auscultation bilaterally and on your musculoskeletal exam your right radial artery cardiac cath site is clean dry and intact there is no hematoma and there is a palpable radial pulse now what does that mean betty so all of that means is that you know you have a little bit of a heart murmur after having the heart attack but i looked on the echocardiogram and it showed that you know you do have mild mitral regurgitation which is just you know a little floppy valve which is is fine we'll just keep an eye on that and then everything else for the most part looks good so let's just talk a little bit about my assessment and plan okay so for your first problem of your inferior myocardial myocardial infarction i wan na go ahead and continue with your aspirin continue on your brilinta you're gon na stay on the brilinta for at least one year and aspirin you're gon na take lifelong until i tell you to okay i wan na go ahead and have you continue on the crestor forty milligrams once a day and i'm gon na go ahead and put in another echocardiogram for about six months okay do you have any questions about that\n[patient] yeah do you think i can no that sounds good i have one other more question though\n[doctor] okay\n[patient] do you think that i can swim again i miss swimming\n[doctor] yeah so at this point you're you know you're out like two weeks and your and your cath site is looks good so you can go ahead and and resume swimming now with that being said i would want you to just do a few laps here and there i do want to enroll you into cardiac rehab that's gon na give you a bit more confidence to go back to exercising and they also give a lot of dietary education and counseling in cardiac rehab does that sounds like something that you can do\n[patient] yeah i think i have to\n[doctor] okay i agree alright i also want you to go ahead and continue with your toprol fifty milligrams once a day and i'm gon na go ahead and order a some liver function studies and a lipid panel to follow up with the next time we meet and i want to see you again in probably six weeks okay\n[patient] okay\n[doctor] okay any questions\n[patient] no i think that's it thank you very much\n[doctor] okay take care bye",
            "tgt": "CHIEF COMPLAINT\n\nFollow up.\n\nMEDICAL HISTORY\n\nPatient reports an myocardial infarction.\n\nSURGICAL HISTORY\n\nPatient reports stent placement in the right coronary artery.\n\nSOCIAL HISTORY\n\nPatient is a fan of the Denver Nuggets basketball team. He also enjoys swimming.\n\nMEDICATIONS\n\nPatient reports taking Brilinta twice a day every 12 hours, aspirin 81 mg at night, Crestor 40 mg once a day, and Toprol 50 mg once a day.\n\nREVIEW OF SYSTEMS\n\nCardiovascular: Denies chest pain.\nRespiratory: Reports shortness of breath with exertion.\nSkin: Denies redness or infection in the right wrist.\n\nVITALS\n\nBlood Pressure: 127/60.\n\n",
            "file": "D2N189-aci-subjective"
        },
        {
            "src": "[patient] and good morning hi beverly\n[doctor] good morning\n[patient] how do you see your last name\n[doctor] howard\n[patient] howard nice to meet you\n[doctor] you too\n[patient] what can i do for you today\n[doctor] well i think i like fell off of my tandem bike with my partner and my knee has been hurting ever since and when did that happen\n[patient] maybe like two weeks ago\n[doctor] okay and which knee are we talking about\n[patient] my right knee\n[doctor] alright and tell me exactly what happened so we were like riding together and i think he said he saw a squirrel or something like that he's a little distractible and you know like he went down so i went down i hit it on the curb like it's really kinda it was sore i gave i i took some ibuprofen and i i like washed it out and put a band-aid on it but it's it's just been like kind of hurting everyday since then so i scheduled an appointment\n[patient] okay is it getting better getting worse or just kinda lingering on\n[doctor] it's it's just holding on and i tried taking like medication right i took some ibuprofen and it was fine it just like it keeps coming back and i i read on the label i'm not supposed to take that stuff for more than two weeks right\n[patient] well it all it all depends everyone's different we'll get to that\n[doctor] okay\n[patient] and your knee was not bothering you at all before this normal knee\n[doctor] yep\n[patient] never okay alright what do you do for living\n[doctor] well i work in a children's hospital so i like play around i i'm a i'm a a baby rocker professionally i go into like the nicu's and i i rock some of the babies\n[patient] gotcha what do you do outside of outside of work is biking kinda your thing\n[doctor] no that was his thing and i think that's why we fell i i should n't trust him but most of the time i go on walks with my dog\n[patient] okay have you broke up with him already or\n[doctor] no i did n't know that knee injury was a reason to but now that you've told me maybe we should talk about that\n[patient] we'll talk about that later too\n[doctor] okay\n[patient] alright so let's take a let's take a peek at your knee here\n[doctor] okay\n[patient] you gon na stick it through the screen or how you're gon na do this alright\n[doctor] okay\n[patient] alright then\n[doctor] i'm just i'm gon na i'm gon na grab your leg we're just gon na take it through just let it relax i'm just gon na take it through a little range of motion i'm gon na kinda poke around all different places you tell me where it hurts okay\n[patient] okay okay\n[doctor] alright now i'm poking i'm poking i'm poking so on the inside part here\n[patient] is this where it hurts\n[doctor] yeah like when you touch it it really hurts\n[patient] right there okay tell me what's worse here or here\n[doctor] on the inside\n[patient] okay so medial joint line tenderness\n[doctor] mm-hmm\n[patient] pes bursa nontender epicondyle nontender back of her knee nice and soft any pain back here\n[doctor] no i do n't think so\n[patient] okay popliteal space is nontender how about over on this side\n[doctor] no okay lateral side nontender skin she has got about a dime size little abrasions dry looks about a week week old right over the medial patella everything else looks good no scars okay how about can you straighten it out all the way i can but sometimes it like hurts a little bit like it almost like it clicks\n[patient] yep that's good though full full extension how far can you bend it\n[doctor] all the way back\n[patient] okay let's see\n[doctor] okay\n[patient] good good and how about the other side let me see the left knee can you bend that one all the way back too\n[doctor] yeah that's fine\n[patient] okay full full symmetric flexion no no deformities go ahead and just let it relax\n[doctor] mm-hmm valgus stress medial collateral ligament intact lateral collateral ligament intact okay so little kind of little laxity posterior drawer let me see the other let me see the other knee\n[patient] mm-hmm yeah so that that feels pretty much normal so she's got a about a one plus posterior drawer anterior drawer negative lachman negative good let's go ahead and just kinda bend and straighten for me\n[doctor] okay\n[patient] good patellar patella tracks fine no crepitus alright let's go back to this medial side you're tender right there is that right\n[doctor] yeah\n[patient] it's tender on the medial joint line but actually negative mcmurray negative lateral side negative mcmurray good so pretty stable you you feel like you you're kinda shifting back a little bit on this side compared to the other side does it feel unstable when you walk does it feel like it shifts\n[doctor] yeah sometimes\n[patient] what's what's the worst thing that that you can do that you do n't like about that knee is it walking standing sitting still getting up from a chair in and out of the car what what do n't you like\n[doctor] walking up a hill like any kind of incline really hurts\n[patient] yeah and you're it's just you're weak are is it\n[doctor] hmmm\n[patient] you actually no\n[doctor] yeah it hurts no\n[patient] what about you i mean are you real weak\n[doctor] no i would say i'm pretty strong\n[patient] did you go to the gym\n[doctor] i go to the gym but i swim so the\n[patient] okay i ca n't treat people like you you you you need to work harder i quit complaining okay\n[doctor] yes sir work harder okay\n[patient] do you do you play sports in in college or high school\n[doctor] i did in high school\n[patient] yeah so and you and you still doing anything athletic now other than just rocking kids\n[doctor] no\n[patient] just kinda you're thinking walking the dog\n[doctor] yeah rocking kids and walking dogs and going on the occasional swim\n[patient] on the occasional swim alright how have you been swimming since you hurt your knee\n[doctor] no no i have n't would you recommend that\n[patient] well i'm not sure yet it's because we might have to do surgery on your knee here and take that leg off\n[doctor] okay\n[patient] it's pretty bad\n[doctor] okay\n[patient] we'll get we'll get to that too\n[doctor] okay\n[patient] so did you already have x-rays of this knee today\n[doctor] yes\n[patient] okay do i go into that to\n[doctor] yeah\n[patient] look at the x-rays do you or just stop here you can okay okay and so what would what would happen now you would you could pause it\n[patient] you're only cup of this\n[doctor] let's take a look at your pictures here and alright so this looks pretty just looking at it looks pretty normal looks pretty healthy you can see how i all the edges of the bones here look pretty good i do n't see any bone spurs of that i do n't see anything broken everything looked looks pretty good kneecap's tracking good you can see the space here there's no real space there that's actually cartilage so that looks pretty healthy and you can see the other side looks both both look the same so x-rays look i do n't see anything obvious on that but looking at your knee here you may have hit that tibia bone and kinda pushed that bone back it feels to me like you may very well have sprained your or injured your posterior cruciate ligament that's what it's feeling like\n[patient] hmmm\n[doctor] i'm not gon na know that for sure or if there is other things going on in there but i think getting an mri scan to look at what you may have done inside there i'm pretty suspicious though that you may have injured that ligament if that's the only thing you did very rarely is this gon na need surgery okay so this may be something we wan na get you into a brace here get you into some therapy and get all your motion back and get your strength back and then maybe check it back in a in a few weeks and see because a lot of times those ligaments can tighten back up\n[patient] it's it's odd for just an isolated posterior ligament to need surgery\n[doctor] mm-hmm\n[patient] but if there's other things going on i ca n't tell you for sure that you did n't injure a meniscus too or maybe chipped some cartilage when that bone shifted so let's let's get an mri scan to look at that if that comes back with just a ligament like i'm suspecting hopefully this is something we can treat with some therapy and some bracing for a while and get this thing back to normal if after that couple months later or so you still have instability and still bothering you then it's possible we may have to do some surgery to fix that ligament\n[doctor] okay\n[patient] does that make sense\n[doctor] yeah yeah so in the meantime though do you want me to still keep taking the ibuprofen yeah i think that's fine for a short if it's helping the big thing right now is we want to get your strength back and your motion back get rid of the swelling that we still see here\n[patient] okay\n[doctor] so that will help with that ice ice packs a few times a day you can take the ibuprofen up to three times a day and i'll look i'll we'll look at the dose here there are some other medicines we can try that maybe do n't have to take so often that may be easier\n[patient] mm-hmm\n[doctor] so i can even send in a prescription for you for something that maybe just twice a day a little easier for you to take without skipping doses\n[patient] okay\n[doctor] okay you can just take it with breakfast and dinner\n[patient] mm-hmm\n[doctor] we'll try and see if it works better if your ibuprofen works better though go ahead and just go back to that but we can try this other prescription first\n[patient] okay\n[doctor] it's not very expensive and i can just call it into your pharmacy\n[patient] okay\n[doctor] and then we can we can get the brace fitted to you today we are not gon na look at a big big custom kind of expensive brace we will just put because it may just be temporary\n[patient] mm-hmm mm-hmm\n[doctor] and then i will get you a referral to physical therapy something that you can do close to home or close to work\n[patient] and then maybe i could see you back here in maybe four to six weeks and recheck this\n[doctor] okay how often am i gon na have to go to physical therapy\n[patient] i'm gon na kinda leave that up to you and the and the therapist i would start with a couple visits and then we'll just really see how you progress and what you can do at home if what if you have access to some equipment or things that we need to do but i want you to go you know at least a few times so somebody can kinda keep an eye on you make sure you're doing the exercises right\n[doctor] okay alright i think that sounds good\n[patient] did you get did you select you last night\n[doctor] i did\n[patient] you yeah what do you think what do you roof for\n[doctor] i so i i'm a little heart broken right now i was for the rockets and the way that these nets are crushing them it's just it's just painful\n[patient] are you serious\n[doctor] yeah\n[patient] rockets\n[doctor] i live in dallas yes\n[patient] yeah yeah that's not that's not my problem though you have not do you not watch the bulls\n[doctor] no no\n[patient] my gosh alright we're gon na have to work on you\n[doctor] okay thanks\n[patient] okay\n[doctor] bye\n[patient] you got four to six weeks to get your attitude straight we'll talk about this later okay\n[doctor] yes sir\n[patient] alright very good any questions at all\n[doctor] no\n[patient] okay so",
            "tgt": "HISTORY OF PRESENT ILLNESS\n\nBeverly Howard is a pleasant 33-year-old female who presents to the clinic today for the evaluation of right knee pain.\n\nThe patient reports that she fell off of a tandem bicycle and struck her right knee on a curb approximately 2 weeks ago. After the injury, she took ibuprofen and treated the wound, but the pain has persisted. She localizes her pain to the medial aspect of the knee. She also reports occasional clicking with full extension of the knee, as well as occasional instability with ambulation. The patient states that her pain is the worst when ambulating up an incline. She denies any previous right knee issues. She enjoys walking her dogs and swimming but has not done this since her injury.\n\nSOCIAL HISTORY\n\nThe patient works in a Children's Hospital.\n\nREVIEW OF SYSTEMS\n\nMusculoskeletal: Reports right knee pain, clicking, and instability.\n\n",
            "file": "D2N190-aci-subjective"
        },
        {
            "src": "[doctor] so hi zachary good to see you today so i'm looking at my notes i see you coming in with some right elbow pain and you also have a past medical history of hypertension diabetes we're gon na check on those so can you tell me what happened to your elbow\n[patient] i just woke up one day it was hurting\n[doctor] it was hurting okay how long ago would you say that was\n[patient] since\n[doctor] since yesterday alright\n[patient] it's actually my it's actually my left elbow my left arm\n[doctor] okay they must have written that down wrong so it is your your left arm are you right handed or left handed\n[patient] right handed\n[doctor] okay so do you think you might have slept on it wrong or anything like that or what\n[patient] no\n[doctor] okay\n[patient] no\n[doctor] so what part of your elbow would you say hurts\n[patient] from my elbow all the way up to the to the neck\n[doctor] elbow up to the neck alright is it your entire elbow or or would you say a a individual part of it is painful\n[patient] just from the elbow up to the neck all the way up the arm\n[doctor] all the way up the arm alright\n[patient] or all the way down the arm to the elbow\n[doctor] okay and what would you describe the pain as is it like a stabbing pain is it numb what what's going on\n[patient] kind of a achiness achiness heaviness\n[doctor] achiness okay did you do anything yesterday that you think might have caused the pain\n[patient] just a just a usual day of working around the house\n[doctor] okay do you remember i know sometimes do chores you end up lifting heavy things do you remember doing that\n[patient] no no no nothing nothing really unusual you know mowed grass and that's about it\n[doctor] okay alright have you taken anything for the pain yet\n[patient] some motrin\n[doctor] okay and would you say that worked for you\n[patient] not really still kinda comes and goes and aches\n[doctor] okay alright so we'll we'll take a look at your your arm there because it's like your entire left arm up from your shoulder to your elbow does hurt in a second we'll do an exam of that so i see you're also coming in we're gon na check on your hypertension and you came in today your blood pressure is a little bit high it was one fifty over ninety i do n't think we talked last time about us getting you a blood pressure cuff so you could take those and keep track and and and and let us know so what have your blood pressures been running lately\n[patient] one twenty five over seventy two\n[doctor] okay that's not\n[patient] average\n[doctor] that's not too bad you might have a little white coat syndrome you seeing me today because it's a little bit high today so you're on that two . five of norvasc have you been taking that\n[patient] yes\n[doctor] okay that's good how about your diet how is that going i know you were having a little trouble before your sot intake was a little bit high\n[patient] i think i'm doing okay so\n[doctor] okay\n[patient] i'm doing okay\n[doctor] alright so as far as your diabetes your last time you came in let's say look at your a1c result it was a seven . two you were on the five hundred of metformin so what have your blood sugars been running\n[patient] i do n't really check them\n[doctor] you do n't check them okay so yeah we can get a a glucose test today and and and just check those because that's something we want to do everyday you know just to make sure you're eating the correct amount and that your sugars are are in range to make sure that and also to make sure that our medication is is the right amount as well so we'll do that that glucose test at the end of your visit and we could see if we can adjust your medication or not so let's go ahead and do a physical exam on you so i just want to double check make sure are you having any chest pain\n[patient] yeah yeah yeah on and off so it kinda comes with the elbow pain arm pain\n[doctor] okay comes with elbow pain arm pain\n[patient] chest pain\n[doctor] chest pain\n[patient] it kinda goes up my neck sometimes too\n[doctor] up your neck alright\n[patient] yeah it's that whole side it just aches comes and goes\n[doctor] comes and goes alright how often is that chest pain happening to you you said it's not constant\n[patient] it just started yesterday\n[doctor] okay so every hour every fifteen minutes would you say\n[patient] i do n't know mostly i had to stop mowing grass the other day it bothered me a little bit but but other than that it just kinda comes and goes i guess a few times a day\n[doctor] okay alright have you had any shortness of breath\n[patient] no\n[doctor] no okay just the chest pain alright\n[patient] yeah\n[doctor] so i'm gon na listen to your heart here and it it does seem like i do hear a slight murmur with your heart here and i i do n't think we've we've heard that before so i think i'm gon na get an ekg as well because i'm concerned you might be having like a mild heart attack so because you have the pain all the way up your elbow that go into your neck and your your chest pain as well i do n't think it's it's it's musculoskeletal pain because you said you had n't done anything with it so far so what i wan na do is and let's talk a little bit about my assessment and plan here so i i do think that you or you do have that chest pain i'm concerned that you know you might be having a mild heart attack i'm gon na get ekg for that we're also gon na get you some aspirin is a nitroglycerin just to see if that helps with that pain as far as your for your diabetes i want you we're gon na get that p oct glucose and we'll keep you on be five hundred of metformin for now and then for your hypertension we'll keep you on that two . five of of norvasc but i think our most immediate issue is the is the chest pain and so we'll do the ekg and depending upon those results we'll we'll call nine one one because we really need to get you to the hospital if that is the case so how does that sound\n[patient] i do n't know i was talking to my brother and he's a he is a heart doctor and he kinda thought maybe it was n't the heart but\n[doctor] okay\n[patient] he he thought maybe i had he thought maybe i had something jobie had you know they took jobie to the hospital\n[doctor] okay\n[patient] so you heard you heard that did you\n[doctor] i did n't hear about that no\n[patient] yeah he he he yeah he could n't stop the\n[doctor] okay could stop doing what\n[patient] he could n't stop pooping\n[doctor] no well yeah i did n't hear about joe biting and and his his not ability his ability did not stop pooping probably had a diarrhea i'm not sure i did n't hear about that but most of the time\n[patient] no it could it could stop pooping rushing\n[doctor] could not poop and you said pooping\n[patient] yeah i know\n[doctor] it could n't stop pooping yeah i mean that that might cause like anxiety or something like that you know we ca n't stop pooten he's he's he's in charge of my united states but right now i'm i'm really you know me i'm concerned about your heart so i do wan na get the ekg just to make sure you know it'll be would n't be good if we did n't get that you know in the case that you you leave here something terrible happened and and i would n't want that to happen on my watch so\n[patient] right\n[doctor] we'll definitely get those tests\n[patient] appreciate it\n[doctor] yeah no problem we'll get those tests and my nurse will come in and we'll we'll we'll take it from there does that sound good\n[patient] okay alright thank you so much\n[doctor] alright thanks\n[patient] yeah",
            "tgt": "CHIEF COMPLAINT\n\nLeft arm pain.\n\nHISTORY OF PRESENT ILLNESS\n\nZachary Wood is a 45-year-old right-hand-dominant male who presents to the clinic today for the evaluation of left arm pain. The onset of his pain began yesterday when he woke up with pain. He denies any specific injury. The patient locates his pain from his left elbow up all the way to his neck. He describes his pain as an achiness. The patient has been taking Motrin for pain, which does not provide him with relief. He also reports intermittent chest pain that radiates up his neck. He notes that he had to stop cutting the grass the other day because of chest pain. The patient denies any shortness of breath.\n\nFor his hypertension, the patient states that his blood pressure has been around 125/72 recently. He is still taking 2.5 mg of Norvasc.\n\nRegarding his type 2 diabetes, his last hemoglobin A1c was 7.2. He takes metformin 500 mg. The patient states that he does not check his blood glucose levels regularly.\n\nMEDICAL HISTORY\n\nPatient reports that he has a past medical history of hypertension and type 2 diabetes.\n\nMEDICATIONS\n\nPatient reports that he currently takes metformin 500 mg and Norvasc 2.5 mg.\n\nREVIEW OF SYSTEMS\n\nCardiovascular: Reports chest pain.\nRespiratory: Denies shortness of breath.\nMusculoskeletal: Reports left elbow, arm, and neck pain.\n\nVITALS\n\nThe patient's blood pressure today is 150/90.\n\n",
            "file": "D2N191-aci-subjective"
        },
        {
            "src": "[doctor] karen is a 34 -year-old female with a history of chronic migraines and hypertension who is here today with abdominal pain so hi there karen it's nice to see you again listen i'm sorry you're not feeling well and you've got abdominal pain like to talk about that in some detail with you but hey i wan na use this new cool app that's gon na help me focus on you a bit more in this visit would that be okay with you\n[patient] sure that's fine\n[doctor] okay great so so karen tell me about your abdominal pain what's been happening\n[patient] well it started about ten days ago with just some mild discomfort in on my right side and it seems to be getting worse over the last couple of days especially\n[doctor] okay and how bad would you say the pain is like it's a zero to ten on a scale today\n[patient] yeah it it waxes and wanes in severity it it's in general probably around a four or a five but sometimes it gets up as high as a seven or eight\n[doctor] okay is there anything that you notice that makes that pain worse or better like rest or movement or eating or anything else\n[patient] it's usually a little worse after a meal\n[doctor] hmmm okay\n[patient] in the morning before i've eaten it's it's not too bad but during the day after a meal it gets worse\n[doctor] okay alright and do you notice that pain radiates anywhere or moves you know any or anywhere\n[patient] it's pretty low it might radiate a little bit to the left but otherwise it's pretty localized to the right side\n[doctor] okay and have you had any nausea or vomiting along with the pain\n[patient] i've had some nausea and a little bit of heartburn but no vomiting\n[doctor] okay and and this is this is this is worse with you said worse worse with meals and is there anything else anything else that that makes it worse\n[patient] it is a little tender if i if i press on it and certain positions seem to make it a little worse when i'm most when it's the highest\n[doctor] okay\n[patient] pain\n[doctor] okay sure any pain with urination or any blood in your urine\n[patient] no no urinary symptoms\n[doctor] okay and how about any diarrhea and any of that or blood in your stool no\n[patient] no change in bowels\n[doctor] okay alright and so would you say that your appetite has been normal or decreased or any different\n[patient] well since i'm a little nauseated i'm not quite as hungry and i feel just kind of a little overall a little more fatigued over the last week\n[doctor] okay okay you did n't overeat you know during the super bowl last weekend did you that was i know probably lots of junk food floating around if your house is anything like mine\n[patient] well once the packers are out of the playoffs i do n't watch the super bowl so nothing i have n't eaten anything unusual\n[doctor] okay well that's good that's good and and no no travel i know you're a big big travel travel fan you know i remember you telling me about your trip to europe last summer that sounded amazing have you been traveling outside of the country again recently\n[patient] not recently just back to wisconsin but no unusual travel or other exposures\n[doctor] okay alright great and okay so so tell me about your migraines how have they been are you still taking the sumatriptan you know as needed when when you developed migraine you have have you had a migraine recently\n[patient] i have not usually they are responsive to just excedrin migraine i use the sumatriptan when i need to if it if it does n't respond to the over the counter analgesic\n[doctor] okay\n[patient] so\n[doctor] okay\n[patient] it's it's been it they've been pretty rare\n[doctor] okay okay great yeah you've learned a lot about it and and the treatments including the the term analgesic and all of that that's pretty impressive you've been you've been through the ringer i think with with those so okay and so you're taking excedrin when you get a migraine and then sort of would you say maybe for breakthrough migraines or worse migraines you'd take a sumatriptan occasionally\n[patient] yeah\n[doctor] okay got it and how about your blood pressure how has that been running at home are you checking your blood pressures daily still and how how your how how have your blood pressures been\n[patient] i have not been checking them daily i i probably check it about two or three times a week\n[doctor] hmmm\n[patient] and they're pretty good the upper number is usually around in the one twenties or low one thirties and the lower number usually in the seventies\n[doctor] okay okay not not too bad it does look like you're a little bit elevated today i i maybe i'm just making you nervous though so i hope not so are you but you're still on lisinopril twenty milligrams per day correct it looks like you might be running low do you need a refill of that\n[patient] yeah actually i was going to ask you about that if i could get a refill that would be great\n[doctor] sure we can do that and so okay but you are still taking that twenty milligrams per day correct\n[patient] correct\n[doctor] okay and alright fair enough so so let's go ahead and and examine you now karen so on your physical exam pretty normal and and unremarkable for the most part on your on your heart exam i do hear that grade three out of six systolic ejection murmur that you've still got that's unchanged from prior exam that just means i hear some heart sounds you know as i'm listening to your heart there i'm not too concerned about that we'll watch that otherwise normal cardiovascular exam and then your your abdominal exam gastrointestinal exam you have some tenderness in the right upper quadrant i would say mild to moderate tenderness and now if you take a deep breath does that and i press here does that hurt you\n[patient] yes\n[doctor] okay yeah you have i would call an equivocal murphy's sign in the right upper quadrant on your abdominal examination as well the rest of your abdomen is soft and no significant tenderness you have no tenderness in the right lower quadrant with deep palpation and you have no cva tenderness on your back exam as well and so we will talk about about that i am a little bit concerned about the tenderness that that i find on your abdominal exam the remainder of your exam karen is pretty normal and unremarkable and and so that's good let's let's talk about my assessment and your plan so first of all for your first problem of abdominal pain you you do seem to have acute abdominal pain with right upper quadrant tenderness that i'm concerned maybe a sign of some gallstones or possibly even an infection in your gallbladder so i'm gon na order some blood tests and an ultrasound today i'm gon na order a cbc chem twelve urinalysis a pregnancy test and also right upper quadrant ultrasound and so we will we will get those tests done right away i'm gon na keep you here we'll see how those look fortunately we've got the facilities for those and if we need to send you to the emergency department based on those results we will i do n't want you to eat anything right now okay in case we find something that might require surgery alright unlikely but it's possible and then okay you know karen i meant to ask you on your history one thing by chance have you had a fever along with this abdominal pain\n[patient] i've had some chills but no documented fevers\n[doctor] okay alright alright good yeah i i see you do n't have a fever today so that's that's good and so alright now for your second problem the migraine headaches you you do have a history of chronic migraines and and you have occasional bouts of of migraines nothing recent so let's continue the excedrin as needed over the counter for treatment there and then also the sumatriptan as needed for breakthrough migraine pain and i i would just encourage you to continue to avoid alcohol binges and caffeine binges and try to get enough sleep and all of that's easier said than done i know so but but that seems to be helping you now for your third problem of hypertension your blood pressure seems to be under adequate control so that's good we'll continue you on the lisinopril twenty milligrams per day and i will write you a refill prescription for that and send that to the pharmacy please continue to check your blood pressures daily so karen how does that all sound for a plan any other questions for me\n[patient] i actually do need a refill on my sumatriptan as well\n[doctor] okay alright sure yeah no problem so for your migraines the migraine problem i'm also gon na write you that that refill prescription for sumatriptan and anything else you can think of\n[patient] no the plan sounds good\n[doctor] alright sounds good we'll see you back in about four weeks or so and actually i am gon na follow up on your results today before i let you go but i'll check on those and and we'll we'll see how how you do and and hopefully be able to get you home today so we'll go from there i'll i'll see you shortly\n[patient] thank you",
            "tgt": "CHIEF COMPLAINT\n\nAbdominal pain.\n\nMEDICAL HISTORY\n\nPatient reports history of chronic migraines and hypertension.\n\nSOCIAL HISTORY\n\nPatient reports enjoyment in traveling and notes that she has not had any big trips since visiting Europe last summer.\n\nMEDICATIONS\n\nPatient reports use of Excedrin Migraine when needed and occasionally sumatriptan. She also takes lisinopril 20 mg per day.\n\nREVIEW OF SYSTEMS\n\nConstitutional: Reports fatigue, chills, and decreased appetite. Denies fever.\nGastrointestinal: Reports abdominal pain, nausea, and heartburn. Denies vomiting, diarrhea, and hematochezia.\nGenitourinary: Denies dysuria and hematuria.\n\nVITALS\n\nBlood pressure is slightly elevated.\n\n",
            "file": "D2N192-aci-subjective"
        },
        {
            "src": "[doctor] good alright hello hannah how are you today\n[patient] i'm doing well\n[doctor] you're doing well\n[patient] i did have this this hacking cough for about three days now\n[doctor] okay tell me more about that cough\n[patient] it started three days ago i was around my sister and she has been sick with the same kind of symptoms and so this cough has just started off with like a gradual cough and now i've just been coughing up some green phlegm here\n[doctor] okay okay so you you started having some mucus with it\n[patient] yes\n[doctor] okay and how about any other symptoms with your cough\n[patient] i'm having a little bit of a sore throat here and then a little bit of a some nasal congestion as well\n[doctor] okay okay and how about any fevers\n[patient] i have n't had a fever yet\n[doctor] no fever okay and then any shortness of breath\n[patient] no shortness of breath\n[doctor] no shortness of breath okay and what have you been doing for your cough\n[patient] i've just been kinda drinking lots of water taking some cough medication over the counter and it seems like it's not really working\n[doctor] it's not helping okay and tell me do you have any history of any seasonal allergies\n[patient] right around spring time i get a little bit of sneezing and the runny runny nose\n[doctor] okay okay and then any how about any body aches for you\n[patient] no body aches\n[doctor] nausea or vomiting\n[patient] no\n[doctor] okay alright so we will definitely examine you and talk more about that and as far as your diabetes how has everything been going with that checking your sugars how has that been going\n[patient] i've been pretty good at checking my blood sugars they've been running around one twenty range\n[doctor] okay okay and i know the metformin is a we started you on a lower dose it's the five hundred milligrams it's a new medication for you you've been tolerating it okay\n[patient] yes i have n't had any problems\n[doctor] okay good any diarrhea sometimes patients will say that\n[patient] no diarrhea\n[doctor] no diarrhea okay and then how about as far as your blood pressure\n[patient] blood pressure has been a little bit high i've noticed\n[doctor] okay\n[patient] kind of one forties the top number\n[doctor] okay\n[patient] and the lower numbers seems like it's been okay around seventies\n[doctor] seventy okay so a bit high and the hydrochlorothiazide have you been able to take that everyday\n[patient] yes i've been taking it everyday\n[doctor] okay and how about your diet how's been thing as far as salty foods\n[patient] i've been trying to stay away from the salty foods but sugar intake i'm having a little bit of trouble with that\n[doctor] okay okay but it seems like you've been making good progress and that could be difficult sometimes and you mentioned being around i think you said your sister a few days ago or a family member\n[patient] yeah she was just kinda sick with similar symptoms and i noticed i started to developed a little bit of a cough right after\n[doctor] after that okay and how is your family doing how is everyone doing other than that other than being sick for your sister how is everyone going\n[patient] everyone's doing great\n[doctor] okay\n[patient] working busy with life yeah\n[doctor] okay and for you too were you on vacation last week and a lot of people had vacation last week\n[patient] yes i was on vacation last week actually\n[doctor] okay hopefully you were n't sick for too much of it\n[patient] no i was feeling okay\n[doctor] okay okay\n[patient] got back and started feeling poorly\n[doctor] sorry about that alright so what i'm gon na do now is i'm gon na go ahead and start your physical exam i looking at your vitals vitals look overall pretty good i do see your blood pressure is elevated at here it's one forty four over seventy two otherwise everything else looks good so let's check you out so first starting i'm just gon na check start with your sinuses and when i press here do you have any pain any tenderness when i do that\n[patient] no\n[doctor] no okay so no frontal sinus tenderness how about when i press on the on your cheeks here\n[patient] maybe a little bit just a little bit\n[doctor] on both sides\n[patient] yes\n[doctor] okay so bilateral maxillary sinus tenderness alright and i'm just gon na take a look at in your mouth if you can open up okay so i do see some do have some erythema of the pharynx and the tonsils are symmetrical i do n't appreciate any exudates now i'm just checking your neck and i do appreciate some anterior cervical adenopathy alright and i'm just gon na take a listen to you alright so listening to your heart so you have a nice regular rate and rhythm and you do still have that two out of six systolic ejection murmur at the left base now i'm taking listen to your lungs and on your lungs exam okay your lungs are nice and clear i do n't appreciate any wheezes rales or rhonchi alright and just looking at your lower extremities i do n't appreciate any edema there so let's talk about my assessment and plan so for your first problem of the cough so looking at your cough it does seem like you have a upper respiratory infection and so basically that's a virus most likely it's a virus that's causing your symptoms especially being around someone else who has similar symptoms and seems like most likely they spread it to you so i want you to continue with doing a lot of the time is just letting the virus run it's course and taking things just to help with your symptoms so drinking lots of fluids that's gon na help you trying i know you've been doing a cough medicine you can even try another one you have to be careful with the blood pressure and diabetes so you can try like a coricidin hbp can help with the cough and lots of rest okay lots of rest now we are in a current pandemic and so something i can check for you if you're okay with that is checking for covid if that's okay with you\n[patient] yes i'm okay with that\n[doctor] okay so we will check you for that today and see how you're doing with that and then we will give you those results okay any questions about that\n[patient] no questions\n[doctor] no okay so for problem number two the type two diabetes so we'll continue you on your metformin five hundred milligrams daily or twice a day you had blood work at your last visit so you'll be due at your next visit for your hemoglobin a1c and that's the check the sugars on your red blood cells so we do that about every three months so at your next visit we'll check that for you and then we will go from there but it seems like you're doing well with that now as far as problem number three your high blood pressure so your blood pressure is elevated here and it sounds like it's been you know creeping up just a little bit at home as well you're on a very tiny dose of the hydrochlorothiazide so what i would like to do is increase it to twenty five milligrams once a day again i would recommend that you take it in the morning just because you may have noticed it can make you urinate quite a bit and then i would love for you to just continue checking as you have been a few times a week just checking your blood pressure at different times of the day so we can continue to see how you do with that okay\n[patient] okay alright that sounds\n[doctor] alright any questions for me\n[patient] no questions\n[doctor] okay\n[patient] thank you\n[doctor] thank you alright so at this point now i'm just gon na press the\n[doctor] i'm gon na",
            "tgt": "CHIEF COMPLAINT\n\nCough.\n\nMEDICAL HISTORY\n\nPatient reports history of seasonal allergies, diabetes type 2, and hypertension.\n\nMEDICATIONS\n\nPatient reports taking metformin 500 mg as well as hydrochlorothiazide every day.\n\nREVIEW OF SYSTEMS\n\nConstitutional: Denies any fever or body aches.\nHENT: Reports sore throat and nasal congestion.\nRespiratory: Reports productive cough with green phlegm. Denies any shortness of breath.\nGastrointestinal: Denies nausea, vomiting, or diarrhea.\n\nVITALS\n\nBlood Pressure: Elevated at 144/72 mm Hg. The remainder of the vital signs look good.\n\n",
            "file": "D2N193-aci-subjective"
        },
        {
            "src": "[doctor] hey betty how're you\n[patient] i'm doing okay aside from this left shoulder pain that i've been having for a few weeks now\n[doctor] wow well i'm sorry to hear that do you remember what you were doing when the pain started\n[patient] i you know i ca n't think about anything specifically but i am very active and i also have been renovating my basement so i have been doing a lot with that\n[doctor] wow okay and do you know if there was any direct or associated trauma that you can think of over the past three weeks like did you fall or hit your shoulder or anything\n[patient] no no trauma that i can think of at all\n[doctor] okay\n[patient] i do n't remember hitting it either\n[doctor] okay now have you ever had pain in that shoulder before\n[patient] you know i'm active and will have aches and pains here and there but nothing that some tylenol ca n't take care of\n[doctor] okay and and it's isolated to your left shoulder\n[patient] it is\n[doctor] okay are you able to move that left arm for me\n[patient] you know anytime i try reaching for something or lifting anything i have a lot of pain and i do n't even try to raise my arm over my head because that's it it really hurts\n[doctor] okay so now i wan na talk a little bit more about that pain are you having pain all of the time or does it wax and wane does it come and go\n[patient] it's all the time and if there is any pressure like when i try to sleep at night i ca n't even lay i'm a side sleeper and it i really gives me a hard time because i'm so uncomfortable so the pain is always there\n[doctor] okay so you ca n't lay on your left side at all\n[patient] i ca n't\n[doctor] alright now do you have that pain when you lay on your back as well or just on your left side\n[patient] i mean it's always there but when i sleep directly on it the pain goes up\n[doctor] okay now let's talk just briefly about your pain so if you have n't taken anything at all or have you been taking anything at all let's start with that have you been taking anything for the pain\n[patient] yeah i've been taking tylenol and i'll take two extra strengths tylenol every six to eight hours\n[doctor] okay\n[patient] and it does help take the edge off\n[doctor] okay that's good now without any tylenol what's your pain level\n[patient] without any tylenol i would say my pain is like a three\n[doctor] okay and then with tylenol with that\n[patient] i'm sorry i keep doing that without any tylenol my pain is like a seven and with tylenol it goes down to a two or three\n[doctor] okay that's good so the tylenol really does help you that that's a good thing\n[patient] yeah\n[doctor] so you talked about renovating your basement did you guys just move in or is it just time for a little house facelift\n[patient] yeah it just time we've been living in this house for some time now and you know with the pandemic we've been home and so decided to do some work\n[doctor] nice have you been into the new home depot that they just opened down the street here\n[patient] no\n[doctor] yeah it's nice my wife and i were there this weekend and they just opened two weeks ago so everything's fully stocked and if you guys are doing some renovations you might run down there and you know save big money at home depot\n[patient] i definitely will check that out\n[doctor] so are you experiencing any numbness or tingling in your arm or hand\n[patient] no\n[doctor] okay so if you do n't mind i'd like to go ahead and do a quick physical exam i've reviewed your vitals everything looks good there and i'm gon na do a focused exam of your left shoulder now you have limited active and passive range of motion there is some tenderness of the greater tuberosity of the humerus and there is no tenderness at the sternoclavicular or clavicular joints and you have good hand grip bilaterally neurovascular exam of your left arm your cap refill is brisk in less than three seconds and motor and sensation is intact to light touch now for review of your x-ray of that left shoulder the good news is i do n't see any fracture or bony abnormality so let me talk to you briefly about my assessment and plan okay so for your first problem of left shoulder pain your symptoms are most likely due to rotator cuff tendinopathy this means that the tendons of the muscles of that left shoulder have been injured and the injury happened to the tendons that make up or attach to the shoulder muscles i'm gon na go ahead and order an mri of your shoulder just to make sure nothing else is going on with that left shoulder i'm also going to go ahead and refer you for physical therapy for approximately six to eight weeks okay now during that time i want you to continue to take tylenol p.r.n . if your symptoms do n't improve we can then consider maybe like a steroid injection of that left shoulder which could hopefully get you some relief now do you have any questions comments or concerns about our treatment plan\n[patient] yeah so i'm really active so do you think that this pain will ever go away\n[doctor] i do i do believe that that pain is gon na go away many of my patients are successful with pt so we are gon na start with that take a conservative approach and see how you do\n[patient] okay alright\n[doctor] alright so i'm gon na have the nurse come in and get you some paperwork and i'll see you in about two about two weeks\n[patient] alright thank you\n[doctor] thank you",
            "tgt": "CHIEF COMPLAINT\n\nLeft shoulder pain.\n\nHISTORY OF PRESENT ILLNESS\n\nBetty Rogers is a pleasant 50-year-old female who presents to the clinic today for the evaluation of left shoulder pain.\n\nFor the past few weeks, the patient has been experiencing constant pain isolated to the left shoulder. She denies any known injury or trauma; however, she is very active and is currently renovating her basement. She denies any associated numbness or tingling as well. While movements such as reaching and lifting exacerbate her pain, full flexion of the shoulder is the most severe. Her pain is also exacerbated if she lays on her shoulder, which subsequently causes sleep disturbance due to her being uncomfortable. She typically takes Tylenol Extra Strength, 2 tablets every 6 to 8 hours, for aches and pains associated with her active lifestyle, and doing so reduces her shoulder pain to 2-3/10 on the pain scale. Without medication, she rates her pain as 7/10.\n\nMEDICAL HISTORY\n\nThe patient denies any previous trauma or injury to left shoulder.\n\nSOCIAL HISTORY\n\nThe patient reports that she has a very active lifestyle. She has also been renovating her basement recently.\n\nMEDICATIONS\n\nThe patient reports that she has been taking Tylenol Extra Strength, 2 tablets every 6 to 8 hours.\n\nREVIEW OF SYSTEMS\n\nMusculoskeletal: Reports left shoulder pain.\nNeurological: Denies left shoulder numbness or tingling.\n\n",
            "file": "D2N194-aci-subjective"
        },
        {
            "src": "[doctor] hey matthew how is it going good to see you today i see here in your notes you are here for some right knee pain and we are also going to check up on your hypertension and diabetes so can you tell me what happened to your knee\n[patient] yes so i was playing basketball yesterday and when i went up for a rebound and i came down and i felt like my knee just popped it started swelling and i could hardly walk when it happened\n[doctor] okay playing basketball how often do you play basketball\n[patient] first time in two years\n[doctor] first time in two years did you watch the game last night\n[patient] yeah unfortunately both teams did n't lose so i was unhappy\n[doctor] you're going home who you going for\n[patient] neither\n[doctor] neither well i was going for unc i'm kinda i'm kinda upset right now but anyway so you say you're playing basketball you you heard felt some knee your knee pop what part of your knee would you say hurts\n[patient] it feels like it's on the inside of the knee\n[doctor] inside of your knee alright and are you able to bear weight on that leg matthew\n[patient] i can now but i i'm favoring it for sure\n[doctor] okay so what type of pain would you describe as it is it stabbing is it\n[patient] it's real achy\n[doctor] real achy\n[patient] since i slept overnight the swelling has went down some\n[doctor] okay have you taken anything for the pain yet\n[patient] i tried some tylenol yesterday\n[doctor] alright did that work for you\n[patient] a little\n[doctor] little do you have any\n[patient] being off of it help more than anything\n[doctor] yeah i be i bet i bet i i hurt my knee before too and it's it's pretty painful on a scale of one to ten what would you say your your pain level is\n[patient] it's about a four right now\n[doctor] about a four okay so it's it's not too bad alright so we'll take a look at that knee in a second so we're also here to check up on your hypertension and diabetes so i'm looking here for your hypertension you're taking five milligrams of norvasc so are you taking that daily\n[patient] yes\n[doctor] yes great i i i'm so happy when my patients are compliant most of the times they do n't take it as as often but i'm i'm really excited for that what have your blood pressures been running i think today\n[patient] you're about one forty over eighty it's a little bit high but i know we we talked about you getting a blood pressure cuff at home and taking those so i do n't check it very often\n[doctor] okay\n[patient] but it's usually in the one forties to one fifties range on that top number and then that bottom number is usually around eighty and i read on the google that that's okay is that okay\n[doctor] i mean it's it's not the best right it's it's we should be around one twenty over eighty right\n[patient] okay\n[doctor] you're a little bit elevated and we could talk about changing your medications to try to get that that down how about your diet how's that going\n[patient] i eat anything i want\n[doctor] alright well we we definitely got ta got ta get your your diet a little bit better i know after the pandemic a lot of people you know went crazy with the diet myself included but i know we got ta get you get back in because for your diabetes i'm looking at your a1c and we we checked it and it was a a seven point two which is not so good right now so have you been taking i think you're on metformin five hundred milligrams daily\n[patient] i do but i got ta take it sometimes it upsets my stomach and so i just kinda skip it\n[doctor] okay so yeah we definitely got ta get you to to take it we could try something else just if you're having interaction with that medication what about your blood sugars are they taking those daily\n[patient] no every once in a while\n[doctor] every once in a while what have they been doing every once in a while when when you do take them\n[patient] probably about a hundred and fifty or so\n[doctor] okay so we got to get those down too so we will talk about getting you consult nutrition just try to get you a better diet i think you know we wan na get you off the medications totally but you know we got ta get you on the right track here alright so let me do a quick physical exam on you i'm gon na check your your your lungs lungs sound good check your heart so listen to your heart you still do have that grade two out of systolic ejection murmur alright but we we knew about that already you've had that for a couple of years so i'm not really worried about that at this at this time so let me take a look at your knee here so when i press right here on the inside the right knee is that painful\n[patient] ow\n[doctor] ow alright and let me have you bend it straighten it it's painful\n[patient] a little yes\n[doctor] a little bit alright i'm gon na do a couple of maneuvers here so your your right knee exam shows that you do have pain to palpation of the medial aspect of that right knee also have some edema some little bit of swelling some ecchymosis as well you do have a negative varus and valgus test of my maneuvers and you know i i do see a little bit of of swelling swelling little redness as well in that knee so we did get an x-ray of your knee your right knee luckily it was normal so there's no fractures no bony abnormalities which is good so you did n't break anything so based on my your based on your x-ray and your exam you have a mcl tear well mcl strain i apologize mcl is straight i do n't know if you have a tear yet we got ta do yeah we had to have to do a mri for that but basically means you twisted your knee when you're playing basketball right and so that ligament is strained or torn just to have to get an mri to determine if it is or not in the time being i want you to continue to take that tylenol just to help with that pain i'm also gon na prescribe you some meloxicam fifteen milligrams just to help with the pain and swelling i'm gon na put you in a knee immobilizer and i want you to stay off of that for the next couple of weeks and we're gon na get a mri as well for that knee how does that sound\n[patient] that's okay\n[doctor] alright for your diabetes i'm going to need you we got to get you to start taking your your blood sugars daily we got to keep track of those alright so i want you to take those daily we'll get a log book so you can keep track of those and bring those back and we can determine how we adjust your medications for now also i'm going to give you a consult to nutrition to try to get your diet a little bit better and then for your hypertension i'm gon na up your medication up up up up your norvasta five milligrams because your blood pressure is a little bit high and hopefully we can a medication adjustment will lower it down to that one twenty over eighty like we like we made alright so i'm going to see you back in two weeks do you have any other questions\n[patient] yes so i heard strawberries can lower your blood pressures are you truth to that\n[doctor] you know i i have n't i have n't heard that before you know\n[patient] you know i know it's normally they say like the the pumice granite seeds or antioxidants and and such but the strawberries i i have n't heard you can try it if you want actually no i i do n't want you to eat too many strawberries because a lot of sugar in your in your\n[doctor] your diabetes is n't going so low right now so stay away from the strawberries because that's a lot of sugar you'll need that\n[patient] sure\n[doctor] alright so any other questions\n[patient] i i think i'm okay right now\n[doctor] alright so my nurse will be in with that appointment and we will see you in two weeks",
            "tgt": "CHIEF COMPLAINT\n\nRight knee pain\n\nHISTORY OF PRESENT ILLNESS\n\nMatthew Allen is a pleasant 40-year-old male who presents to the clinic today for the evaluation of right knee pain. The onset of his pain began yesterday after he went up for a rebound while playing basketball and felt a pop in his knee. He states that he experienced swelling and difficulty with ambulation following this incident. He locates his pain today to the medial aspect of his knee. His pain is described as aching and is rated at 4 out of 10. In terms of his swelling, he states that this has improved some. He is also able to weight-bear, but he finds that he is favoring his left leg while doing so. His tried treatments include Tylenol with some relief as well as rest.\n\nThe patient has a history of hypertension and diabetes. He reports that he does not check is blood pressure at home very often, but he typically runs 140 to 150 range over 80. He is taking 5 mg of Norvasc daily. In terms of his diet, he states that he enjoys eating whatever he likes. His most recent A1C was 7.2. He is taking metformin 500 mg daily, however there are days where he skips this because of gastrointestinal upset. He denies checking his blood sugar at home consistently and that when he does check he has been around 150.\n\nMEDICAL HISTORY\n\nPatient reports history of hypertension and diabetes.\n\nSOCIAL HISTORY\n\nPatient reports playing basketball, however this most recent event was the first time he played in 2 years.\n\nMEDICATIONS\n\nPatient reports he is taking Norvasc 5 mg daily, metformin 500 mg daily, and Tylenol.\n\nREVIEW OF SYSTEMS\n\nMusculoskeletal: Reports right knee pain and swelling.\n\nVITALS\n\nBlood pressure is 140/80 today.\n\n",
            "file": "D2N195-aci-subjective"
        },
        {
            "src": "[doctor] mister thompson is a 67 -year-old male with a history of essential hypertension hyperlipidemia and osteoarthritis who is here today with elevated and fluctuating blood pressures so hi there mister thompson it's nice to see you again listen i understand you're having some trouble with your blood pressure control i would like to discuss that with you but first i want to ask you i'd like to use this app this new fancy app that's gon na help me focus on you a bit more in our conversation would that be okay with you\n[patient] yes that's fine\n[doctor] okay great it's gon na record our conversation okay perfect so jerry tell me mister thompson tell me about your blood pressure readings recently i understand you're concerned about them they have been up they have been down what's going on and any other symptoms\n[patient] normally my blood pressure has been very well controlled over about the last three to four weeks there have been periods where i felt a little lightheaded slight headache and when i checked my blood pressure the upper number has been occasionally over one eighty which is way past you know what any of the numbers have been in the past\n[doctor] okay okay and okay and yeah that does sound unusual for you and so it's been high but you've also felt lightheaded at times have you checked your blood pressure when you were feeling lightheaded was it was it low at those times or have you done that\n[patient] i've done it both when i felt fine and then when i had the lightheaded episodes actually it's been on the high side\n[doctor] okay alright understood and you have n't passed out or anything have you\n[patient] not recently\n[doctor] okay and have you had any chest pain or trouble breathing along with you know your elevated blood pressure\n[patient] sometimes a little heaviness in my chest but no no nothing sustained and i do n't have any respiratory or breathing difficulty\n[doctor] okay excellent and how about any headaches or other neurologic symptoms like numbness or weakness or you know balance instability or anything like that\n[patient] little unsteady when i get the dizziness and a slight headache when the blood pressure numbers have been a little higher\n[doctor] okay and when you say dizzy are you feeling lightheaded like you might pass out or you feeling that the world spinning around you or what\n[patient] just a little fuzzy where you just feel more lightheaded\n[doctor] okay alright understood and you've not had any any fever or nausea vomiting anything like that have you or diarrhea\n[patient] no\n[doctor] okay and are you feeling any palpitations or your heart racing anything unusual there\n[patient] not usually no\n[doctor] okay and are you still taking the lisinopril twenty milligrams once per day no actually i see we last visit we increased that to twice per day you're still taking that lisinopril twenty milligrams twice per day\n[patient] yes i am\n[doctor] okay you are not missing doses or anything are you by chance\n[patient] very rarely\n[doctor] okay great great you're still using that pill box that we suggested i think you had a pretty good system going there maybe maybe you're using that app now to take to keep track of one when to take your medicine are you doing that\n[patient] yes yeah i've i've used the pillbox and then tried the app it was a little confusing but i'm i'm pretty much on on track with staying on my medication schedule pretty accurately\n[doctor] that's great i think i think i remember you saying it was tricky to get that app set up but then your grandson helped you with it and those kids amazing what they can do these days right anything like that i always trust them my kids before me so hey by the way how did he do in his softball or in his in his little league tournament last month i think you said he had a big tournament coming up how did that go\n[patient] they they did great they they got all the way to the finals and then the team that the team that beat them was probably a little older a little bit more season but they had a great time\n[doctor] wow wow how fun that's fantastic well congrats good stuff alright well listen so so you're still taking your your lisinopril how about for your hyperlipidemia your your high cholesterol there are you still taking that atorvastatin\n[patient] yes\n[doctor] okay excellent and your osteoarthritis i know you've been you know a golfer in the past and you know you wan na get out on the course and things is that still under control are you able to get out and and and walk the full course and things still\n[patient] most of the time you know there are times when the weather changes that i have to maybe play less play less or or skip a day\n[doctor] yeah yeah but you're still okay well you're still able to get out and then you're kinda taking i think you're taking some tylenol for for you know mild mild pain and changing your activity as needed is that right\n[patient] correct\n[doctor] okay alright good good okay well listen let's go ahead and examine you here jerry so on your physical exam for the most part it's pretty normal and unremarkable on your heart exam you still have that grade three out of six systolic ejection murmur that's unchanged from your prior and just means yeah i'm hearing some heart sounds from the valves that's that's not surprising and i'm not concerned about it we're just watching that one otherwise on your your lung exam you have some mild bibasilar rales but no wheezes or rhonchi and excellent air movement and you have trace lower extremity edema on your extremity exam there bilaterally and otherwise really pretty normal exam so let's let's talk about my assessment and your plan alright so first of all for your first problem of your elevated blood pressure i do think your blood pressure is a little bit out of control meaning we need to make some adjustments i'm going to actually increase your your lisinopril to sixty milligrams twice per day and i'm also going to add twenty five milligrams per day of hydrochlorothiazide and that should help even things out i want you to check your blood pressure measurements twice a day for me for the next two weeks then let's see you back in two weeks and we'll we'll check on how you're doing and also for your second problem of hyperlipidemia i i wan na keep you on the atorvastatin i'm also going to send couple of blood tests i'm gon na send a cholesterol panel also a cbc with differential and a comprehensive metabolic panel and we'll check a urinalysis as well look and see how your kidneys are doing there as well and so we'll continue the current management with your atorvastatin there for your hyperlipidemia now for your third problem osteoarthritis i want you to continue to stay active as best you can do n't over do it but walking and you know getting out golfing when you can that's great you can take tylenol for the pain if you have some mild some mild pain there and yeah otherwise i think that cover it i think the adjustments in your blood pressure medicine should help and i wan na see you back in four weeks no let's make two weeks in follow-up and otherwise any questions for me how does that sound\n[patient] i do n't think so anything that i need to do when the weather warms up as far as you know my fluids drinking liquids and things\n[doctor] yeah you know be sure you're staying well hydrated you know six to eight glasses of water per day is a good good idea and you you know when when it warms up you're certainly gon na prespire more and lose lose more fluid so so i would i would recommend that you continue to have you know a a standard six to eight glasses of of fluid intake per day but yeah that you know that should do it and if you're feeling particularly dehydrated you might wan na increase that if you have an increased activity level so alright any other questions for me\n[patient] how much beer should i drink\n[doctor] probably not the best thing with you know with with with your high blood pressure fluctuating the way it is so not more than a couple drinks a week hate to tell you\n[patient] okay\n[doctor] alright okay great seeing you we'll see you back see you in a couple of weeks you take care",
            "tgt": "CHIEF COMPLAINT\n\nElevated and fluctuating blood pressures.\n\nMEDICAL HISTORY\n\nPatient reports history of essential hypertension, hyperlipidemia, and osteoarthritis.\n\nSOCIAL HISTORY\n\nPatient reports he enjoys playing golf.\n\nMEDICATIONS\n\nPatient reports he is taking lisinopril 20 mg twice per day, atorvastatin, and occasional Tylenol.\n\nREVIEW OF SYSTEMS\n\nConstitutional: Denies fever.\nCardiovascular: Reports heaviness in chest. Denies heart palpitations or syncope.\nRespiratory: Denies dyspnea.\nGastrointestinal: Denies nausea, vomiting, or diarrhea.\nNeurological: Reports headache and lightheadedness. Denies syncope.\n\n",
            "file": "D2N196-aci-subjective"
        },
        {
            "src": "[doctor] so donna is a 37 -year-old female she is here with complaint of headache she has a history of hypertension and diabetes so donna tell me what's going on\n[patient] yeah lately i've just been having quite a bit of a headache and i mean every now and then i'll get it but lately it's just been getting worse and i've noticed that my blood pressure has been running high i've been taking it maybe like once a week but the past three weeks it's been really high than usual so i was a little worried\n[doctor] do you remember the numbers that you're getting on your blood pressure readings\n[patient] yeah so one of them was like one sixty over eighty seven and then the last one was like one seventy five over ninety two\n[doctor] okay so it's really high i was looking back and it looks like your blood pressure was pretty normal last time we saw you is one twenty four over eighty two have you been able to take your blood pressure medicine the lisinopril that you've been prescribed\n[patient] i have but sometimes i forget i'm i'm embarrassed to tell you that but yeah sometimes i forget i get busy like especially on the weekends i'm very good during the week but on the weekends i tend to forget it and that's when i'm most busy too\n[doctor] yeah well i'm also curious you know you have diabetes have you been checking your blood sugar\n[patient] yeah i have because i thought maybe you know that's why i'm getting the headaches maybe my sugar was too low or maybe too high but my sugar has been okay it's been running like one twenty sometimes it does get down to like one hundred\n[doctor] okay and have you noticed are you urinating more than usual or anything like that\n[patient] not really so much it's it's been pretty much the same but pretty normal\n[doctor] okay and when you get these headaches what are you taking for them\n[patient] well i take my tylenol hoping it'll just you know go away and then it does some just for a little bit but then it it just goes throughout the day and i start to get them again\n[doctor] okay and when you first had the headaches what would you rate the headache at zero no pain ten the worst pain ever\n[patient] i would say when i first get them it's about i would say a seven out of ten\n[doctor] okay\n[patient] yeah\n[doctor] and then after you take the tylenol what does it go down to\n[patient] it goes down to probably about a four maybe five it i still feel it i still feel annoying but it's not as pounding as as it normally would be\n[doctor] okay\n[patient] if i did n't take the tylenol\n[doctor] yeah and have you ever had headaches like this before\n[patient] not like this you know you know as you know sometimes i get migraine but i know i never really take anything for it that's like once a year or once or every two years but not like not like this one headaches like this one\n[doctor] okay and have you had any congestion anything like that cough runny nose\n[patient] yeah i thought maybe because you know now it's springtime and i tend to get my allergies but it it's it's very different and i've not actually had any like runny nose or cough or congestion along with the headache\n[doctor] okay if you tap on your forehead do you have any tenderness\n[patient] right here\n[doctor] yeah\n[patient] just a little not really too much\n[doctor] okay if you tap down here on these bones your cheek bones any tenderness there\n[patient] a little bit not as much as i guess if i tap up here\n[doctor] okay and then if you kinda push on your neck around here any tenderness\n[patient] it it's a little tender but it's not it is a little bit i'd say\n[doctor] okay okay so you do n't have any frontal sinus tenderness no maxillary sinus tenderness it sounds like you do n't have any lymphadenopathy that would just be if your lymph nodes were tender so yeah you know let's just talk about a few things that i wan na do and then i want you to actually come in and and be seen by doctor ruth so first off your headache i think taking tylenol is great you can keep taking that you know your lisinopril you're on twenty milligrams once a day which is a medium dose but i think we can increase that so for your hypertension and your headaches i'm gon na have you increase your lisinopril to forty milligrams once a day\n[patient] okay\n[doctor] and then i want you to keep checking your blood pressure and i wan na order some blood tests i'd like to get some just normal blood work we'll get a hemoglobin a1c some laboratory tests things like that and and then for your diabetes i'm gon na have some diabetic education for you that i want you to be able to review it sounds like your blood sugar has been running a little bit high and after you get the blood tests after that's all done i want you to come in to see me or doctor ruth and we'll just make sure that everything is okay that we get your blood pressure under control any questions for me\n[patient] no i mean i've been walking and i know i get the headaches but is it alright if i still continue my walks\n[doctor] yeah that's great i think exercise is wonderful for everything going on go ahead and walk still\n[patient] okay great we'll do that thank you\n[doctor] you're welcome thanks so much donna",
            "tgt": "CHIEF COMPLAINT\n\nHeadache.\n\nMEDICAL HISTORY\n\nPatient reports history of hypertension and diabetes. She has migraines rarely every 1 to 2 years.\n\nSOCIAL HISTORY\n\nPatient reports she walks for exercise.\n\nALLERGIES\n\nPatient reports history of seasonal allergies.\n\nMEDICATIONS\n\nPatient reports taking lisinopril 20 mg once a day and Tylenol.\n\nREVIEW OF SYSTEMS\n\nHENT: Denies congestion or runny nose.\nRespiratory: Denies cough.\nGenitourinary: Denies polyuria.\nNeurological: Reports headaches.\n\n",
            "file": "D2N197-aci-subjective"
        },
        {
            "src": "[doctor] okay michael so i see in here that you're here because you're experiencing some symptoms that your pcp was concerned about i also see that he ordered a ct so could you tell me what what started what happened why do you think you are here\n[patient] hi doctor how are you\n[doctor] hi i'm great thanks for asking\n[patient] well so yeah i just happened to have gone in for my regular visit and i just explained to my pcp that you know what i've been having some back pain it's usually on the left and you know he asked some questions and he said i should come see you\n[doctor] alright yeah back pain especially like that like was it sharp could you tell me what kind of pain it was\n[patient] well yeah some days it was sharp some days it was n't some days it moves some days it does n't but it's mostly on the left\n[doctor] okay\n[patient] that's\n[doctor] alright\n[patient] yeah\n[doctor] unloving the spectrum that we have right here let's see if we can dig down and get some details well a couple of things i wan na ask have you been a bit more tired than lately\n[patient] no not recall\n[doctor] alright how about your appetite are you hungry or or not as hungry\n[patient] i i would say about his that that's pretty much unchanged\n[doctor] okay your appetite is unchanged alright what about your water consumption\n[patient] that i'm sorry what did you say\n[doctor] no it's fine how about your water consumption\n[patient] yes but i've been drinking a lot more water and i do realize that i i wake up sometimes during the night to you know use the restroom to pee more than i normally do\n[doctor] okay so we have noticed an increase in urine output okay how do you have like any normal activities are you playing any sports\n[patient] yeah i ride i ride a bike every so often\n[doctor] okay\n[patient] so good yeah\n[doctor] okay and are you like watching any other sports like did you watch march madness\n[patient] no sorry\n[doctor] be still my heart okay that's fine i'll forgive you so\n[patient] thank you\n[doctor] okay but how is school like are you like are are things going well like are you enjoying like your your time there\n[patient] yeah school is actually going well gotten good grades\n[doctor] nice\n[patient] although my my physics teachers socks cheese\n[doctor] they usually do anybody who chooses to engage in physics for the rest of their life i question their choices it's fine okay but are you when you're like while you are at school like has anybody been sick i know like with you know covid has been going around but like have you noticed anybody like that sick all the time around you\n[patient] sick all the time everybody is sick these days\n[doctor] alright\n[patient] so\n[doctor] but what about at home how about your siblings are any of them sick\n[patient] most of them are healthy yeah most of them are healthy although you know i have a brother who smokes i have told him not to smoke he does n't listen\n[doctor] mm-hmm\n[patient] house told not to smoke at the house but you know anyway\n[doctor] okay so there is a smoker at home you know that does that does affect you so we might have to have a conversation with your brother and anybody else but it's good to know that people are n't sick i do see here though that you have kind of a a history of recurrent strep like you you seem to be having these sore throats a lot i think it says that you've had four in the last five months is that correct\n[patient] yeah strep and bfs i'm not quite sure what it is just seems to come on you know i get this sore throat and fibroid i'm told i have strep\n[doctor] okay\n[patient] sometimes you know my doctor knows what he is doing strep everyday strep everyday but anyway if he says i have strep then i have strep\n[doctor] i okay i respect that and i'm glad that you you listen to him at the end of the day that's always a good thing alright so now that we've gotten like kind of a lot of the history out of the way i do want to do my physical exam is that okay\n[patient] sure\n[doctor] alright so when i look in your throat like i'm not noticing any erythema no swelling your tonsils are midline so those look good when i'm feeling here on your neck i'm not appreciating any like lymphadenopathy no cervical adenopathy and like i wan na check those things because i just wan na make sure i'm not seeing any physical signs of like any kind of strep right now right i do n't want i wan na make sure you're not having an infection when i listen to your lungs i do n't appreciate any wheezes rales rhonchi that means i'm not hearing funky sounds your heart sounds great no murmur no rub no gallop when i press on your back remember you told me you had that left back pain when i press on it does it hurt\n[patient] no\n[doctor] okay alright great no tenderness on palpation when i press on your abdomen are you feeling any pain\n[patient] no\n[doctor] alright no rebound no guarding that's great okay so based on my physical exam we are gon na have a couple conversations one that ct that your your primary care doctor the the one that you you question his judgment it is showing a couple things that we are a little concerned about it could be that these recurrent strep episodes that you've been having it looks like they are like potentially that they are caused something called glomerular nephritis right there's just some some swelling here and we have to be careful of something like that because it could lead to like kidney disease chronic kidney disease and we wan na make sure that we cut that off right so the first thing is i'm gon na refer you for your problem of glomerulonephritis i'm gon na refer you to an ent i want them to look at you and maybe consider taking out your tonsils to see if that could help with some of the recurrent strep though that you're feeling but i would like to leave that to them to make that decision for you and me we're gon na do some more like confirmations right i'm gon na order some labs i want several a lipid panel a ua a cmp a cbc a vitamin d and a tsh all of these things will give me more information about kind of like what's happening in your body right now in terms of like your hormones and you know your iron levels and to make sure that you are like getting all the nutrition that you need and that your body is operating appropriately i know that that was a lot of words but let me know what questions do you have about your care and your treatment\n[patient] how much are all these tests going to cost\n[doctor] they are going to be free ninety nine because your mom is paying for them\n[patient] okay that's that's good to know\n[doctor] yes\n[patient] and when do i when do i have to do those tests\n[doctor] i would prefer you to get them done as soon as possible so when you walk out of this room there is a a blood lab right next door i need you to go ahead and do some of those draws some of them i will need you to not have eaten we are gon na do them it's called fasting and you can make sure that you have n't eaten when you do but they will the lab techs will know so you will be able to knock out most of those today\n[patient] okay and i'm not sure i will be able to do that today because i have a class right after this\n[doctor] mm-hmm\n[patient] and right after that i have to go to work\n[doctor] mm-hmm\n[patient] you know if i told you i'm about changing jobs did i\n[doctor] no you did n't mention that but one of the cool things about being a doctor is i can write you a note so you're gon na do it and then you can go to the class and we could figure it but like it's really cool that you're changing jobs i'm happy for you i hope you know that like it's always great to be able to make some income and make some decisions that means that you'll be able to start paying for your test soon uh\n[patient] well yeah this new job there is no insurance and my old boss sucks so i'm hoping i'll get a new boss and you know hopefully some free food with with this ut because it's had a restaurant so we'll we'll see how that goes\n[doctor] we might have to have a conversation about the free food at the restaurant if we do n't get some of these infections under control because your salt intake is about to be very important okay\n[patient] got it\n[doctor] alright okay so do you have any more questions before i send my nurse in\n[patient] do i need to get a shot today\n[doctor] no shots today just stopped\n[patient] okay and when do i have to come back for the results\n[doctor] i need you to come back in a week\n[patient] okay can we do that over the phone by the way\n[doctor] we could if if your results are normal but if we need to have additional conversations i'm gon na need you to come back\n[patient] excellent\n[doctor] okay\n[patient] thank you very much\n[doctor] no problem",
            "tgt": "CHIEF COMPLAINT\n\nBack pain.\n\nMEDICAL HISTORY\n\nPatient reports that he has a frequent history of strep throat with 4 episodes within the last 5 months.\n\nSOCIAL HISTORY\n\nPatient reports that he is a student. He also mentions that he rides his bike every so often and that he is in the process of switching jobs. His new job will be at a restaurant.\n\nFAMILY HISTORY\n\nPatient reports that his siblings are mostly healthy. He does have a brother who smokes while at home.\n\nREVIEW OF SYSTEMS\n\nConstitutional: Denies fatigue or change in appetite.\nGenitourinary: Reports increased urine output.\nMusculoskeletal: Reports left-side back pain.\nEndocrine: Reports increased water consumption\n\n",
            "file": "D2N198-aci-subjective"
        },
        {
            "src": "[doctor] hi billy how are you doing the medical assistant told me that you have a cough today\n[patient] yep i'm doing pretty good you know cough started about a week ago or so you know i just started bringing up some yellow stuff and not feeling the greatest the last two days though\n[doctor] okay alright so the cough started a week ago but you have have started feeling worse over the last two days correct\n[patient] yep\n[doctor] okay\n[patient] yep\n[doctor] alright now have you had any fevers\n[patient] not that i remember i i feel warm but never really took my temperature\n[doctor] you feel warm okay alright any chills\n[patient] no no chills you know just a little achy at times\n[doctor] okay and how about any shortness of breath do you ever feel short short of breath at all\n[patient] no no i have no shortness of breath\n[doctor] no shortness of breath okay and how about any runny nose sore throat sinus pain or pressure\n[patient] yeah i get a like congested you know kinda drainage down my throat and you know a little bit of pressure in my sinuses\n[doctor] okay and anyone else sick in your household\n[patient] no unfortunately just need\n[doctor] just you okay and what do you do for work\n[patient] i work as a teacher\n[doctor] you're a teacher okay well that that can you know explain a lot okay now how about your hypertension now i know that you have a history of hypertension we kinda battled with that over the over the past year or so how are you doing with that did you buy the blood pressure cuff that i asked you too\n[patient] no\n[doctor] no\n[patient] i do n't check it at all\n[doctor] you do n't check it at all okay that's that's okay i i looked at it here we will talk about that in a minute and are you taking the lisinopril i think we have you on twenty milligrams a day\n[patient] i think that's what i'm taking\n[doctor] okay but you do take it\n[patient] yeah it's a white pill\n[doctor] okay alright yeah i'm not really sure what it looks like but okay as long as you're taking it so that's good and how about your diet are you watching your are you watching your salt intake\n[patient] not really i just kinda i feel the blood pressure medicine would do what's supposed to do\n[doctor] okay alright alright well what else is going on are you a are you a sports fan i was really sad to see that the that cincinnati bangel has lost the super bowl do you follow baseball or anything like that\n[patient] no i was n't too sad about that i'm a brown span\n[doctor] you're a brown span okay yeah\n[patient] now when you bring up sports though you know i also have actually when i was coughing a couple earlier this today i twisted my knee\n[doctor] you twisted your knee how did you how did you do that\n[patient] i was coughing i fell down the stairs\n[doctor] you were coughing and you fell down the stairs today okay alright well how many how many stairs did you fall down\n[patient] man it's like probably maybe it was four or five\n[doctor] four or five stairs and what knee did you injure\n[patient] my right knee\n[doctor] your right knee and have you been able to walk since that happened that happened this morning\n[patient] yeah correct\n[doctor] okay\n[patient] yeah but i i still can walk it just hurts mostly on the inside\n[doctor] mostly on the inside okay and can you can you can you bend your knee and straighten it\n[patient] yep\n[doctor] yeah okay and are you limping at all or you just walking pretty normally\n[patient] just i have a little bit of a limp\n[doctor] okay does it feel like it's gon na give out\n[patient] no\n[doctor] okay have you taken anything for the pain\n[patient] no i just been taking just stuff for over the counter stuff for my cough and cold stuff kinda like dayquil\n[doctor] okay\n[patient] i do n't take anything else\n[doctor] okay have they helped at all with the cough\n[patient] little bit little bit with the cough\n[doctor] okay alright lastly i just want to talk a little bit about your diabetes now in terms of your diabetes are you watching your sugar intake\n[patient] no no i do n't i do n't even take my blood sugars either\n[doctor] okay are you taking what's that\n[patient] i'm a bad patient i do n't take my blood sugars\n[doctor] that's okay you're not a bad patient that's okay it happens i know things you know you're you're busy but you know we do want i do want you to stay healthy you know you're you are a patient of mine i want i want to continue to see you over a long period of time so it's important for you to to you know watch your diet you know because we can have some complications from diabetes like kidney dysfunction and eye problems and things like that and i know that you are 74 and you know you have n't really had a lot of issues up until this point and you know so you have a you know still a long life to live so i would like to see you you know try to you know monitor your diet and and your blood sugars are you taking the metformin\n[patient] yeah i think that's the big pill\n[doctor] okay i'm not really sure what it looks like but you're supposed to be taking a thousand milligrams twice a day are you taking it twice a day\n[patient] yeah i'm taking my wife puts in the my box i take something twice a day i know that\n[doctor] okay how is your wife doing she is a very lovely person i i i remember seeing her at your last visit\n[patient] she is doing fine\n[doctor] she\n[patient] as long as she stays on the other side of the house no\n[doctor] yeah i say the same thing to my husband okay well let's go ahead i wanted you to just do a quick physical exam so i'm gon na be calling out some of my exam findings and i'm gon na let you know what they mean when i'm done okay so looking here at your vital signs you know you do n't have a fever here in the office which is good your temperature is ninety eight . four on your blood pressure it seems like you are doing a pretty good job monitoring your blood pressure your blood pressure is right where it should be it's about one twenty five over sixty two which is good your heart rate is nice and slow in the eighties and your oxygenation is fine it's ninety seven percent on room air so all of that is is really good now on on your facial exam i'm just pressing on your face here do you have any pain to palpation\n[patient] just right underneath my eyes\n[doctor] on one on what side\n[patient] actually both\n[doctor] okay okay on on facial examination the patient has pain to palpation of the bilateral maxillary sinuses on nasal exam there are there is erythema and edema of the nasal turbinates bilaterally with associated yellow discharge on throat exam can you open up your mouth on your throat exam the the uvula is midline there is no erythema or edema or exudate in the peritonsillar space on neck examination i do appreciate some bilateral cervical lymphadenopathy and on your lung exam there is coarse rhonchi present bilaterally that clears with cough on your heart exam your heart is in a nice regular rate and rhythm i do n't appreciate any murmur and on your right knee exam does it hurt when i press here\n[patient] yep\n[doctor] okay there is pain to palpation on the right knee and i'm just gon na move it all around does that hurt\n[patient] little bit yeah\n[doctor] okay so there is decreased flexion and extension of the right knee there is associated ecchymosis to the right medial knee there is no evidence of an effusion okay so billy what does all of that mean that means that you just have signs of that you have a little bit of an upper respiratory infection that might have caused some congestion in your in your lungs which we will talk about okay and then and as far as your knee exam it just shows that you do have some inflammation and some evidence that you had injured it earlier so let's just talk a little bit about you know my assessment and my plan for you for all of these issues okay so for your first problem of your cough you know i do believe that you just have a a viral syndrome at this time you probably have some mild bronchitis i really just wan na go ahead and just you know recommend some supportive care you can continue to take over the counter medications we can prescribe guaifenesin six hundred six hundred milligrams twice a day to help cough up some of that phlegm and i do n't think you need need any antibiotics at this time but certainly if your symptoms worsen i want you to call me and then we can go ahead and consider ordering a chest x-ray to make sure that you do n't have any pneumonia okay how does that sound\n[patient] that sounds good\n[doctor] okay so for your second problem of your right knee pain i do believe you have a a a right medial collateral ligament strain from the fall this morning and i really wan na just go ahead and and i'll prescribe some meloxicam fifteen milligrams once a day and we can refer you to physical therapy to help strengthen those muscles around that area and i'm gon na go ahead and just order a right knee x-ray just to make sure that you did n't injure any bones although i do n't think you did but we'll just go ahead and order that right knee x-ray how does that sound\n[patient] okay that sounds like good good plan\n[doctor] okay and then for your third problem of your hypertension let's just continue on the lisinopril twenty milligrams a day i wan na go ahead and order a lipid panel to make sure everything is okay from that standpoint and lastly your fourth problem your diabetes i wan na go ahead and order a hemoglobin a1c just to make sure we do n't have to make any adjustments to your metformin and i really want you to try to monitor your sugar intake and report your blood sugars to me through the patient portal how does that sound\n[patient] okay i'll try that i try my best\n[doctor] alright that sounds good i'll i'll be in touch with you with those results okay\n[patient] okay appreciate it\n[doctor] alright take care bye",
            "tgt": "CHIEF COMPLAINT\n\nCough.\n\nMEDICAL HISTORY\n\nPatient reports history of hypertension and diabetes.\n\nSOCIAL HISTORY\n\nPatient reports that he is a teacher.\n\nMEDICATIONS\n\nPatient reports taking lisinopril 20 mg daily and metformin 1000 mg twice a day.\n\nREVIEW OF SYSTEMS\n\nConstitutional: Reports \"feeling warm\". Denies chills.\nHENT: Reports nasal congestion, sore throat, and sinus pressure.\nRespiratory: Reports productive cough with yellow sputum. Denies dyspnea.\nMusculoskeletal: Reports body aches and right knee pain. Denies right knee instability.\n\nVITALS\n\nTemperature is 98.4 today.\nBP: 125/62.\nHeart rate is nice and slow in the 80s.\nSpO2 is 97% on room air.\n\n",
            "file": "D2N199-aci-subjective"
        },
        {
            "src": "[doctor] alright okay theresa so i understand that you're you're having a bit of some headache here and then your blood pressure has been running high can you tell me a little bit about what's happening\n[patient] yeah i've had blood high blood pressure for a long time my provider gave me chlorthalidone i do n't really take it because it gives me a stomachache but yeah i get headaches right here on the top of my head they kinda come and go they're throbbing tylenol helps the headache\n[doctor] okay alright and then so how long have you had this headache has this been recent or like acute or you've been having this for since you've had your blood pressures\n[patient] hmmm it's been on and off for about a month\n[doctor] a month okay alright and then are you having any other kind of symptoms with that like are you having any kind of you know dizziness lightheadedness any nausea vomiting\n[patient] yeah sometimes i feel dizzy and my vision gets a little blurry\n[doctor] okay alright how about like chest pain or shortness of breath are you experiencing any of that when you have these headaches in your blood pressure\n[patient] chest pain or shortness of breath\n[doctor] okay very good alright and then you said you were you've taken some tylenol for that and you said it did help a little bit or did n't sorry\n[patient] it does help\n[doctor] it does help good very good so how often are you taking your your medication are you taking that as prescribed like daily it sounds like you missed a few times but for the most part are you taking it\n[patient] yeah i forget a lot so i probably take it like every other day\n[doctor] okay every other day alright and then are you also now i know you also have some diabetes so are you how are you doing with that one are you pretty much taking your metformin everyday\n[patient] hmmm i probably take it when i take my other medicine like every other day\n[doctor] every other day okay so i do see that you know the nurse took your your vital signs this morning that your blood pressure is running quite a bit high it was like one seventy two over ninety eight so that's that's really a little higher than where we want it to be especially that you're on your medication but what we're gon na do is we're gon na take i'm gon na take a look at you real quick and then we can discuss you know maybe there's some changes that we can do in terms of your current regimen how about diet and your have you been sticking with that low sodium diet at all\n[patient] no i love mcdonald's i eat it all the time\n[doctor] i love mcdonald's too my favorite is big mac i do n't know about you but i got ta have my big mac with those large fries which you what's your favorite mcdonald's treat there\n[patient] i need to think of what fully of fish i love flare of fish\n[doctor] well at least you're eating the fish but but they can be very high in sodium especially the fast foods so we'll have to talk about maybe they can look at you know some some diet changes as well so the other thing is for your for your blood sugar here i see that you know you're running a bit high as well it looks like you're like you're about one seventy this morning and i i i i assume that you were fasting last night is that right okay so that's that's a little higher than what we want it's not bad it's below two hundred but it's getting kinda close to the borderline from where our limit is so we will take we take a look at that and also we'll figure out what we can do with that as well alright so at this point how about are you how is how is work how is life it's been good otherwise how's the family\n[patient] they are good i did eat a lot of my kids easter candy over the weekend so maybe that's why my sugar is high\n[doctor] okay alright great alright alright just just around easter okay not not too much during the the year hopefully\n[patient] yeah i try\n[doctor] well that's good so let's go ahead and do a physical exam on you real quick here okay and so i'm looking at your vital signs it looks like your blood pressure i we mentioned that today is pretty high your heart rate looks good it's with it's within normal limits here and then your oxygenation is fine so you did mention you did n't have any shortness of breath so that's good so let me just feel around your neck real quick here i do n't appreciate any jugular venous distention on your neck exam i no carotid bruits so that's good let me go ahead and listen to your lungs and your heart here real quick alright so on your auscultation of your lungs they're clear bilaterally on your heart exam though i i do sense a two out of six systolic ejection murmur now that was also there last year so it has n't changed any so we'll just keep monitoring that one and then let me take a look at your extremities here real quick theresa so let me look at your hands you got a little bit of slight edema bilaterally on your upper extremities but let me look at your legs here okay so you have a one plus pitting edema noted here on your legs bilaterally so that means you're retaining a lot of that salt that you're eating unfortunately okay so so let me go ahead and tell you about my assessment and plan here so definitely what you're experiencing is some uncontrolled hypertension now most of the time you know it's multifactorial right it's your diet it could be the medication regimen if you're not following that and then it might be that we are gon na need to change the medication around and also change your diet but i would like to start with going ahead and i want to continue your current medication regimen today i do wan na really encourage that you do take that everyday maybe set a reminder like on your you know do you use your iphone a lot for your reminders and things maybe we can go ahead and do that get a reminder make sure that you take that everyday but with that i would like to go ahead and also monitor your blood pressure let's do it three times a week it can be much when we do it everyday but maybe three times a week do you have a blood pressure monitor at home\n[patient] no\n[doctor] okay so i can recommend some really good ones nowadays that you can use at home and they're not that expensive and at least it'll give you some you know idea of what your blood pressure is running at and then i want you to come back like in a month because i wan na go ahead and see how your blood pressure is doing now that you know you're you you're taking your blood pressure medication everyday the other thing is i do wan na go ahead and have a nutritionist come and talk to you about you may maybe some dietary changes i'd like for you to start a \u2013 diet it's really to to help you know a lot of reduce a lot of that sodium intake when you're when you're when you're taking in your food so a nutritionist is gon na be able to help you figure out some foods that you know that you may like that you can actually use as an alternative besides the mcdonald's although you can have that once in a blue moon but you know not not too often okay\n[patient] okay sounds good\n[doctor] great and then for your diabetes i wan na go ahead and let's go ahead and increase your your metformin to fifteen hundred milligrams i think all for that too i want you to go ahead and continue taking your blood sugars to make sure as as you normally would to make sure that you know that change in medication is is actually being effective alright do you have any other questions for me at this time\n[patient] nope\n[doctor] okay great well i'm gon na have the nurse check you out and and i'll have the scheduler schedule you for a one month follow-up we'll take a look and see how you're doing from there see if we have then we will move from there okay\n[patient] sounds good thank you\n[doctor] thanks theresa",
            "tgt": "CHIEF COMPLAINT\n\nHeadache and high blood pressure.\n\nREVIEW OF SYSTEMS\n\nRespiratory: Denies shortness of breath.\nCardiovascular: Denies chest pain.\nNeurological: Reports blurry vision, dizziness, and headaches.\n\nVITALS\n\nBlood pressure today was 172/98. Oxygenation is within normal limits.\n\n",
            "file": "D2N200-aci-subjective"
        },
        {
            "src": "[doctor] hey steven so i see that you're here and you've been experiencing some back pain for a while could you tell me a bit about that\n[patient] yeah it's been back has been hurting for a while\n[doctor] mm-hmm\n[patient] for about a couple of years and tried a couple things but nothing seems to work\n[doctor] okay so let's start start with what happened did something cause the pain\n[patient] i think well i played basketball and i bumped one time and i fell and i hit i think i fell on my back got fell real hard\n[doctor] mm-hmm\n[patient] so it's been hurting after ever since that\n[doctor] okay and then how severe is the pain on a scale of like one to ten\n[patient] i think it's around a seven\n[doctor] wow okay could you describe it for me is it like sharp is it throbbing\n[patient] it it hurts pretty bad it's it's sharp\n[doctor] okay\n[patient] throbs sometimes\n[doctor] and does it radiate\n[patient] sometimes it hurts more than others and i'm not sure why\n[doctor] and does it radiate anywhere\n[patient] yeah it goes down my leg my left leg\n[doctor] okay alright\n[patient] like my toes get numb a little sometimes\n[doctor] wow okay and how about like so hmmm you said it goes down your left leg how about any like are you experiencing any loss of sensation in like the genital or rectal area\n[patient] i hope not\n[doctor] that's okay i i it's gon na help me isolate like what's what exactly is going on so please do n't feel embarrassed to answer the questions do you have any weakness\n[patient] yeah sometimes i try to stand up and and and like i i ca n't go get weak or if i'm standing up for too long\n[doctor] okay so would you would you say that there are certain positions that make you feel better or worse\n[patient] yeah like lying on my side makes me feel better\n[doctor] okay\n[patient] yeah\n[doctor] and then you said that standing also makes it worse right\n[patient] yeah if i stand for a while\n[doctor] okay and then have you experienced any like loss of control of like your bladder or your bowels\n[patient] yeah i pooped myself once\n[doctor] okay so incontinence just once though like over the last two years right it's not like a consistent thing\n[patient] no it's not consistent i think i stood up for too long i think i was drinking too\n[doctor] okay okay you mentioned earlier that you tried some things in the past like what were they\n[patient] so i i had a doc gave me some injections before i'm not sure what they were though\n[doctor] okay alright and i see in your chart here that you had physical therapy did you feel that that was effective\n[patient] no i feel like i could do them the same exercises at my house like they charged me and like it\n[doctor] okay but did the did the exercises help\n[patient] i mean i guess a little\n[doctor] okay not a so not as effective as we would have liked did they put you on any pain medications\n[patient] yeah it was just a white pill i'm not sure what it was\n[doctor] okay do n't worry i think i can look that up in your chart i just wan na make sure that we have the story straight alright so i know that you said that you mentioned that you played basketball you know before how how like what's your activity like now\n[patient] i mean i sit at home all day\n[doctor] okay\n[patient] watch tv\n[doctor] okay\n[patient] so not very active i've gained about eighty pounds the past year\n[doctor] okay that's a pretty okay that's a pretty significant weight gain well i i just have a few more questions have you do you know if any of your family members have spine conditions\n[patient] i think my fourth cousin has scoliosis\n[doctor] okay okay but that's that's a little distant but anybody direct like sister brother mom dad\n[patient] i do n't think so i mean i do n't even my dad though\n[doctor] okay okay and then do you have a personal history of smoking\n[patient] what type of smoking\n[doctor] any smoke you do n't have to tell me exactly but\n[patient] okay\n[doctor] have you smoked\n[patient] next maybe that i have n't\n[doctor] are you it's okay i'm your doctor i'm not here to judge you i just want to make sure that i'm like you know when the conclusions that we come to and like my assessment and plan for you i need to know this information so one more time do you smoke or have you smoked before\n[patient] okay i smoked\n[doctor] okay that's fine how much and how often and what was it\n[patient] i'm not telling you all that i'm just telling you i smoked\n[doctor] okay you have\n[patient] too many questions are you the fit\n[doctor] i'm your doctor i have to\n[patient] are you the fence you sound like the fence next question\n[doctor] i'm not a op i promise alright that's fine but let me know are you currently like smoking\n[patient] no\n[doctor] okay okay i just have to ask alright so i do wan na do a quick physical exam i did review your vitals and like part of why i wan na know about your smoking history is that you are stating kind of low like it looks like you are might be in the ninety five percentile range and so we might need to explore some things\n[patient] sent them off yeah\n[doctor] pardon\n[patient] because i'm fat my cousin was fat too and and he gained a bunch of weight he he had to have oxygen\n[doctor] you know honestly there are a few other factors weight gain does n't necessarily help you're right but like smoking has like a stronger impact so but it's okay we can explore like you know other options here i as i listen to your heart you have a regular rate and rhythm i do n't appreciate any murmur on so i'm gon na go ahead and do a back exam i do n't notice any overlying erythema or ecchymosis on your skin so no redness or bruising when i push here on your spine does that hurt okay okay so there is midline tenderness on the l4 l5 disk space with right sided lumbar paravertebral tenderness when you bend forward does it hurt\n[patient] yeah it hurts\n[doctor] okay and when you bend backward does it hurt\n[patient] a little bit\n[doctor] okay so pain with lumbar flexion and extension alright and as i raise your leg does this hurt when i raise your leg up\n[patient] stop\n[doctor] okay so supine straight leg test positive alright just a couple more things on neurological examination there is decreased sensation to light touch at the right lateral thigh at l4 dermatome patella and achilles reflexes are symmetrical so i just wanted to make sure that i documented all of that in your chart and in a you can ask me any questions but i did look over the results of the\n[patient] what does that mean like am i dying\n[doctor] no no no you're not dying but i think we have i think i have a good idea of what's causing your back pain so first let's talk about the mri that you had the results show a disk desiccation a disk bulge with parison paracentral disk herniation resulting in moderate right for neural foraminal stenosis okay\n[patient] that's a big word\n[doctor] those are huge words it's okay so let me tell you what like what all this means and what we're gon na do like for my assessment and plan so for your problem of chronic lumbar back pain based on your symptoms your exam and reviewing your mri that's consistent with a herniated disk at the l4 l5 with radiculopathy what this means is that one of your disks that sits between your spinal vertebrae is bulging out and this bulge is pinching on some nerves that's why you feel the tingling in your leg alright so that it's also why you felt pain when i pushed on that area so i'm gon na recommend some a spinal injection with a strong anti-inflammatory medication called a corticosteroid right i think you said that you had one before but i think this is something\n[patient] i had to have someone hold me down i do n't like needles so do you can i take a pill i do n't want that\n[doctor] we could yeah we could give you something to help calm down like the anxiety i would just write you a prescription for one and you would take that maybe three hours before you came in for your appointment and then you should feel calm enough to be able to do the injection\n[patient] okay\n[doctor] alright\n[patient] can i get pain pills too\n[doctor] can you\n[patient] for pain\n[doctor] can you get what now\n[patient] pain pills\n[doctor] so once i inject the cotocoid steroid in the in your spine it's gon na happen under fluoroscopy right and it's going to be it's a it's just a type of of like x-ray sorry to because i need to be very specific in where i do this injection so i say this because you should n't need anymore pain pills after we do this injection it should help with the inflammation and directly target the bulge to help you out so after this injection give it maybe a day and if you say that you're still experiencing pain then we can talk about maybe giving you pain medication but remember before you said it was n't as effective so i think this steroid shot is the best chance that we have\n[patient] i'd say it was n't effective\n[doctor] okay sorry i i i saw that they gave you strong pain meds but remember you said the white one did you say it was effective\n[patient] yeah i said i said the white ones i said they worked\n[doctor] okay i'm sorry so alright so maybe when let's okay so what we're still gon na do though we're gon na do the injection and then if it still hurts after that then we can explore that pain medication i do n't want you to have to consistently be on pain medication it's not necessarily like a good long term solution if after we monitor this you still are experiencing pain we are gon na try the pain meds however i would maybe recommend surgery\n[patient] i do n't want i know\n[doctor] right and so this is we're just gon na try everything that we can before you know before we get to that place\n[patient] mm-hmm\n[doctor] do you have any questions\n[patient] no\n[doctor] alright\n[patient] when it when is it when am i having this this when do you want me to get this injection\n[doctor] okay so you're gon na go to the front and schedule it this is a very quick and common procedure it should only take about an hour we will need to do this note like if this if this is successful we would only maybe do this four times a year so whenever at the front desk go ahead and schedule i think that mine pretty available to be able to help you with this alright any other questions\n[patient] no\n[doctor] okay thank you",
            "tgt": "CHIEF COMPLAINT\n\nBack pain.\n\nHISTORY OF PRESENT ILLNESS\n\nSteven Reed is a pleasant 60-year-old male who presents to the clinic today for evaluation of back pain. The onset of his pain began 2 years ago after he fell and landed onto his back while playing basketball. His pain is rated at 7 out of 10 and is described a sharp with occasional throbbing. At times his pain will radiate down his left lower extremity. He also reports experiencing intermittent numbness in his toes. Prolonged standing exacerbates his pain and makes him feel weak. He is able to get some pain relief when laying on his side. In terms of his bowel and bladder habits, he reports 1 episode of incontinence over the last 2 years which he believes was due to prolonged standing and possible alcohol consumption. He other denies any other changes and denies loss of sensation in the genital or rectal area. He has tried an injection in the past, but notes that he does not like needles and had to be held down. Pain medication was tried but he is unable to recall the name of the medication. He also attended physical therapy with minimal relief. Currently he states that he is not very active and tends to watch tv all day. He has gained 80 lbs over the last year.\n\nSOCIAL HISTORY\n\nPatient reports previously playing basketball, but he is now not very active and sits at home all day. He has a history of smoking, but denies smoking currently.\n\nFAMILY HISTORY\n\nPatient reports his 4th cousin has scoliosis.\n\nREVIEW OF SYSTEMS\n\nGenitourinary: Denies bowel or bladder changes.\nMusculoskeletal: Reports back pain.\n\nVITALS\n\nOxygen saturation is in 95 percentile range.\n\n",
            "file": "D2N201-aci-subjective"
        },
        {
            "src": "[doctor] good morning sharon how you doing\n[patient] hi i'm i'm okay today i'm having some shoulder pain\n[doctor] i see that i see that here in the nurse's notes it looks like you're having some right shoulder pain says here that you've guys have been remodeling your house what do you do you remember what you were doing when that right shoulder pain started\n[patient] yeah i was up on a ladder painting and kinda reaching out and fell took a fall and kinda braced myself but i i was painting\n[doctor] okay so it does sound like there might have been some direct trauma to that area now it says here that this happened about three weeks ago were you able it sounds like you were able to get up and continue but you were having some pain did you take anything at that time to help with that shoulder pain\n[patient] yeah i i iced the arm and then i also i also took some advil\n[doctor] okay now have you had any shoulder pain before of that right shoulder or is this the first time or or the first insult to that area\n[patient] first time\n[doctor] okay and now are you able to move that right arm for me\n[patient] yes i'm able to move but i do have some pain lifting overhead raising my arm overhead\n[doctor] okay alright now do you have pain all the time or does it come and go\n[patient] it is some pain is all the time but it some is intermittent\n[doctor] okay now i you mentioned that you had taken some ibuprofen for that pain now let's talk a little bit about your pain rating okay zero being none ten being the worst pain you've ever felt in your life can you rate your pain for me without any tylenol or advil or any nsaid can you rate your pain for me\n[patient] about a six\n[doctor] okay now when you take that medication can you rate your pain for me what what's that pain level get to\n[patient] it goes down to about a four\n[doctor] okay so it does help take the edge off of that pain and and you're able to kinda move around a little bit then\n[patient] yes\n[doctor] okay so the remodel tell me a little bit about that my wife and i were working on our remodel and we went they just built the brand-new lowe's here in town have you guys been there yet\n[patient] no we have not\n[doctor] well i did n't know if you know this or not but you can save big money there that's the rumor\n[patient] okay\n[doctor] so yeah we we've been down there we got some pain we we got went and got some samples and then hey while we were there we ended up deciding to put down a bunch of flooring too so i really recommend you guys if you get a chance go over there and take a look at their sales and and see if you ca n't finish your remodeled project\n[patient] that sounds great i'll have to take a look at the flooring as well\n[doctor] that sounds good so now just out of curiosity are you experiencing any numbness or tingling in in your arm or hand\n[patient] i did when i initially hurt it but i'm not no longer having any numbness or tingling\n[doctor] okay so a little bit about my physical exam i'm gon na do a quick physical exam on you today now your vitals look good but specifically on your right shoulder exam you do have limited active and passive range of motion and there is tenderness to the greater tuberosity of the humerus now there is no tenderness at your sternoclavicular joint and you do have good strong bilateral hand grips and on your neurovascular exam of your right arm you do have brisk capillary refill of less than three seconds and you do have equal and bilateral response to sensation and touch which is good now taking a look at your x-ray that we did when you came in today good news is that right shoulder x-ray reveals no fracture or bony abnormality mkay so let me tell you a little bit about my assessment and plan now i your symptoms are most likely due to rotator cuff tendinopathy i think that you've injured the tendons of the muscles that make up the shoulder so that i think that's that's why you are having the that shoulder pain i do wan na order an mri of that right shoulder just to make sure that nothing else is going on now i'm gon na refer you to physical therapy and that's gon na be about six to eight weeks now my patients are very successful with their pt and let's see how you do before we make the decision that we would do additional treatment such as a steroid injection to that shoulder i do want you to continue to take an nsaid if you can tolerate tylenol i want you to go ahead and take tylenol for that pain do you have any questions comments or concerns about our treatment plan\n[patient] no i think it sounds good ca n't wait to to get some relief\n[doctor] okay so i know we ordered it for six to eight weeks but i wan na see you again in two weeks and we'll evaluate how you're doing and make some additional treatment plan at that at that time okay\n[patient] okay\n[doctor] alright sounds good we will get the nurse come in and she will take care of you and i will see you in two weeks\n[patient] thank you\n[doctor] thank you",
            "tgt": "CHIEF COMPLAINT\n\nRight shoulder pain.\n\nHISTORY OF PRESENT ILLNESS\n\nSharon Wright is a pleasant 36-year-old female who presents to the clinic today for the evaluation of right shoulder pain. The onset of her pain began 3 weeks ago, when she was painting on a ladder when she reached out to catch herself because she fell. She states that she braced herself with her right arm. The patient reports that she was able to get up and continue painting. She states that she experienced numbness and tingling in her arm and hand when she initially injured her right shoulder, however this has resolved. She states that she iced her arm and took Advil for pain. The patient denies any previous shoulder pain. She reports constant pain with lifting her arm overhead. The patient rates her pain level as a 6 out of 10 without medication and a 4 out of 10 with medication.\n\nREVIEW OF SYSTEMS\n\nMusculoskeletal: Positive right shoulder pain.\nNeurological: Denies numbness and tingling.\n\nVITALS\n\nVitals look good today.\n\n",
            "file": "D2N202-aci-subjective"
        },
        {
            "src": "[doctor] good afternoon matthew how are you\n[patient] i'm okay\n[doctor] it looks like here that the that you've been brought in for some vision changes and looks like you're having trouble with your right eye can you tell me a little bit about what brought you in to see me today\n[patient] yeah you know i started noticing my wife and i we we eat out almost every night and it's when especially when we go to fancy place\n[doctor] mm-hmm\n[patient] i have trouble adjusting in the that dark dim environment\n[doctor] okay and i reviewed my technician's notes before i came in to see you and it says you know you you've been having that decreased vision when you're reading especially in dark place like you just said but it also mentions here that it looks like you told her that when you look at straight lines like in your door frame it looks like things have been looking a little crooked to you how long has that been going on\n[patient] well you know it's been going on a little while probably getting worse over the last three to four months and you know my my office has paneling and you know how that paneling has that dark grooves in it those straight lines well they always look wavy to me\n[doctor] okay alright so it's been going on a few months now you mentioned that you and your wife go out to eat every night have you tried the new the new italium place over there on main street\n[patient] my gosh yes we were just there the other night down in the it's down in the basement of that big building yeah we went there the other night and i got ta tell you it was like the saprano family was sitting across from us there was this bunch of old guys that had bottles of of red wine all over the table and they were my gosh it was so good and the food i mean i mean i ca n't tell you how great the food was\n[doctor] it was\n[patient] it was just phenomenal\n[doctor] it was amazing my wife and i went over there the other day and when we walked downstairs it was like i was walking into a scene out of saprano's\n[patient] mm-hmm\n[doctor] but the food was amazing it was the best egg plant parmer's john i've i've ever had where really super excited about going back there here very very soon\n[patient] yeah i had the bio marsal and it was my gosh it was to die for\n[doctor] i'll have to get that next time i go so in reviewing your paperwork here it looks like you made mention that you smoke are you still smoking about a pack a day\n[patient] yeah i i tried i've tried i've done hypnosis i've done lozenges i've done chewing gum and i get real close but you know i'll just go out one evening without the wife and and the next thing i know i'm i'm you know buying a cigarette off of somebody and it's it's really hard for me to get that stopped\n[doctor] yeah i i appreciate that but it's really gon na be important that you try to to either cut back or quit smoking altogether now that leads me into my next concern here it looks like you have a history of high blood pressure and i'm just wondering are you are you taking your blood pressure medication as prescribed and and are you checking your blood pressures on a regular basis\n[patient] i'm glad you just mentioned that because i have n't taken my blood pressure pill for a while it's up in the cupboard and it's back in that corner and i just i ca n't forget to take it\n[doctor] okay it's really gon na be important that you take your medication for your blood pressure as prescribed i'd really like to see you start doing that today and then let's let's go ahead and and let's set that that pill bottle down on the counter and see if that does n't help you remember to take that blood pressure medicine if it's okay with you i would like to do a a quick physical exam on your eyes i'm gon na go ahead and take off your glasses and put your chin here in the chin rest for me\n[patient] okay that's a bright light\n[doctor] yeah i'm sorry about that it it's just gon na help me check the lenses in both of your eyes so it looks like the anterior segment examination reveals posterior chamber intraocular lenses in both eyes for the right eye the cornea is clear no nvi peak hole cup to disc is . two fundus examination of the right eye shows the retina to be attached three hundred and sixty degrees no holes or tears noted and rpe changes in the fovea now the posterior segment exam shows drusen in the macula retinal thickening and presence of subretinal fluid and exudate accumulation and it is positive for a hemorrhage now for your left eye the cornea is clear no mvi pecal cup to disc is . three rpe changes in the fovea no hemorrhage noted or subretinal fluid noted and the retina is attached appropriately now i reviewed the results of your diagnostic exam so the otc exam shows those drusen deposits under the rpe which is the retinal pigment epithelium and then the subretinal fluid so the srf accumulation and choroidal neovascular membrane can also be visualized in that test now the fluorescein angiography so the using the the fluorescein there reveals that the focal area of the leakage in the right eye is consistent with neurovascular age related macular degeneration now for my impression and plan it looks like the diagnostic test and the eye exams are consistent with the neovascular age related macular degeneration also called wet macular degeneration now it's advanced to a stage that usually leads to more severe vision loss happening now this happens when those abnormal blood vessels start to grow beneath the retina what happens is they leak fluid and blood which is wides called wet macular degeneration and what happens is secondary to that it creates a large blind spot in the center of your visual field that's why it it kinda looks like you'll see a black dot in the center of your vision field now it is the most common cause of severe vision loss now the good news is we have a plan for you for this now once a month i want to give you an injection of lucent now it's gon na be injected in the vitreous portion of the eye after we numb the eye so you're not gon na feel any pain and those injections yeah i know the one once i numb the eye you wo n't feel any pain in that injection at all patients report no pain at all for the actual injection\n[patient] have you ever somebody stick a needle in your eye\n[doctor] well\n[patient] what i mean not not yeah literally stick a needle in your eye\n[doctor] yeah literally yeah\n[patient] yeah\n[doctor] the good news is injection given over time can slow the rate of the vision decline and maybe even stop it however i also have to let you know that there could be a situation where you may still note a small amount of vision loss but this is your best chance of maintaining that vision for as long as you can so i know i have given you a lot of information i wan na pause here and see if you have any questions comments or concerns before we get you scheduled for that injection\n[patient] no i'm i mean as as long as you think it wo n't hurt a lot that will be good\n[doctor] okay i think it's gon na be our best plan to help slow this disease process\n[patient] okay\n[doctor] alright so i'm gon na have the nurse come in and get you prepped and we're gon na go ahead and do the first injection today\n[patient] okay okay\n[doctor] sounds good i'll be back in a couple of minutes\n[patient] okay thank you very much\n[doctor] thank you",
            "tgt": "CHIEF COMPLAINT\n\nVision changes in the right eye.\n\nMEDICAL HISTORY\n\nPatient reports history of high blood pressure.\n\nSOCIAL HISTORY\n\nPatient reports he is smoking 1 pack of cigarettes daily.\n\nREVIEW OF SYSTEMS\n\nEyes: Reports right eye vision changes.\n\n",
            "file": "D2N203-aci-subjective"
        },
        {
            "src": "[doctor] okay well hi joe i understand you've hurt your knee how how are you doing\n[patient] i'm doing okay this feels you know definitely feels like it's swollen and kinda hurts me a little bit\n[doctor] so what did you do what happened\n[patient] i was i was skiing with some with some friends and i was going down it was snowing pretty hard and i could n't really see as as the two paths kind of come came together and i the front end of the skis i kind of dug into the snow and i ended up basically doing a cart wheel but kinda like stopped halfway through and could feel a pop in my my right knee and then you know just pain right after that came about through the knee so\n[doctor] yeah that sounds painful and so when did this occur\n[patient] it it occurred over the weekend on saturday\n[doctor] and have you been able to to walk at all at all or no\n[patient] a a little bit but it's definitely swollen and it's definitely painful\n[doctor] okay so what all have you been doing for the pain\n[patient] just like taking some you know advil and then just icing you know icing on and off you know a little heat here and there just you know trying to comfort but that's about it\n[doctor] have you ever had any type of injury to your knee before and it is this the left or right knee\n[patient] it's the right knee no it's the first time i've had any knee injuries\n[doctor] okay alright let's see take anything for it okay well let's see let's just do a quick physical exam here so so your now your vitals those look alright your no fever you're at ninety seven . nine your heart rate is sixty four sounds healthy respirations are sixteen blood pressure is one ten over seventy four your o2 sat looks good at you know ninety eight percent so look real healthy there and so i'm just gon na do a quick physical exam so i do appreciate some edema and some ecchymosis around surrounding your knee your right you said right knee right\n[patient] yeah\n[doctor] okay positive pain to palpation and let's bring your leg out are you having pain when with flexion or extension\n[patient] a little bit no not not crazy real pain but there is definitely some pain there\n[doctor] okay pain with flexion and extension and how about the range of motion having full range of motion here\n[patient] yeah pretty much i can get the full range just feels a little tight and will hurt\n[doctor] okay alright and for diagnostics so your x-ray so there's no fracture appreciated no bony abnormalities so that looks alright so let me tell you a little bit about my impression and plan with this so you have a knee contusion so for treatment we'll we need to rest that apply ice you know two three times a day for twenty minutes at a time take some nsaids or you know nonsteroidal anti- inflamma medication such as ibuprofen every six to eight hours as needed so i just wan na really get some rest with that if that does n't improve then we can go ahead and maybe come back in and we might do some physical therapy as well i do n't know i'm not sure i like this one all that well any do you have any questions on that\n[patient] no sounds very good\n[doctor] okay let's venture a little bit more because i need five minutes so where so where were you skiing at\n[patient] so i was actually up we actually took a trip up up north and i was in the i'm in mount saint helen and washington so i was just walking in myself going out and stuff but yeah it was it was a good trip but cut a little short because of that yeah it was fun though i like going i like going to skiing so hopefully i can do some more\n[doctor] well washington sounds nice i have n't been there but it sounds like it's pretty nice area to be in and they have a lot of maple syrup there do n't they produce a lot of maple syrup\n[patient] they do they do have a lot of maple syrup and it's it's it's interesting that the the winter actually is n't their busiest time for vacation or vacations or it's more into your spring into your fall with hikers and all the outdoor activities there's actually a very impulsive torist during the summertime which i never knew but one of the locals have told me that they do actually better business during the summer so the hikers kayakers and the maple syrup in the fall and everything so\n[doctor] that sounds good now i also meant to ask you so when you did this cartwheel through the air did you have any other injuries to any other parts of your body anything else that you're having any issues with\n[patient] my shoulder feels a little bruised\n[doctor] okay\n[patient] little bit but that's about it yeah just because i kinda landed on that lead shoulder when i fell\n[doctor] okay let's take a quick look yeah i do appreciate a little bit of bruising here are you having any problem raising it up or or with movement with your range of motion\n[patient] once i raise it up though it's a it is a little little tender i can feel it being tender when i raise it up\n[doctor] okay we'll just go ahead and get an x-ray of that right shoulder too just to be sure if you because who knows maybe you might have done something with that as well so we'll go ahead and have my nurse take you to do that and then we'll talk again alright\n[patient] sounds great",
            "tgt": "CHIEF COMPLAINT\n\nRight knee injury.\n\nHISTORY OF PRESENT ILLNESS\n\nJoe Reed is a pleasant 42-year-old male who presents to the clinic today for the evaluation of a right knee injury. The patient sustained this injury when he was skiing with some friends. He states the front end of his skis dug into the snow and he ended up doing a cartwheel through the air until he stopped halfway and felt a pop with immediate pain in his right knee. The patient reports pain and swelling in his right knee since the injury. He has been able to ambulate although he notes difficulty due to swelling and pain. The patient has been taking Advil as well as icing and applying heat to his knee intermittently. He denies any previous knee injuries.\n\nThe patient also reports right shoulder pain and bruising. He states he landed on his right shoulder when he fell. He reports tenderness with raising his arm.\n\nREVIEW OF SYSTEMS\n\nMusculoskeletal: Right knee pain and swelling. Right shoulder pain and bruising.\n\nVITALS\n\nBlood Pressure: 110/74 mmHg.\nHeart Rate: 64 beats per minute.\nRespiratory Rate: 16 breaths per minute.\nOxygen Saturation: 98%\nBody Temperature: 97.9 degrees F.\n\n",
            "file": "D2N204-aci-subjective"
        },
        {
            "src": "[doctor] hey angela how are you\n[patient] i'm good how are you\n[doctor] i'm good so i see we are here you had a recent diagnosis of stage three nonsmol cell lung cancer and so we are following up on your neo adevant chemotherapy so you can you tell me how you're doing today\n[patient] yeah you know i'm i'm doing okay i have a little bit of some shortness of breath that i noticed over the weekend and you know i i'm i considered myself pretty active before this i would walk my dog around the block and now i i ca n't even walk you know down the street without being short of breath\n[doctor] okay yeah yeah i mean that's that's definitely understandable it says you had a four point four centimeter left upper lobe nodule in there so it's kinda big but that's understandable and we're doing the chemo to try to reduce that that that tumor that you do have so how often do you normally run with your dogs\n[patient] i mean i would i would take them for i would normally take them for like mile long walks everyday and just this weekend i could only walk down to the end of the street i had to have my husband take the dog fit walk\n[doctor] man okay what kind of dog do you have\n[patient] i have a dobrman\n[doctor] yeah they are pretty active that makes sense alright so have you been coughing have you had any phlegm\n[patient] i've been having a dry cough no phlegm\n[doctor] okay have you noticed any fever\n[patient] no fever\n[doctor] no fever alright what about any other symptoms like any body aches any sore throat sinus pain\n[patient] well i mean now that you mentioned it like every time i swallow it hurts it does n't feel like i have a cold because it hurts down here more in my chest but every time i swallow it it's really painful\n[doctor] okay so when you are swallowing i know some of my patients feel this do you feel like the food is getting stuck\n[patient] no the food is not getting stuck it just hurts\n[doctor] okay what about when you're you're taking liquids are you able to take in both hydrocort liquids\n[patient] i mean i definitely feel like over the weekend i have n't been taking it as much because it hurt so much but i i am able to i am able to drink and i've been taking ensure and things like that i had a milk shake\n[doctor] okay that's that's that's that's good yeah we we definitely want you to to take in as much liquid as possible best especially since you're on the chemotherapy and the radiation just so you wo n't get dehydrated because that will make you feel a lot worse if you are dehydrated okay so on a on a mental emotional standpoint i know you said you have your husband with you how you doing with that you have the support that you need you need to speak to me though\n[patient] it's very helpful you know as you can understand i'm just like devastated when i got this diagnosis and i'm just i'm just trying to figure everything out and but he is very good and my daughter is is very helpful too and i you know i think for the most part i'm very fortunate to have them\n[doctor] okay so how how are you feeling on your chemo see you're on a combination of sysplatin and a topicide you had your last dose a few days ago any nausea any fatigue from that\n[patient] i was a little nauseated and tired but i took the zofran that you prescribed and that seemed to help and you know i i got some rest it's it's it's been okay\n[doctor] okay that's good so let me do a quick physical exam on you just gon na check your vitals here so your vitals are normal your pulse ox is okay so everything's good with that so i'm gon na feel your neck on your neck exam i do n't appreciate any cervical lymphadenopathy no subclavicular adenopathy your heart exam regular rate and rhythm no murmur your lung exam so i do notice some crackles in your lungs bilaterally that's just a faint sound we hear when you take a deep breath so that could mean you have some fluid in there and that is to be expected due to your lung cancer diagnosis so i'm gon na look at your skin exam so on your skin exam on your chest i do see some erythema on the anterior aspect of your chest on the left side and that could be due to that radiation sometimes patients do get a radiation burn and it's it'll get better with time especially once you're done with the the radiation treatment and on your extremity it there is no lower extremity edema in your legs so prior to coming to see me you did get a chest x-ray it looks like you do have mild radiation umitis that means you have inflammation of your lungs due to the radiation so let's talk a little bit about my assessment and plan for you so your first diagnosis you know is is the lung cancer so we are gon na continue you on that chemo regimen on that you do have continue on that that current radiation doses i think you're on forty five grade yep you're on that and then when the when the regimen's complete we'll do some more testing and hopefully we can see a resection of that tumor so that has just gotten little smaller and we can go inside and and take it out so for your second diagnosis the radiation pneumonitis i'm gon na prescribe you a low dose steroid prednisone forty milligrams one tablet a day for five days have you been on on a steroids before\n[patient] no i've only ever heard bad things about them they make people jittery and gain weight\n[doctor] i mean and and i for you that's that that's for patients that you know who are on them for a a long period of time right you're only gon na be on it for five days that should n't affect you too bad you might feel when you coming off of it after the five days a few muscle aches other than that you should be fine you should n't really experience much weight gain other other than not not much at all since you're only on on it for five days so but that's gon na help you reduce some of the inflammation in your lungs help you breathe better so we can continue the radiation treatment because we definitely need to do that because our most important thing right now is to try to decrease the size of that tumor okay and then for your third issue the oddy ophagia or it come terms the painful swallowing right you said you had that from the from the radiation so that's from the inflammation of your lungs that's kinda creeping up to your esophagus that's why you're you're feeling that pain so i'm gon na prescribe you a lidocaine squishy and swallow you can do that four times a day and so you'll do it and you'll be able to eat immediately afterwards because it would do some of that pain free from swallowing and that will help you taking liquids and food because we definitely need you well off it and and and hydrated while you're going through this cancer therapy okay\n[patient] okay\n[doctor] alright so do you have any questions for me\n[patient] no\n[doctor] alright so we will get you those medications those prescriptions and then we will see you back in two weeks\n[patient] okay great thank you\n[doctor] thanks",
            "tgt": "CHIEF COMPLAINT\n\nFollow-up of stage III non-small cell lung cancer.\n\nMEDICAL HISTORY\n\nPatient reports recent diagnosis of stage III non-small cell lung cancer.\n\nSOCIAL HISTORY\n\nPatient reports she was previously active taking mile long walks with her doberman. She states her husband is her support system and has been helpful with this new diagnosis. Her daughter has also been helpful.\n\nMEDICATIONS\n\nPatient reports receiving chemotherapy consisting of Cisplatin and etoposide. She is also taking Zofran.\n\nREVIEW OF SYSTEMS\n\nConstitutional: Reports fatigue. Denies fever.\nHENT: Reports odynophagia.\nRespiratory: Reports dyspnea and dry cough.\nGastrointestinal: Reports nausea.\n\nVITALS\n\nVitals are normal including pulse oximetry.\n\n",
            "file": "D2N205-aci-subjective"
        },
        {
            "src": "[doctor] hey joshua good to see you today so take a look at your chart here brenda and i see that you're coming in you you have i think you have a kidney stone so can you tell me what's going on how are you feeling and you're my my patient\n[patient] and i'm your patient yeah\n[doctor] yeah\n[patient] i've been having pains let's just say for the last two weeks\n[doctor] okay\n[patient] it's it starts up in the right flank and radiates down to my groin and you know it it's under control but i have bouts where it kinda gets a little out of control\n[doctor] okay so is it is it a constant pain or does it come and go for you\n[patient] it comes and goes it depends on how much i've been drinking and you know what sort of activities i've been doing but it's still there\n[doctor] alright so have you noticed any pain when you've been urinating\n[patient] not really\n[doctor] okay have you noticed any blood in your urine\n[patient] no blood i did have an episode where the pain radiated to one of my testicles which was kinda weird but but yeah it it sort of calmed down a little bit in that regards\n[doctor] okay have you taken anything for the pain\n[patient] yeah i've been taking some ibuprofen and that kinda like calms it down a little bit but it persists\n[doctor] okay and what would you say like your pain score is out of ten\n[patient] it's probably a four out of ten when it gets a little more out of control for the most part it's probably in the order of one or two out of ten\n[doctor] okay so it is it's it's it's not too bad\n[patient] it's a new ones yeah but i know it's there it does n't go away\n[doctor] okay yeah yeah a lot of my patients you know have that that minor pain so you\n[patient] i'm a horrible active by the way\n[doctor] no yeah that's that's that's totally fine that's totally fine you know i'm just playing the doctor on tv so good good alright so have you had any other symptoms nausea vomiting anything like that\n[patient] no nausea no vomiting i had some i felt like it might have been like chills but no fevers nothing along those lines\n[doctor] okay that's good do you know anybody in your family that has had kidney stones in the past\n[patient] yeah all in my family has had kidney stones in the past\n[doctor] no well they did n't set you up good did they\n[patient] yeah i i i guess i can blame them but but yeah it's been a it's been an issue with the family for as long as i've been aware of\n[doctor] okay alright and i'm reading here it looks like you've had them before as well right\n[patient] i have yeah i passed some by myself and i've had to have surgery a couple of times as well\n[doctor] okay so the ones that you passed by yourself how many days would you say it would take to to pass\n[patient] usually within within a week i manage to to get them out\n[doctor] okay alright so you got anything fun plan for the weekend\n[patient] just getting this pain under control\n[doctor] okay well that that sounds like a good plan we can definitely help you out with that alright so i'm gon na do a quick physical exam on you looks like your blood pressure is a little bit elevated and i think that's probably because you're in pain and that's understandable everything else looks fine so on pressing on your abdomen does that hurt\n[patient] no no no pain\n[doctor] alright so press here in the back and your cva does that back here in\n[patient] yeah it's a little tender yeah it's little tender\n[doctor] okay so on your physical exam there seems to be no tenderness to palpation of your abdomen there is cva tenderness on your your right side here and that's due to that kidney stone so we did get a a ct scan before you came in so it does show that you have a stone measuring point five centimeters in size located on the proximal right ureter so that's that duct that passes from your kidney to your bladder i do n't see any evidence of high flow nephrosis so there is nothing obstructing causing swelling in your your kidney so that's good to hear so i do n't think you hopefully wo n't need any surgery for this one so let's talk a bit little bit about on my assessment and plan so you know you've done this a couple of times you have that kidney stone so what i want you to do is just have you continue to push fluids and hopefully we can pass the stone your pain your pain you're doing okay right now so i'm just gon na continue you on that ibuprofen do you think that's that's working you said for you\n[patient] so far so good but since the weekend is coming around i i i rather have something stronger if it's possible\n[doctor] okay so i can prescribe you some tramadol you know that should help fifty milligrams that should help you out if you do have any of that pain if you get any breakthrough pain from that you can take that ibuprofen it should help you you know with everything and hopefully you can get through that weekend i know you went to the your pcp prior to coming to see me did they give you a strainer\n[patient] they did they did yeah and i've been i've been using that but so far nothing\n[doctor] okay so continue to use the strainer whenever you urinate so hopefully we can catch the stone i'm also gon na order a bmp a urinalysis and urine culture and based on what that shows we can see if we need to put you on any antibiotics i do n't think you have an infection but you know there is that possibility and then i want to see you again in one to two weeks if you are still having symptoms and if you know you still have the stone with you we can talk about further treatment possible lithotripsy you know that's the shockwave treatment i'm pretty sure you've had that prior to\n[patient] yeah yeah yeah yeah that's what i want\n[doctor] what that is okay so do you have any other questions for me\n[patient] no i'm friend\n[doctor] alright so i'll see you again in two weeks i'll have my nurse come in and bring you that prescription for the tramadol and i think we are all good\n[patient] perfect thank you\n[doctor] alright great",
            "tgt": "CHIEF COMPLAINT\n\nRight flank pain.\n\nHISTORY OF PRESENT ILLNESS\n\nJoshua Reyes is a pleasant 18-year-old male who presents to the clinic today for evaluation of right flank pain.\n\nFor the last 2 weeks, the patient has been experiencing pain that starts in his right flank and radiates down into his groin. He also recalls one episode in which the pain radiated down into one of his testicles. Although his pain is intermittent depending on his fluid intake and activity level, he rates the pain as a 4/10 at its worst. Otherwise, the pain is a 1-2/10. He denies any pain with urination, hematuria, nausea, vomiting, or fevers, but recalls possibly having chills at one point. Over-the-counter ibuprofen provides partial relief of his pain. Of note, the patient has a personal history of kidney stones, some which were passed independently, usually within a week, while others required surgical intervention or lithotripsy. He also has several family members with a histories of kidney stones.\n\nMEDICAL HISTORY\n\nThe patient has a personal history of kidney stones treated conservatively, surgically, and with lithotripsy.\n\nFAMILY HISTORY\n\nThe patient has a significant family history of kidney stones.\n\nREVIEW OF SYSTEMS\n\nConstitutional: Reports chills. Denies fever\nGastrointestinal: Denies nausea or vomiting.\nGenitourinary: Reports right flank pain. Denies dysuria or hematuria.\n\nVITALS\n\nBlood pressure: Slightly elevated\n\n",
            "file": "D2N206-aci-subjective"
        },
        {
            "src": "[doctor] hi frank how are you i heard the medical assistant told me that you're having some shortness of breath\n[patient] i am i am i am okay i am not great\n[doctor] you are okay you are not great okay well how long have you been having some shortness of breath\n[patient] it's been about a week\n[doctor] it's been about a week okay now have you ever experienced these symptoms before\n[patient] yeah this happened about six months ago and i came in and they changed my lasix dose and i seemed to get better\n[doctor] okay alright so let's talk a little bit about that now i know that you have a history of coronary disease you know you had had a heart attack back in twenty eighteen we put that stent in your right coronary artery i know that the pumping function of your heart was a little low you know that what we call that ejection fraction was about thirty five percent have you been watching your salt intake\n[patient] yeah but you know it's been the holidays the last couple of weeks and you know i we've had a bunch of family get togethers and i i do n't think my diet has been everything it should have been\n[doctor] okay alright now have you noticed any swelling in your legs\n[patient] yes definitely\n[doctor] okay and are you taking the lasix now i know that we had increased it to about forty milligrams once a day are you taking it\n[patient] yeah i take it everyday\n[doctor] you take it everyday okay do you notice that you're urinating any less recently\n[patient] no it seems about the same\n[doctor] okay\n[patient] you know i i urinate at night you know at least once sometimes twice a night that's a little more it happened before\n[doctor] okay alright and do you feel short of breath at rest or is it mostly when you're just walking around\n[patient] walking around stairs in particular walking quickly\n[doctor] okay and how about when you're sleeping at night are you able to lay flat or do you have to sit up a little bit\n[patient] i gone from one pillow to two pillows\n[doctor] okay alright and do you ever wake up really short of breath does it ever wake you up\n[patient] it did that six months ago it has not done that so far this time\n[doctor] okay alright now tell me a little bit about when was the last time you saw your nephrologist\n[patient] about about a month ago\n[doctor] okay because as you know you know we we do talk about the fact that you have some kidney dysfunction about stage three so it's gon na be important for you to continue to follow up with your kidney doctor now are you how are you doing staying away from things like motrin and advil i know that you had had some knee pain in the past and you know how are you doing staying away from those medications\n[patient] yeah everybody has told me not to use it so i do n't except when i have pretty bad pain i had an episode about a week ago some pain in my feet actually and i i had to take motrin to get rid of it so yeah i took motrin for a while and i stopped as quickly as i could\n[doctor] okay now are you able to take tylenol do you not feel any relief from tylenol when you take it\n[patient] yeah tylenol's lovely it just is not very effective\n[doctor] okay alright yeah because i think we really want you to stay away from that those anti-inflammatories because that can make your kidney function worse and obviously you know we do n't wan na see you go on dialysis or anything like that so we'll have\n[patient] mean neither\n[doctor] right so we'll have to you know really work on that now tell me a little bit about are you watching the potassium and stuff in your diet\n[patient] nobody's really talked to me about that so\n[doctor] okay yeah so you want\n[patient] i did n't know what high potassium foods are\n[doctor] okay i'm sorry i've never talked to you about that in the past i that's my fault so yeah so you wan na make sure you stay away from things like bananas oranges you know potatoes have lots of potassium that type of thing and so you know because with your kidney function you know that can cause your potassium levels to go up because you do n't get rid of the potassium as you should you know\n[patient] something to eat\n[doctor] what's that\n[patient] is there anything left is there anything left over that i ca n't eat\n[doctor] so yeah you can eat you know how about this how about we give you a a referral to a dietitian and they can help you with that\n[patient] sounds good\n[doctor] now are you watching the nba playoff should i or should i not bring that up i is that a sensitive subject i mean i'm a self expand and and we did sweep the nuts so\n[patient] yeah well i mean that's fan and i could n't sleep last night but you know\n[doctor] okay well maybe we should n't talk about\n[patient] kinda used to it you know where they where the favorite to win and then like that\n[doctor] yeah i know i i i will say i think jason tatum and jaylen brown paid played phenomenally so i do think that they help with the cell fix over the edge so but that's all we'll talk about that what's that\n[patient] i said yeah too bad they did\n[doctor] yeah alright well i wan na just go ahead and do a quick physical exam on you okay so you know looking at your vital signs here in the office you know your your blood pressure is about one thirty five over eighty so it's it's not too bad and maybe like to see it a little bit lower i'm just gon na be calling out my physical exam findings and i'm gon na let you know what they mean when i'm done okay so on your neck exam i appreciate some jugular venous distention up to about nine centimeters there are no carotid bruits on your lung exam i do appreciate bibasilar crackles with occasional rhonchi that clears when you cough on your heart exam i do appreciate a three out of six systolic ejection murmur heard at the left base and on your lower extremity exam i do appreciate one to two plus pitting edema bilaterally so frank what does that mean all that means is that you have findings on you that suggest that you're retaining fluid now we'll have to talk a little bit about how we're going to address that okay so i wan na just go over a little bit about my assessment and my plan for you okay so for the for your first problem of your shortness of breath i do believe you're having a an acute heart failure exacerbation so i wan na go ahead and increase your lasix from forty milligrams a day to eighty milligrams a day and i want you to call me in two days and let me know how your weight has been with increasing the diuretic now if you start to have worsening shortness of breath before that i want you to yeah call me we may have to admit you to the hospital for some intravenous diuretics okay i also wan na go ahead and just obtain\n[patient] salt on lasix all at once am i take it all at once or do i divide it up\n[doctor] how about you start taking the the increased dose in the morning and then we'll see how you do and if necessary i'll have to add a second dose in the afternoon that you can take around four o'clock in the afternoon i do n't want you to take it too late at night because then you will be going to the bathroom all night okay\n[patient] that sounds correct\n[doctor] so i also want to go ahead and order a chest x-ray just to make sure that we are not missing anything else okay for your second problem of your coronary artery disease you know it sounds like you're doing well except for this heart failure exacerbation so i wan na go ahead and order another echocardiogram to check out that heart murmur that i hear on your physical exam just to make sure that that's not getting any worse and to make sure that the pumping function of your heart is stable and i'm gon na go ahead and call doctor white and let them know that i want you to be seen by them okay okay and then for your third problem of your stage three chronic kidney disease i want you to go ahead and try to you know do n't please do n't take anymore motrin or advil i do want you to try to stick with tylenol and if you're still having a significant problem with with some pain i want you to call me and we'll talk about some alternative medications that we can use or therapies okay i will also want to go ahead and order a complete metabolic panel just to make sure that your kidney function is stable does that sound okay\n[patient] that sounds good do you have any idea what was going on with my foot pain before\n[doctor] well how long have you been having it how long you've been having that foot pain\n[patient] that's why i took the motrin it lasted you know four five days slowly went away\n[doctor] it was in both of your feet\n[patient] one\n[doctor] one and where in your foot was was it\n[patient] just in front of the big toe\n[doctor] just in front of the big toe okay have you ever had a history of gout\n[patient] nobody has told me about that\n[doctor] okay alright well it sounds like it could've been gout you know with your chronic kidneys chronic kidney disease it it's a possibility so for this possible gout flare for your fourth problem of your possible gout flare let's go ahead i wan na just go ahead and order a uric acid just to see and it's something that we can talk about there is an alternative medication that you can take with your kidney function that that would n't hurt it that would n't injure it any further and i think it would work just the same\n[patient] okay\n[doctor] okay any other questions\n[patient] just as long as you think i'm gon na get better\n[doctor] i think you're gon na get better yes i think we're gon na you know i really want you to watch your salt intake and i'm gon na go ahead and order that dietary dietitian referral so that you can get your diet under control but you really have to watch your salt intake i think that that's kind of what this heart failure exacerbation is about maybe a little dietary indiscretion\n[patient] okay\n[doctor] okay anything else\n[patient] yeah no that's good thank you\n[doctor] okay you're welcome bye",
            "tgt": "CHIEF COMPLAINT\n\nShortness of breath.\n\nMEDICAL HISTORY\n\nPatient reports a history of coronary disease, acute myocardial infarction in 2018, stage 3 chronic kidney disease, and knee pain. He denies a history of gout.\n\nSURGICAL HISTORY\n\nPatient reports placement of a coronary artery stent in the right coronary artery in 2018.\n\nSOCIAL HISTORY\n\nPatient reports that he is a fan of basketball.\n\nMEDICATIONS\n\nPatient reports taking Lasix 40 mg once a day.\n\nREVIEW OF SYSTEMS\n\nRespiratory: Reports shortness of breath.\nGenitourinary: Denies changes in urination.\nMusculoskeletal: Reports swelling in bilateral lower extremities and great toe pain.\n\nVITALS\n\nBlood Pressure: 135/80 mmHg.\n\n",
            "file": "D2N207-aci-subjective"
        }
    ]
}