text
stringlengths 6
3.62k
| intents
listlengths 1
9
| sections
listlengths 1
4
| __index_level_0__
int64 0
3.89k
|
|---|---|---|---|
hey dragon , show me the blood pressure . okay , so here in the office today it is a little bit elevated , okay ? so your blood pressure is a little bit high . so the results , um , do show that . um , hey dragon , show me the labs . okay , so good news is is your- your labs are all essentially normal , so the results of your labs are essentially normal , okay ? so ... um , my assessment is that your- ... you do have hypertension still . um , and i think we need to increase your blood pressure medicine a little bit , okay ? so i'm gon na increase your lisinopril to 10 milligrams a day , just once a day , um , but i'm gon na increase that a little bit , okay ? and then want you to check it and i'm gon na have you come back in a month and we'll see how you're doing with regards to that , okay ?
|
[
"Discussion",
"Follow-up",
"Medication",
"Lab Examination",
"Reassessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,800 |
and then your third problem was your carpal tunnel . that seems to be doing well . if you notice any tingling or any changes or you get some of those symptoms back , just let me know . okay ?
|
[
"Discussion",
"Follow-up",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,801 |
all right . so , we'll try the spironolactone and schedule a followup in two weeks to check your blood pressure and electrolytes . uh , if the new med does n't work , the next up is going to be the resistant hypertension clinic .
|
[
"Discussion",
"Follow-up",
"Referral",
"Medication"
] |
[
"Plan"
] | 3,802 |
doctor: mr. roberts presents with resistant hypertension . he's on three meds and maximum dose . i have added spironolactone to his regiment . we will need to monitor his potassium and sodium . he will have a metabolic panel and blood pressure check in two weeks . uh , next medication would be carvedilol , uh , which i try to avoid giving , it's potential for erectile dysfunction . i have talked to the patient about that , and the potential side effects of spironolactone , including the gynecomastia and electrolyte disturbances . if he is not controlled on spironolactone , the next step would be sending him to resistant hypertension clinic .
|
[
"Acute Assessment",
"Medication",
"Diagnostic Testing",
"Follow-up",
"Discussion"
] |
[
"Assessment",
"Plan"
] | 3,803 |
doctor: you're welcome , and have a good rest of your day . so review of symptoms is positive for diarrhea , nausea , and abdominal pain . assessment and plan . brittany edwards is a pleasant female with ibs and functional abdominal pain , aggravated by high stress , poor eating habits , and poor sleeping habits . i've encouraged dietary and lifestyle modifications , as well as starting a neuromodulator such as elavil 25 milligrams at bedtime for ibs . she can use bentyl 20 milligrams as needed 30 to 45 minutes prior to eating out at a restaurant . she can also use zofran if needed . however , i have encouraged her to reduce greasy and fatty foods and alcohol consumption . i have asked her to follow up in one month by emailing over mychart regarding any side effects and issues , or issues with elavil or if adjustments are needed .
|
[
"Vegetative History",
"Personal History",
"Medication",
"Other Treatments",
"Reassessment",
"Follow-up"
] |
[
"Subjective",
"Assessment",
"Plan"
] | 3,804 |
doctor: all righty , so ros is constitutional significant for impaired ability to carry out daily functions . negative for fever or unintentional weight loss . gu is significant for urinary incontinence and wearing a diaper . negative for genital sores , decreased or painful output . neurological significant for continued walking impairment and cognitive impairment . negative for headaches , recent falls , or hallucinations . psychiatric is negative for depression , excessive worrying , or mood swings . let's go ahead and use the short pe . vitals , let's see , blood pressure is 124/80 , heart rate 64 , respirations 18 , weight 174 pounds , and pain zero out of 10 . mr . watson is a pleasant and cooperative man who's able to converse easily through , um , though his daughter does add some details . the shunt sight was clean , dry , and intact with a confirmed setting of two . um he was tested um for recent and remote memory , attention span , and concentration in fund of knowledge . he scored a 26 out of 30 on the mmse when tested with spelling and 25 out of 30 when tested with calculations . of note , he was able to get two of the three memory words with cuing , and the third with multiple choice . this was a slight improvement over his initial score of 23 out of 30 with calculations and 24 out of 30 with spelling . and at the time he was unable um in the previous test , excuse me , he was unable to remember any memory words with cuing without and only one with multiple choice . gait testing using the tinetti assessment tool . he was tested without an assistive device and received a gait score of six to eight out of 12 and a balance score of 12 out of 16 for a total score of 18 to 20 out of 28 . this is slightly improved from his initial score of 15 to 17 out of 28 . cranial nerves , pupils are equal . eoms are intact . face symmetric . no disarchria . motor normal for bulk and strength . coordination slow from no- finger to nose . of note , the ct scan from the head of 10/15/2020 shows a frontal horn span at the level of foramen of monro of 4.6 centimeters with a third ventricular contour that is flat with a span of 10 millimeters . by my reading there is a tiny amount of blood in the right front region with a tiny subdermal collection . this was not noticed or noted by the radiologist who stated any extra axial fluid collections . there is also substantial small vessel ischemic change . diagnosis adult hydrocephalus , gait impairment , urinary incontinence and urgency , and cognitive impairment .
|
[
"Personal History",
"Vegetative History",
"Physical Examination",
"Radiology Examination",
"Reassessment",
"Lab Examination"
] |
[
"Subjective",
"Objective",
"Assessment"
] | 3,805 |
amanda taylor , birth date october 31st 1949 . patient is a 72 year old woman who comes for followup for hypertension . her history includes significant alcohol use disorder and mi- mild hypercholesterolemia . at last visit on april 16th her blood pressure was 130 over 90 . after presenting at 150 over 100 she was prescribed hydrochlorothiazide 12.5 milligrams by mouth once daily , and lisinopril 20 milligrams by mouth once daily . cmp and cbc were essentially unremarkable . hi miss taylor , how are you today ?
|
[
"Greetings",
"Therapeutic History",
"Drug History"
] |
[
"Subjective"
] | 3,806 |
all right , well everything looks good . you can go ahead and sit up miss taylor . all right , so the good news is everything is looking okay . i think we both agree if you were able to stop drinking your blood pressure would cease to be an issue for you .
|
[
"Discussion",
"Other Treatments",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,807 |
doctor: miss taylor is drinking alcohol four to five days per week to excess . no tobacco , no substance abuse , skin is moist , good trigger . on exam she is alert , pleasant , in no acute distress . she is not diabetic , there is no tremor , no cva tenderness , chest clear to percussion and auscultation , unlabored breathing , cardiac rhythm regular , no murmur , no gallop , jvp flat , with a head at 90 degrees . she does not appear anxious , agitated or depressed . my impression , alcohol use disorder . she would like to start naltrexone which we have previously discussed . she will take the injectable form and start on may 17th . we reviewed side effects and risks . the potential benefit of alcohol cessation would be highly beneficial to her for many reasons . hypertension , she is taking lisinopril 10 milligrams daily and hydrochlorothiazide 12.5 milligrams daily . quite possibly her blood pressure will improve completely with cessation of alcohol . her target bp is 130 to 140 over 70 to 80 . i will see her back week of june 14th , which is likely around the time of her second naltrexone injection . i recommend upgrading influenza vaccination and shingrix . number two , she did defer this .
|
[
"Drug History",
"Personal History",
"Physical Examination",
"Acute Assessment",
"Reassessment",
"Medication",
"Follow-up",
"Discussion"
] |
[
"Subjective",
"Objective",
"Assessment",
"Plan"
] | 3,808 |
you'll hear me talk through your exam , so that i can get it all documented . uh- ? use my general physical exam template . pelvic exam demonstrates no external lesions . normal labia majora and labia minora . normal physiological discharge , with normal color and smell . ms. ross , i'm going to touch you , now . you'll feel my fingers , and the speculum in your vagina . you'll feel some pressure , now . cervix is normal . vaginal wall is normal . no cervical motion tenderness and no adnexal tenderness or masses noted . swabs were done for std testing . okay , ms. ross . everything looks good from a visual standpoint . i'm going to send off std testing for , uh , gonorrhea , chlamydia , trichomoniasis , and i'll have you give some blood for syphilis , hiv and hepatitis c. some of these tests will take longer than others . we will call you , if we see anything , but if you have n't heard anything , you can call us in three days for results .
|
[
"Physical Examination",
"Discussion",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,809 |
okay . so i think we'll set that up for you now . we'll also do an x-ray on that knee . i can send you for a physical therapy , and if nothing is helping , then we really might need to get a surgery consult to see what we can do with that knee .
|
[
"Referral",
"Diagnostic Testing",
"Other Treatments"
] |
[
"Plan"
] | 3,810 |
yep . once we're done talking here , and as far as the edema in your legs , uh , we'll take an x-ray to look for the cause , but there is a lot you can do as well . the compression socks are a good start . um , and also , do you eat a lot of salt ?
|
[
"Discussion",
"Medication",
"Other Treatments",
"Diagnostic Testing"
] |
[
"Plan"
] | 3,811 |
okay that's that's no problem so you are positive for murphy's signs but i do n't appreciate any peritoneal signs so let's talk a little bit about your results that i reviewed before you came in today so your abdominal ultrasound shows multiple gallstones present in the gallbladder and i do appreciate some mild thickening now the common bile duct size is within normal limits at four . one millimeters now let's talk a little bit about my assessment and plan for you okay i do believe you have some mild cholecystitis with gallstones i do n't appreciate any frank obstruction but it looks like your gallbladder is inflamed and it looks like that's happened maybe over the last few weeks since you've been having those symptoms now since you have n't had any improvement with dietary modifications i am going to make the recommendation that we do remove your gallbladder and i would like to perform a laparoscopic cholecystectomy now what that means is i'll make a few small incisions and insert a scope with some of those instruments that's gon na remove that gallbladder through one of those little bitty incisions now the surgery is gon na take about an hour to an hour and a half and you'll probably spend the night in the hospital because we just wan na monitor you post procedure to make sure everything is okay you're still gon na wan na avoid those high fat foods after surgery and eat foods that are gon na be high in fiber now do you have any questions about what our assessment and plan is for for this
|
[
"Physical Examination",
"Discussion",
"Other Treatments",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,812 |
okay alright well looking at your vital signs here in the office you do n't have any fever your blood pressure looks quite good it's about one twenty two over seventy six your heart rate is appropriate at eighty two beats per minute and your oxygenation is ninety five percent on room air on your cervical spine exam there is no tenderness to palpation of the cervical spine there is full range of motion on head exam there does not appear to be any trauma there is no ecchymosis or bruising on the right shoulder exam on your musculoskeletal exam there is pain to palpation of the posterior shoulder at the acromioclavicular joint there is decreased abduction and adduction to about ninety degrees only there is there is a he has pain with supination and pronation of the right arm and there is a palpable radial radial artery pulse okay so what does that mean that just means that you have some you know evidence of the injury there and we'll we're gon na talk about that so i had the nurse do a shoulder x-ray on you before i came in the room and the results of your right shoulder x-ray showed that you have an acute acromioclavicular joint fracture so you just have a a a small fracture of the acromion i do n't think that it it's gon na be anything that we need to do surgery for so let's just talk a little bit about my assessment and plan so for your right shoulder injury for your acute acromioclavicular joint fracture i wan na go ahead and just put you in a sling for now i wan na go ahead and prescribe meloxicam fifteen milligrams once a day i wan na go ahead and just order a cat scan of your right shoulder just to kinda get a better look of how the joint looks and we're gon na go ahead and refer you to physical therapy to strengthen your shoulder in hopes of avoiding surgery in the future how does that sound
|
[
"Physical Examination",
"Acute Assessment",
"Other Treatments",
"Referral",
"Radiology Examination",
"Medication"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,813 |
okay alright well let me let me examine you here in a second and we'll think about you know what we need to do especially with your coughing and your shortness of breath okay so nita i'm i'm examining you now let's pretend i did my exam i'm just gon na verbalize some of my findings so i can put it into my chart okay and i'll explain what those things mean so on my exam you've got no jvd there is no swelling in your neck no carotid bruits your lung exam you've got some rails and some rhonchi on on more on the right side i do n't hear any wheezing right now there is some diminished breath sounds in the right side as well on your heart exam you've got two over successolic ejection murmur you've had that in the past that's unchanged from before the rest regular rate and rhythm otherwise your belly exam is nice and soft on your extremity exam you've got one plus nonpitting edema on both of your lower extremities on your on your ankles no calf tenderness no negative homan sign so what does all this mean so basically you've got you know you've got some sort of infection or something going on in your lungs that i can hear right now the rest of your exam is pretty much stable it's unchanged from before so let's talk about what we what we should do about this so for the for the first problem with the shortness of breath the first thing i wan na do is go ahead and get a chest x-ray for you okay you've been coughing up blood i also wan na send you to the emergency department to get some blood testing done i'm worried about a blood clot or something else going on so i wan na get a cat scan of your chest as well so i'm gon na go ahead and refer you to the emergency department i'll call them and and have you head over that way they can get a chest x-ray and a cat scan and some blood work as well and then we'll evaluate why you're having the shortness of breath and why you're coughing up this blood okay and then depending on what they find you may need you know it could be as simple as a pneumonia or it could be something a little bit more serious we may have to get you know start you know depending on what you find we will get the right treatment started any questions about that or can you drive to the emergency department from here or is that okay
|
[
"Physical Examination",
"Discussion",
"Diagnostic Testing",
"Reassessment",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,814 |
alright for the second problem for the diabetes since your blood sugar is running a little bit high once you get over this i'm blood sugars running a little bit high once we get you over this hump of the shortness of breath and get this diagnosed i'm gon na go ahead and order another hemoglobin a1c today we will probably increase your dose of metformin from five hundred twice a day to seven fifty twice a day so why do n't we do that and then why do n't we have we'+C20:C23ll have the hemoglobin a1c back and then we can once you get over this illness that you're undergoing we'll we'll we'll discuss that more i'll have you come back in about three weeks to just discuss your diabetes and what our treatment plan will be for that okay
|
[
"Discussion",
"Follow-up",
"Medication",
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,815 |
a hundred percent yeah you know like i one of the things that i struggle with is like are eggs good for you or bad for you you know like with cholesterol i feel like it changes every other year or something like that so you're right there may be some pieces of information that we do need to update and and you know over a fresh of course would n't hurt but if you do n't mind i'm gon na go ahead and start my physical exam i'm gon na call out my findings and just go let me know if you have any questions or if anything sounds anything that you you want me to expand on further but this is just for the recording sake so we can get everything documented okay
|
[
"Discussion",
"Physical Examination",
"Other Treatments"
] |
[
"Objective",
"Plan"
] | 3,816 |
absolutely that's awesome and so it'll be like a a movie like coming soon to a shelf near you that's great for your second problem right we have this longstanding diabetes i want to increase your metformin to a thousand milligrams twice a day i know that you're saying you're having a hard time keeping up with that so i want you to do a good job of like checking and recording your blood sugars every day i do need you to follow up with me in a couple weeks i also wan na order something called an a1c since you are having a hard time with like the blood like the blood sugars everyday an a1c will give me a more accurate picture of like a longer period of time and then we might need to evaluate like what are what other options that we have if your sugars if we ca n't get them a bit more under control i do want you to follow up with me in a couple of weeks about the about your diabetes and for your third problem of hypertension we're just gon na continue you on your lisinopril at ten milligrams that's it seems to be doing it's job i'm really i'm really glad about that and it's probably due to the walking that you're doing i forgot to mention for your diabetes we are gon na i'm gon na recommend a a referral to diabetic counseling that way you can get like a bit more information on like the steps that you can take to help you with that
|
[
"Follow-up",
"Referral",
"Medication",
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,817 |
your x-ray honestly looks great in that i do n't see any kind of fracture or bony abnormality so that's what makes me think that this is like a tendon related thing right so in reviewing your x-ray like it it does support the the the assessment and plan that i have given you i
|
[
"Discussion",
"Radiology Examination"
] |
[
"Objective",
"Plan"
] | 3,818 |
okay okay so lem me talk a little bit about my impression and plan so for that low back pain i believe you have a musculoskeletal low back strain i'm going to order a low back x-ray so we'll order that and get that done as an outpatient i do n't expect to see anything significant but it's gon na tell me how those joint spaces look and if you know if we're dealing with any disk issue but that will be the start of it and i'm also gon na order some physical therapy two for two reasons to help with a little bit with the pain but also strengthen some of the muscles there in the back so those are the two things that we are gon na do now i want you to take take four hundred milligrams of ibuprofen you can take that occasionally with some tylenol when the pain gets more severe up to about three times a day i'm gon na also give you a prescription for some flexeril that's a muscle relaxant and i want you to take one of those once a day every evening but be careful if you're doing any strenuous or hazardous activities such as driving after you take those now for your diabetes my impression is that your diabetes is is under control i noticed that we do n't have n't had a a1c for almost five months so i'm also gon na order an a1c so we can find out where we are with that continue with your diet and exercise we know that's really important and then continue with your metformin i'm not gon na make any changes today but we'll go ahead and look at that once i get that results of that a1c do you have any questions for me
|
[
"Reassessment",
"Discussion",
"Diagnostic Testing",
"Acute Assessment",
"Other Treatments",
"Referral",
"Medication"
] |
[
"Assessment",
"Plan"
] | 3,819 |
okay the patient has a positive varus test there is full range of motion there is a negative lachman sign the patient does on cardiovascular exam the patient does have a palpable dorsalis pedis and posterior tibialis pulse okay well let's just i wan na talk a little bit about i had the nurse do an x-ray on you and i looked at the results of your knee x-ray and it does n't show any acute fracture or bony abnormality which is not surprising based on your injury so let's just talk a little bit about you know my assessment and my plan for you so i think you do have a a lateral a lateral collateral ligament strain based on your exam findings and this this type of injury essentially can be healed by itself you know i do n't think we're gon na need to refer you to surgery or anything like that i want you to go ahead and i'm gon na prescribe meloxicam fifteen milligrams once a day i do wan na go ahead and refer you to physical therapy because if we strengthen up those muscles and areas around that injury then that will make your knee stronger it help prevent future injuries are you able to ice it at all during the day now you said you working you work in sales so you said you're home
|
[
"Physical Examination",
"Acute Assessment",
"Other Socials",
"Referral",
"Radiology Examination",
"Medication"
] |
[
"Subjective",
"Objective",
"Assessment",
"Plan"
] | 3,820 |
yeah okay okay great not great so yeah go ahead and sit up for me so dennis my diagnosis is achilles tendinitis and it's really from overuse when we see this frequently when somebody starts to you know get in and train aggressively for an event i'm unfortunately i'm gon na have to ask you to stop training for a a week or two i know that's concerning but i really want this to heal before we move into that next phase i did n't ask you about medication but i'm assuming whatever you were doing was n't working significantly so what i'd like you to do is take some ibuprofen or advil that's the same medication and i want you to take three tablets every six hours and that's really an anti-inflammatory see if we can eliminate some of that tendinitis type pain that you're getting that inflammation around that achilles tendon i'm gon na also order a couple physical therapy visits and the reason for that is i'd like you to get some strength and stretching understanding i think it's important for you especially here at the beginning is to get some of that real stretching knowledge in and learn how to stretch those muscles before you start these activities and they are gon na help strengthen your your lower extremities also and i want you to come back to me within you know a week to ten days following your first couple physical therapy appointments so i can monitor how you're doing i see no reason for an x-ray at this point but if this continues we're gon na you know if you're still having pain ten days in significant pain without change modification of your activity then we may have to look at more aggressive treatment plans how does that sound for you
|
[
"Discussion",
"Medication",
"Referral",
"Acute Assessment"
] |
[
"Assessment",
"Plan"
] | 3,821 |
okay so we did a x-ray of your right foot before you came in and it showed no evidence of osteomyelitis that means that there is no bone infection which is really good so let me just talk a little about my assessment and plan of your your foot so you do have that diabetic foot ulcer so what i'm gon na do is i'm going to order a abi or ankle brachial index and that's just to determine your blood supply just to see if we can actually heal that wound i know it's been there for about a year which is a pretty long time and so we just need to see if we can if you do have that blood flow just in case we need to to make other goals for that foot just to depend upon that i'm also gon na do a debridement here have you had that done before of the
|
[
"Discussion",
"Radiology Examination",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,822 |
alright so your vital signs look good you know so i'm glad that it looks like you're tolerating your medication pretty well on your neck exam i do n't appreciate any jugular venous distention so and then on top of that i'm not i do n't appreciate any carotid bruits so i'm not feeling anything like too concerning on your heart exam though there is a three over six systolic ejection murmur heard at the that i'm hearing at the left base that's not like a huge deal especially considering like what you've been through already in terms of the hospital but it is something that i wan na know in your chart when i listen to you your lungs your lungs are clear over here with your extremities i do notice you know some lower lower edema swelling sorry some lower swelling edema lower limb edema and it it is pitting one plus on your right radial artery the cath site is clean dry and intact without hematoma and i also your right radial artery pulses are palpable so i did review the results of your ekg and they show a normal sinus rhythm and a good r wave progression and a a evolutionary changes that are anticipated after a stemi one of the reasons though that we had you come in is that we noticed on your echo there is a reduced ejection fraction of thirty five percent we are a little bit concerned about that so let's talk about my assessment and plan for you your primary and like first diagnosis is gon na be coronary artery disease right you already have a history of that but you know we're gon na do some things to make we're gon na continue to evaluate that over time i want you to continue your aspirin eighty one milligrams daily and your brilinta ninety milligrams twice daily i wan na continue you on a high dose statin called lipitor and you're gon na be taking that eighty milligrams a day and we're gon na continue you on your toprol and that's gon na be fifty milligrams daily i am gon na refer you to cardiac rehab so we can get you some education and give you some confidence to get back to exercising regularly i know it was kinda scary to have such an episode but i promise like most of the patients i have love cardiac rehab and i think you'll do pretty well for your second diagnosis we have newly you have newly reduced left ventricular dysfunction and moderate mitral regurgitation what i think is like what that means is that you're you're pumping like the way that your heart is pumping is a bit concerning but i think like given your history that it will improve over time they got you into the cath lab pretty quickly so i think that the muscle is just kinda like stunned like surprised and since you're compliant with your meds i think you will recover we are gon na continue you on your lisinopril twenty milligrams daily however considering that you are retaining fluid i think that your third diagnosis is like we are crossing into acute heart failure i'm gon na prescribe something called a diuretic it's called lasix and i do want to we need to take that forty milligrams once a day i wan na add aldactone twelve . five milligrams daily and i need you to get labs finally we will repeat another echo in about two months last but not least there is the hypertension your blood pressure seems fine i think with the aldactone that you'll tolerate that pretty well but we do want to maybe get you into some nutrition counseling to consider like what other diet options might be available to you maybe suggestions of things that you have n't thought about like cutting out meat especially any kind of preserved meat like pepperoni but maybe finding you some alternatives how does that sound
|
[
"Physical Examination",
"Discussion",
"Referral",
"Medication",
"Other Treatments",
"Radiology Examination",
"Diagnostic Testing",
"Reassessment",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,823 |
no i mean every so often the stents can become narrowed again but you know that's why you're seeing me your cardiologist so that i can follow you for that now if you start to have symptoms again of any chest pain like you had before or any shortness of breath when you start to exert yourself i want you to tell me and we might have to go ahead and send you for further testing to make sure that those stents are okay but typically if you continue to take the medication watch your diet that type of thing your stents will will stay open for a long time
|
[
"Referral",
"Medication",
"Diagnostic Testing"
] |
[
"Plan"
] | 3,824 |
okay that's okay yeah i certainly can help you with that now managing your diabetes is also going to play an important role in your coronary artery disease which it sounds like you already know that which is really good so i will put in another referral for diabetic education for you how are you doing watching your sweets i know that you know you do have an afinity for those chocolate chip cookies
|
[
"Referral",
"Vegetative History"
] |
[
"Subjective",
"Plan"
] | 3,825 |
okay yeah that's really high so we want it to be about six so you you do have some work to do with your diet
|
[
"Other Treatments",
"Lab Examination"
] |
[
"Objective",
"Plan"
] | 3,826 |
so let's just go over a little bit about my assessment and and plan for you going forward so for your first problem of your coronary artery disease i think you're doing really well i wan na go ahead and refer you for cardiac rehab just so that you can be more active and have some confidence in in exercising again okay and i am gon na go ahead and refill your metoprolol your crestor forty milligrams once a day as well as the aspirin okay i do n't think we need to proceed with a a stress test or anything at this time but you know to let me know if you have any symptoms okay
|
[
"Referral",
"Medication",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,827 |
and then for your third problem of your diabetes i am gon na go ahead and order another hemoglobin a1c and i'm gon na put that referral in for the dietitian to give you some dietary education and i'm gon na go ahead and talk with your primary care physician about your your insulin regimen okay
|
[
"Referral",
"Medication",
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,828 |
yeah well better to stay on the flovent daily and then just use the albuterol if you need it but if you stay on the flovent daily it will decrease the frequency of those attacks so yeah alright well let's go ahead and examine you okay so on your physical exam it's pretty normal for the most part unremarkable but i i'll i'll say on your on your heart exam you do still have a grade three out of six systolic ejection murmur that's unchanged from your prior exam and and i'm not worried about that we're kinda watching that but it just means i hear some heart sounds when your valves are moving and otherwise normal heart exam for your abdominal exam you do have mild tenderness in the epigastrium of your abdomen your abdomen's otherwise soft there's no tenderness in the right lower quadrant whatsoever and there is no significant tenderness in the right upper quadrant so i think you know that's right where your stomach is in the upper abdomen so i think that you know that may be you may be right this could be some gastritis so so then otherwise on your exam on your lung exam you do have some mild end expiratory wheezes very faint and otherwise normal lung exam with excellent air movement and otherwise pretty normal physical exam so let's talk about your my assessment and your plan here so first of all for the first problem of the abdominal pain i do think that you have acute gastritis and i think this is probably related to the caffeine intake and i i know that you've had a a moderately heavy history of alcohol use too so i want you to cut back on the alcohol as well you know keep that down to a dull roller like maybe keep that less than two or three drinks a week would be great and then also cut back on the caffeine and that should help and i'm going to write you a prescription for zantac as well as we need and so i'll write you a prescription you can take that twice a day that should help with the acid in your stomach and the pain and then i'm going to check a urinalysis a urine pregnancy test a cbc a comprehensive metabolic panel as well and we'll see what those results show just to be sure it's nothing else going on and then for your second problem of diabetes type two let's continue you on the metformin but i wan na adjust the dose slightly i'm gon na increase the morning dose to one thousand milligrams and the evening dose we can keep at five hundred so we'll go metformin one thousand milligrams in the morning and five hundred milligrams in the evening please continue to check your blood sugars let me know what they are when you come back you know we just keep track of those and then we'll see you back in four weeks by the way i wan na have you follow up with me in four weeks and for your third problem of asthma let's continue you on the flovent that seems to be doing pretty well continue to take that daily and then also albuterol as needed so how does that sound for a plan any other questions comments suggestions
|
[
"Physical Examination",
"Discussion",
"Follow-up",
"Medication",
"Other Treatments",
"Diagnostic Testing",
"Reassessment",
"Acute Assessment",
"Drug History"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,829 |
okay yeah that's that's really good yeah so i that's that's pretty good so what we're gon na do we're gon na get a a1c just to see you know that range and it's possibility we can we can you know lower that metformin dosage but we will do that after your visit then we will take a look at that so lem me go ahead and will do that quick exam of your elbow but first i want to make sure you're not having any chest pain or anything like that
|
[
"Medication",
"Diagnostic Testing",
"Vegetative History"
] |
[
"Subjective",
"Plan"
] | 3,830 |
alright so your right elbow exam shows you have pain to palpation of the olecranon area of the posterior elbow you do have mild pain with flexion and extension but you do have also normal range of motion at that elbow so we we did do an x-ray before you came in and luckily nothing's broken no fracture no bony abnormality so it's a normal x-ray which is really good so let me just talk to you a little bit about my assessment and plan for you so you have a elbow contusion i believe your son did hit you with the lacrosse stick and it caused that that pain i see some swelling little inflammation there as well you have a little bit of a bruise i think that's that's what happened so for that i know you're having some pain i'm gon na prescribe you eight hundred milligrams of ibuprofen you can take that twice a day and that should help with some of that swelling and pain i also want you to ice it three times a day for twenty minutes at a time that should also help with the swelling and pain and just for the time being for the next couple of weeks just you know maybe you know not play lacrosse with your son just to help that heal then you can get back on on the field so for your your high blood pressure we're just gon na keep you on the hypertension we'll just keep you on that twenty milligrams of lisinopril looks like you're doing great with that and your diet and then for your diabetes we will keep you on the five hundred milligrams of metformin and we will also get a a1c just to check your levels and see if we do need to adjust the medication in the future alright so do you have any questions for me
|
[
"Discussion",
"Medication",
"Other Treatments",
"Radiology Examination",
"Diagnostic Testing",
"Reassessment",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,831 |
now i did review the results of your echocardiogram which shows a preserved ef of fifty five percent abnormal diastolic filling and also mild to moderate mitral regurgitation so what all that means let me go ahead and tell you about my assessment and plan so for your first problem of your you know congestive heart failure it sounds like this was caused by you know dietary indiscretion in an uncontrolled hypertension so what i wan na do is i want you to continue on bumex two milligrams one daily that's that water pill that you're talking about and then i want you to continue to watch your diet and also avoid salty foods i know you love your pizza and chicken wings but we are gon na have to cut back on those okay kevin
|
[
"Medication",
"Other Treatments",
"Radiology Examination",
"Reassessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,832 |
i'm sorry so you definitely there is some tenderness to palpation and anterolaterally in the soft tissue there is no laxity on anterior drawer and inversion stress and there is no bony tenderness on palpation of the foot now i'm just gon na take a look at your right foot here just to make sure it's still intact here so okay good on the neurovascular exam of your right foot your capillary refill is less than three seconds with strong dorsalis pedis pulse and your sensation is intact to light touch so that's good sign now so gregory i did review the results of your right ankle x-ray and it showed no fracture so that's good so let's go ahead and talk about my assessment and plan so for your problem of right ankle pain what i'm seeing is that your symptoms are consistent with right ankle sprain so what i would like to do is i would like you to keep your leg elevated and especially when you're seated and to continue to ice it okay
|
[
"Physical Examination",
"Acute Assessment",
"Other Treatments",
"Radiology Examination"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,833 |
okay well i'm sorry to hear that okay so that's that's helpful information though okay let's go ahead and do physical exam on you there julie i'm gon na go ahead and take a look at your vital signs looks like your blood pressure looks good so that's good now on your heart exam i do n't appreciate any murmur rubs or gallops on your lung exam your lungs are clear on your eye exam i do n't appreciate any zenthomas and also on your neck exam here there is no thyroid megaly so now on your abdominal exam i do n't appreciate any hepatomegaly or splenomegaly why can i see these today so i reviewed the results of your cholesterol level and it was elevated at two ten so that's high so let me go ahead and tell you about my plan so for your problem of elevated cholesterol what we wan na do is you know the american academy of pediatrics actually recommends that all children be screened screened once you know they become between ages and nine and eleven and then again between ages seventeen and twenty so that's why you were screened okay so we do we yeah so we do this because studies have shown a link between high cholesterol and premature heart attacks so i wan na go ahead and order a full cholesterol panel there could be other reasons that could be causing the the high cholesterol but i'll go ahead also and check some glucose a complete metabolic panel some thyroid studies and liver panels and i wan na perform a genetic testing to see if this problem is familial or this is a secondary cause so we are also gon na go ahead i wan na follow up in a follow-up with a well balanced diet so including a variety of foods that are lower in saturated fat and sugars so i want you to follow that and i want you to meet a nutritionist and so who can give you information about what kind of foods to eat okay
|
[
"Physical Examination",
"Referral",
"Other Treatments",
"Diagnostic Testing",
"Reassessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,834 |
okay alright well certainly you know i looked at your ekg that did we did in the office when you came in the ekg i do n't see any signs of a heart attack or anything like that so i'm you know we should definitely talk about the plan for this chest pain in a few minutes but right now the good news is i do n't see any signs of a heart attack or anything like that so let's talk a little bit about your other conditions since you are here today how are you doing with your diabetes i know we have you on metformin and we talked about last time about you know improving your diet and exercise i'm glad you're exercising but i'm so sorry to hear about the chest pain so tell me about how is that going
|
[
"Personal History",
"Therapeutic History",
"Lab Examination"
] |
[
"Subjective",
"Objective"
] | 3,835 |
so let me examine you elizabeth for a second for the because we're running out of time here for a second so i'm gon na go ahead and do my exam we got ta just did my magical exam and i'm gon na go ahead and verbalize some of my findings just so i can get it documented in my note okay and i'll explain things as we go along so there is no jvd there is no swelling in your neck there's no carotid bruits your lung exam is clear i do n't hear any crackles or rhonchi your heart exam you do have a two over six systolic ejection murmur you had that in the past otherwise it's regular rate and rhythm your pulses are equal your belly exam is nice and soft your no tenderness no guarding no masses that i can feel on your belly and your back exam is fine your extremity exam you have a little bit of swelling in your lower legs one plus nonpitting edema or swelling in the in your in your ankle area here no calf tenderness so what does all this mean i'll explain that in a second so basically your exam is pretty normal except for you have a little bit of swelling in your legs so you know with this chest pain i'm a little bit so the first diagnosis that we talk about is this chest pain i'm worried about my suspicion is you have something called unstable angina especially considering your history of diabetes and the suspected history of high blood pressure and your family history of of heart disease in the past as well i'm i'm gon na go ahead and refer you to cardiology i reviewed your ekg today so that looks normal so that's good no other signs of a heart attack but i am worried that you may have some sort of a blockage going on that's causing this chest pain i'm gon na go ahead and start you on some aspirin daily i'm also gon na give you a prescription just a baby aspirin you can take eighty one milligrams once a day and also i'm gon na give you a prescription for nitroglycerin it's a it's a little pill you split underneath your tongue if you have this chest pain if it does n't go away after one or two pills i want you to go to the hospital call nine one one and go to the hospital but we will try to get you into cardiology the next week and get you set up for some sort of a stress test to look at your heart okay any questions about that
|
[
"Physical Examination",
"Discussion",
"Referral",
"Medication",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,836 |
and for the second problem the diabetes you know i think you're doing fairly well continue with your eye ophthalmology appointment you have for your eye exam for the diabetic retinopathy continue the metformin five hundred milligrams twice a day i'm gon na order another hemoglobin a1c today and i'm gon na have you come back in about two weeks and we can see if we need to make any adjustments continue to try to stay away from you know the the pop and the sweet things and once we have your heart taken care of or make sure your heart is okay you can and we can hopefully resolve this chest pain that you're having get back to your exercise regimen okay any questions about that
|
[
"Discussion",
"Follow-up",
"Medication",
"Other Treatments",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,837 |
okay alright so patella and achilles reflexes are symmetrical alright so i received before you came in here we got an mri and so in reviewing your results it does show a disk desiccation a disk bulge with paracentral disk herniation resulting in moderate right neuroforaminal i do n't like this word neural foraminal stenosis what those complicated words is that i just said is that it seems that you have a a a herniated disk with nerve impingement so let's talk about my assessment and plan alright your symptoms are in line with a i'm sorry you have lumbar back pain at the l4 l5 disk space due to a herniated disk with radiculopathy this means that one of your disks that sits between your vertebrae like the bones in your spine is bulging out and the bulge is pinching on some nerves so that's why you are feeling that pain like radiating down your leg i'm gon na recommend something a spinal injection with a strong nsaid and called the i'm sorry and a corticosteroid i'm just gon na inject it into the lumbar spine under fluoroscopy which you can think of like an x-ray to localize the exact area of your pain this should help with the inflammation that's causing your pain i know that sounds a bit scary it this is a typical procedure that i do all the time it's in office and we can get you scheduled today if you would like so what questions do you have right now
|
[
"Discussion",
"Medication",
"Radiology Examination",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,838 |
alright so for your your left knee pain i believe you you have a mcl strain or a medial collateral ligament that's the inside of your knee i think when you were running with your knee she had somehow twisted it and so you strained that ligament there so for that what i want to do i'm going to give you some pain medication that's not an nsaid so i will put you on some tramadol you can take fifty milligrams you can do that twice a day and then you can take that tylenol as needed for breakthrough pain alright i'm gon na put you in a knee immobilizer leg knee immobilizer and you can wear that for the next week i just wan na keep the knee from moving so it can heal a little bit and reduce some of the inflammation that you're seeing here and i also want you to ice it and you can do that three or four times a day for twenty thirty minutes at a time and that should help some of that swelling as well and i i you know i know your niece is gon na be upset but i just do n't want you to be running probably for the next three weeks with her just to help us get time to let allow the knee to heal so how does that sound
|
[
"Discussion",
"Medication",
"Other Treatments",
"Acute Assessment"
] |
[
"Assessment",
"Plan"
] | 3,839 |
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 ?
|
[
"Physical Examination",
"Reassessment"
] |
[
"Objective",
"Assessment"
] | 3,840 |
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 ?
|
[
"Discussion",
"Follow-up",
"Medication",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,841 |
so , let's look at your pulmonary function test . 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 .
|
[
"Acute Assessment",
"Lab Examination",
"Medication"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,842 |
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 . 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 ?
|
[
"Referral",
"Medication",
"Reassessment",
"Drug History"
] |
[
"Assessment",
"Plan"
] | 3,843 |
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 . 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 . 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 ?
|
[
"Reassessment",
"Diagnostic Testing",
"Radiology Examination",
"Medication"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,844 |
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 . so the results of your po- your covid test are positive .
|
[
"Reassessment",
"Acute Assessment",
"Lab Examination"
] |
[
"Objective",
"Assessment"
] | 3,845 |
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 ?
|
[
"Therapeutic History",
"Acute Assessment",
"Other Treatments"
] |
[
"Subjective",
"Assessment",
"Plan"
] | 3,846 |
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 .
|
[
"Reassessment",
"Diagnostic Testing",
"Follow-up",
"Other Treatments",
"Medication"
] |
[
"Assessment",
"Plan"
] | 3,847 |
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 . how are you doing with your diet for your diabetes ?
|
[
"Acute Symptoms",
"Reassessment",
"Lab Examination"
] |
[
"Subjective",
"Objective",
"Assessment"
] | 3,848 |
okay . all right . how are you doing with your high blood pressure ?
|
[
"Acute Symptoms",
"Reassessment"
] |
[
"Subjective",
"Assessment"
] | 3,849 |
okay . 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 . 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 . 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 . 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 ?
|
[
"Physical Examination",
"Discussion",
"Diagnostic Testing",
"Acute Assessment",
"Follow-up",
"Other Treatments",
"Medication"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,850 |
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 .
|
[
"Reassessment",
"Follow-up",
"Other Treatments"
] |
[
"Assessment",
"Plan"
] | 3,851 |
that sounds great . all right . so , let's talk just a little bit about , you know , my assessment and my plan for you . 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-
|
[
"Reassessment",
"Discussion",
"Other Treatments",
"Medication"
] |
[
"Assessment",
"Plan"
] | 3,852 |
there's no evidence that i'm concerned about anything at this time . hey dragon , show me the diabetes logs . so on your diabetic labs , your hemoglobin a1c is elevated . it's at eight . i'd like to see it closer to six . 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 .
|
[
"Reassessment",
"Discussion",
"Lab Examination"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,853 |
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 ?
|
[
"Acute Assessment",
"Referral"
] |
[
"Assessment",
"Plan"
] | 3,854 |
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 . 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 . 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 .
|
[
"Physical Examination",
"Discussion",
"Diagnostic Testing",
"Acute Assessment",
"Personal History",
"Other Treatments",
"Referral",
"Vegetative History"
] |
[
"Subjective",
"Objective",
"Assessment",
"Plan"
] | 3,855 |
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 ?
|
[
"Discussion",
"Personal History",
"Medication",
"Reassessment"
] |
[
"Subjective",
"Assessment",
"Plan"
] | 3,856 |
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 .
|
[
"Other Treatments",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,857 |
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 . 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 .
|
[
"Discussion",
"Medication",
"Diagnostic Testing",
"Reassessment",
"Vegetative History"
] |
[
"Subjective",
"Assessment",
"Plan"
] | 3,858 |
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 .
|
[
"Diagnostic Testing",
"Follow-up",
"Referral"
] |
[
"Plan"
] | 3,859 |
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 ?
|
[
"Therapeutic History",
"Discussion",
"Medication"
] |
[
"Subjective",
"Plan"
] | 3,860 |
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 . 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 .
|
[
"Personal History",
"Therapeutic History",
"Lab Examination",
"Diagnostic Testing",
"Follow-up"
] |
[
"Subjective",
"Objective",
"Assessment",
"Plan"
] | 3,861 |
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 . . 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 . no evidence of loosening or early complications . thanks .
|
[
"Physical Examination",
"Radiology Examination",
"Reassessment"
] |
[
"Objective",
"Assessment"
] | 3,862 |
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 .
|
[
"Acute Symptoms",
"Personal History",
"Chitchat"
] |
[
"Subjective"
] | 3,863 |
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 ?
|
[
"Therapeutic History",
"Chitchat"
] |
[
"Subjective"
] | 3,864 |
alright dorsiflexion is normal looks like that you have normal range of motion so that's good any pain down your legs
|
[
"Acute Assessment",
"Other Treatments",
"Radiology Examination"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,865 |
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
|
[
"Physical Examination",
"Discussion",
"Acute Assessment",
"Medication"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,866 |
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
|
[
"Physical Examination",
"Radiology Examination",
"Acute Assessment"
] |
[
"Objective",
"Assessment"
] | 3,867 |
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
|
[
"Discussion",
"Medication",
"Other Treatments",
"Referral",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Assessment",
"Plan"
] | 3,868 |
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
|
[
"Physical Examination",
"Discussion",
"Medication",
"Radiology Examination",
"Diagnostic Testing",
"Reassessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,869 |
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
|
[
"Discussion",
"Diagnostic Testing",
"Other Treatments"
] |
[
"Plan"
] | 3,870 |
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
|
[
"Discussion",
"Medication",
"Diagnostic Testing",
"Vegetative History"
] |
[
"Subjective",
"Plan"
] | 3,871 |
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
|
[
"Physical Examination",
"Referral",
"Diagnostic Testing",
"Acute Assessment",
"Vegetative History"
] |
[
"Subjective",
"Objective",
"Assessment",
"Plan"
] | 3,872 |
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
|
[
"Discussion",
"Medication",
"Other Treatments",
"Reassessment",
"Drug History"
] |
[
"Subjective",
"Assessment",
"Plan"
] | 3,873 |
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
|
[
"Physical Examination",
"Medication",
"Other Treatments",
"Radiology Examination",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,874 |
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
|
[
"Discussion",
"Follow-up",
"Referral",
"Medication",
"Other Treatments",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,875 |
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
|
[
"Physical Examination",
"Discussion",
"Follow-up",
"Medication",
"Diagnostic Testing",
"Reassessment",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,876 |
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
|
[
"Physical Examination",
"Medication",
"Reassessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,877 |
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
|
[
"Discussion",
"Referral",
"Diagnostic Testing",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,878 |
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
|
[
"Discussion",
"Referral",
"Diagnostic Testing",
"Acute Assessment"
] |
[
"Assessment",
"Plan"
] | 3,879 |
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
|
[
"Physical Examination",
"Discussion",
"Follow-up",
"Medication",
"Other Treatments",
"Acute Assessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,880 |
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
|
[
"Therapeutic History",
"Physical Examination"
] |
[
"Subjective",
"Objective"
] | 3,881 |
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
|
[
"Physical Examination",
"Acute Assessment",
"Medication"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,882 |
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
|
[
"Physical Examination",
"Medication",
"Therapeutic History",
"Radiology Examination",
"Reassessment",
"Other Treatments"
] |
[
"Subjective",
"Objective",
"Assessment",
"Plan"
] | 3,883 |
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
|
[
"Discussion",
"Medication",
"Other Treatments",
"Reassessment"
] |
[
"Assessment",
"Plan"
] | 3,884 |
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
|
[
"Physical Examination",
"Discussion",
"Medication",
"Radiology Examination",
"Reassessment"
] |
[
"Objective",
"Assessment",
"Plan"
] | 3,885 |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.