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doctor: okay . all right . and any weakness in , in your legs ? patient: no , no weakness , just , just the weird numbing . like , it's , like , almost like it's falling asleep on me .
D2N007
9
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . all right . and any weakness in , in your legs ?
200
doctor: okay . and are you able to , um , do your activities of daily living ? do you exercise , go to the store , that type of thing ? patient: yeah , i am . it bothers me when i'm on my feet for too long and sitting too long , just the extremes of each end .
D2N007
10
[ "Personal History", "Other Socials" ]
[ "Subjective" ]
okay . and are you able to , um , do your activities of daily living ? do you exercise , go to the store , that type of thing ?
201
doctor: okay . and i know that you've had a coronary artery bypass grafting at the young age of 27 , so how's that going ? patient: yeah , i had con- i had a congenital ... you know , i had a congenital artery when i was a baby , so , um , they had to do a cabg on me , um , fairly young in life , but i've been ... my heart's been doing , doing well , and arteries have been looking good .
D2N007
11
[ "Personal History" ]
[ "Subjective" ]
okay . and i know that you've had a coronary artery bypass grafting at the young age of 27 , so how's that going ?
202
doctor: okay . all right , well , let's go ahead and do a quick physical exam . um , so looking at you , you do n't appear in any distress . um , your neck , there's no thyroid enlargement . uh , your heart i hear a three out of six , systolic ejection murmur , uh , that's stable . your lungs otherwise sound clear . your abdomen is soft , and you do have some pain to palpation of your lumbar spine . uh , and you've had decreased flexion of your back . uh , your lower extremity strength is good , and there's no edema . so let's go ahead and look at some of your results . hey , dragon , show me the ecg . okay , so that looks basically unchanged from last year , which is really good . hey , dragon , show me the lumbar spine x-ray . hey , dragon , show me the back x-ray . great . so this looks good . that's also stable from last year . okay . so let's go ahead and , you know , my , my plan for you at this time , you know , from a chronic back pain standpoint , if you need , um , you know , some more physical therapy , and i can refer you to physical therapy to help with those symptoms that are kind of lingering . patient: mm-hmm .
D2N007
12
[ "Physical Examination", "Lab Examination", "Radiology Examination", "Referral", "Reassessment" ]
[ "Objective", "Assessment", "Plan" ]
okay . all right , well , let's go ahead and do a quick physical exam . um , so looking at you , you do n't appear in any distress . um , your neck , there's no thyroid enlargement . uh , your heart i hear a three out of six , systolic ejection murmur , uh , that's stable . your lungs otherwise sound clear . your abdomen is soft , and you do have some pain to palpation of your lumbar spine . uh , and you've had decreased flexion of your back . uh , your lower extremity strength is good , and there's no edema . so let's go ahead and look at some of your results . hey , dragon , show me the ecg . okay , so that looks basically unchanged from last year , which is really good . hey , dragon , show me the lumbar spine x-ray . hey , dragon , show me the back x-ray . great . so this looks good . that's also stable from last year . okay . so let's go ahead and , you know , my , my plan for you at this time , you know , from a chronic back pain standpoint , if you need , um , you know , some more physical therapy , and i can refer you to physical therapy to help with those symptoms that are kind of lingering .
203
doctor: um , and we can always give you some pain medication if you , if you get some pain periodically with activity . how do you feel about that ? do you need some pain medication ? patient: no , i think physical therapy is the right way to , way to start out on this .
D2N007
13
[ "Discussion" ]
[ "Plan" ]
um , and we can always give you some pain medication if you , if you get some pain periodically with activity . how do you feel about that ? do you need some pain medication ?
204
doctor: okay . hey , dragon , order physical therapy referral . and then in terms of your depression , we talked about increasing your prozac , so we'll increase it from 20 milligrams to 40 milligrams . it's just one tablet once a day . patient: okay .
D2N007
14
[ "Medication", "Referral" ]
[ "Plan" ]
okay . hey , dragon , order physical therapy referral . and then in terms of your depression , we talked about increasing your prozac , so we'll increase it from 20 milligrams to 40 milligrams . it's just one tablet once a day .
205
doctor: um , and i'll send those to your pharmacy . does that sound okay ? patient: that sounds great .
D2N007
15
[ "Chitchat" ]
[ "Null" ]
um , and i'll send those to your pharmacy . does that sound okay ?
206
doctor: hey , dragon , order prozac , 40 milligrams , once a day . and then in terms of your ... the heart bypass that you've had ... let's go ahead and just order another echocardiogram for you , and i wan na continue you on the aspirin for now , okay ? patient: okay .
D2N007
16
[ "Medication", "Diagnostic Testing" ]
[ "Plan" ]
hey , dragon , order prozac , 40 milligrams , once a day . and then in terms of your ... the heart bypass that you've had ... let's go ahead and just order another echocardiogram for you , and i wan na continue you on the aspirin for now , okay ?
207
doctor: hey , dragon , order an echocardiogram . hey , dragon , order aspirin 81 milligrams daily . okay , so the nurse will come in . she'll help you schedule those things , and we'll go from there , okay ? patient: okay .
D2N007
17
[ "Medication", "Diagnostic Testing" ]
[ "Plan" ]
hey , dragon , order an echocardiogram . hey , dragon , order aspirin 81 milligrams daily . okay , so the nurse will come in . she'll help you schedule those things , and we'll go from there , okay ?
208
doctor: all right , take care . patient: thank you .
D2N007
18
[ "Chitchat" ]
[ "Null" ]
all right , take care .
209
doctor: hey , dragon , finalize the note .
D2N007
19
[ "Chitchat" ]
[ "Null" ]
doctor: hey , dragon , finalize the note .
210
doctor: hi , stephanie . how are you ? patient: i'm doing okay . how are you ?
D2N008
0
[ "Greetings" ]
[ "Subjective" ]
hi , stephanie . how are you ?
211
doctor: i'm doing okay . um , so i know the nurse talked to you about dax . i'd like to tell dax a little bit about you , okay ? patient: okay .
D2N008
1
[ "Chitchat" ]
[ "Null" ]
i'm doing okay . um , so i know the nurse talked to you about dax . i'd like to tell dax a little bit about you , okay ?
212
doctor: so , stephanie is a 49-year-old female with a past medical history significant for congestive heart failure , kidney stones and prior colonoscopy who presents today for an abnormal lab finding . so , stephanie , i called you in today because your hemoglobin is low . um , how have you been feeling ? patient: over the past couple of months , i've been really tired and dizzy . lately , i've been really just worn out , even just , you know , walking a mile or going to work , doing things that i've done in the past every day that have been relatively okay , and i have n't gotten tired . and now , i've been getting tired .
D2N008
2
[ "Acute Symptoms", "Personal History" ]
[ "Subjective" ]
so , stephanie is a 49-year-old female with a past medical history significant for congestive heart failure , kidney stones and prior colonoscopy who presents today for an abnormal lab finding . so , stephanie , i called you in today because your hemoglobin is low . um , how have you been feeling ?
213
doctor: okay , yeah . i , you know , the nurse told me that you had called with these complaints . and i know that we have ordered some labs on you before the visit . and it did , it c- you know , your , your , your hemoglobin is your red blood cell count . and now , and that came back as a little low on the results , okay ? so , have you noticed any blood in your stools ? patient: uh , no , i have n't . i did about three years ago , um , and i did a colonoscopy for that , but nothing since then .
D2N008
3
[ "Acute Symptoms", "Personal History", "Vegetative History" ]
[ "Subjective" ]
okay , yeah . i , you know , the nurse told me that you had called with these complaints . and i know that we have ordered some labs on you before the visit . and it did , it c- you know , your , your , your hemoglobin is your red blood cell count . and now , and that came back as a little low on the results , okay ? so , have you noticed any blood in your stools ?
214
doctor: okay , yeah . i remember that , okay . and how about , you know , do your stools look dark or tarry or black or anything like that ? patient: no , nothing like that .
D2N008
4
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
okay , yeah . i remember that , okay . and how about , you know , do your stools look dark or tarry or black or anything like that ?
215
doctor: okay . and have you been , um , having any heavy menstrual bleeding or anything like that ? patient: no , not that i've noticed .
D2N008
5
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
okay . and have you been , um , having any heavy menstrual bleeding or anything like that ?
216
doctor: okay , all right . and any , have you passed out at all , or anything like that ? any weight loss ? patient: no , no weight loss or passing out . i have felt a bit dizzy , but it has n't l- led to me passing out at all .
D2N008
6
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
okay , all right . and any , have you passed out at all , or anything like that ? any weight loss ?
217
doctor: okay . so , you endorse some dizziness . you endorse some fatigue . have you , but you have n't had any weight loss , loss of appetite , anything like that ? patient: no , nothing like that .
D2N008
7
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
okay . so , you endorse some dizziness . you endorse some fatigue . have you , but you have n't had any weight loss , loss of appetite , anything like that ?
218
doctor: okay , all right . so , you know , let's talk a little bit about that colonoscopy . i know you had a colonoscopy about three years ago and that showed that you had some mild diverticuli- diverticulosis . um , no issues since then ? patient: nope , no issues since then .
D2N008
8
[ "Personal History" ]
[ "Subjective" ]
okay , all right . so , you know , let's talk a little bit about that colonoscopy . i know you had a colonoscopy about three years ago and that showed that you had some mild diverticuli- diverticulosis . um , no issues since then ?
219
doctor: okay , all right . and then i know that , uh , you know , you have this slightly reduced heart function , you know , your congestive heart failure . how have you been doing watching your salt intake ? i know that that's kind of been a struggle for you . patient: um , it's been more of a struggle recently . i've been traveling a lot . i went up to vermont , um , to go , um , explore the mountains . and along the way i stopped at , you know , mcdonald's and got two cheeseburgers . and so , i , i could be doing better . i've noticed some swelling in my , my legs . um , but nothing too extreme that where i thought i should call .
D2N008
9
[ "Personal History", "Vegetative History" ]
[ "Subjective" ]
okay , all right . and then i know that , uh , you know , you have this slightly reduced heart function , you know , your congestive heart failure . how have you been doing watching your salt intake ? i know that that's kind of been a struggle for you .
220
doctor: okay , all right . and any shortness of breath or problems lying flat at night , anything like that ? patient: no , nothing like that .
D2N008
10
[ "Acute Symptoms" ]
[ "Subjective" ]
okay , all right . and any shortness of breath or problems lying flat at night , anything like that ?
221
doctor: okay , all right . and then in terms of the kidney stones , i know that you had those a couple years ago , as well . any recent flare ups ? have you had any , any back pain , flank pain , anything like that ? patient: no , nothing like that .
D2N008
11
[ "Personal History" ]
[ "Subjective" ]
okay , all right . and then in terms of the kidney stones , i know that you had those a couple years ago , as well . any recent flare ups ? have you had any , any back pain , flank pain , anything like that ?
222
doctor: okay . any blood in your urine that you've seen ? patient: no .
D2N008
12
[ "Vegetative History" ]
[ "Subjective" ]
okay . any blood in your urine that you've seen ?
223
doctor: okay , all right . um , okay . well , i know that the nurse did a review of system sheet when you came in . and we've just talked a lot about your , your s- your symptoms , you know , your dizziness , your fatigue and that type of thing . anything else that i might have missed , fever chills , any nasal congestion , sore throat , cough ? patient: uh , i've had a little bit of nasal congestion just because with the seasons changing , i , i get seasonal allergies . but everything else has been okay .
D2N008
13
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
okay , all right . um , okay . well , i know that the nurse did a review of system sheet when you came in . and we've just talked a lot about your , your s- your symptoms , you know , your dizziness , your fatigue and that type of thing . anything else that i might have missed , fever chills , any nasal congestion , sore throat , cough ?
224
doctor: okay , all right . well , i'm gon na go ahead and do a quick physical exam , okay ? patient: okay .
D2N008
14
[ "Chitchat" ]
[ "Null" ]
okay , all right . well , i'm gon na go ahead and do a quick physical exam , okay ?
225
doctor: hey , dragon , show me the vital signs . so , here in the office today , your vital signs look great . your blood pressure is fine . your heart rates r- right where it should be , which is good , okay ? i'm just gon na do a quick exam . and i'll let you know what , what i find , okay ? patient: okay .
D2N008
15
[ "Physical Examination" ]
[ "Objective" ]
hey , dragon , show me the vital signs . so , here in the office today , your vital signs look great . your blood pressure is fine . your heart rates r- right where it should be , which is good , okay ? i'm just gon na do a quick exam . and i'll let you know what , what i find , okay ?
226
doctor: all right . so , your physical , physical examination looks fine . so , on your heart exam , i do hear a three out of six systolic ejection murmur , which we've heard in the past , okay ? and on your lower extremities , i do notice some trace to one plus pitting edema in your ankles , which is probably from the salt intake , okay ? patient: mm-hmm .
D2N008
16
[ "Physical Examination" ]
[ "Objective" ]
all right . so , your physical , physical examination looks fine . so , on your heart exam , i do hear a three out of six systolic ejection murmur , which we've heard in the past , okay ? and on your lower extremities , i do notice some trace to one plus pitting edema in your ankles , which is probably from the salt intake , okay ?
227
doctor: so , we'll talk about that . i wan na just look at some of your results , okay ? patient: okay .
D2N008
17
[ "Chitchat" ]
[ "Null" ]
so , we'll talk about that . i wan na just look at some of your results , okay ?
228
doctor: hey , dragon , show me the echocardiogram . so , i just wanted to go over the results of your last echocardiogram , that was about six months ago . that shows that you do have the low pumping function of , of your heart at about 45 % , which is not terrible . and it does show that you have some moderate mitral regurgitation . so , that's that slight heart murmur i heard in your exam , okay ? hey , dragon , show me the hemoglobin . and here , this is the hemoglobin that i was referring to . it's low at 8.2 , okay ? so , we'll have to talk a little bit about that , all right ? so , let me go over a little bit about my assessment and my plan for you , okay ? so , for you first problem this new anemia , uh , i wan na go ahead and send off some more labs and anemia profile , just to see exactly what type of anemia we're dealing with . i also wan na go and refer you back to the gastroenterologist for another evaluation , okay ? hey , dragon , order referral to gastroenterology . so , they're gon na do , uh , probably do an endoscopy and another colonoscopy on you . um , but again , i wan na send off those labs just to make sure that it's not something else , okay ? patient: okay .
D2N008
18
[ "Lab Examination", "Radiology Examination", "Diagnostic Testing", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
hey , dragon , show me the echocardiogram . so , i just wanted to go over the results of your last echocardiogram , that was about six months ago . that shows that you do have the low pumping function of , of your heart at about 45 % , which is not terrible . and it does show that you have some moderate mitral regurgitation . so , that's that slight heart murmur i heard in your exam , okay ? hey , dragon , show me the hemoglobin . and here , this is the hemoglobin that i was referring to . it's low at 8.2 , okay ? so , we'll have to talk a little bit about that , all right ? so , let me go over a little bit about my assessment and my plan for you , okay ? so , for you first problem this new anemia , uh , i wan na go ahead and send off some more labs and anemia profile , just to see exactly what type of anemia we're dealing with . i also wan na go and refer you back to the gastroenterologist for another evaluation , okay ? hey , dragon , order referral to gastroenterology . so , they're gon na do , uh , probably do an endoscopy and another colonoscopy on you . um , but again , i wan na send off those labs just to make sure that it's not something else , okay ?
229
doctor: for your next problem your congestive heart failure , um , i do think you're retaining a little bit of fluid . so , i'm gon na go ahead and start you on some lasix 40 milligrams once a day . i want you to continue you on your toprol 50 milligrams daily . and as well your , as well , as your lisinopril 10 milligrams a day . i really want you to watch your salt intake , okay ? get a scale , weigh yourself every day . and call me if your weight starts to go up , okay ? patient: okay .
D2N008
19
[ "Follow-up", "Medication", "Reassessment" ]
[ "Assessment", "Plan" ]
for your next problem your congestive heart failure , um , i do think you're retaining a little bit of fluid . so , i'm gon na go ahead and start you on some lasix 40 milligrams once a day . i want you to continue you on your toprol 50 milligrams daily . and as well your , as well , as your lisinopril 10 milligrams a day . i really want you to watch your salt intake , okay ? get a scale , weigh yourself every day . and call me if your weight starts to go up , okay ?
230
doctor: 'cause i might need to give you more diuretic . patient: all right .
D2N008
20
[ "Medication" ]
[ "Plan" ]
'cause i might need to give you more diuretic .
231
doctor: and for your last problem your kidney stones , uh , i think everything seems to be fine right at this time . again , continue to watch your diet and stay hydrated . um , and i know that might be a little difficult with the diuretic , but do your best . uh , and give me a call if you have any question , okay ? patient: okay .
D2N008
21
[ "Follow-up", "Reassessment" ]
[ "Assessment", "Plan" ]
and for your last problem your kidney stones , uh , i think everything seems to be fine right at this time . again , continue to watch your diet and stay hydrated . um , and i know that might be a little difficult with the diuretic , but do your best . uh , and give me a call if you have any question , okay ?
232
doctor: all right . any questions right now ? patient: not that i can think of .
D2N008
22
[ "Chitchat" ]
[ "Null" ]
all right . any questions right now ?
233
doctor: okay , great . hey , dragon , finalize the note .
D2N008
23
[ "Chitchat" ]
[ "Null" ]
doctor: okay , great . hey , dragon , finalize the note .
234
doctor: hi , bryan . how are you ? patient: i'm doing well . i'm a little sore .
D2N009
0
[ "Acute Symptoms", "Greetings" ]
[ "Subjective" ]
hi , bryan . how are you ?
235
doctor: all right , well , i know the nurse told you about dax . i'd like to tell dax a little bit about you , okay ? patient: that's fine .
D2N009
2
[ "Chitchat" ]
[ "Null" ]
all right , well , i know the nurse told you about dax . i'd like to tell dax a little bit about you , okay ?
236
doctor: so bryan is a 55-year-old male with a past medical history significant for prior discectomy , who presents with back pain . so , bryan , what happened to your back ? patient: you ... my wife made me push a , uh , refrigerator out through the other room , and when i was helping to move it , i felt something in my back on the lower right side .
D2N009
3
[ "Acute Symptoms", "Personal History" ]
[ "Subjective" ]
so bryan is a 55-year-old male with a past medical history significant for prior discectomy , who presents with back pain . so , bryan , what happened to your back ?
237
doctor: okay , on the lower right side of this back ? patient: yes .
D2N009
4
[ "Acute Symptoms" ]
[ "Subjective" ]
okay , on the lower right side of this back ?
238
doctor: okay . those wives , always making you do stuff . patient: yes .
D2N009
5
[ "Chitchat" ]
[ "Null" ]
okay . those wives , always making you do stuff .
239
doctor: and what day did this happen on ? how long ago ? patient: uh , this was about five days ago .
D2N009
6
[ "Acute Symptoms" ]
[ "Subjective" ]
and what day did this happen on ? how long ago ?
240
doctor: five days ago . patient: and , you know , i have that history of discectomy .
D2N009
7
[ "Acute Symptoms" ]
[ "Subjective" ]
five days ago .
241
doctor: okay . all right . and , and what have you taken for the pain ? patient: um , i have , uh , been taking ibuprofen . uh , and i tried once tylenol and ibuprofen at the same time , and that gave me some relief .
D2N009
9
[ "Therapeutic History" ]
[ "Subjective" ]
okay . all right . and , and what have you taken for the pain ?
242
doctor: okay . all right . and have you had any symptoms like pain in your legs or numbing or tingling ? patient: um , no , nothing significant like that .
D2N009
10
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . all right . and have you had any symptoms like pain in your legs or numbing or tingling ?
243
doctor: okay , just the pain in your back . patient: just the pain in the back . it hurts to bend over .
D2N009
11
[ "Acute Symptoms" ]
[ "Subjective" ]
okay , just the pain in your back .
244
doctor: okay , and any problems with your bladder or your bowels ? patient: no , no .
D2N009
12
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
okay , and any problems with your bladder or your bowels ?
245
doctor: i know the nurse said to review a symptom sheet when you checked in . patient: mm-hmm .
D2N009
13
[ "Discussion" ]
[ "Objective" ]
i know the nurse said to review a symptom sheet when you checked in .
246
doctor: and i know that you were endorsing the back pain . any other symptoms ? chest pain ? shortness of breath ? abdominal pain ? patient: no .
D2N009
14
[ "Acute Symptoms" ]
[ "Subjective" ]
and i know that you were endorsing the back pain . any other symptoms ? chest pain ? shortness of breath ? abdominal pain ?
247
doctor: nausea ? vomiting ? patient: no other symptoms .
D2N009
15
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
nausea ? vomiting ?
248
doctor: okay . all right . well , let's go ahead and do a quick physical exam . hey , dragon , show me the vital signs . so your vital signs here in the office look really good . you do n't have a fever . your blood pressure's nice and controlled . so that ... that's good . i'm just gon na check out your back and your heart and your lungs , okay ? patient: okay .
D2N009
16
[ "Physical Examination" ]
[ "Objective" ]
okay . all right . well , let's go ahead and do a quick physical exam . hey , dragon , show me the vital signs . so your vital signs here in the office look really good . you do n't have a fever . your blood pressure's nice and controlled . so that ... that's good . i'm just gon na check out your back and your heart and your lungs , okay ?
249
doctor: okay , so on physical examination , you know , your heart sounds great . there's ... it's a regular rate and rhythm . your lungs are nice and clear . on your back exam , you do have some pain to palpation of the right lumbar spine , uh , in the paraspinal muscles along with decreased flexion and extension of the back , and you have a positive straight leg on the right . or positive straight leg raise on the right , uh , but your strength is good bilaterally in your lower extremities . so that means that i think that you've injured your back . patient: okay .
D2N009
17
[ "Physical Examination" ]
[ "Objective" ]
okay , so on physical examination , you know , your heart sounds great . there's ... it's a regular rate and rhythm . your lungs are nice and clear . on your back exam , you do have some pain to palpation of the right lumbar spine , uh , in the paraspinal muscles along with decreased flexion and extension of the back , and you have a positive straight leg on the right . or positive straight leg raise on the right , uh , but your strength is good bilaterally in your lower extremities . so that means that i think that you've injured your back .
250
doctor: uh , but , you know , i think it's something that we can , we can fix , okay ? patient: okay , you do n't think there's anything wrong with the ... where i had the surgery before .
D2N009
18
[ "Personal History" ]
[ "Subjective" ]
uh , but , you know , i think it's something that we can , we can fix , okay ?
251
doctor: i do n't think so . patient: okay .
D2N009
19
[ "Personal History" ]
[ "Subjective" ]
i do n't think so .
252
doctor: let's took at some of your results . hey , dragon , show me the back x-ray . so this is an x-ray of your lumbar spine . you know , there's good bony , bony alignment . i do n't see any fracture or anything like that . so that's a good sign . um , hey , dragon . show me the labs . and your labs here all look good , so i'm , i'm happy to see that . uh , so let's talk a little bit about my assessment and my plan for you , okay ? patient: okay .
D2N009
20
[ "Lab Examination", "Radiology Examination" ]
[ "Objective" ]
let's took at some of your results . hey , dragon , show me the back x-ray . so this is an x-ray of your lumbar spine . you know , there's good bony , bony alignment . i do n't see any fracture or anything like that . so that's a good sign . um , hey , dragon . show me the labs . and your labs here all look good , so i'm , i'm happy to see that . uh , so let's talk a little bit about my assessment and my plan for you , okay ?
253
doctor: so i ... my assessment for your first problem , your back pain . i think you have a lumbar strain . i do n't think that anything else is going on , but i wan na go ahead and order an mri- patient: okay .
D2N009
21
[ "Diagnostic Testing", "Acute Assessment" ]
[ "Assessment", "Plan" ]
so i ... my assessment for your first problem , your back pain . i think you have a lumbar strain . i do n't think that anything else is going on , but i wan na go ahead and order an mri-
254
doctor: just to be sure . patient: okay .
D2N009
22
[ "Discussion" ]
[ "Assessment", "Plan" ]
just to be sure .
255
doctor: okay ? and then i'm gon na prescribe you some meloxicam 15 milligrams once a day along with some ultram , 50 milligrams every four hours as needed , okay ? patient: okay .
D2N009
23
[ "Medication" ]
[ "Plan" ]
okay ? and then i'm gon na prescribe you some meloxicam 15 milligrams once a day along with some ultram , 50 milligrams every four hours as needed , okay ?
256
doctor: um , and then we'll go ahead and refer you to some physical therapy once we get the mri results back , okay ? patient: should i continue to take the tylenol and the ibuprofen ?
D2N009
24
[ "Discussion", "Medication", "Referral" ]
[ "Plan" ]
um , and then we'll go ahead and refer you to some physical therapy once we get the mri results back , okay ?
257
doctor: you can stop the ibuprofen . patient: okay .
D2N009
25
[ "Discussion", "Medication" ]
[ "Plan" ]
you can stop the ibuprofen .
258
doctor: you can take tylenol if you want . patient: okay .
D2N009
26
[ "Discussion", "Medication" ]
[ "Plan" ]
you can take tylenol if you want .
259
doctor: you know to call me if , if you need anything . patient: okay .
D2N009
27
[ "Chitchat" ]
[ "Null" ]
you know to call me if , if you need anything .
260
doctor: any questions , uh , bryan ? patient: no , no questions .
D2N009
29
[ "Chitchat" ]
[ "Null" ]
any questions , uh , bryan ?
261
doctor: okay . hey , dragon , finalize the note .
D2N009
30
[ "Chitchat" ]
[ "Null" ]
doctor: okay . hey , dragon , finalize the note .
262
doctor: hi keith , how are you ? patient: ah , not too good . my blood sugar is n't under control .
D2N010
0
[ "Greetings" ]
[ "Subjective" ]
hi keith , how are you ?
263
doctor: and , uh , so keith is a 58-year-old male here for evaluation of high blood sugar . so , what happened ? ha- have you just been taking your blood sugars at home and noticed that they're really high ? or ? patient: yeah i've been taking them at home and i feel like they've been creeping up slightly .
D2N010
1
[ "Acute Symptoms", "Personal History" ]
[ "Subjective" ]
and , uh , so keith is a 58-year-old male here for evaluation of high blood sugar . so , what happened ? ha- have you just been taking your blood sugars at home and noticed that they're really high ? or ?
264
doctor: have- ... what have they been running , in like the 200's or 300's ? patient: 300's .
D2N010
2
[ "Personal History" ]
[ "Subjective" ]
have- ... what have they been running , in like the 200's or 300's ?
265
doctor: they've been running in the 300's ? and tell me about your diet . have you been eating anything to spark- ... spike them up ? patient: to be honest my diet has n't changed much .
D2N010
3
[ "Acute Symptoms", "Personal History" ]
[ "Subjective" ]
they've been running in the 300's ? and tell me about your diet . have you been eating anything to spark- ... spike them up ?
266
doctor: okay . have you- ... go ahead . patient: actually it has n't changed at all . much of the same .
D2N010
4
[ "Personal History", "Vegetative History" ]
[ "Subjective" ]
okay . have you- ... go ahead .
267
doctor: okay and what do you con- consider the same ? are you eating lots of sugar ? like , teas and coffees and- patient: i do n't take sugar with my tea .
D2N010
5
[ "Personal History", "Vegetative History" ]
[ "Subjective" ]
okay and what do you con- consider the same ? are you eating lots of sugar ? like , teas and coffees and-
268
doctor: okay , all right . and how about , um , like any added sugars into any kind of processed foods or anything like that ? patient: uh , i think most of my sugars come from fruit .
D2N010
6
[ "Vegetative History" ]
[ "Subjective" ]
okay , all right . and how about , um , like any added sugars into any kind of processed foods or anything like that ?
269
doctor: from what ? patient: fruit .
D2N010
7
[ "Vegetative History" ]
[ "Subjective" ]
from what ?
270
doctor: fruit , okay . patient: yeah .
D2N010
8
[ "Chitchat" ]
[ "Null" ]
fruit , okay .
271
doctor: all right . um , and have you been feeling sick recently ? have you had any fever or chills ? patient: uh , i have not .
D2N010
9
[ "Acute Symptoms" ]
[ "Subjective" ]
all right . um , and have you been feeling sick recently ? have you had any fever or chills ?
272
doctor: body aches , joint pain ? patient: uh , a bit of joint pain .
D2N010
10
[ "Acute Symptoms" ]
[ "Subjective" ]
body aches , joint pain ?
273
doctor: multiple joints , or just one joint ? patient: uh , my knee . uh , sorry , right knee to be more exact .
D2N010
11
[ "Acute Symptoms" ]
[ "Subjective" ]
multiple joints , or just one joint ?
274
doctor: your right knee ? patient: yeah .
D2N010
12
[ "Acute Symptoms" ]
[ "Subjective" ]
your right knee ?
275
doctor: okay . and what happened ? patient: ah , to be honest , nothing much . i just noticed it when you said it .
D2N010
13
[ "Personal History" ]
[ "Subjective" ]
okay . and what happened ?
276
doctor: okay , all right . um , and how about any nausea or vomiting or belly pain ? patient: uh , i was nauseous a couple of days back but , uh , that's just because i was sitting in the back of a car . i hate that .
D2N010
14
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
okay , all right . um , and how about any nausea or vomiting or belly pain ?
277
doctor: okay . all right . and no burning when you urinate or anything like that ? patient: not at all .
D2N010
15
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
okay . all right . and no burning when you urinate or anything like that ?
278
doctor: okay . all right . so , um ... you know , i know that you've had this reflux in the past . how are you doing with that ? are you still having a lot of reflux symptoms or do you feel like it's better since we've put you on the protonix ? patient: i think it's a bit better . uh , i do n't get up at night anymore with reflux and that's always a good thing .
D2N010
16
[ "Personal History", "Therapeutic History", "Vegetative History" ]
[ "Subjective" ]
okay . all right . so , um ... you know , i know that you've had this reflux in the past . how are you doing with that ? are you still having a lot of reflux symptoms or do you feel like it's better since we've put you on the protonix ?
279
doctor: okay , all right . and i know you have this history of congestive heart failure . have you noticed any recent , uh , weight gain or fluid retention ? patient: um , not really .
D2N010
17
[ "Acute Symptoms", "Personal History", "Vegetative History" ]
[ "Subjective" ]
okay , all right . and i know you have this history of congestive heart failure . have you noticed any recent , uh , weight gain or fluid retention ?
280
doctor: no ? okay . um , and any problems sleeping while laying flat ? patient: uh , i- i prefer to sleep on my side so i ca n't really say .
D2N010
18
[ "Acute Symptoms", "Vegetative History" ]
[ "Subjective" ]
no ? okay . um , and any problems sleeping while laying flat ?
281
doctor: okay , but even then , you're flat . patient: yup , yeah .
D2N010
19
[ "Chitchat" ]
[ "Null" ]
okay , but even then , you're flat .
282
doctor: okay . all right . and i know that we had an issue with your right rotator cuff , is that okay ? patient: it's surprisingly good now .
D2N010
20
[ "Personal History" ]
[ "Subjective" ]
okay . all right . and i know that we had an issue with your right rotator cuff , is that okay ?
283
doctor: okay , all right . all right , well let's go ahead and we'll do a quick physical exam . so ... feeling your neck , i do feel like your thyroid's a bit enlarged here . um , your heart is nice and regular . your lungs are clear . your abdomen , um , is nice and soft . your right knee shows that you have some erythema and- and an insect bite with associated fluctuants . and , um , you have some lower extremity edema on the right hand side . so let's go ahead and look at some of your results . i know the nurse had reported these things and we ordered some labs on you before you came in . hey dragon , show me the vital signs . okay , well your- your vital signs look good , which is good . hey dragon , show me the lyme titer . okay , so , you know , your lyme titer is a little elevated , so i think we'll have to go ahead and- and look into that a little bit , okay ? patient: makes sense .
D2N010
21
[ "Physical Examination", "Lab Examination" ]
[ "Objective" ]
okay , all right . all right , well let's go ahead and we'll do a quick physical exam . so ... feeling your neck , i do feel like your thyroid's a bit enlarged here . um , your heart is nice and regular . your lungs are clear . your abdomen , um , is nice and soft . your right knee shows that you have some erythema and- and an insect bite with associated fluctuants . and , um , you have some lower extremity edema on the right hand side . so let's go ahead and look at some of your results . i know the nurse had reported these things and we ordered some labs on you before you came in . hey dragon , show me the vital signs . okay , well your- your vital signs look good , which is good . hey dragon , show me the lyme titer . okay , so , you know , your lyme titer is a little elevated , so i think we'll have to go ahead and- and look into that a little bit , okay ?
284
doctor: that can certainly cause your blood sugar to be elevated . um , hey dragon , uh , show me the rapid strep . and you also have , uh , positive for strep . so i think we have some reasons as to why your blood sugar is so high . so my impression of you , you know , you have this hyperglycemia , which is probably related to some infections going on in your body . um , from a- a- a rapid strep standpoint we're gon na go ahead and treat you with penicillin or , i'm sorry , amoxicillin , 500 milligrams , three times a day . uh , make sure you take it all , even if you start feeling better , okay ? patient: for sure .
D2N010
22
[ "Medication", "Lab Examination", "Acute Assessment" ]
[ "Objective", "Assessment", "Plan" ]
that can certainly cause your blood sugar to be elevated . um , hey dragon , uh , show me the rapid strep . and you also have , uh , positive for strep . so i think we have some reasons as to why your blood sugar is so high . so my impression of you , you know , you have this hyperglycemia , which is probably related to some infections going on in your body . um , from a- a- a rapid strep standpoint we're gon na go ahead and treat you with penicillin or , i'm sorry , amoxicillin , 500 milligrams , three times a day . uh , make sure you take it all , even if you start feeling better , okay ?
285
doctor: hey dragon , order amoxicillin , 500 milligrams , three times a day for 10 days . um ... okay . and from ... , and from all- ... a positive lyme titer aspect , we should go ahead and order a western blot , just pcr to see if you have any , um , to see if it's actually acute lyme , okay ? patient: okay .
D2N010
23
[ "Medication", "Diagnostic Testing" ]
[ "Plan" ]
hey dragon , order amoxicillin , 500 milligrams , three times a day for 10 days . um ... okay . and from ... , and from all- ... a positive lyme titer aspect , we should go ahead and order a western blot , just pcr to see if you have any , um , to see if it's actually acute lyme , okay ?
286
doctor: okay . um , hey dragon , order a western blot pcr for lyme . okay . all right . well we'll go ahead and , um , the nurse will come in soon and she'll set you up with these tests , okay ? patient: yeah . you said lyme . is that related to lyme disease ?
D2N010
24
[ "Discussion", "Diagnostic Testing" ]
[ "Plan" ]
okay . um , hey dragon , order a western blot pcr for lyme . okay . all right . well we'll go ahead and , um , the nurse will come in soon and she'll set you up with these tests , okay ?
287
doctor: yes it is , yeah . patient: you're certain i do n't have alpha-gal syndrome though , right ? i'm terrified of that one .
D2N010
25
[ "Discussion" ]
[ "Plan" ]
yes it is , yeah .
288
doctor: have what ? patient: alpha-gal syndrome , the one where a tick bites you and you get an allergic reaction to meat .
D2N010
26
[ "Discussion" ]
[ "Plan" ]
have what ?
289
doctor: yeah , i do n't think so . have you eaten meat over the last couple of days ? patient: i have .
D2N010
27
[ "Discussion" ]
[ "Plan" ]
yeah , i do n't think so . have you eaten meat over the last couple of days ?
290
doctor: okay . well i- ... it's , you know , your blood sugar's elevated so you might be having an inflammatory response to that , but we'll go ahead and order some tests to look into it , okay ? patient: that sounds good .
D2N010
28
[ "Discussion", "Diagnostic Testing" ]
[ "Plan" ]
okay . well i- ... it's , you know , your blood sugar's elevated so you might be having an inflammatory response to that , but we'll go ahead and order some tests to look into it , okay ?
291
doctor: all right . call me if anything happens , okay ? patient: definitely .
D2N010
29
[ "Chitchat" ]
[ "Null" ]
all right . call me if anything happens , okay ?
292
doctor: all right . hey dragon , finalize the note .
D2N010
30
[ "Chitchat" ]
[ "Null" ]
doctor: all right . hey dragon , finalize the note .
293
doctor: hi , roger . how are you ? patient: hey . good to see you .
D2N011
0
[ "Greetings" ]
[ "Subjective" ]
hi , roger . how are you ?
294
doctor: good to see you . are you ready to get started ? patient: yes , i am .
D2N011
1
[ "Chitchat" ]
[ "Null" ]
good to see you . are you ready to get started ?
295
doctor: roger is a 62 year old male here for emergency room follow-up for some chest pain . so , roger , i heard you went to the er for some chest discomfort . patient: yeah . we were doing a bunch of yard work and it was really hot over the weekend and i was short of breath and i felt a little chest pain for probably about an hour or so . so , i got a little nervous about that .
D2N011
2
[ "Acute Symptoms", "Personal History" ]
[ "Subjective" ]
roger is a 62 year old male here for emergency room follow-up for some chest pain . so , roger , i heard you went to the er for some chest discomfort .
296
doctor: okay . and had you ever had that before ? patient: no , i never have , actually .
D2N011
3
[ "Personal History" ]
[ "Subjective" ]
okay . and had you ever had that before ?
297
doctor: okay . and- patient: whose mic is on ? i'm in .
D2N011
4
[ "Chitchat" ]
[ "Null" ]
okay . and-
298
doctor: okay . and , um , how are you feeling since then ? patient: um , after , uh , we were done , i felt fine ever since , but i thought it was worth looking into .
D2N011
5
[ "Acute Symptoms" ]
[ "Subjective" ]
okay . and , um , how are you feeling since then ?
299