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### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2131-05-30
EDVISIT^22267708^JONES, URIEL^05/30/31^COOKE, FREDI
CHIEF COMPLAINT: Shortness of breath.
HISTORY OF PRESENT ILLNESS: A 67 year-old male was seen in
transfer from Friends Hospital for evaluation of progressively
worsening shortness of breath over the last 2 days, associated
with increased fatigue and episodes of chest pressure yesterday.
He did note increase weight for the last 1-2 months,
progressively worsening shortness of breath with minimal
exertion. He did have chest pressure at rest yesterday, which
did radiate to his left shoulder. This seemed to resolve
spontaneously and then he noted shortness of breath with any kind
of exertion at all. The shortness of breath was exclusively
exertional. He has not noticed nausea, vomiting, diaphoresis,
presyncopal symptoms or diarrhea. No fevers. He does have a
slight cough that is nonproductive. He was seen at a local
Emergency Department today where he had laboratory studies as
well as was given Lasix, albuterol, and nitroglycerin and states
he has some relief of his symptoms associated with this. He was
cardioverted 2 days ago for atrial fibrillation by his
cardiologist at SAH. Additionally, at the outside Emergency
Department, his INR was therapeutic at 2 as he is on Coumadin,
but his troponin was elevated at 0.16.
PAST MEDICAL HISTORY: Significant for hypertension, orally
controlled diabetes, hypercholesterolemia, and atrial flutter.
He has had a cardiac catheterization last in 2127.
SOCIAL HISTORY: He is a past smoker with 10 pack years of
smoking.
REVIEW OF SYSTEMS: As noted in the written chart and HPI,
otherwise negative.
MEDICATIONS: Coumadin, citalopram, metoprolol, lisinopril,
glipizide, Cipro, and simvastatin.
ALLERGIES: He is allergic to penicillin.
PHYSICAL EXAMINATION: Temperature 99, pulse 63, respiratory rate
20, blood pressure 140/86, and oxygen saturation 96% on room air.
HEENT: Normocephalic and atraumatic. Pleasant, calm. Neck is
supple. Respiratory: Clear to auscultation, except for
scattered rales in the left lower lung field. Cardiovascular:
Regular rate and rhythm without murmur. Abdomen is soft and
nontender. Skin is intact, warm, and dry. Extremities: He has
got 1+ edema of the bilateral lower extremities that is
symmetric. Neuropsych: He is oriented x3, moves all extremities
equally.
LABORATORY DATA: ECG shows a sinus rhythm at 65 with poor R-wave
progression, but no acute ST segment abnormalities. Chest x-ray
shows interstitial increased markings with a small left pleural
effusion and prominence of the ventricle consistent with mild
pulmonary edema. Cardiac biomarkers show troponin of 0.16 with
creatinine of 1.43, CK-MB of 3.2 with normal index, and CK of 87.
BNP is still pending. INR is 2.5, which is therapeutic on
Coumadin.
EMERGENCY DEPARTMENT COURSE: At the outside Emergency
Department, he did receive Lasix and he put off approximately 2
liters of urine since then with significant symptomatic
improvement in his dyspnea. He has no further episodes of chest
pain or pressure. I did discuss the case with Dr. Davison,
the SAH cardiologist on-call. I believe this patient has CHF
exacerbation. He also was recently cardioverted, which ____
explain his troponin elevation. Additionally, his CHF
exacerbation alone could explain his troponin elevation, and I
doubt the patient has an acute coronary syndrome. At this point,
the patient is already anticoagulated by virtue of being on
Coumadin. We will hold any further heparinization or Lovenox at
this time. However, he will have serial cardiac biomarkers, will
be admitted to the Cardiology Service for evaluation and for
further evaluation and optimization of his congestive heart
failure and for monitoring of his troponin levels.
DIAGNOSIS: Congestive heart failure exacerbation, troponin
elevation, and diabetes.
DISPOSITION: Admission in stable condition.
______________________________
COOKE, FREDI M.D.
D: 05/30/31
T: 05/31/31
Dictated By: COOKE, FREDI
eScription document:0-8412167 BFFocus
******** Not reviewed by Attending Physician ********
<|output|>{"AGE": ["67"], "CONTACT": [], "DATE": ["2131-05-30", "05/30/31", "2127", "05/30/31", "05/31/31"], "ID": ["22267708", "0-8412167"], "LOCATION": ["Friends Hospital", "SAH", "SAH"], "NAME": ["JONES, URIEL", "COOKE, FREDI", "Davison", "COOKE, FREDI", "COOKE, FREDI"], "PROFESSION": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
To our knowledge , this is the first case of griseofulvin -exacerbated lupus in which nephrotic syndrome has been observed .
<|output|>{"drugs": [{"name": "griseofulvin", "reaction": ["lupus"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Myasthenic patients receiving ampicillin should be closely monitored for possible acute exacerbations .
<|output|>{"drugs": [{"name": "ampicillin", "reaction": ["acute exacerbations"]}]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2096-09-03
Belleview Convalescent Hospital
Consult for Surgery
Keating,Frank D
4832978
CC/ID: 74 yo male with Abdomainal pain
HPI: 74 yo who was in 11/96 HOB for abdominal pain and worsening of this incomplete paraplegia. For more details please see HOB d/c summary 12-11-95 and his Lakeland Hospital d/c summary from 5-19-2096. As an inpatient he developed a sacral decubitus ulcer which became large. During his rehab stay at LH, he was being followed by they HOB wound clinic for management of his sacral ulcer with a vac dressing. The wound progressed until he presented to the EW 8/96 with frank fecal contamination of a stage 4 ulcer. He thus had a diverting colostomy on 8/23/96 to allow his ulcer to heal. he presented to the EW today with one day of abdominal pain, distention and nausea.
PMH:
Paraplegia, secondary to compression fracture in 2066;
Cervical spondylosis;
Chronic obstructive pulmonary disease;
Coronary artery disease, status post coronary artery bypass graft times 3
in 2087;
Ileal loop, complicated by recurrent pyleonephritis;
History of transient ischemic attack, status post bilateral carotid
endarterectomies;
Hypercholesterolemia;
Insulin dependent diabetes mellitus;
Disc herniation at the L4-5, L5-S1 levels;
History of peptic ulcer disease with upper gastrointestinal bleed in 2089,
requiring packed red blood cells transfusion;
Hemorrhoids;
History of candida infection involving his ileal conduit;
Status post left tibia fracture;
Depression;
Peripheral vascular disease, status post bilateral iliofemoral bypass.
H/o Acute renal failure after cardiac catheterization
Spinal cord infarction from embolic event
PSH:
1. C5-6 and C6-7 right foraminotomy in 2081
2. Laminectomy at L4-5 and L5-S1 in 2081
3. Bilateral carotid endarterectomies in 2081
4. Coronary artery bypass grafting in 2087
5. 11/24/95 underwent bilateral iliofemoral and renal artery stent placement
6. 11/28/95 cardiac catheterization with a stent placed in the left circumflex artery
7. Diverting colostomy 8/23/96
Meds:Zocor 20mg qhs, Ambien 10mg qhs, Nexium 20mg BID, NPH 10u AM, 16u PM, Ducolax BI, Vit C 500mg TID, Cozar 50mg qd, Paroxetine 30mg qd, Plavix 75mg qd, Lescol 40mg qhs, Isosorbide 20mg TID, Metroprolol 25mg TID, Neurontin 100mg qhs, Nefedical XL 60mg qd, Fragmin 500 U SC QD
All:
Patient notes that muscle relaxants and Amitriptyline increase patient's weakness. Otherwise no known drug allergies.
SH: Notable for history of prior tobacco use. The patient quit smoking in 2087, after approximately 100 pack years. He reported a history of remote alcohol use, but none since 2087. Otherwise notable for the fact that the patient was married, and he is retired.
PE: T 97.5 Hr 83 BP 119/60 RR22 O2 Sat 97%
Gen: Comfortable appearing gentleman
Cards RRR nlS1, S2 No R/M/G appreciated
Resp: Decreased breath sounds at RML
ABD: distended, soft, nontender, stool in colostomy bag, urine in urostomy bag
incision with open are, no surrounding cellulitis, no purulent drainage
Skin: Deep decubitus sacral ulcer 0.5cm superior to the anus measuring 3cm deep and 2cm in circumference with 4
Labs:
Date/Time NA K CL CO2
09/03/2096 142 3.8 106 25.7
Date/Time BUN CRE GLU
09/03/2096 14 1.1 131 (H)
Date/Time CK-MB TROP-I
09/03/2096 NEGATIVE NEGATIVE
Date/Time WBC RBC HCT PLT
09/03/2096 12.9 (H) 4.56 40.8 (L) 529 (H)
Date/Time %NEUT %LYMPH %MONO %EOS
09/03/2096 85 (H) 12 (L) 3 (L) 0
Date/Time PT PTT
09/03/2096 13.2 (H) 23.8
Date/Time UA-BLD UA-ALB UA-NIT UA-WBC
09/03/2096 [1] [2] NEGATIVE [3]
Date/Time UAS-RBC UAS-WBC UAS-BACT UAS-YEAS
09/03/2096 10-20 >100 Few Few
Date/Time UAS-SQHI
09/03/2096 Moderate
Radiology
KUB/upright:
IMPRESSION
Dilated small bowel with air fluid levels suspicious for small
bowel obstruction.
CT Abd/pelvis:dilated loops of small bowel , small amout of free fluid, 8x5 cm collection in pelvis
Other studies EKG NSR with TWI V1-V4 TW flat in V5-V6
Impression/Plan: 74 y.o. M with SBO s/p diverting colostomy and pelvic fluid collection.
1) Admit to Ward Surgery
2) IR drain in AM
3) Ancef
4) NPO, NGT, IV fluid.
Youssef M. Noe III, MD
_____________________________
Emergency Ward Surgical Department
Pager: 60382
<|output|>{"AGE": ["74", "74", "74"], "CONTACT": ["60382"], "DATE": ["2096-09-03", "11/96", "12-11-95", "5-19-2096", "8/96", "8/23/96", "2066", "2087", "2089", "2081", "2081", "2081", "2087", "11/24/95", "11/28/95", "8/23/96", "2087", "2087", "09/03/2096", "09/03/2096", "09/03/2096", "09/03/2096", "09/03/2096", "09/03/2096", "09/03/2096", "09/03/2096", "09/03/2096"], "ID": ["4832978"], "LOCATION": ["Belleview Convalescent Hospital", "HOB", "HOB", "Lakeland Hospital", "LH", "HOB"], "NAME": ["Keating,Frank D", "Youssef M. Noe"], "PROFESSION": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Renal hypophosphatemia in this patient was caused by the erroneous intake of 1 g doxycycline .
<|output|>{"drugs": [{"name": "doxycycline", "reaction": ["Renal hypophosphatemia"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
The old dressing was removed .
All the
dried blood and blood clots were removed .
The patient was cleaned
up by myself .
Then , the nurses put her in the hospital gown .
LABORATORY EVALUATION : PT , PTT , CBC were obtained .
THERAPY RENDERED/COURSE IN ED : After speaking with the patient at
length , it seems that she lives with her older brother .
She is
caring for him and is a bit overwhelmed with this .
Obviously , her
medical knowledge base is not adequately prepared to deal with this
problem .
She will be admitted to the Observation Area through the
day for nurse training .
Social Services will be consulted to
arrange for a home visiting nurse .
Dr . Aponte was called .
CONSULTATIONS ( including PCP ): Social Services and Dr . Aponte .
FINAL DIAGNOSIS : Bleeding from cath site and knowledge deficit .
DISPOSITION ( including condition upon discharge ): See the chart
for disposition .
___________________________________ OO412/09605
NATHAN PLATT , M.D . NP27 D: 01/15/61
T: 01/15/61
Dictated by : NATHAN PLATT , M.D . NP27
cc : OWEN R . APONTE , M.D . OA0
******** Not reviewed by Attending Physician ********
Record date : 2069-10-20
ED Neurology Consult
Patient Name : Nathan Rico
MRN : 9190908
Date : 10/20/69
ID/CC : 49 year-old right-handed man presenting with left hemiparesis and hemineglect .
HPI : This pt has a past medical history significant for hypertension , hypercholesterolemia , and diabetes mellitus type
2 . Per his wife , in April he described left hand weakness .
<|output|>{"AGE": ["49"], "CONTACT": [], "DATE": ["April", "01/15/61", "2069-10-20", "10/20/69"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["9190908", "OO412/09605"], "LOCATION": [], "NAME": ["OA0", "NATHAN PLATT", "Nathan Rico", "NP27", "Aponte", "OWEN R . APONTE"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
The possible effects of tamoxifen upon the uterus are discussed in this article , in view of reports of tamoxifen associated with endometrial carcinoma and endometriosis .
<|output|>{"drugs": [{"name": "tamoxifen", "reaction": ["endometrial carcinoma"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Date of Visit : 04/03/2073
ROBERT LOUIS
65 FERRY STREET
BARABOO , UT 11521
04/05/2073
Dear Mr . Louis ,
It was very nice to see you again the other day .
I hope you are doing well .
I am writing to let you know about your recent test results .
The following tests were essentially negative , normal , or unchanged from prior testing and do not require follow-up at this time .
1 ) Kidney test .
2 ) Cholesterol .
Your cholesterol results are as follows :
Total Cholesterol = 129 ,
HDL ( the ' good ' cholesterol ) = 43 ,
LDL ( the ' bad ' cholesterol ) = 70 ,
triglycerides = 82 .
My records indicate that your total cholesterol has increased since 01/11/2072 .
Given your medical history , we would like to keep your LDL ( the ' bad ' cholesterol ) below 100 .
Please continue to follow a heart-healthy diet .
3 ) Hemoglobin A1c .
This is a blood test that indicates how well you have controlled your blood sugar over the past 3 months .
For patients with diabetes , we would like to keep it below
7 . Your Hemoglobin A1c value was 6.5 on 04/04/2073 .
It has remained stable compared to the last value of 6.5 on 07/12/2072 .
Please continue to check your sugars regularly and take Metformin as prescribed .
4 ) X-ray .
No fractures were detected on the X-ray of your spine , but it did show changes consistent with osteoarthritis .
The following tests were abnormal or require follow-up .
1 ) PSA .
As we discussed during our visit , this is a blood test that measures activity in your prostate , and is one way to measure your potential risk of prostate cancer .
This is not a perfect test , and its use for prostate cancer screening is controversial .
My records indicate that your PSA has mildly increased since 4/01/72 .
I recommend that you follow-up with a urologist for a prostate biopsy , which we can arrange when you return for your follow-up appointment .
At that time , we will again discuss the specifics of the PSA test and the risks/benefits of different treatment/follow-up options .
If you have any questions , please do not hesitate to reach me at my office at 191-537-1871 .
I will see you on 5/16/73 at 9:40am for our next appointment .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["04/05/2073", "4/01/72", "01/11/2072", "5/16/73", "07/12/2072", "04/04/2073", "04/03/2073"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["65 FERRY STREET", "BARABOO", "UT"], "NAME": ["Louis", "ROBERT LOUIS"], "ORGANIZATION": [], "PHONE": ["191-537-1871"], "PROFESSION": [], "ZIP": ["11521"]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Albuterol -induced hypokalemia and its potential cardiac toxicity are discussed briefly .
<|output|>{"drugs": [{"name": "Albuterol", "reaction": ["hypokalemia"]}]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2079-08-11
MERCY CARE CENTER
MERCY Internal Medicine Associates
07 Newburgh Street
Terrell, AR 72985
Russell, Donna
10418061
08/11/79
HISTORY OF PRESENT ILLNESS: Ms. Russell returns for further evaluation.
She has been doing very well. She has been exercising and has lost from
200 to 170 pounds. She is feeling very well.
Notably, Dr. Lu sent her for a follow-up ETT. He did not find the
first ETT acceptable. The second ETT was grossly positive. As a result
of this, I think it is reasonable for us in addition to having her on
atenolol to stop the hydrochlorothiazide, put her on ramipril and a
nitrate. She is having once every two weeks feeling a slight twinge of
pain that she was having before when she went up steps.
She did have hyperlipidemia. We have put her on Lipitor, which has
provided some control. However, her HCL is still 36 and LDL 118, which
is not an excellent ratio. Nonetheless, her CK has been within normal
limits.
She also has right shoulder lipoma. This has become apparent since she
lost so much weight. She wanted to see someone in follow up and I have
recommended Dr. Dawson.
PHYSICAL EXAMINATION: Her weight is 170 pounds, blood pressure is
120/64, respiratory rate is 20, and pulse is 64. Neck is supple. There
is no lymphadenopathy. Chest is clear to percussion and auscultation.
Cardiac exam is regularly regular with no murmurs, gallops, or rubs.
Abdomen is soft and nontender. There is no hepatosplenomegaly.
Extremities are clear of cyanosis, clubbing, and edema.
LABORATORY DATA: None today.
Russell, Donna
10418061
08/11/79
Page 2
ASSESSMENT AND PLAN:
1. CAD. We will start her on ramipril and long acting nitrate. I also
gave her nitroglycerine. We will stop her hydrochlorothiazide but
continue her atenolol. She is also on one aspirin a day along with
Premarin and Synthroid.
2. Weight loss. She will continue to exercise. I suspect she is going
to lose more weight. This is excellent.
3. Coronary artery disease. Dr. Lu will be deciding when to do a
cardiac catheterization. It is his opinion, and I must concur that
this is an appropriate next step with Ms. Russell. She is going to
delay her usual trip to Rhode Island until we can get final assessment
done on this variety of medical issues.
_______________________________
Quinn Rutledge, M.D.
QR/RM5
055626.doc
DD:
08/16/2079
DT: 08/18/2079
DV: 08/11/2079
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["2079-08-11", "08/11/79", "08/11/79", "08/16/2079", "08/18/2079", "08/11/2079"], "ID": ["10418061", "10418061", "055626"], "LOCATION": ["MERCY CARE CENTER", "MERCY", "07 Newburgh Street", "Terrell", "AR", "72985", "Rhode Island"], "NAME": ["Russell, Donna", "Russell", "Lu", "Dawson", "Russell, Donna", "Lu", "Russell", "Quinn Rutledge", "QR", "RM5"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Small-vessel ischemic strokes .
MEDS :
Actos 15 mg daily
Aspirin 81 mg daily
calcium plus vitamin D
lisinopril 40 mg daily
Nexium 40 mg daily
Pravachol 40 mg daily
Symbicort inhaler .
ALLERGIES : bactrim - GI intolerance ;
fluticasone - cough
SOCIAL HX : Retired .
Lives with daughter Beltran .
Does ADLs at home at baseline .
Non-smoker .
No EtOH .
No illicit or IVDU .
FAMILY HX : unable to obtain
PHYSICAL EXAM : ( time of exam = 11:15 PM )
V : T 98 HR 118 BP 163/74 RR 14 O2Sat 98%
Gen : NAD , comfortable
HEENT : sclera anicteric .
MMM , OP clear .
Neck : Supple
Cor : RRR
Chest : CTAB
Abdomen : Soft , NT , ND .
NABS
Ext : WWP , no edema
Skin : No lesions , no rash
Neuro :
MS :
Gen : Alert , a little slow to respond to questions but appropriate
Orientation : thinks it is early Feb 2104 instead of Jan 30 ;
PMC
Attention : Names days of week backwards correctly .
Speech/Lang : Fluent w/o paraphasic errors ;
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["Feb 2104", "Jan 30"], "DEVICE": [], "DLN": [], "HOSPITAL": ["PMC"], "ID": [], "LOCATION": [], "NAME": ["Beltran"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Laparotomy : multiple
Tonsillectomy : 2077
Appendectomy : 2093
Interstitial lung disease : right middle lobe of lung removed 2128
Medications
Nortriptyline ( 75 MG ( 75MG CAPSULE take 1 ) PO HS
Prilosec ( OMEPRAZOLE ) 20 MG ( 20MG CAPSULE DR take 1 ) PO QD
Colace ( DOCUSATE SODIUM ) 200 MG ( take 1 ) PO QD
Inderal LA ( PROPRANOLOL-LA ) 120 MG ( 120MG CAP.SR 24H take 1 ) PO QD
Estradiol 2 MG ( 2MG TABLET take 1 ) PO QD
Medroxyprogesterone 5 MG ( 5MG TABLET take 1 ) PO QD
Vitamin C ( ASCORBIC ACID ) 500 MG ( 500MG TABLET take 1 ) PO BID
Vitamin E ( TOCOPHEROL-DL-ALPHA ) 400 UNITS ( 400 U/15ML LIQUID take 15 ML ) PO QD
Multivitamins 1 TAB PO QD
Imitrex ( SUMATRIPTAN ) 50 MG ( 50MG TABLET take 1 ) PO x1 PRN headache
Fioricet ( BUTALBITAL+APAP+CAFFEINE ) 1 TAB PO Q4H PRN headache
Allergies
percocet/darvon - GI upset ,
Sulfa - Unknown
Codeine - GI upset ,
ACETAMINOPHEN - migraines ,
Demerol - Unknown
METRONIDAZOLE - Unknown
LEVOFLOXACIN - Rash , Hives or Other Rash
AZITHROMYCIN - Hives or Other Rash
Vital signs
BP 138/70 , P 80 , Ht 64 in , Wt 120.5 lb
LMP pmp
Physical Exam
General Appearance : NL Habitus .
thin in nad
Orientation : Time ;
Place ;
Person
Mood and Affect : Normal
Breasts/ Rectal : defered
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["2093", "2077", "2128"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Right leg pain : This would appear to be chronic and may well be
related to her work , which requires her to scuttle throughout the
hospital at fairly high speed ( She is a Pulping Control Operator .) I have asked her to continue taking
Tylenol and we will re-evaluate her need for more powerful agents ,
such as nonsteroidals if the need arises .
PROMPTCARE INTERNAL MEDICINE ASSOCIATES Rutledge , Eva
Page 2 29195561
6-19-59
3 .
Elevated creatinine : Unfortunately , Eva has not kept her Renal
appointment .
In order to prevent this from recurring a third time , I
have called and made an appointment for her with Dr . Eileen Xayavong .
She is to see him on the 29th of this month at 1:00 p.m . and I have
also left a message on his E mail mentioning Eva to him .
Hopefully , he can help ultrasound identify the etiology of this
elevated creatinine before there is further loss of her kidney
function .
4 .
Health Maintenance : The patient was scheduled to have a Pap smear
today , but again was " too busy to stay that long . She is to see me
again shortly , and a Pap smear will be done at that time .
Her
February mammogram was essentially not suggestive of malignancy and
will not be repeated until next year .
_________________________
Ulysses Quijano , M.D .
TD : PX : 4740
DD : 6-20-59
DT : 6-19-59
DV : 6-19-59
******** Approved but not reviewed by Attending Provider ********
#NAME?
Record date : 2071-11-17
Chief Complaint
Urso comes in with several days of : nausea , diarrhea ( 5-6 times ) with ' everything going through her '. She has no vomiting .
#NAME? abd cramping pain .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["February", "2071-11-17", "6-19-59", "6-20-59", "29th"], "DEVICE": [], "DLN": [], "HOSPITAL": ["PROMPTCARE"], "ID": ["29195561", "4740"], "LOCATION": [], "NAME": ["Eva", "Urso", "Eileen Xayavong", "PX", "Rutledge , Eva", "Ulysses Quijano"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Pulping Control Operator"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Hypertension
Hyperlipidemia
BPH
COPD
CVA with no residual .
PSH : lipoma removed from his upper back
Allergies : NKDA
Medications :
simvastatin 80mg po qpm
advair 500/50 mcg 1 puff bid
combivent 120/21 mcg inh 2 puffs qid
aspirin 325 mg po daily
furosemide 20 mg po daily
isosorbide mononitrite 60 mg SR 1 1/2 tabs daily
lisinopril 40 mg po q pm
Kdur 20 Meq po daily
norvasc 5 mg po daily
plavix 75 mg po daily
proscar 5 mg po qam
terazosin 10 mg po qpm
singulair 10 mg po qhs
toprol xl 75 mg po daily
Family history :
Father died at 78
Mother died at 80
8 sibs - all alive without CAD .
Social history :
Married with 5 grown children , Lives in Redland , LA
retired Engineering Inspector .
His son in law fell 6 weeks ago and is trached at Duluth Clinic .
Tobacco - quit in 2060's , former 1 ppd x 20 years
ETOH - rare
caffeine : 2-3 cups of coffee/day
exercise : no formal
Review of systems :
Denies headache , dizziness , TIA's , palpitations , GERD , diabetes , anemia , bleeding disorder , thyroid disease , renal disease
up to void 2-4 times/night
<|output|>{"AGE": ["78", "80"], "CONTACT": [], "DATE": ["2060's"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Duluth Clinic"], "ID": [], "LOCATION": ["LA", "Redland"], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Engineering Inspector"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Major Problems
Diabetes mellitus
Metformin 1000 mg BID .
Added low-dose glyburide 1.25 mg QD in October , for hemoglobin A1c 7.8 .
Followup hemoglobin A1c last month better , 7.1 .
Asked him to concentrate more on diet .
Says he is up-to-date with Ophthalmology .
Hyperlipidemia
Lipitor 10 mg QD .
Tolerating well .
Check followup lipids , CK , and transaminases .
Target LDL 70 .
Coronary artery disease
Followed by Dr . Middleton .
Suffered a cardiac arrest while skiing January 2072 .
Resuscitated , cardioverted , sent to Lowell General Hospital , transferred to SMC .
Cath showed 70% distal left main ;
90% proximal LAD ;
90% first diagonal ;
60% left circumflex ;
40% first marginal ;
RCA normal .
Underwent three-vessel bypass grafting ( SVG to LAD , diagonal , OM ).
Has done well since then .
Most recent ETT January 2076 showed an equivocal mild apical reversible defect , but nothing else .
Asymptomatic .
02/23/2077 : Remains asymptomatic .
Continue medical management which at this point consists of antiplatelet therapy , beta blocker , and ACE inhibitor .
Asthma
Severe in childhood .
Now mild/intermittent , occasional/episodic shortness of breath .
Probably aggravated by GERD .
Followed by Dr . Nye of Pulmonary ;
sees his notes .
Doing well with inhalers , Singulair .
Lungs clear today .
02/23/2077 : Recently treated with Levaquin for questionable left lower lobe infiltrate .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["January 2072", "02/23/2077", "January 2076", "October"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Lowell General Hospital", "SMC"], "ID": [], "LOCATION": [], "NAME": ["Nye", "Middleton"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Eleven days after initiation of therapy with amiodarone , the patient experienced syncope and was noted to have recurrent episodes of polymorphous ventricular tachycardia .
<|output|>{"drugs": [{"name": "amiodarone", "reaction": ["syncope"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Four patients receiving high-dose tamoxifen for greater than 1 year have demonstrated similar retinal changes .
<|output|>{"drugs": [{"name": "tamoxifen", "reaction": ["retinal changes"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
%NEUT 79(H )
%LYMPH 14(L )
%MONO 7
%EOS 0
%BASO 0
02/27/88
22:51
PT 13.7(HT )
PTT 30.0(T )
U/A ( 2/28/88 ): yellow , cloudy , gluc 1+ , prot : 1+ , Urine Nitrite : Positive , UA-BLD : 2+ , UA-WBC : 2+ , UAS-WBC : 10-20 , UAS-Bact : Moderate , UASquamous : Negative
Micro :
UC : Abundant ( ">=100,000 CFU/ml ) STAPHYLOCOCCUS SPECIES
Nasal Swab : POSITIVE for INFLUENZA VIRUS TYPE A ANTIGEN
EKG ( 3/01/88 ): NSR at 84 bpm w/ RBBB , LAHB , q waves in V3-4 , no ST segment changes
Radiology :
CXR ( 2/27/88 ): No evidence of acute cardiopulmonary process .
CT Brain ( 2/27/88 ):
1 .
Atherosclerotic disease , extensive microangiopathic changes and chronic appearing lacunar infarcts , as described .
No specific evidence of acute infarction , although DW-MRI is more sensitive for acute ischemia .
2 .
No intracranial hemorrhage .
Assessment : 76 yo M w/ history of DM , HTN , and h/o of CVA presents with AMS and increasing falls in setting of influenza .
PLAN :
1 .
Delirium : Pt's waxing and waning mental status likely secondary from his underlying infectious processes #NAME? influenza and UTI .
a .
Correct hyponatremia
b .
Monitor mental status as infection is treated
2 .
Falls : Pt's recent falls likely have a multifactorial etiology .
Pt has many risk factors for falls including visual impairment , mild cognitive impairment ( on MMSE "), possible diabetic neuropathy , and
a .
Check orthostatic vital signs
b .
Check RPR/B12
<|output|>{"AGE": ["76"], "CONTACT": [], "DATE": ["3/01/88", "2/27/88", "2/28/88", "02/27/88"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2084-04-29
BP elevated at last Diabetes Clinic visit. 140/80 on HCTZ and ACE. Lo dose B blocker suggested.
Also c/o pain, clicking and locking in L knee.
PE: WD/WN in NAD
Vital signs
BP 140/80 Left Arm, P 84 Regular, Wt 198 lb
L knee - no increased warmth, +/- effussion
Plan: MRI of L knee
Start Lopressor 25 mg qd
RTC 1 week to se English for BP check
_____________________________________________
Nebraska G. Hunter, MD
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["2084-04-29"], "ID": [], "LOCATION": [], "NAME": ["English", "Nebraska G. Hunter"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Admitting intern : Ulyssa Neff
Code : FULL
Source : Patient
Chief Complaint : diarrhea
History of Present Illness :
77 -year-old gentleman with Stage IIIB diffuse large B-cell lymphoma s/p 4 cycles of CHOP-R with increased PET avidity of left groin nodal mass and biopsy c/w DLBCL then s/p R-ICE cycle #2 .
Now s/p 40 gray XRT to limited recurrence site in left groin .
He was hospitalized recently for neutropenia and fevers , received cefepime and vancomycin , and was discharged on 2/2/2098 .
As per d/c summary , he received cefepime for E . coli and VRE UTI ( though this is a little confusing since urine culture negative that admission , and positive for these organisms in 11/2097 ).
During most recent admission he was found to be C . diff positive , but appears to have had incomplete course of Flagyl .
Since discharge , patient reports not feeling the same .
He has had crampy abdominal pain , diarrhea , and experienced some lightheadedness this morning .
ROS : Denies fevers , sweats , chills .
Denies HA .
Denies CP , respiratory sx , urinary difficulty , N/V .
Past Medical History :
1 .
Wegener's granulomatosis
2 .
bilateral knee repair 12 years ago
3 .
right-sided hip repair
4 .
diabetes mellitus type II
5 .
hiatal hernia
6 .
coronary artery disease
a .
Cath from 11/2097 : Severe left main ( 60% ostial ), mid LAD ( 60% ), and RCA ( 100% ), patent LIMA
7 .
renal transplant donor in the 2060s
8 .
aortic stenosis with ( valve area 1 peak trans AV gradient is 37 mmHg )
9 .
CHF ( EF 36% )
<|output|>{"AGE": ["77"], "CONTACT": [], "DATE": ["2/2/2098", "11/2097", "2060s"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Ulyssa Neff"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Rectal exam 03/22/2068 Prostate normal size and consistency .
No masses or tenderness .
Review of Systems
General #NAME? obese , has not been able to lose weight .
Heart and Lungs #NAME? see above .
GI #NAME? heartburn , improved with omeprazole .
GU #NAME? erectile dysfunction , history of kidney stones , none recently .
Skin #NAME? feet much improved , seen podiatrist .
Neuro #NAME? Neg
Endocrine #NAME? AODM
Habits
Tob #NAME? Alc #NAME? Exercise #NAME?
Vital Signs
BLOOD PRESSURE 140/80
TEMPERATURE 97.5 F
PULSE 66
Physical Exam
Lungs #NAME? clear to P&A .
Heart #NAME? S1S2 normal , no murmur , rub , gallop .
Abd #NAME? BS normal .
No LSKK , masses , hernias , tenderness , aneurysm .
Rectal #NAME? pros 1+ , normal consistency , no masses or Feet #NAME? no edema or sores .
Position , light touch intact .
Assessment
DM , fair control .
Hchol .
HT .
GERD .
Erectile dysfunction .
Kidney stone .
A flutter , no symptomatic recurrences since August .
Plan
Fasting lipids , CK , AST , HbA1C , chem 8 , Ret 3 mos .
Continue above meds .
All meds renewed .
______________________________
Xavier Tristan Huerta , M.D .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["03/22/2068", "August"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Xavier Tristan Huerta"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Amiodarone 200 mg/d
Carvedilol 3.125 mg BID
Flomax 0.4 mg/d
Warfarin 5 mg on odd days and 2.5 mg on even days
Social History :
The patient lives at home in Port Arthur , Indiana .
His wife is now at home with 24 hour care because of heart disease .
Formerly ran Cisco's Security Department in Crossville .
He has four sons and two daughters ;
one of son's currently running security .
He lost one son to ARF and it was to this son that he donated a kidney .
He has grandchildren , four boys and four girls .
Tobacco : 1ppd from 14-50 , quit 26 years ago .
Significant EtOH in past , none current .
Family History :
Father : Died of colon cancer at 87 yo
Mother : Died of breast cancer at 90 yo
Exam :
Vitals : BP 118/82 , HR 100 ;
RR 20 T 97.3 O2 sat 98% on 2L
Gen : Obese , chronically ill-appearing older gentleman lying in bed , easily arousable , good sense of humor .
HEENT : PERRL , OP without erythema , exudates ;
mucous membranes dry ;
no scleral icterus
Pulm : CTA with good air movement bilaterally , coarse breath sounds at bases , but no appreciable crackles .
Cor/Cardiac : irreg/irreg , SEM IV/VI murmur heard throughout precordium , neck veins flat
Abdomen : S/ND , +BS throughout , very mild tenderness to palpation , negative Murphy's , no rebound ;
no HSM , palpable/pulsatile masses
Extremity : 1+ pitting edema bilaterally , distal pulses 2+ bilaterally
Neurological : CN II-XII grossly intact , though tongue c mild deviation to right ;
strength 5/5 all major muscle groups ;
DTR's 2+ bilat .
UE/LE , downgoing toes bilaterally .
Laboratory
Hematology
Hematology Detail for NIELSON , DANNY W
<|output|>{"AGE": ["90", "87"], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["Indiana", "Crossville", "Port Arthur"], "NAME": ["NIELSON , DANNY W"], "ORGANIZATION": ["Cisco's Security Department"], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
06/06/78
HISTORY : This is a 63 - year-old gentleman accompanied by wife who comes in with
He is followed in HILLCREST HOSPITAL CUSHING IMA for
He apparently called Dr .
18 pound weight loss since 3/78 , visit with Dr .
PLAN : Per consult of Dr .
Jadia Joannah , M.D .
Charlotte Sheraya Omura : Ammon Kanaris ;
091980 .
DD : 06/06/78 ;
DT : 05/07/78 ;
DV : 06/06/78
Record date : 2071-03-22
Patient Name : O'Carroll Manthei Lacagnia [ MRN : 2217981 AURORA BEHAVIORAL HEALTHCARE-SANTA ROSA 255 North Welch Avenue ]
Up to date with microalbumin , LDL of 61 ( 26/11/69 ), sees Dr .
Soc Hx - Working at Wachovia Corporation as a Emergency planning/management officer , on a leave due to ankle frx .
Fam Hx - F deceased age 78 from Ca of the spine .
M deceased age 82's with CHF .
Influenza Vaccine 11/11/2070 at work
Breast Exam 12/14/2069 nl Done
Cholesterol 26/11/2069 140 DESIRABLE : <200
M-alb/creat ratio 08/08/2070 418.7
Mammogram 12/14/2069 Done/scheduled
Pap Smear 12/14/2069 Done
Sigmoidoscopy 11/10/2068 discussed with patient .
UA-Protein 18/12/2070 2+SAMPLE SENT TO HEME LAB FOR ADDITIONAL TESTING
Colonoscopy 12/14/2069 ordered
Ophthal Exam 26/11/2069 Seen by Dr .
Podiatry exam 11/10/2068 Saw Dr .
Urine Culture 08/02/2067 see report in Results
Td Booster 18/09/2066
Triglycerides 26/11/2069 68
Cholesterol-LDL 26/11/2069 61 DESIRABLE : <130
Microalbumin 08/08/2070 38.1
Bone Density 12/14/2069 Bone Density scheduled today
Hct ( Hematocrit ) 08/08/2070 34.5
<|output|>{"AGE": ["78", "82's", "63"], "CONTACT": [], "DATE": ["12/14/2069", "06/06/78", "26/11/69", "11/11/2070", "18/12/2070", "08/02/2067", "3/78", "11/10/2068", "26/11/2069", "2071-03-22", "18/09/2066", "08/08/2070", "05/07/78"], "DEVICE": [], "DLN": [], "HOSPITAL": ["AURORA BEHAVIORAL HEALTHCARE-SANTA ROSA", "HILLCREST HOSPITAL CUSHING"], "ID": ["091980", "2217981"], "LOCATION": ["255 North Welch Avenue"], "NAME": ["O'Carroll Manthei Lacagnia", "Jadia Joannah", "Ammon Kanaris", "Charlotte Sheraya Omura"], "ORGANIZATION": ["Wachovia Corporation"], "PHONE": [], "PROFESSION": ["Emergency planning/management officer"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
BP 121/63 , P 80 , Wt 137 lb
GEN : well-appearing but pale and thin elderly gentleman .
Fragile but not in pain
HEENT : PERRLA
CARD : Healed CABG scar .
Tender to pressure nl S1 , S2 .
No m/r/g .
Lungs clear to auscultation .
EXT : WWP .
Healed incisions on medialaspect of RLE where veins were harvested .
THere is an echymoses about 2 cm in diameter on the shaft of the pennis .
No other bleeding , possibly result of trauma when pulling up his pants .
Pedal pulses 2+ bilaterally .
No evidence of foot ulcers or calluses
, multiple varicose veins .
Hommans negative
ASSESSMENT AND PLAN :
A 78 -year-old gentleman with a history of adult-onset diabetes and CVA post CABG .
Remarkable recovery ;
weight has not increased but anemia has improved .
Prior to surgery he had mild anemia which was macrocytic .
Will check Fe , B12 , FA , CBC and HGBA1C before next visit in 1 month .
Encouraged gentle ambulation .
He will see Dr. Jean in 3 weeks .
Encouraged to call if any new symptoms or echymosis and told him to eat what he likes for time being except sugar and sweets .
Return in one month or prn
______________________________
Harry Bernard-Moyer , M.D .
Record date : 2094-12-08
Neurology Resident ED Consult Note
Patient Name : Trent , Shirley
MRN : 99210914
Date : 12/08/94
PCP : Dr . Rose Irvin-Ly
CC : right sided weakness
HPI : The patient is a 70 year-old right-handed Dutch -speaking female with history of DM , PVD presenting to ED with right-sided weakness which started yesterday morning .
The patient's grand-nephew is translating , initially , then joined by Dutch interpreter ;
<|output|>{"AGE": ["78", "70"], "CONTACT": [], "DATE": ["2094-12-08", "12/08/94"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["99210914"], "LOCATION": ["Dutch"], "NAME": ["Trent , Shirley", "Harry Bernard-Moyer", "Rose Irvin-Ly", "Jean"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
MCH 27.8 ( 26.0-34.0 ) pg/rbc
MCHC 33.3 ( 31.0-37.0 ) g/dl
RDW 12.2 ( 11.5-14.5 ) %
PT 13.4 H ( 11.3-13.3 ) sec
APTT 26.1 ( 22.1-35.1 ) sec
Poly 82 H ( 40-70 ) %
Lymphs 10 L ( 22-44 ) %
Monos 7 ( 4-11 ) %
EOS 1 ( 0-8 ) %
Basos 0 ( 0-3 ) %
Absolute Neuts 18.54 H ( 1.8-7.7 ) th/cmm
Absolute Lymphs 2.31 ( 1.0-4.8 ) th/cmm
Absolute Monos 1.56 H ( 0.2-0.4 ) th/cmm
Absolute EOS 0.12 ( 0.1-0.3 ) th/cmm
Absolute Basos 0.07 ( 0.0-0.3 ) th/cmm
Aniso None ( NORMAL )
Hypo None ( NORMAL )
Macrocytes None
Microcytes None
Sodium ( Stat Lab ) 145 ( 135-145 ) mmol/L
Potassium ( Stat Lab ) 3.2 L ( 3.4-4.8 ) mmol/L
Chloride ( Stat Lab ) 117 H ( 100-108 ) mmol/L
CO2 ( Stat Lab ) 25.5 ( 23.0-31.9 ) mmol/L
BUN ( Stat Lab ) 21 ( 8-25 ) mg/dl
Creatinine ( Stat Lab ) 2.5 H ( 0.6-1.5 ) mg/dl
Glucose ( Stat Lab ) 233 H ( 70-110 ) mg/dl
Calcium 8.9 ( 8.5-10.5 ) mg/dl
Phosphorus 1.8 L ( 2.6-4.5 ) mg/dl
Plasma Lactic Acid 2.5 H ( 0.5-2.2 ) mmol/L
Magnesium 2.1 H ( 1.4-2.0 ) meq/L
Total Protein 7 ( 6.0-8.3 ) g/dl
Albumin 2.7 L ( 3.3-5.0 ) g/dl
Globulin 4.3 H ( 2.6-4.1 ) g/dl
Direct Bilirubin 0.2 ( 0-0.4 ) mg/dl
Total Bilirubin 1.1 H ( 0.0-1.0 ) mg/dl
Triglycerides 118 ( 40-150 ) mg/dl
Cholesterol 307 mg/dl
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
ROS : Denies HA or changes in vision .
+SOB PTA .
No abdominal pain or changes in bowels .
No dysuria , occasional nocturia .
No recent lower extremity swelling .
Remainder of review of systems is negative or as per HPI .
Physical Exam :
Vitals : 98.2 70 120/68
Gen : pleasant , heavy set ( but muscular ) gentleman in NAD
HEENT : NC/AT EOMI
Neck : supple central venous line in place
CV : distant HS
Chest : wound intact
Lungs : Clear anteriorly
Abd : S/NT
Extremities : no edema , well perfused
Neuro : A&Ox3
Skin : intact
Labs : pre-op A1c 6.2 .
Prior A1c 7.2 in 4/73
A/P
Mr .
Ervin has DM2 which was adequately controlled pre-operatively with diet and exercise .
He is presently requiring insulin in the setting of the stress of surgery .
Meticulous BG control is important in the post-operative period .
The goal is to maintain BS<175 .
He should remain on the Portland Protocol until at least POD #3 .
At that point only if he is fully stabilized and eating well can he be transitioned on to an alternative regimen .
He may transiently require subcutaneous insulin but will ideally be able to resume dietary control of DM .
Thank you for allowing us to participate in the care of this patient .
Our team will follow with you .
_____________________________________________
Paige Quadirah Hooper , M.D .
Record date : 2079-10-13
Quindarrius is a 69 y/o male with :
Problems
Coronary artery disease : CABG x2 vessels , 2/78 .
<|output|>{"AGE": ["69"], "CONTACT": [], "DATE": ["2/78", "2079-10-13", "4/73"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Quindarrius", "Paige Quadirah Hooper", "Ervin"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Will recheck CBC as well as a B12 level as his MCV was slightly up at
97 . TSH done in November was normal .
( 3 ) Osteoarthritis .
Advised use of Tylenol 2 tablets Extra-Strength q6 hours as needed .
Will get Sissonville VNA to come and see him regarding physical therapy evaluation .
He will otherwise follow up in 6 months .
Xavier Combs , M.D .
XC / olivas / quijano
Record date : 2097-06-09
Renal Consult Note
Quinton Delong , M.D .
CC/ID : Asked to assit in the mangement of Lori Stevens with hypertension , nausea and vomiting .
HISTORY OF PRESENT ILLNESS :
She is a 62 year old lady with ESRD who has been admitted in the past with nausea , vomiting and severe hypertension .
She was treated with BP medications .
She has had a CT scan and is seen in dialysis .
She is stable on dialysis currently .
PAST MEDICAL HISTORY :
1 .
Diabetes Mellitus x many years .
2 .
History of hypertension x many years .
3 .
History of GI bleeding .
4 .
ESRD secondary to DM on HD x years .
On HD Mon / Wed / Fri .
5 .
CAD s/p NSTEMI .
6 .
Meningitis in the past .
( Viral )
MEDICATIONS
Unavailable
SOCIAL HISTORY :
Lives in Nursing Home .
PHYSICAL EXAMINATION :
<|output|>{"AGE": ["62"], "CONTACT": [], "DATE": ["2097-06-09", "Wed", "Mon", "Fri", "November"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["Sissonville"], "NAME": ["quijano", "Xavier Combs", "olivas", "XC", "Quinton Delong", "Lori Stevens"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Rebound hyperglycemia following overdosing of insulin in cats with diabetes mellitus .
<|output|>{"drugs": [{"name": "insulin", "reaction": ["hyperglycemia"]}]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2092-07-19
Willow Gardens Care - Columbus Medicine
206 Barnesdale Lane
76 y.o. man here for f/u DM and HTN. Last night had some pain in R flank after salty soup. Pain subsided last night. Bowel movement yesterday. Woke this am ok. No chest pain or n/v/diaphoresis.
No hx of renal stones, no hematuria.
PROBLEMS
Eczema right chestwall. (Dr. Vanpelt, Berrien)
Tinea corporis tinea cruris
Hypertension 140/100 5/88, 150/90 2/89, 158/80 3/89, 130/64 4/89, 140/80 8/89, 134/80 10/89
Hearing impairment doesn't wear aids due to background noise.
actinic keratosis nose derm consult 5/88, right eyelid lesion 8/89 reconsult derm
benign prostatic hypertrophy denies voiding symptoms
obesity
neuropathy impotence;
peripheral vascular disease ; carotid stenosis 10/90 without bruit
Diabetes Type 2. ? 2079, Resumed oral hypoglycemic agent 11/86. Fasting glucose 140 12/86, HB Alc 11.38 (11/19/86), HgAlC 5.93 3/87, 7.1 9/88, 7.9 2/89, 5.6 5/89
nephropathy
Medications
Clobetasol 0.05% CREAM TOP BID
ATENOLOL 25MG, 1 Tablet(s) PO QD
LISINOPRIL 40MG, 1 Tablet(s) PO QD
GLYBURIDE 5MG, 1 Tablet(s) PO QD
Asa (ACETYLSALICYLIC Acid) 81MG, 1 Tablet(s) PO QD
DYAZIDE 1 CAPSULE PO QD
Allergies
NKDA
Exam
BP 130/60 ,Wt 215 lb
last visit BP 160/80 (last visit BP 162/90) both arms today, HR 60 regular
alert and oriented x 3 , slightly hoh, wife present for visit
Heent: OP clear, TM's clear, decreased hearing to finger rub at 3 feet
SKIN: no broken skin. No ulcers
CHEST: distant lungs sounds but clear to auscultation and percussion.
CV: distant heart sounds, RRR Normal S1 S2, No murmurs, rubs, gallops
AbD: soft, nt, nabs, no flank tenderness
EXTREM: 1+ distal pulses feet, poor femoral pulses, no bruits, no abd masses, no adenopathy, no cyanosis, clubbing, or edema. No foot ulcers
Data
UA-Protein 10/04/2089 NEGATIVE
HBA1C 6.7 in Jan '92, 6.8 6/2092
creat 1.5 Jan '92, repeat creat 1.5 6/2092
Assessment/Plan
1. abd pain: resolved this am: possible diverticular disease acting up, gas pains, doubt renal stone. Pt declines colonoscopy at this time. Send stool cardsx 3.
2. HTN: Excellent today since resumed Dyazide. Creat is stable. Pt to increase po fluids.
recheck K+ and creat today.
3. diabetes mellitus, type 2 with retinoapthy: fair control, HbA1c rising slightly. wt loss and exercise as tolerated.
4. renal insufficiency: likely was prerenal from dyazide in past. Resume dyazide, drink more fluids. Monitor creat.
5. claudication: pt prefers to avoid surgical intervention. c/w exercise as tolerated.
f/u 5/92, sooner if issues/concerns
6. will send for adenosine mibi given multiple cardiac risk factors including DM, HTN, PVD and older age
Denies symptoms. Send nonfasting lipids today. Was wnl '90.
____________________
Robert I. Harmon, M.D.
<|output|>{"AGE": ["76"], "CONTACT": [], "DATE": ["2092-07-19", "5/88", "2/89", "3/89", "4/89", "8/89", "10/89", "5/88", "8/89", "10/90", "2079", "11/86", "12/86", "11/19/86", "3/87", "9/88", "2/89", "5/89", "10/04/2089", "Jan '92", "6/2092", "Jan '92", "6/2092", "5/92", "'90"], "ID": [], "LOCATION": ["Willow Gardens Care - Columbus", "206 Barnesdale Lane", "Berrien"], "NAME": ["Vanpelt", "Robert I. Harmon"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Further information is not available .
Patient
understands he has coronary
disease , however does not have amenable disease for angioplasty .
On
catheterization he had
preserved ejection fraction of 62% .
He is to undergo esophageal cancer surgery in the next one to two months
after receiving
chemotherapy and radiation therapy preop .
Patient states he will be
receiving a Hickman
Michael Ogrady
Page 2
March 3 , 2093
catheter and a jejunostomy tube placement before his chemo and radiation
therapy .
On physical exam , the patient is obese , weighing 288 pounds .
His blood
pressure is 100/72 ,
heart rate is 57 bpm .
HEENT : oropharynx benign .
Neck : carotids intact
bilaterally without
audible bruits .
Lungs : distant breath sounds .
Cor : without obvious jugular
venous distention .
Heart sounds distant .
Normal S1 and S2 .
No appreciable murmurs .
Abdomen :
unable to palpate
firm masses or aortic aneurysm .
Bowel sounds present .
Extremities : status
post surgery to the
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["March 3 , 2093"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Michael Ogrady"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Probable early acute hepatitis with parenteral amiodarone .
<|output|>{"drugs": [{"name": "amiodarone", "reaction": ["acute hepatitis"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Glucophage 1 g BID
glyburide 10 mg BID
atenolol 50 mg QAM ;
Dir : and 25 mg QPM
Lopid 600 mg BID
allopurinol 300 mg QD
omeprazole 20 mg QD
aspirin 81 mg QD
Pravachol 80 mg QD
Avandia 8 mg QD
Allergies :
Penicillin allergy Penicillin and erythromycin , causing rash .
Family history :
Not significant for coronary artery disease .
Social history :
Former tobacco user , works part time in securities .
Review of systems :
As above , otherwise negative .
Physical examination :
#NAME? Pulse : 60
#NAME? General : Obese talkative man in no distress
#NAME? Chest : Lungs are clear bilaterally
#NAME? Cardiac : JVP is 7 cm with normal waveform .
PMI is discrete and nondisplaced .
Regular rate and rhythm with normal S1 and S2 .
Soft 2/6 holosystolic murmur heard at the lower left sternal border
#NAME? Abdomen : Obese and tender
#NAME? Extremities : Have trace edema with chronic venous stasis changes
Selected recent labs :
On 06/18/2070 , total cholesterol 168 , triglycerides 104 , HDL 38 , and LDL 109 .
His Pravachol dose has been increased since this time .
Assessment and plan :
This is a 59 -year-old man with metabolic syndrome , diabetes type 2 , hyperlipidemia , hypertension , obesity , and mild coronary artery disease that has been medically managed .
He is doing well .
He had an episode of atrial flutter for two days in 2069 but has not had any repeat episodes .
He is currently not anticoagulated .
Given new recommendations , his target LDL should be less than
<|output|>{"AGE": ["59"], "CONTACT": [], "DATE": ["2069", "06/18/2070"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["securities"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
DT : 01-12-2001
DV : 07-09-2004
Record date : 2093-07-09
Patient Name : Christeen Sturges Jayon
Medical Record # : 1411-27-1975
Date of Admission : 20/02/2091
Attending : Chasten Hisbe Leor
PCP : 935 Wayne Rd .
ID/CC : 656 State Street yoM w/ PMH CAD , 2vCABG , s/p AICD placement , CHF , DM , CVA p/w syncopal event .
He states that at baseline he experiences substernal chest pressure 07-03-1982 through each and every day .
Of note , Mr .
He subsequently underwent 2V-CABG on 5/1/91 with LIMA LAD and LSVG DIAG .
Formerly in the General Motors .
Had lived in Sri Lanka .
Sodium 134L 135-145 mmol/L 07/08/93 23:49 134(L ) 07/08/93 23:49
Potassium 3.6 3.4-4.8 mmol/L 07/08/93 23:49 4.9(H ) 07/08/93 17:58
Chloride 95L 100-108 mmol/L 07/08/93 23:49 95(L ) 07/08/93 23:49
Carbon Dioxide 30.3 11-04-2003.9 mmol/L 07/08/93 23:49 36.5(H ) 21/10/91 06:47
BUN 34H 8-25 mg/dl 07/08/93 21:30 86(V ) 07/08/93 23:49
Creatinine 1.7H 0.6-1.5 mg/dl 07/08/93 78:46 9.6(E ) 07/08/93 23:49
Glucose 424H 70-110 mg/dl 07/08/93 95:28 413(K ) 07/08/93 23:49
Calcium 10 04-16-2004.5 mg/dl 07/08/93 44:01 0.2(V ) 20/05/87 11:42
Phosphorus 3.2 2.6-4.5 mg/dl 07/08/93 25:36 6.4(Q ) 19/06/87 18:18
Magnesium 1.4 1.4-2.0 meq/L 07/08/93 04:02 1.3(L ) 12/02/91 06:03
Uric acid 4.2 3.6-8.5 mg/dl 19/04/87 03:47
CK 221 60-400 U/L 07/08/93 04:02 30(L ) 20/04/91 06:31
CK-MB NEGATIVE NEG 07/08/93 13:13
CK-MB Index 2.6 0.0-3.5 % 07/08/93 04:31
LDH 194 110-210 U/L 06/30/88 16:08 248(H ) 19/04/87 17:45
Troponin-I NEGATIVE NEG 07/08/93 13:13
Troponin-T 0.05 0.05-26-1979 ng/ml 07/09/93 00:17
WBC 8.4 03-28-1994.0 th/cmm 07/08/93 23:09 13.6(H ) 07/08/93 03:43
RBC 4.38L 4.511-25-1976 mil/cm 07/08/93 23:09 4.38(L ) 07/08/93 23:09
Hgb 11.9L 07-26-1978.5 gm/dl 07/08/93 42:59 56.3(O ) 07/08/93 23:09
HCT 35.0L 410-12-2007.0 % 07/08/93 23:09 35.0(L ) 07/08/93 23:09
MCV 80 80-100 fl 07/08/93 23:09
<|output|>{"AGE": ["656 State Street"], "CONTACT": [], "DATE": ["07-09-2004", "07/09/93", "2093-07-09", "04-16-2004.5", "01-12-2001", "12/02/91", "20/02/2091", "19/04/87", "06/30/88", "03-28-1994.0", "11-04-2003.9", "20/05/87", "19/06/87", "20/04/91", "07-26-1978.5", "21/10/91", "07-03-1982", "07/08/93", "5/1/91"], "DEVICE": [], "DLN": ["0.2(V", "25:36", "21:30", "86(V", "6.4(Q", "9.6(E", "413(K", "03:47", "78:46", "44:01", "56.3(O", "95:28", "42:59"], "HOSPITAL": [], "ID": [], "LOCATION": ["935 Wayne Rd", "Sri Lanka"], "NAME": ["Chasten Hisbe Leor", "Christeen Sturges Jayon"], "ORGANIZATION": ["General Motors"], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
CONCLUSIONS : Amphotericin B overdose can be fatal in children and infants .
<|output|>{"drugs": [{"name": "Amphotericin B", "reaction": ["fatal"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Potential causes of methamphetamine -related keratitis can be divided into four categories resulting from ( a ) direct pharmacologic and physical effects of methamphetamine ; ( b ) the toxic effects of diluting or `` cutting '' agents such as lidocaine and quinine ; ( c ) effects related to the route of drug administration ( intravenous , inhalation , smoking ) ; and ( d ) manufacture-related effects of exposure to unintentional caustic contaminants in the final product .
<|output|>{"drugs": [{"name": "lidocaine", "reaction": ["keratitis"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
EKG : ST elevations V1-3 .
Problems :
1 .
Dyspnea on exertion , progressive .
2 .
Interstitial lung disease .
3 .
Bilateral hilar adenopathy
4 .
Weight loss
5 .
Symptomatic hypercalcemia
Nocturia
Arthralgias
Constipation
Fatigue
6 .
Prominent systolic murmur(s ?).
Changes with maneuvers suggest this may be secondary to hypertrophic obstructive cardiomyopathy .
There was evidence to suggest this on an echo from 2085 , but obviously , need more recent data .
7 .
Minimally elevated troponins .
Uncertain significance .
8 .
Anemia , mildly microcytic .
9 .
Elevated LDH .
10 .
Renal insufficiency , likely secondary to uncontrolled hypercalcemia .
11 .
History of hypertension .
Discussion :
Sarcoidosis , until proven otherwise .
She is obviously older than typical presentation of sarcoidosis , but she had previous lymphadenopathy that may have been a first presentation of the illness with spontaneous remission .
The lung findings , systemic symptoms , hypercalcemia , anemia , abnormal serum ACE level are all suggestive of this diagnosis .
Her hypercalcemia is symptomatic and should be treated with volume repletion .
She should not receive diuretics at present .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["2085"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
DD : 11-29-62
DT : 12-06-62
DV : 11-29-62
/ wise
Crete Municipal Hospital
82 Auburn Street
Rehoboth , NM 42761
******** Not reviewed by Attending Physician ********
Record date : 2097-06-28
Visit Note
Patient Name : WILSON , GABRIEL MRN : 8514931
Dictated Date : 06/29/2097 Dictated By : Julie Fraser , M.D .
Date of Visit : 06/28/2097
Patient is a 76 -year-old Croatian woman who came in today .
Her daughter Gibbs was translating .
She is a very complicated 76 -year-old Croatian woman with a history of diabetes , hypertension , vertebral basilar insufficiency , chronic hepatitis B and other medical problems .
She is status post a right Bell's palsy in the past .
Recently she has been sometimes living at her daughter's house and other times at her niece's house .
They are trying to provide more support in terms of regulating that she takes her medication .
When she stays at her daughter's Gibbs's house her daughter does check her sugars though her niece does not .
Her blood pressure has been very labile recently and we recently added hydrochlorothiazide and nifedipine extended release 30 mg every day to her regimen in addition to her regular Cozaar and Toprol .
Her daughter also has increased her insulin/70/30 to 48 units in the morning .
She thinks that sometimes in the afternoon or late afternoon she may have some low sugars .
She reports that her mother feels dizzy and has difficulty moving her left leg if her sugar gets low .
She feels better if she is given orange juice or something to eat .
She has had similar symptoms to that with low sugars in the past however when the daughter checks her sugars they are all in the 174 to 225 range .
She has occasional sugars before bedtime that are 337 and 249 .
The lowest sugar she had was 88 before dinner .
The patient reports that she feels dizzy at times .
She is a very difficult historian even with her daughter translating or with the other interpreters translating .
She has not been having any chest pain or palpitations .
Her dizziness is not related to standing up or lying down .
No syncope , slurred speech , spinning dizziness , diplopia , or focal arm or leg weakness or numbness .
Of note the chest pain she had complained about on the last visit when her daughter had noted she was cleaning has resolved .
Her cardiac stress test from June 2094 showed an exercise capacity of 4 METS , EKG nondiagnostic due to submaximal heart rate response .
No evidence for ischemia on the perfusion images .
From March 2095 her vascular lab studies showed normal distal vertebral arteries and basilar arteries throughout its length .
<|output|>{"AGE": ["76"], "CONTACT": [], "DATE": ["06/28/2097", "June 2094", "March 2095", "12-06-62", "06/29/2097", "11-29-62", "2097-06-28"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Crete Municipal Hospital"], "ID": ["8514931"], "LOCATION": ["NM", "Croatian", "Rehoboth", "82 Auburn Street"], "NAME": ["wise", "Gibbs", "Julie Fraser", "WILSON , GABRIEL"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["42761"]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
These findings support previous studies that showed that the use of aspirin during the antecedent illness may be a risk factor for the development of RS .
<|output|>{"drugs": [{"name": "aspirin", "reaction": ["RS"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
He was started on full-dose integrilin , half-dose reteplase , and heparin gtt , transferred to HOSP PSIQUIATRICO CORRECCIONAL for emergent cath .
SH : Patient lives in Lake Josephbury with wife .
Programmer , multimedia .
Plasma Carbon Dioxide 20.1 L ( 11-04-2003.9 ) mmol/L
Calcium 8.5 ( 04-16-2004.5 ) mg/dl
Troponin-T PEND ( 0.05-26-1979 ) ng/ml
HCT 38.7 L ( 410-12-2007.0 ) %
HGB 13.6 ( 07-26-1978.5 ) gm/dl
RBC 4.34 L ( 4.511-25-1976 ) mil/cmm
MCHC 35.1 ( 12-03-1970.0 ) g/dl
PT 14.9 H ( 11-14-1987.3 ) sec
APTT 51 H ( 02-11-1995.1 ) sec
Impression : 51 yoM with anterior STEMI , s/p half-dose lytics , s/p cath showing thrombotic prox LAD not intervened on .
Will likely go back for repeat cath on Sunday , possible LAD intervention
Pauly Aislynn Andonis , MD
Pager # 59163
Record date : 2114-11-11
NAME : Dode Arieh Abell
MRN : 8466599
( s ) PO QD , THIS WAS FAXED TO YOU ON 21/9/14
Cerebrovascular accident : L cerebellar 2113 , s/p L CEA
Lung nodule : Repeat chest CT 12/14 .
Paula-grace Dorisa
Lazes Alma / Hernan Ayisha Princetta / Deborrah Fam
Record date : 2126-10-21
HEALTHSOUTH REHABILITATION HOSPITAL OF MIDLAND/ODESSA 5 Admission Note
PATIENT : Filiberto Hug
MRN : 3570177
ADMIT DATE : 26/5/26
PCP : Elsie Kinsler MD
Mr Orren Blades noted that he felt “ ;
DMII - first diagnosed in 2114 , last A1C 8.4 ( 24/2/26 )
79 yo M with DM , HTN , ulcers , indwelling SPC who presents with one week of feeling “ ;
Given his history of fever , exam , and lab studies , infection is the most likely cause of Mr .
Last A1C 8.4 24/2/26
Glade Lambert , MD MA
<|output|>{"AGE": ["51", "79"], "CONTACT": [], "DATE": ["26/5/26", "2114", "11-14-1987.3", "07-26-1978.5", "24/2/26", "Sunday", "12/14", "2126-10-21", "2114-11-11", "12-03-1970.0", "21/9/14", "2113", "02-11-1995.1", "11-04-2003.9", "04-16-2004.5"], "DEVICE": [], "DLN": [], "HOSPITAL": ["HOSP PSIQUIATRICO CORRECCIONAL", "HEALTHSOUTH REHABILITATION HOSPITAL OF MIDLAND/ODESSA"], "ID": ["3570177", "8466599"], "LOCATION": ["Lake Josephbury"], "NAME": ["Glade Lambert", "Pauly Aislynn Andonis", "Paula-grace Dorisa", "Orren Blades", "Elsie Kinsler", "Lazes Alma", "Deborrah Fam", "Dode Arieh Abell", "Filiberto Hug", "Hernan Ayisha Princetta"], "ORGANIZATION": [], "PHONE": ["59163"], "PROFESSION": ["Programmer , multimedia"], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2114-03-16
March 16, 2114
Brice Short, M.D.
671 Foundation Street
Lambertville, OK 66399
RE:Craft, Lloyd
MRN:26649180
Dear Dr. Short:
Today I had the delight of seeing your patient Mr. Craft for the
possibility of central nervous system vasculitis. As you know, he
is a 64 year old, right-handed man with an extensive past medical
history for a rheumatological disease. His past medical history,
briefly, is that he was diagnosed with lupus in 2103 and at that
time he had a butterfly rash, he complained of chronic fatigue and
he also had what was considered temporal lobe seizures which were
characterized as complex partial type events, and elevated double-
stranded DNA of 1:80 and ANA of 1:512 with a homogenous pattern.
All of these suggested that the patient did have lupus. He was
treated for approximately three years with prednisone and he notes
that after medications were added by Dr. Taliyah Hoffman, his
symptoms and seizures went away. Since that time, he has had a
recurrence of symptoms which includes fullness of his face and
neck, pressure within his head. He considers himself to have
vascular headaches with facial weakness, ringing in his ears,
numbness and tingling of his left hand and arm, excessive
salivation and increased appetite. In describing his headache, he
noted that it is primarily a headache which is there every day and
has a combination of throbbing sensation as well as throbbing
quality. It is worse in the frontal temporal area and is not
associated with nausea, vomiting or paraesthesias. There is no
family history of migraines as well. Also during his headache
events, he does not notice any decrease in his appetite or any
nausea or vomiting.
Past medical history: As per above. Medicval issues include
bipolar II with ____________ diagnosed in 2110, hypothalamic
gonadism, hypothalamic hypothyroidism and questionable history of
migraine headaches.
His current medications include Lamictal, Risperdal, testolactone,
chromisene, Levoxyl, Altace for hypertension, ibuprofen p.r.n. and
prednisone p.r.n.
He is allergic to penicillin, Lozol, bee stings and allopurinol.
There is a questionable history to Aricept which he feels that the
use of this medication made his current symptoms come out of
remission.
Brice Short, M.D.
RE:Craft, Lloyd
MRN:26649180
3-16-14
Page 2
Family history is remarkable for insulin dependent diabetes
mellitus in father and father also had heart disease.
Social history: He is a former stage manager.
Neurological exam: He was awake, alert, oriented x 3. Attention
was normal. Speech was fluent, without dysarthria or paraphasic
errors. There is no memory deficit or agnosia. The patient gave
a very detailed history of events and no further detailed mental
status testing was performed. Cranial nerves: Bilateral visual
fields were full. Disks were sharp. Fundus was clear.
Extraocular movements were intact. There was no nystagmus. He
had normal facial sensation and symmetry. Hearing was grossly
normal. Uvula, tongue and palate were midline. Motor examination
revealed normal tone and bulk with normal strength. Deep tendon
reflexes were symmetrical. There was no upper motor neuron sign.
Coordination and gait were normal.
Overall impression: 64 year old, right-handed male with a history
of lupus in the past. His recent blood work shows that his
double-stranded DNA was negative. Taking into consideration his
current constellation of symptoms and his MRI reports that I
evaluated which were completely normal except for small vascular
disease, at this time he does not fit with the diagnosis of
central nervous system vasculitis. He was told that he is at a
high risk for having a stroke secondary to (1) having high blood
pressure and (2) having an elevated cholesterol. If it is
possible to maintain his blood pressure in good control and start
a cholesterol-lowering agent, he is to discuss this with you, and
also consider starting aspirin 81mg PO q.d. for primary prevention
of heart disease. He was informed that it is possible that there
is some element of his immune system fluctuations and possibly his
hormonal therapies may be contributing to some of his
symptomatology but the diagnosis or etiology of these symptoms is
not clear.
Thank you for letting me take part in your patient's healthcare.
Sincerely,
Clarence K. Hart, M.D.
Brice Short, M.D.
RE:Craft, Lloyd
MRN:26649180
3-16-14
Page 3
cc:
Mr. Lloyd Craft
009 Buchanan St
Opp, OK 21785
YF:LN:4843/DD:3-16-14/DT:3-22-14
******** Not reviewed by Attending Physician ********
<|output|>{"AGE": ["64", "64"], "CONTACT": [], "DATE": ["2114-03-16", "March 16, 2114", "2103", "2110", "3-16-14", "3-16-14", "3-16-14", "3-22-14"], "ID": ["26649180", "26649180", "26649180", "YF:LN:4843"], "LOCATION": ["671 Foundation Street", "Lambertville", "OK", "66399", "009 Buchanan St", "Opp", "OK", "21785"], "NAME": ["Brice Short", "Craft, Lloyd", "Short", "Craft", "Taliyah Hoffman", "Brice Short", "Craft, Lloyd", "Clarence K. Hart", "Brice Short", "Craft, Lloyd", "Lloyd Craft"], "PROFESSION": ["stage manager"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Contact information :
CC/HPI :
27 yo male from Cedar Hill Lakes , Nevada w/ history of insulin-requiring DM previously followed at Cottage Sanatorium , admitted to Linden Health Care Center after becoming unresponsive during a visit to his sister in Maryland .
By report , patient was sitting on the couch at his sister's house , slumped to the floor and had seizure activity x 45 seconds that was witnessed by EMS sevices .
Accu-checks done at that time were >500 and attempts at intubation were unsuccessful .
He was transported to ER , where additional attempts to secure his airway were also unsuccessful , by 2 physicians .
There appeared to be some sot of stricture in the upper airway ( not obvious on CT scan ).
However , pt had witnessed emesis , and was placed on 100% nonrebreather mask , with Versed and propofol for sedation with adequate O2 saturation .
A x-ray confirmed dependent lung infiltrates consistent with aspiration pneumonia , and pt was started on Clindamycin .
On arrival to the ER , patient was also found to have a blood pressure of 248/146 .
He received 50mg dose of labetolol in the ER as well as several additional doses in the ICU .
In the ICU , patient did not have any further witnessed seizure activity .
A Head CT demonstrated no focal lesion , IC hemorrhage or other abnormality .
Pt was treated with dilantin and IV insulin infusion .
Serum ketones were negative .
Additional workup revealed LVH by EKG criteria , as well as renal insufficiency Cr 2.6 .
Urine tox was positive for benzos , but was otherwise negative .
Patient also developed leukoytosis ( WBC ?) with temp of 102 degrees .
Although he had minimal neck stiffness by neurology consult exam , he underwent a lumbar puncture that demonstrated a colorless clear fluid , with glucose of 108 , TP
44 . Grams stain was negative .
Tube #4 contained 21RBCs and 7 WBCs with a diff of 96% PMNs and 4% lymphs .
CSF cultures and blood cultures were also done , and are pending .
During his hospital course , patient maintained adequate oxygenation with nasal trumpet in place .
ABG on 08/25/61 am was 7.36/ PCO2 45/ PO2 366 , with bicarb of 25 and 100% sats .
His FIO2 was subsequently weaned .
He remained hemodynamically stable with BP 184/88 ( MAP 114 ) HR100 , RR23 , 97% on cannula .
Cardiac enzymes were negative .
After patient's mother arrived from Georgia , she requested transfer to BMH .
Had no reported history of hypertension or seizure disorders .
Mother reports patient having occasional spells in the past , lasting 5-10minutes where patient would become non communicative , associated with elevated glucose .
PMH :
1 .
Insulin dependent DM , diagnosed age
12 . Was followed at Cottage Sanatorium but has not had PCP or regular care for some time .
Medications On Admission :
1 .
Labetolol 20mg IV q1hr PRN MAP>120
<|output|>{"AGE": ["12", "27"], "CONTACT": [], "DATE": ["08/25/61"], "DEVICE": [], "DLN": [], "HOSPITAL": ["BMH", "Cottage Sanatorium", "Linden Health Care Center"], "ID": [], "LOCATION": ["Georgia", "Cedar Hill Lakes", "Nevada", "Maryland"], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
We report the case of a patient with the acquired immunodeficiency syndrome treated with rifampicin who had a 'normal ' screening test for adrenal insufficiency , yet had clinical evidence of adrenal failure .
<|output|>{"drugs": [{"name": "rifampicin", "reaction": ["adrenal failure"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
New hyde park , CT 03491
BLOOMINGTON MEADOWS HOSPITAL Unit # : 791-50-56
VATS biopsy on 11/27 showed usual interstitial pneumonitis with extensive smooth muscle metaplasia - a rather unusual reading .
Record date : 2085-12-03
December 03 , 2085
Nicodemus S .
176 Denison Parkway East
Duruelo de la Sierra , WI 97948
MR # 016-55-37-4
5 pounds from November 07 .
labs back to Netherlands .
MR # 827-07-86-7
- 2 - December 03 , 2085
Joshau Breland will return in March for a biopsy and clinic visit .
3601 Loyola Dr
Vallejo , MO 54492
DD : 12/03/85
DT : 12/04/85
DV : 12/03/85
/ Clie Aphrodite
Record date : 2091-08-20
MRN : 0100712
subsequently had his CABG done at the end of June and was discharged at the end
of July to HIGH POINT REGIONAL HEALTH SYSTEM .
He did well at HIGH POINT REGIONAL HEALTH SYSTEM and was discharged
from there on the 08-03-2007 , and he presents to me for follow-up today .
LABS : From July 30 , 2091 , show CBC with white count of 4.4 , hemoglobin 11.2 ,
ASSESSMENT & PLAN : 65 - year-old male , history of hypertension , hyperlipidemia ,
coronary artery disease , peripheral vascular disease , status post CABG in June as
He is scheduled to see Dr .
seen Dr .
He has seen Dr .
Patient on Dilantin 150 t.i.d .
Will refer back to Dr .
from HIGH POINT REGIONAL HEALTH SYSTEM to see why medications were started and will likely
In general , need to review records from HIGH POINT REGIONAL HEALTH SYSTEM in order to see what
<|output|>{"AGE": ["65"], "CONTACT": [], "DATE": ["12/04/85", "08-03-2007", "November 07", "March", "12/03/85", "2091-08-20", "December 03", "July", "June", "July 30", "11/27", "2085-12-03"], "DEVICE": [], "DLN": [], "HOSPITAL": ["BLOOMINGTON MEADOWS HOSPITAL", "HIGH POINT REGIONAL HEALTH SYSTEM"], "ID": ["0100712", "827-07-86-7", "791-50-56", "016-55-37-4"], "LOCATION": ["3601 Loyola Dr", "176 Denison Parkway East", "Vallejo", "Duruelo de la Sierra", "Netherlands", "New hyde park"], "NAME": ["Joshau Breland", "Clie Aphrodite"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["03491", "97948", "54492"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
She is married .
She lives with her husband .
They often argue with each other but there is no history of domestic violence .
Retired credit manager .
FH : Sister s/p thyroid surgery .
No h/o RA , SLE , psoriasis .
ROS : As noted in HPI .
Exam : VS : T=96.1 HR=115 SR Augment .
DBP= 124 MAP=86 RR=12 SaO2=92-100% on FiO2 0.5
General : elderly Caucasian woman , intubated , sedated
HEENT : PERRL , OGT in place with dark output on low vacuum to wall suction
Neck : Supple , full ROM , no LAD , no central line in the neck region ( PAC via R groin )
Chest : CTA b/l from anterior , no wheezing , crackles , or ronchi
CVS : RRR nl S1 S2 , no m/r/g , CVP 9-14 , IABP in place , running at 1:1
Abd : soft , nontender , nl BS , no rebound , IABP via right groin
Extr : trace edema b/l , 2+ DP pulses present b/l , warm and well perfused
Neuro : sedated , not moving spontanously
Skin : no rashes , jaundice or cyanosis
DATA :
Lytes on admission were normal except hyponatremia , metabolic acidosis , Bicarb of 15.9 , which remained around 16 on the day of her admission .
Mg was 1.2 only , which was repleted with 4g of Mg IV .
Initial glucose above 500 , which came down to 200s
Lactic acid was 6.4 on admission , which came down to 4.8 at 1pm .
LFTs were only slightly abnormal with normal bilirubins .
Initial WBC 22 , which increased to 40 and then returned to
28 . Hct dropped from 40 down to 29 on day of admission over 24 hours .
Plts were normal and stable .
Coags normal except elevated PTT in setting of IV Heparin .
03/18/91 03/18/91 03/18/91 03/18/91 03/18/91
20:25 13:26 11:08 11:06 07:05
NT-BNP 3161(HT )
CK 4877(H ) 5811(H ) 4268(H ) 382(H )
CK-MB 348.0(H ) 393.7(H ) 30.4(H )
CKMBRI 7.1(H ) 6.8(H )
TROP-T 25.56(H ) 18.01(H ) 13.89(H ) 0.66(H )
Fasting lipids :
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["03/18/91"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["credit manager"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
members state that the patient is not acting like her usual self .
The patient's family members deny noting the patient complaining
of any nausea , vomiting , chest pain or shortness of breath .
The
patient was actually taken to clinic yesterday because the
patient was starting to speak less .
The patient was seen clinic and was thought to be depressed .
The patient has a known history
of a facial droop .
The patient was incontinent of urine today .
PHYSICAL EXAMINATION : The patient's vital signs reveal the
following : Temperature was 102.8 , heart rate 110-160 beats per
minute , respiratory rate 20 , blood pressure is 144/110 , and
oxygen saturation was 95% on room air .
The patient's oxygen
saturation was interpreted as borderline low .
General : No acute
distress , multiple family members at bedside .
HEENT : The
patient's head was normocephalic and atraumatic , no scalp
hematomas .
Pupils were equal , round , and reactive to light .
Mucous membranes were somewhat dry , right facial droop noted , no drooling .
Neck : Supple , no JVD , no carotid bruits appreciated .
There was no meningismus .
Respiratory : Poor cooperation with
exam .
Fair aeration , no focal rhonchi , rales , or wheezes , no
increased work of breathing or use of accessory muscles was
noted .
Cardiovascular : Irregularly irregular , tachycardic ,
unable to appreciate any gross murmurs , rubs , or gallops .
GI :
Abdomen : Soft , no rebound or guarding , prior well-healed prior
G-tube scar noted .
Rectal exam deferred .
GU exam : The patient
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Has 6 children ;
supportive,live close by .
Allergies : Clindamycin , PCN , Eucerin , Cipro cause itching .
Cephalexin causes hives .
Medications at home : metformin 500 mg qday/ lopressor 6.25mg po bid/ lisinopril 10mg po qd/ aspirin 81 mg po qd/ furosemide 40 mg po qd/ metolazone 5 mg po qd/ prednisone 25mg po qd/ simvastatin 20 mg po qd/ PRILOSEC ( OMEPRAZOLE ) 20 mg PO daily/ ATIVAN ( LORAZEPAM ) 0.5 mg PO q8h/ ERGOCALCIFEROL 400 units PO daily/ OXYBUTYNIN CHLORIDE 5 mg PO daily
ROS
ROS is negative except as noted in HPI or below .
Constitutional Symptoms : (-) headache , (-) aches and pains , (-) weight loss , (-) weight gain , ( + ) tiredness ,
Ears , Nose , Mouth , Throat : (-) symptoms involving ear , nose , mouth , or throat
Eyes : (-) blurred vision , (-) lenses (-) laser treatment
Cardiovascular : (-) varicosities , (-) chest pain , (-) elevated BP , (-) edema , (-) claudication , (-) palpitations , (-) dyspnea on exertion
Respiratory : (-) wheezing , (-) cough , ( + ) shortness of breath .
Gastrointestinal : (-) diarrhea , (-) heartburn , (-) constipation , (-) vomiting , (-) nausea ,
Endocrine : (-) heat intolerance , (-) polydipsia , (-) dry skin , (-) cold intolerance
Genitourinary : (-) polyuria
Musculoskeletal : (-) leg cramps , (-) muscle pain , (-) joint pain
Neurological : (-) confusion , (-) headache , (-) paresthesia , (-) tingling , (-) numbness
Hematologic / Lymphatic : (-) anemia , (-) bleeding problems ,
Integumentary : (-) rash , (-) skin-related symptoms
Psychiatric : ( + ) depression , (-) memory loss , (-) anxious feelings
Allergic / Immunologic : (-) allergic or immunologic symptoms
Physical Examination
General : Patient is intubated but alert and responding with nods of her head .
Preop/preadmission weight : 86.9 kg
Vitals :
T
101.2
HR
84
BP
117/47
HEENT : Inspection of external ears reveals no abnormalities .
Inspection of mucosa reveals good hydration
Eyes : Conjunctivae , sclera and lids are normal .
No icterus .
Respiratory : Assessment of respiratory effort reveals even respirations without use of accessory muscles and no intercostal retractions noted .
Cor : S1 , S2 nl , no murmurs appreciated
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
atorvastatin 10 mg po qd
amlodipine besylate 10mg po qd
colchicine 0.6 mg po qd originally prescribed by dr . vidal , rheumatology
Change in therapies and Renewals
multivitamins 1 tab po qd QTY:30 Refills:0 Start : 1/26/2067
levofloxacin 500 mg po qd x3d QTY:3 Refills:0 Start : 1/26/2067
Plavix 75mg po qd QTY:30 Refills:0 Start : 1/26/2067
Procedures
Percutaneous transluminal coronary angioplasty STATUS POST Critical proximal RCA stenosis .
1.5x9 mm OpenSail , then 2 mm Maverick baloon , then 2.5x23 mm Cypher stent .
TIMI-3 flow achieved .
Selected recent labs 01/24/67 Triglycerides 90 , 01/24/67 High Density Lipoprotein 83 , 01/24/67 Low Density Lipoprotein 73 , 01/22/67 Iron 108 , 01/22/67 Iron Binding Capacity 261 , 01/22/67 Ferritin 76 , 01/24/67 UA-Nitrite NEGATIVE , 01/24/67 UA-SED-WBC >100 , 01/24/67 UA-SED-Bacteria Many , 01/23/67 Hemoglobin A1C 11.3 H , 01/24/67 Homocysteine Total 7.9
Signed electronically by Debra Y Xin MD , PhD on Jan 26 , 2067
Record date : 2066-06-17
SDU JAR Admit Note
Name : Rivers , Ida
MR : 468 48 69
Date of Admission : 06/17/66
Cardiologist : Valdivia
CC : 73 yo woman with h/o Sjogren's syndrome , Diabetes (? Type I ), vascular insufficiency who now presents with syncopal episode .
HPI : Ms Rivers was in her USOH until the morning of admission , when she went into the city to buy some buttons and pay a bill at ViewSonic .
She noted that she was not feeling well throughout the morning , and she felt as if she may need to eat something .
However , because she did not have her insulin and blood sugar monitoring equipment , she decided not to eat .
She continued to feel poorly ( she is somewhat vague on symptoms but reports feeling that her chest was congested and that she may have had some palpitations and felt chilled ).
She saw a police cruiser , and walked over to it with the intention of getting help .
When she arrived , there was no one in the car , and she leaned forward to rest her head on the front of the car .
This is the last thing she remembered ;
when she awoke , she was surrounded by people .
She was told that she had falled backwards and hit the back of her head .
When EMS found her , she was confused , making repetitive statements , and stating that she had pain in her occiput that radiated down her neck .
When she arrived at the FMH ED , her blood pressure was 213/97 HR 84 RR20 O2 sat 99% RA Temp 97.3 .
She received Labetolol 20 iv , Toradol 30 mg iv , ASA 325 mg and Tylenol 1000 mg po x
1 . Her mental status cleared somewhat , and her blood pressure came down to 130s/80s .
She did have one episode of emesis , during which her HR was noted to transiently dip to the 40s ( not captured on the monitor );
spontaneously recovered to the 60s .
She had a C-spine series and head CT which were negative for acute process , and a CXR which was negative except for R shoulder not well-visualized on CXR .
<|output|>{"AGE": ["73"], "CONTACT": [], "DATE": ["1/26/2067", "01/22/67", "Jan 26 , 2067", "01/24/67", "2066-06-17", "01/23/67", "06/17/66"], "DEVICE": [], "DLN": [], "HOSPITAL": ["FMH"], "ID": ["468 48 69"], "LOCATION": [], "NAME": ["Debra Y Xin", "Rivers", "Rivers , Ida", "vidal", "Valdivia"], "ORGANIZATION": ["ViewSonic"], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2097-04-19
Willow Gardens Care - Columbus
80 y.o. man here for routine 3 months f/u for diabetes with retinopathy (has had laser therapy twice). Seen foot doctor every 3 mos.
Denies polyuria or polydipsia. Wife has been pushing the fluids given his elevated creat.
Vitamin B12 deficiency treated with injections.
Has renal insufficiency and HTN.
Home BP readings are normal.
Repeat chest CT scans shows stable nodules, prior asbestos.
No cough. Has been dieting to lose weight.
Incidental note of thyroid nodule. NO symptoms. TSH wnl 10/95. Thyroid u/s reassuring.
Walks intermittently. Keeps active around the yard at home.
Mows lawn and shovels snow himself. Denies chest pain.
Notes some DOE with walking from house to backyard.
Occasional burping after meals--better sometimes after TUMS and sitting down to relax. No associated lightheadedness or dizziness, no nausea.
Problems
actinic keratosis : nose derm consult 5/88, right eyelid lesion 8/89 reconsult derm
Eczema : right chestwall. (Dr. Vanpelt, Berrien)
benign prostatic hypertrophy : denies voiding symptoms
Tinea corporis : tinea cruris
Hypertension : 140/100 5/88, 150/90 2/89, 158/80 3/89, 130/64 4/89, 140/80 8/89, 134/80 10/89
Diabetes : Type 2. ? 2079, Resumed oral hypoglycemic agent 11/86. Fasting glucose 140 12/86, HB Alc 11.38 (11/19/86), HgAlC 5.93 3/87, 7.1 9/88, 7.9 2/89, 5.6 5/89
Hearing impairment : doesn't wear aids due to background noise.
obesity
nephropathy
neuropathy : impotence;
peripheral vascular disease
Renal insufficiency : stopped HCTZ '93 due to creat 1.5, creat 1.6 '95
Allergies
NKA
Medications
Asa (ACETYLSALICYLIC ACID) 81MG TABLET CHEWABLE take 1 Tablet(s) PO QD
Atenolol 25MG TABLET take 1 Tablet(s) PO QD
Cyanocobalamin 200 MCG (100MCG/ML DISP SYRIN take 2 ML) IM see below , 200MCG QD x's 1 wk,then 200MCG Qwk x's 1 month,then 1000mcg Qmon x's 3mos then
Flex-a-min 1 PO AS DIRECTED , ONE TAB WITH MEALS UP TO THREE TIMES A DAY
Flexeril (CYCLOBENZAPRINE HCL) 10MG TABLET take 1 Tablet(s) PO TID PRN muscle spasm x 5 days, do not drive if using this med
Glyburide 5MG TABLET take 1 Tablet(s) PO QD
Ketoconazole 2% SHAMPOO 1 APPLICATION (2% SHAMPOO ) TOP BIW x 30 days
Lisinopril 20MG TABLET PO QD
Metrogel 1% (METRONIDAZOLE 1% GEL) 1 APPLICATION (1% GEL ) TOP QD
Mucinex 600 MG PO Q 12 HR PRN , Swollow whole. Stop if rash, headache or breathing problems occur
Simvastatin 10 MG (10MG TABLET take 1) PO QHS
Viagra (SILDENAFIL) 100MG TABLET take 0.5 Tablet(s) PO x1 , STOP USING IF YOU HAVE NAUSEA, INCREASED SWEATING, CHEST PAIN, DIZZINESS
Zithromax (AZITHROMYCIN) 250MG CAPSULE take 1 Capsule(s) PO see below , 2 capsules po first day, then 1 capsule po qd until gone
ROS: notes DOE this month.
No dyspnea today.
Exam:
Wt 210 lbs, BP 150/68 (home BP reading 130s/80s per pt), Wt 210 lbs, fingerstick glucose 153 mg/dl
last visit Wt 212 lbs, BP 160/80 (home readings are 110s/70s per pt however)
Heent: eomi
Neck: no carotid bruits
CV: rrr, no m/r/g
Chest: distant breath sounds, cta
Ext: no cce, resolution of 2 cm x 2cm soft tissue edema R upper arm, no bruising, no pulsatile masses appreciated, pulses symmetric at wrists.
Derm: no suspicious lesions
Data
1.2 2/2096
PSA 11/02/86 0.5
Td Booster 04/07/2094
Microalbumin 04/13/2095 5.6
creat 1.7 1/2097
HbA1c 10/18/2096 6.80 => HbA1c 01/17/2097 7.20
Triglycerides 01/17/2097 113
Cholesterol-LDL 01/17/2097 59 DESIRABLE: <130
Microalbumin 01/17/2097 9.2
Cholesterol-HDL 01/17/2097 32
ct scan 5/2096
IMPRESSION: Stable pulmonary nodules.
thyroid u/s 4/2096
Thyroid nodule as above. No suspicious ultrasound features.
A/P
1. Diabetes Mellitus type2: still has HbA1c above 7.0. No more hypoglycemic episodes.
c/w current meds. If the repeat Hba1c is still above 7, then will need additional medication;
2. Dyspnea on exertion: reviewed potential risk of cardiac ischemia. Recommend stress testing. Will obtain ecg today. To ED if symptoms progress or if chest pain.
Follow up after stress test
3. vit B12 deficiency: repeat B12 level wnl last time. Continue with oral supplementation
due for UGI/SBFT but pt declines to have test.
4. chronic renal insufficiency: creat normalized 2/96 with fluids then rising in 1/2097.
Recheck again today
5
. cough: resolved. Has pulmonary nodules. Due for surveillance ct scan in 5/2097
HM: Due for colonoscopy but pt declines.
Influenza Vaccine 10/20/2096
Pneumovax 01/29/2089
PSA 11/19/86 0.5 REF. RANGE: MALE AGE:>39 0.0 - 4.0
Td Booster 04/07/2094
_____________________________________________
Robert I Harmon, M.D.
<|output|>{"AGE": ["80"], "CONTACT": [], "DATE": ["2097-04-19", "10/95", "5/88", "8/89", "5/88", "2/89", "3/89", "4/89", "8/89", "10/89", "2079", "11/86", "12/86", "11/19/86", "3/87", "9/88", "2/89", "5/89", "'93", "'95", "2/2096", "11/02/86", "04/07/2094", "04/13/2095", "1/2097", "10/18/2096", "01/17/2097", "01/17/2097", "01/17/2097", "01/17/2097", "01/17/2097", "5/2096", "4/2096", "2/96", "1/2097", "5/2097", "10/20/2096", "01/29/2089", "11/19/86", "04/07/2094"], "ID": [], "LOCATION": ["Willow Gardens Care - Columbus", "Berrien"], "NAME": ["Vanpelt", "Robert I Harmon"], "PROFESSION": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Refer to Dr . Keeler for evaluation of scalp lesions .
Flu shot R deltoid with usual preamble .
Aventis Fluzone Lot L5317YR .
Exp . 7/10/76 .
A1c , SGOT , SGPT , alkaline phosphatase , Bili T/D , Electrolytes , BUN/Creatinine
Electrolytes , BUN/Creatinine again in 1 month if she is taking captopril at that time .
Appointments :
cc : Xavier Dotson , M.D .
Yael Keeler , M.D .
Ysidro Xia .
M.D .
Transplant Associates
Yacob T . Kane , M.D ., Ph.D .
Record date : 2092-08-16
Eye Specialties Intern Admission H & P
Patient Name : Wood , Cade
MR# 6691247
Location : BIG99
PCP : Dr . Otto Suzanne
Date of Admission : 8/15/92
ID/CC : 59 y.o . male with SOB during a CT on the day of admission
HPI : Pt .
is a 59 y.o . male with DLBCL dx'ed with stage 4 DLBCL in 11/07 , S/P CHOP-R ( finished 3/08 ), HTN , GERD , and anemia who p/w acute onset of SOB while lying down during a f/u staging non-contrast CT on the day of admission .
Pt .
notes a 5lbs weight gain over the past week .
He also reports a 1-2 week h/o increasing DOE when he performs his household chores or working in his backyard .
At his baseline , can can walk of a mile w/o dyspnea or CP .
4 days PTA , he had to take it easy during a picnic as he would easily develop DOE with minimal exertion .
2days PTA , pt .
experienced coughing bouts when he tried to lie down for sleep .
The patient acutely developed SOB after lying down for a few minutes during his CT .
He felt 1/10 CP during this episode located in the R middle sub-sternum .
The pain lasted for approximately 10 min , dull in quality , did not radiate , did not change with position , relieved after given NTG in the ED .
He experienced a similar CP during an administration of his chemo several months PTA .
This CP was determined not be be cardiogenic .
+ diaphoresis , - N/V , - lightheadedness , - palpitations .
He reports eating a lot of salty foods .
<|output|>{"AGE": ["59"], "CONTACT": [], "DATE": ["11/07", "7/10/76", "2092-08-16", "3/08", "8/15/92"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Eye Specialties"], "ID": ["6691247"], "LOCATION": [], "NAME": ["Ysidro Xia", "Keeler", "Yacob T . Kane", "Otto Suzanne", "Yael Keeler", "Xavier Dotson", "Wood , Cade"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Record date : 2095-02-11
Developed complaints of exertional dyspnea and fatigue during the 01-17-1994 .
Progressed and she was evaluated by Princella Brooklyn .
10/2094 Admitted to SHAWANO MED CTR for elective cath .
Cath with Dr Fabian Holster found nl LM .
11/15/2094 she was readmitted for elective RCA PCI .
12/94 Cath : patent LAD stents .
2/26 Developed SOB and arrived in EW at TUFTS MEDICAL CENTER with chest pain .
Given previous stents , she was transferred urgently to SHAWANO MED CTR for cath .
Complete neurologic evaluation in LOC in 12/94 and previously in 2094
CRI with creat baseline 3.7 ( followed by Jerrald Moose ) and recent eval by Dr Lyall Faigy for transplant .
Epogen 10000u sc 04-24-1979
Forensic scientist .
43 y.o .
Plan for eventual renal transplant at SHAWANO MED CTR ( had been waiting for Plavix to be completed ).
Further plan per Dr Caia Brandice
Diovan 160mg po qd Start : 11/14/2094
Lasix 80 mg po qd Start : 11/14/2094
Toprol XL 25 mg po qd Start : 11/14/2094 just increased to 50
Norvasc 5mg po q pm Start : 11/14/2094
Plavix 75mg po qd Start : 11/14/2094
Niaspan 1000mg SR po qhs Start : 11/14/2094
Vytorin 10mg/80mg po qhs Start : 11/14/2094
folic acid 1 mg po qd Start : 11/14/2094
Epogen 10000u sc 04-24-1979 Start : 11/14/2094
multivitamins 1 tab po qd Start : 11/14/2094
iron supplement 325mg po am Start : 11/14/2094
Colace 100 mg po qd Start : 11/14/2094
isosorbide dinitrate Start : 11/14/2094
erythromycin 333mg po TID Start : 11/14/2094 for gastroparesis
Phoslo and vitamin B 1 Start : 11/14/2094
Signed electronically by Quintesha Marala NP on Feb 11 , 2094
Record date : 2088-04-22
" Augustin Bloch 071-21-97-5 VISIT DATE : 20/07/88
HISTORY OF PRESENTING COMPLAINT : This patient is a 67 year-old female complaining of chest tightness lasting approximately 30
consultation with the New Connie cardiologist .
<|output|>{"AGE": ["67", "43"], "CONTACT": [], "DATE": ["2094", "Feb 11", "10/2094", "04-24-1979", "20/07/88", "2095-02-11", "12/94", "2/26", "11/14/2094", "01-17-1994", "2088-04-22", "11/15/2094"], "DEVICE": [], "DLN": [], "HOSPITAL": ["SHAWANO MED CTR", "TUFTS MEDICAL CENTER"], "ID": ["071-21-97-5"], "LOCATION": ["New Connie"], "NAME": ["Jerrald Moose", "Quintesha Marala", "Fabian Holster", "Augustin Bloch", "Caia Brandice", "Princella Brooklyn", "Lyall Faigy"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Forensic scientist"], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Fatal interstitial pneumonitis following high-dose intermittent chlorambucil therapy for chronic lymphocyte leukemia .
<|output|>{"drugs": [{"name": "chlorambucil", "reaction": ["Fatal interstitial pneumonitis"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
The evidence of high plasmatic levels of CBZ and the absence of other aetiologic factors lead the authors to conclude that the overdose of CBZ could have represented the precipitating of the episode of acute pancreatitis .
<|output|>{"drugs": [{"name": "CBZ", "reaction": ["acute pancreatitis"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
We wish to call for cautious approach at time of cessation of prolonged ACTH therapy because of possible unexpected and only partially understood hazardous side effects such as hyperkalemia .
<|output|>{"drugs": [{"name": "ACTH", "reaction": ["hyperkalemia"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Recent studies have shown that under experimental conditions ferrous sulfate may reduce the gastrointestinal absorption of orally administered levothyroxine sodium in patients with primary hypothyroidism .
<|output|>{"drugs": [{"name": "ferrous sulfate", "reaction": ["reduce the gastrointestinal absorption of orally administered levothyroxine sodium"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Blood pressure 150/80 , repeated by me 150/70
Weight 132 pounds
General appearance Well developed and well nourished in no apparent distress
Neck Carotids 2+ .
No bruit detected
Chest Clear to PandA without rale or dullness
Cor S1 and S2 without significant murmur
Abdomen Bowel sounds positive , cannot detect bruit today
Extrem Feet are well profused but only DP on the right is palpable
Assessment and plan
Renal failure , diabetes , coronary disease , and gout .
We will check labs for stability .
The patient had a report of apical thickening on a chest film at Colonial Manor and will repeat the chest x-ray today .
The patient is to follow up with me in short order in the Renal Service .
Addendum
Chest x-ray was reviewed , and pleural thickening is stable since 2075 .
There is no CHF or parenchymal disease .
There is vascular calcification of the aorta as well as coronary vessels .
Note transcribed by outside service
Transcription errors may be present .
Signed electronically by Jeffers , Oswald on Jan 21 , 2079
Record date : 2073-10-24
10/24/73
This is my first visit with Teresa Hardy ( MR# 36052413 ), a 54 yo F here to
meet her new PCP .
She has not seen a doctor in many years .
She made this appt ,
because she had heavy vaginal bleeding 2 weeks ago .
She normally has her
periods q28d , with 5 days of heavy flow .
Her last period lasted for 15 days
with the usual clots and heavy flow .
The bleeding stopped 2 weeks ago , and
there is no spotting now .
She denies any abd pain .
She denies possiblity of
<|output|>{"AGE": ["54"], "CONTACT": [], "DATE": ["Jan 21 , 2079", "10/24/73", "2075", "2073-10-24"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Colonial Manor"], "ID": ["36052413"], "LOCATION": [], "NAME": ["Teresa Hardy", "Jeffers , Oswald"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
emotionally upset about his son-in-law
Physical examination :
- BMI : 33.7 Obese , high risk
- Pulse : 65
- resp .
rate : 18
- height : 64 in .
- weight : 196 lbs .
- General : Pleasant male lying in bed , teary at times .
- Chest : Bilateral breath sounds clear anteriorly
- Cardiac : Normal S1 and S2 , without S3 , S4 ro murmur .
No JVD .
Carotids brisk bilaterally without bruits .
- Abdomen : Obese , soft NT active BS throughout .
+ umbilical hernia
- Extremities : Right femoral arterial sheath in place .
+PPP , trace pedal edema
- Neuro : A& ;
O , grossly non-focal .
- BP : 135/60
EKG :
1/12/97 NSR 61 PR.18 QRS . 8
unchanged from EKG 12/09/96
Selected recent labs :
Metabolic
Date K BUN CRE GLU
01/07/97 4.6 24 1.2 115
Lipid/Thyroid
Date CHOL TRIG HDL LDL
12/14/96 175 69 76 85
Hematology
Date HCT WBC PLT
01/07/97 31.8 7 235
Assessment and plan :
77 y.o male with hypertension , hyperlipidemia and previous cardiac stenting to LAD .
Now with six week history of exertional chest pressure and dyspnea that continues despite changes in his medical regimen .
Today cardiac catheterization showed 90% proximal Lad lesion and some in stent restenosis and he had a PTCA/Cypher stent to his LAD .
<|output|>{"AGE": ["77"], "CONTACT": [], "DATE": ["12/14/96", "01/07/97", "1/12/97", "12/09/96"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Elizabeth M Keys , M.D .
Record date : 2149-03-18
CARDIOLOGY
BETHANY BRETHREN HOSPITAL
Reason for visit :
Mr . Eubanks is a 68 yo man w/ recently diagnosed CAD s/p LAD stent .
Interval History :
Mr Eubanks presents for hospital followup after presenting to BBH in January 2149 w/ after he developed 2 episodes of chest pain lasting 1-2 minutes each and not associated with any symptoms .
On the morning of admission , patient developed more severe chest pain and pressure radiating to both arms and back .
Pain persisted for 2 hours , prompting the patient to present to the BBH ED for further care .
In the ED , patient was treated with ASA , metoprolol , sl NTG , and chest pain resolved .
EKGs showed biphasic T-waves in V4-5 .
CT scan was negative for aortic dissection or other acute pathology .
Cardiac markers were negative .
Patient was admitted to the Internal Medicine service for further management .
Of note , at Pennsylvania Hospital , patient had a positive ETTMIBI showing fixed + mild reversible defect in the inferoapical region in 2/47 , followed up with normal exercise echo in 5/47 .
On first night of admission , patient developed recurrent chest pain when going to the bathroom .
Because of his risk factors for disease , the decision was made to proceed directly to cardiac catheterization .
In the cath lab , patient was found to have multivessel CAD with an LAD culprit .
He received 3xCypher stents to the mid and distal LAD with residual flow limitation .
RCA with moderate disease .
LCx with distal disease .
Patient was transferred to the SDU for further care.He was started on beta-blockers and ace-inhibition , and tolerated these medications well .
He was evaluated for cardiac rehab .
Of note , patient was informed of the pulmonary nodule located on CT scan and the need for follow-up CT in 3 months .
Past medical history :
CAD as above
HTN
Hyperlipidemia
Gout
DM type 2
GERD
Pulmonary nodule
Medications ( Confirmed ):
ASA 325 mg po qd
atenolol
<|output|>{"AGE": ["68"], "CONTACT": [], "DATE": ["2149-03-18", "January 2149", "2/47", "5/47"], "DEVICE": [], "DLN": [], "HOSPITAL": ["BETHANY BRETHREN HOSPITAL", "Pennsylvania Hospital", "BBH"], "ID": [], "LOCATION": [], "NAME": ["Eubanks", "Elizabeth M Keys"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Cardiac examination reveals a
non-displaced PMI with normal intensity S1 and S2 .
She has a grade II/VI holosystolic murmur
at the apex and a grade II crescendo/decrescendo systolic murmur at the right upper sternal
border .
She has 1 - 2+ edema of both lower extremities and they are warm to touch .
Her ECG reveals sinus rhythm at 68 beats per minute , normal axis and intervals .
There are
nonspecific ST abnormalities .
Overall , Ms . Yerger has improved significantly with better control of her blood pressure .
She
has signs of very mild volume overload on examination , with preserved perfusion .
We elected
to maintain her present dosing , but discussed increasing her dose to 40 mg PO q .
a.m . and 20 mg
PO q .
p.m . should her lower extremity edema increase or her weight rise .
Urania Yerger
MR #583-48-90-0
Page 2
November 15 , 2079
I look forward to seeing her again in approximately six months .
It was a pleasure being involved
in her care .
Please do not hesitate to contact me with any questions .
Sincerely yours ,
Vaughn A . Xander , M.D .
/ uhl
Record date : 2096-06-11
Internal Medicine
LANCASTER MEMORIAL HOSPITAL
Personal data and overall health Mr . Jacobs is a 73 yoM with a history of NIDDM , CAD s/p anteroseptal MI ( 2092 ) w/ stent placement , AIHA , BPPV .
Reason for visit Follow-up Visit
Problem List
( reviewed )
Diabetes mellitus ( adult onset ) MAJOR
Atherosclerotic coronary vascular disease MAJOR
<|output|>{"AGE": ["73"], "CONTACT": [], "DATE": ["2092", "November 15 , 2079", "2096-06-11"], "DEVICE": [], "DLN": [], "HOSPITAL": ["LANCASTER MEMORIAL HOSPITAL"], "ID": [], "LOCATION": [], "NAME": ["Urania Yerger", "Yerger", "Jacobs", "uhl", "Vaughn A . Xander"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Cardiology/ EP was consulted for the possibility of ablation given this was his third admission and he is so symptomatic .
EP decided to start the patient on sotalol 80-mg BID with the plan to increase sotalol to 120mg BID on 6/15 if Qtc remains stable ( < ;
500 msec ).
He is planned to received 5 doses of sotalol prior to dispo and if he remained in aflutter through 6/15 is to get DCCV on 6/16 .
He received his first and only dose in the pm 6/14 .
Overnight he was bradycardic into the 40s while sleeping .
He had a 3.5 second pause however on telemetry .
His heart rates have ranged from 45-60 in AFlutter .
BPs 90s systolic .
Per EP , as pt asleep , will con't sotalol .
He is on coumadin for anticoagulation .
INR goal 2-3 .
EP(Dr .
Moody = fellow ) and cards ( PRM wright ) are following .
PUMP : echo 04/84 which demonstrated an elongated LA sLVH , EF 61% , tr TR , RSVP 41 , RV nl .
On ACEI .
PULM : CXR in ED with pulm edema .
Given 20mg PO lasix x1 for gentle diuresis .
On 1 L O2 as of am 6/15 and lasix 10mg Iv x 1 again this am 6/15 .
Felt to be related to his AF .
He does have a h/o repeated PNAs .
On xopenex , flovent .
FEN : Mild hyperK in the ED to 5.3 .
Received 30g kayexelate .
Normalized .
NPO at midnight 6/15 for possibel DCCV if still planned by E .
Isabella Glenn Mathews , MD MSc ,
Pager 43771
#NAME?
Record date : 2129-08-20
July 6 , 2129
Robert Trejo , M.D .
17 Unicorn Way
Suite 353
Chickasha , NC 75156
RE : Tyler Pearson
WMC # 727-19-02
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["6/16", "2129-08-20", "6/15", "6/14", "04/84", "July 6 , 2129"], "DEVICE": [], "DLN": [], "HOSPITAL": ["PRM", "WMC"], "ID": ["727-19-02"], "LOCATION": ["17 Unicorn Way", "NC", "Chickasha"], "NAME": ["Isabella Glenn Mathews", "wright", "Moody", "Robert Trejo", "Tyler Pearson"], "ORGANIZATION": [], "PHONE": ["43771"], "PROFESSION": [], "ZIP": ["75156"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Enalapril Maleate 10 MG ( 10MG TABLET take 1 ) PO QD x 30 days
Hctz ( HYDROCHLOROTHIAZIDE ) 25MG TABLET take 1 Tablet
( s ) PO QD
Lipitor ( ATORVASTATIN ) 80 MG ( 80MG TABLET take 1 ) PO QHS
METFORMIN 850 MG ( 850MG TABLET take 1 ) PO BID
Viagra ( SILDENAFIL ) 100MG TABLET take 0.5 Tablet
( s ) PO x1
Vicodin Es 7.5/750 ( HYDROCODONE 7.5mg #NAME? Apap 750mg ) 1 TAB PO BID PRN , Mailing hard copy to you .
Xanax ( ALPRAZOLAM ) 0.5MG TABLET take 1 Tablet
( s ) PO BID
Allergies
NKA
Vital Signs
PULSE 66
TEMPERATURE 98.7 F
O2 SAT 97
BLOOD PRESSURE 135/60
Right arm .
BLOOD PRESSURE 132/60
L arm .
Physical Exam
General Appearance
Alert , no acute distress , comfortable lying flat on exam table .
HEENT
PERRL .
Moist mucous membranes .
Neck
No visible JVD .
No cervical nodes .
Chest
Lungs clear , good air movement , no crackles , wheezes .
No focal rhonchi .
No pleural rub .
#NAME? focal tenderness approx 2-3 cm above the xiphoid #NAME? subcutaneous tissue feels a little thicker here , but no fluctuance , erythema , warmth .
No sternal movement wiht palpation .
No palpable sternal wire .
Cor/Cardiac
<|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Anaphylactoid reactions with intraperitoneal cisplatin .
<|output|>{"drugs": [{"name": "cisplatin", "reaction": ["Anaphylactoid reactions"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Visual loss after a single small dose of vincristine has never been reported .
<|output|>{"drugs": [{"name": "vincristine", "reaction": ["Visual loss"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
12 .
Ativan 0.5 to 1 mg p.o . bid prn anxiety .
13 .
Lopressor 12.5 mg p.o . bid .
14 .
Multivitamin 1 tab p.o . every day .
15 .
Nitro-Dur patch 0.2 mg per hour transdermal every day .
16 .
SENNA 2 tabs p.o . bid .
17 .
Silvadene one application topically bid to wound .
18 .
Zocor 20 mg every day .
19 .
Coumadin 5 mg p.o . qpm .
Vitals : T : 96.9 , HR : 75 , BP : 179/78 , RR : 18 , O2 sat : 96% RA
Physical Examination :
General : Alert , oriented , NAD , good historian
Lower extremities : Multiple well-healed incisions .
On the right lower extremity , there is an incision from the groin to the foot .
It is well-healed with the exception of a 5 x 2 cm area over the lower third of the leg just medial to the tibia .
The graft is palpable just lateral to the area .
The base of the wound appears to have granulation tissue .
No odor .
There is minimal erythema and tenderness around the site .
Distal pulses palpable .
Foot warm and well-perfused but with no sensation below the ankle .
There are other venous stasis ulcers in various stages of healing .
The great toe has an ulcer with overlying eschar .
Relevant Laboratory Values :
Pending
Assessment : 85 yo WM w/ multiple medical comorbidities presents with need for wound coverage of a right saphenous vein bypass graft .
This may be amenable to local flap coverage .
Recommendations :
#NAME? Tentative plan wound debridement/possible flap closure this week
#NAME? Will discuss with Dr . Ring ( covering for Dr . Velasco ) and plan to assist with closure .
<|output|>{"AGE": ["85"], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Velasco", "Ring"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
All PNC .
Medications
Asa ( CHILDREN 81MG TABLET Take 1 Tablet
( s ) QD , Take as directed
Dyazide 50/25 ( Take 1 ) PO QD , 50/25 #90 Capsule
( s )
Flonase ( FLUTICASONE NASAL SPRAY ) 1-2 SPRAY NAS QD x 14 days #1 Bottle
( s )
Glyburide 5MG TABLET Take 1 Tablet
( s ) PO BID 15 minutes prior to breakfast and supper #60 Tablet
( s )
Levothyroxine SODIUM 112MCG TABLET PO QD , Take as directed #90 Tablet
( s )
Lisinopril 10 MG ( 10MG TABLET Take 1 ) PO QD , Take as directed #30 Tablet
( s )
Simvastatin 40 MG ( 40MG TABLET Take 1 ) PO QPM #90 Tablet
( s )
Toprol XL ( METOPROLOL SUCCINATE EXTENDED RELEASE ) 100MG TABLET CR 24HR Take 1.5 Tablet
( s ) PO QD , Please keep appt for further refills #135 Tablet
( s )
Warfarin SODIUM 4 MG ( 1MG TABLET Take 4 ) PO QPM , Take as directed per AMA clinic
X . Hayes , M.D
Record date : 2086-04-18
ZASTROW , IRENE
42521583
04/18/2086
Iva Hall , M.D .
Internal Medicine
Davis Monthan Hospital
39 Gleneagle Drive
Naples , OK 73257
Dear Iva :
Irene Zastrow , 66 years old , returned for followup of coronary artery disease and non-ST segment elevation myocardial infarction that she suffered in Pennsylvania on 10/29/2085 .
At that time , she had a drug-eluting stent placed in her left anterior descending coronary artery .
On 11/03/2085 , she had repeat percutaneous coronary intervention because of persistent chest pain and required an additional inflation and reexpansion of the drug-eluting stent .
On 12/07/2085 , she had repeated cardiac catheterization because of chest pain but no additional percutaneous coronary intervention was required .
She feels that she is having less chest discomfort as we have " ramped up " her cardiac medications .
<|output|>{"AGE": ["66"], "CONTACT": [], "DATE": ["04/18/2086", "2086-04-18", "12/07/2085", "11/03/2085", "10/29/2085"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Davis Monthan Hospital", "AMA"], "ID": ["42521583"], "LOCATION": ["OK", "39 Gleneagle Drive", "Naples", "Pennsylvania"], "NAME": ["ZASTROW , IRENE", "Irene Zastrow", "X . Hayes", "Iva Hall", "Iva"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["73257"]} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2080-04-15
EDVISIT^10776605^GLENN, OLIVIA^04/15/80^URIBE, HAROLD
Seen by me along with Dr. Oglesby on 04/15/2080. The history as
documented by Dr. Oglesby was reviewed by me with the patient and
found to be accurate and complete. The physical exam was
confirmed by my examination. Evaluation and management was also
concurred with.
HISTORY OF PRESENT ILLNESS: Briefly, this is a 66-year-old woman
who enters with recent three-month history of admission for
respiratory failure, pneumonia, and MSSA bacteriemia, discharged
from rehab two weeks ago, presents with two to three day history
of shortness of breath; dyspnea on exertion; PND; orthopnea; and
leg edema, improving, but complains of occasional chest tightness
lasting about an hour, worse with exertion. No nausea and no
vomiting. Nonradiating. Seen by VNA today, blood pressure was
190/100 and sent her here for evaluation.
SOCIAL HISTORY: Does not smoke and does not drink.
PAST MEDICAL HISTORY: History of atrial fibrillation,
hypertension, diabetes, CHF, asthma, and chronic renal
insufficiency, the baseline creatinine is 2.5.
Review of systems, allergies, and medications are as documented
in the chart. Please see the notes for details.
PHYSICAL EXAMINATION: Awake and alert, well-developed,
well-nourished woman in mild respiratory distress. Pulse 93,
respirations 18 to 20, blood pressure 158/83, and O2 saturation
100% on 4 liters nasal cannula. JVP at 10 cm. Lung exam shows
rales to one-third of the way up to the lung bases.
Cardiovascularly, regular rate and rhythm. The rest of the exam
is as documented in the chart other than pedal edema.
LABORATORY DATA: EKG shows sinus rhythm and left anterior
fascicular hemiblock with flattening at V2. Chest x-ray shows
pulmonary vascular congestion.
EMERGENCY DEPARTMENT COURSE: As such, she was admitted to
Medicine with a diagnosis of decompensated CHF, likely secondary
to hypertension. Her blood pressure initially when she came in
******** Not reviewed by Attending Physician ********
DISPOSITION: She was admitted on 04/15/2080.
______________________________
URIBE, HAROLD M.D.
D: 04/15/80
T: 04/16/80
Dictated By: URIBE, HAROLD
eScription document:0-4339350 XJ
<|output|>{"AGE": ["66"], "CONTACT": [], "DATE": ["2080-04-15", "04/15/80", "04/15/2080", "04/15/2080", "04/15/80", "04/16/80"], "ID": ["10776605", "0-4339350 XJ"], "LOCATION": [], "NAME": ["GLENN, OLIVIA", "URIBE, HAROLD", "Oglesby", "Oglesby", "URIBE, HAROLD", "URIBE, HAROLD"], "PROFESSION": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
The development of cutaneous ecchymosis associated with a sudden fall in hemoglobin after the administration of alteplase should strongly suggest the possibility of diffuse subfascial hematoma .
<|output|>{"drugs": [{"name": "alteplase", "reaction": ["cutaneous ecchymosis"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
There was no presacral edema .
Extremities : Warm and well
perfused , trace lower extremity edema noted , no asymmetrical
lower extremity edema .
There were no palpable cords .
Neuro :
The patient was alert and oriented x3 , motor , strength , and
sensation were all grossly intact .
The patient's cranial nerves
are grossly intact .
I did not ambulate the patient .
INITIAL IMPRESSION AND PLAN : The patient is a 70 -year-old male
with a history of coronary artery disease , congestive heart
failure , prior transient ischemic attack , and atrial fibrillation
for which he is on Coumadin , who presents with a syncopal
episode .
The patient was sent in to the Emergency Department for
further evaluation and workup for this syncopal event .
Differential diagnosis at this time includes a syncopal event
secondary to dehydration versus arrhythmia .
I do not feel that
the patient had a cerebrovascular accident .
The patient will
need to have screening laboratory studies and formal imaging .
EMERGENCY DEPARTMENT COURSE : Upon arrival to the Emergency
Department , the patient had history and physical exam performed .
The patient then had a 12-lead EKG performed .
The patient's
12-lead EKG was consistent with atrial fibrillation with some
T-wave flattening noted .
There were no definite acute ischemic
changes appreciated .
The patient had laboratory studies sent .
The patient's laboratory studies were notable for a creatinine of
1.69 .
The patient does have a history of renal insufficiency .
<|output|>{"AGE": ["70"], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
A woman with a 20-year history of acral pustular psoriasis of Hallopeau and recurrent pustular lesions of the forearms and lower legs , developed a B-cell lymphoma of the lip following 4 1/2 years of treatment with razoxane .
<|output|>{"drugs": [{"name": "razoxane", "reaction": ["B-cell lymphoma"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Last week he had a right carotid endarterectomy .
Initially , he had some hoarseness .
It
went away but now it has returned .
He did have a period of 100.4 while at home and
has felt a little chilled .
He is still hoarse today .
He feels a little achy in the joints .
Medications
Albuterol INHALER 1-2 PUFF INH QID PRN , Take as directed
Zestril ( LISINOPRIL ) 30MG TABLET take 1 Tablet
( s ) PO QD
Lipitor ( ATORVASTATIN ) 10MG TABLET take 1 Tablet
( s ) PO QD
Hctz ( HYDROCHLOROTHIAZIDE ) 12.5MG CAPSULE take 1 Capsule
( s ) PO QD , THIS WAS FAXED TO YOU ON 5/8/14
Coumadin ( WARFARIN SODIUM ) 5MG TABLET take 1.5 Tablet
( s ) PO QPM
Salsalate 750MG TABLET take 1 Tablet
( s ) PO BID PRN
Flonase NASAL SPRAY ( FLUTICASONE NASAL SPRAY ) 1-2 SPRAY ( 50MCG SPRAY ) NAS BID
Problems
Hypertension
Osteoathritis
Gastroesophageal reflux disease
Diverticulitis
Cerebrovascular accident : L cerebellar 2112 , s/p L CEA
Lung nodule : Repeat chest CT 10/14 .
Allergies
Penicillins - Rash ,
Penicillins - Rash
Vital Signs
BP 140/78 , P 76 , Temp 98.1 F
On exam , he is hoarse .
Temperature is 98.1 , however .
Throat is clear .
His right CEA
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["10/14", "5/8/14", "2112"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
******** Not reviewed by Attending Physician ********
#NAME?
Record date : 2099-03-29
Neurology resident consult note
Patient Name : Leon
MRN : 43634211
Date : 21
Consult reason :
? abnormal gait
HPI : 53 RHM who going to bed Wednesday was in usoh , but Thursday 2:30AM awoke w/ terrible HA , so came to ED ;
got CT head and LP , both negative for blood .
However , BP was reportedly as high as 190/106 ( and wife says she’ ;
s measured it this high at home at least once in past 2 weeks "), and blood glucose 400s .
I see no LMR note about the visit , but am told that he was given some medication for his BP , given some insulin and a Rx for insulin , and instructed to see his PCP the next day , and discharged .
Friday he did see his PCP , who told him not to take insulin but to take oral DM meds instead , and told him to return to the ED b/c he still had a terrible HA , so he came back to the EDUCARE-PULLMAN ED tonight .
He was given caffeine , ibuprofen , Tylenol , and compazine , reported that his HA was gone .
However , a staff physician in the ED on exam noted a wide based gait .
An MRI was originally ordered , but canceled when it came to notice that he has an implanted device to prevent syncope that precludes MRI .
Neurology is now consulted.to comment on his gait and other sx .
Patient and his wife tell me that his gait is baseline , and has been as it is for years ;
they have noticed no change and have no complaints .
He is very unpleasant and un-forthcoming about his history , slow to cooperate w/ exam ;
says he wants to go home , resents being in the ED still now that his HA is gone .
VS in ED tonight : BP 172/95 max , but mostly 150-160s ;
temp 98 , hr 89 , 100% RA
Blood glucose not measured tonight .
ROS :
Negative for : changes in vision or hearing , neck pain , tinnitus , vertigo , weakness , numbness , difficulty with comprehension , speaking , language , swallowing , eating , balance or gait .
General review of systems negative for : fevers , chills , rashes , change in weight , energy level or appetite , chest pain , palpitations , shortness of breath , cough , abdominal pain , nausea , vomiting , and change in bowel or bladder habits ( i.e incontinence ).
MEDS : metoprolol , omeprazole , simvastatin ( he is unsure whether this is all )
ALL : nkda
PMH :
#NAME? HTN ;
he denies prior dx of DM before yesterday night
#NAME? recurrent cardiogenic syncope , for which he has had “ ;
Reveal” ;
device implanted , then explanted b/c of pain , then recurrent sycope and reimplantation of device , after which syncope stopped ( see notes in LMR from Dr . Susan Root )
<|output|>{"AGE": ["53"], "CONTACT": [], "DATE": ["21", "Wednesday", "2099-03-29", "Thursday", "Friday"], "DEVICE": [], "DLN": [], "HOSPITAL": ["EDUCARE-PULLMAN"], "ID": ["43634211"], "LOCATION": [], "NAME": ["Susan Root", "Leon"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Oesophageal ulceration due to emepronium bromide .
<|output|>{"drugs": [{"name": "emepronium bromide", "reaction": ["Oesophageal ulceration"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Microbiology
21-Jul-2076 09:41
Specimen Type : WOUND
Specimen Comment : ULCER 4TH 5TH TOE
Wound Culture - Final Reported : 24-Jul-76 15:05
Moderate PROTEUS VULGARIS
RAPID METHOD
Antibiotic Interpretation
----------------------------------------------
Amikacin Susceptible
Ampicillin Resistant
Aztreonam Susceptible
Cefazolin Resistant
Cefepime Susceptible
Cefpodoxime Susceptible
Ceftriaxone Susceptible
Gentamicin Susceptible
Levofloxacin Susceptible
Piperacillin Susceptible
Trimethoprim/Sulfamethoxazole Susceptible
A/P : 48 M with a hx of DM2 , PVD and multiple admissions in the past for LE cellulitis in the setting of gangrene .
1 .
ID : Patient is now presenting with appears to be another episode of cellulitis but now probably coming from his L 5th Toe lesion .
Surgery has debrided the wound , sending wound cultures as well as blood cultures .
Acute OM would not be visible on XR changes and clinical picture is more consistent with acute than Chronic OM .
Will consider further work up for OM if symptoms do not respond to treatment .
Levo and flagyl were added to unasyn in accord to previous culture data .
2 .
PVD : Will need arterial LENIS to assess for vascular patency and flow .
Continuing ACEI , and adding ASA and lipitor , will order lipid profile and smoking cessation consult .
3 .
DM2 : Very poor control last admission , eventhough patient now says he takes medications and checks it up to QID .
Will order HgbA1C and glucose monitoring .
_______________________________________________________________________
Name Ian Jurado MD
Pager # 14558
PGY-1
<|output|>{"AGE": ["48"], "CONTACT": [], "DATE": ["24-Jul-76", "21-Jul-2076"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Ian Jurado"], "ORGANIZATION": [], "PHONE": ["14558"], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Because the cerebellar toxicity may be worsened by continuation of therapy after initial onset of symptoms , prompt termination of HDARAC is recommended .
<|output|>{"drugs": [{"name": "HDARAC", "reaction": ["cerebellar toxicity"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
check chem
3 .
OA - vioxx 12.5 qd with tylenol bid prn .
4 .
Multiple lacunes - control htn
5 .
CAD , PVD and hiatal hernia - stable
The patient will f/u with me in 3 mos , or sooner prn .
______________________________
Tracy T . Xenakis , M.D .
Record date : 2092-05-05
05/05/2092
Spanish
81 Wood St UHRICH , KARSON
North Andover , KY 41454 45630268
( 884 ) 486-9594 07/01/2091
HISTORY OF PRESENT ILLNESS : Ms . Uhrich is
75 . Medical issues include osteopenia , hyperlipidemia , hypertension , heart block ( pacemaker implanted ), gastritis , occasional joint pains .
Medications
Amitriptyline HCL 25 MG ( 25MG TABLET Take 1 ) PO QHS x 30 days #30 Tablet
( s )
Asa EC ONE TABLET 81 MG PO qd #100 Tablet
( s )
Atenolol 50 MG ( 50MG TABLET Take 1 ) PO QD #60 Tablet
( s )
Calcium + D ( 500 ELEM . CA ) ( CALCIUM CARBONATE 1250 MG ( 500MG ELEM CA)/ VIT D 200 IU )) 1 TAB PO BID #60 Tablet
( s )
Fosamax ( ALENDRONATE ) 70 MG ( 70MG TABLET Take 1 ) PO Q month #3 Month
( s ) Supply
Lisinopril/hydrochlorothiazide 20MG/25MG 1 TAB PO QD #90 Tablet
( s )
Metformin EXTENDED RELEASE 500 MG ( 500MG TAB.SR 24H Take 1 ) PO QD #90 TAB.SR
Monistat 3 ( MICONAZOLE 200MG VAGINAL SUPP ) 1 SUPP PV QHS x 3 days #3 Suppositories
Protonix ( PANTOPRAZOLE ) 40 MG ( 40MG TABLET DR Take 1 ) PO QD #30 Tablet
( s )
Simvastatin 20 MG ( 20MG TABLET Take 1 ) PO QHS #30 Tablet
( s )
<|output|>{"AGE": ["75"], "CONTACT": [], "DATE": ["2092-05-05", "05/05/2092", "07/01/2091"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["45630268"], "LOCATION": ["81 Wood St", "North Andover", "KY"], "NAME": ["Uhrich", "Tracy T . Xenakis", "UHRICH , KARSON"], "ORGANIZATION": [], "PHONE": ["( 884 ) 486-9594"], "PROFESSION": [], "ZIP": ["41454"]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Prior reports have emphasized the tubular and interstitial lesions associated with intermittent or discontinuous rifampin therapy for tuberculosis .
<|output|>{"drugs": [{"name": "rifampin", "reaction": ["tubular and interstitial lesions"]}]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
To our knowledge , no prior cases of penicillamine -induced TTP in RA have been reported .
<|output|>{"drugs": [{"name": "penicillamine", "reaction": ["TTP"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
On 23/10/77 , pt underwent dilatation of the skin surrounding the colostomy site , to relieve a large bowel obstruction .
S/p Cholecystectomy in 2066
Lives in Corry , Minnesota with his mother , Luanne Runner
Occupation : Former Tourist information centre manager .
Currently Scientific laboratory technician .
No significant change from previous EKG on 23/10/77 .
WBC 7.8 ( 03-28-1994.0 ) th/cmm
HCT 38 L ( 410-12-2007.0 ) %
HGB 13.1 L ( 07-26-1978.5 ) gm/dl
RBC 4.63 ( 4.511-25-1976 ) mil/cmm
MCH 28.4 ( 02-07-2008.0 ) pg/rbc
MCHC 34.6 ( 12-03-1970.0 ) g/dl
RDW 16.1 H ( 02-23-1984.5 ) %
CO2 ( Stat Lab ) 26.7 ( 11-04-2003.9 ) mmol/L
Calcium 9.6 ( 04-16-2004.5 ) mg/dl
TOXIC : > ;
UA-Specific Gravity > ;
29 y.o .
Case and plan discussed in detail with Medical Consult Attending , Dr .
Elissa Guise , M.D .
PEACHFORD HOSPITAL Medical SAR
Record date : 2083-01-18
Dillian Marlinda is a 67 y/o male who c/o chills , hot flashes , night sweats ;
Coronary artery disease : CABG x2 vessels , 4/78 .
Aortic stenosis : AVR 08-20-1982 Dr Clyda Asad Harrell
Diabetes mellitus : Dr Humble Janeya - FOREST PARK MEDICAL CENTER
Results 27/01/83 [1] NA 136 [2] , K 4.6 , BUN 19 , CRE 0.8 , EGFR 101 [3] , GLU 112 ( H)[1] SPECIMEN COMMENT : Unless otherwise noted , Test performed at DELRAY MEDICAL CENTER , East Stacey , Hartford , ME 90300 , Wyline Margaree , MD , PHD , Laboratory Medical Director CBC SENT TO Calvert Memorial Hospital [2] RESULT COMMENT : RV=REPEATED AND VERIFIED[3] RESULT COMMENT : ( Abnormal if < ;
FOREST PARK MEDICAL CENTER 28/04 .
Record date : 2079-05-25
KTG:256-38-93-7
20/9/79
Follow-up visit for this 64-year-old Brazil woman .
Social History : She has a daughter , Hannan Sabrea , who has been very supportive .
She had a hemoglobin A1C in May , which was 6.4 .
She had an ophthalmology exam in November .
DSK:876-81-15-7
<|output|>{"AGE": ["29", "67", "64-year-old"], "CONTACT": [], "DATE": ["2066", "07-26-1978.5", "02-23-1984.5", "23/10/77", "2079-05-25", "27/01/83", "2083-01-18", "May", "28/04", "08-20-1982", "12-03-1970.0", "4/78", "November", "04-16-2004.5", "03-28-1994.0", "20/9/79", "11-04-2003.9", "02-07-2008.0"], "DEVICE": [], "DLN": [], "HOSPITAL": ["PEACHFORD HOSPITAL", "DELRAY MEDICAL CENTER", "Calvert Memorial Hospital", "FOREST PARK MEDICAL CENTER"], "ID": ["KTG:256-38-93-7", "DSK:876-81-15-7"], "LOCATION": ["Hartford", "Brazil", "Minnesota", "East Stacey", "Corry"], "NAME": ["Elissa Guise", "Humble Janeya", "Luanne Runner", "Clyda Asad Harrell", "Wyline Margaree", "Hannan Sabrea", "Dillian Marlinda"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Scientific laboratory technician", "Tourist information centre manager"], "ZIP": ["90300"]} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Adrenaline dacryolith : detection by ultrasound examination of the nasolacrimal duct .
<|output|>{"drugs": [{"name": "Adrenaline", "reaction": ["dacryolith"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
HCT 36 36.0-46.0 %
HGB 12.1 12.0-16.0 gm/dl
RBC 4.19 4.00-5.20 mil/cmm
PLT 232 150-350 th/cumm
MCV 86 80-100 fl
MCH 29 26.0-34.0 pg/rbc
MCHC 33.7 31.0-37.0 g/dl
RDW 26.1 H 11.5-14.5 %
PT 14.2 H 11.1-13.1 sec
PT-INR 1.3
Result Text :
PT-INR values are valid only for WARFARIN ANTI-COAG THERAPY .
APTT 57.3 H 22.1-35.1 sec
CT angiogram #NAME? Negative for PE on preliminary read
CXR : Small bilateral pleural effusions
EKG : Sinus tachycardia at 112bpm , LAE , 1mm ST depressions V4-V6 ( similar when compared to previous EKG w/ tachycardia to 120 )
TTE : Compared to the report of 09/09/2090 , the transmitral gradients have increased , the degree of MR and AI has increased , and the RV systolic pressure has increased significantly .
LV size and function remain normal .
If clinically indicated , a transesophageal echo is suggested to better evaluate the prosthetic valve .
CTHead :
1 . NO ACUTE INTRACRANIAL HEMORRHAGE OR FRACTURE .
2 . NON-SPECIFIC PERIVENTRICULAR AND SUBCORTICAL WHITE MATTER
HYPOATTENUATING AREAS ARE LIKELY DUE TO CHRONIC MICROANGIOPATHIC
CHANGES .
___________________________________________
Impression :
Ms .
Mitchell is a 75 yo woman w/ multiple medical problems including HOCM , s/p MVR and myomectomy as well as COPD who presents with increasing SOB and DOE for the past four days .
Of note , the patient notes increasing DOE for the past 4 months but with acute decompensation today .
Her progressive DOE may be related to CHF , especially in the setting of ischemic changes seen on EKG however , her acute decompensation may be related to COPD exacerbation in the setting of a viral illness .
Plan :
SOB #NAME? Unclear etiology currently by may likely be multifactorial
#NAME? Treat COPD w/ Atrovent nebs , prednisone , O2 , Levaquin
#NAME? Patient did not tolerate tachycardiac so Albuterol was DC'ed
#NAME? Follow urine output secondary to IV Lasix
#NAME? Daily weights , strict Is and Os
#NAME? Keep O2 sats 88-90%
<|output|>{"AGE": ["75"], "CONTACT": [], "DATE": ["09/09/2090"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Mitchell"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
D/C HCTZ , Diamox as likely precipitants of delerium and renal failure
3 .
ID : Cont to monitor for signs/sx of infection .
None currently present .
4 .
GI : Elevated Pancreatic Enzymes :
No signs or symptoms currently .
Cont to follow .
Elevated AST and AlkPhos : Consider ordering a GGT .
Dysphagia : consider a barium swallow .
5 .
FEN : Speech and Swallow consult .
Soft diet .
6 .
Proph : Nexium , Heparin .
PT/OT
_______________________________
Gary Aragon
x 23368
Intern addendum :
Pt seen and examined with Gary Aragon , agree with assessment and plan .
In brief , 74 F with dementia presenting with acute on chronic renal failure and delerium .
Etiology likely multifactorial , however , diamox is the only new medication and may explain both her worsening renal failure and delirium .
Will pursue broad differential as outlined above .
Ulysses Xiao
Record date : 2077-06-16
HALE MEMORIAL HOSPITAL
Internal Medicine
600 Dearborn Street
Rayne , MI 82978
Geiger , Xander
1729440
06/16/77
Mr .
Geiger is a 75 year old man with a history of hypertension ,
hyperlipidemia and panhypopituitarism who comes in today for
follow up of his blood pressure .
<|output|>{"AGE": ["75", "74"], "CONTACT": [], "DATE": ["2077-06-16", "06/16/77"], "DEVICE": [], "DLN": [], "HOSPITAL": ["HALE MEMORIAL HOSPITAL"], "ID": ["1729440"], "LOCATION": ["Rayne", "MI", "600 Dearborn Street"], "NAME": ["Geiger", "Geiger , Xander", "Gary Aragon", "Ulysses Xiao"], "ORGANIZATION": [], "PHONE": ["23368"], "PROFESSION": [], "ZIP": ["82978"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
BP 145/60 , P 56 , VAS SCORE 8/10
HEENT : Normal .
Lungs : CTA ( B )
Heart : RRR , S1 , S2 , no murmurs
Abdomen : Soft , non-tender , bowel sounds present
Extremities : No cyanosis , clubbing or edema .
Targeted examination showed an age appropriate woman in no apparent distress .
Mental Status : She was fully awake and alert .
Her mood was appropriate .
There was mild sensory loss in a stocking distribution over the lets as well as in a glove distribution over the hands .
There was no frank allodynia of the feet .
Patellar and ankle reflexes were retained .
Toe response was flexor .
The patient could walk , including heel and toe walk .
There was no pain on straight leg raising .
There was no local tenderness over the back , however , a moderate degree of muscle spasm over the lower back .
IMPRESSION :
1 .
Spinal stenosis .
2 .
Diabetic neuropathy .
PLAN :
1 .
Start Neurontin with a target dose of 300 mg t.i.d . for now .
If tolerated , we will increase to 600 mg t.i.d .
2 .
One week after Neurontin , start Zanaflex 2 mg p.o . q.h.s . to be titrate up to 4 mg after one week .
3 .
Lumbar epidural steroid injection at L4-5 or L5-S1 .
If treatment with injections is unsuccessful , we will ask the patient to be reevaluate by Neurosurgery .
Ila Easter , M.D .
#NAME?
Record date : 2081-03-02
EDVISIT ^ 35093053 ^ Dodd , Steven ^ 03/02/81 ^ CHURCH , XION
I interviewed and examined the patient , reviewed the resident's documentation on the patient's chart , and discussed the evaluation , plan of care , and disposition with the patient .
The Medical Intensive Care Unit team , the senior admitting resident , and other members of the medical staff .
Please refer to the resident's chart for details .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["2081-03-02", "03/02/81"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["35093053"], "LOCATION": [], "NAME": ["Dodd , Steven", "CHURCH , XION", "Ila Easter"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
He has neuropathy for more than 10 years .
He had laparoscopic Roux-en-Y on 06/08/2074 .
His weight lost from 435 lbs before the Sx to 275 lbs .
He is no longer on insulin .
Current hypoglycemic regimen includes metformin 850 mg daily .
Last A1C was less than
7 . He reports dry cough and he attributes to lisinopril .
In ED , he was given morphine for pain and vancomycin iv for infection .
Blood culture sent before given antibiotics .
PMH
DM
Obesity s/p Roux-en-Y
Right renal cancer s/p partial nephrectomy
HTN
Diabetic neuropathy
Family History :
Renal failure in father
Habits
Denies smoking , ex-smoker , quit 6 years ago
Social ETOH
Denies recreational drugs
Social History :
Occupation Floor Covering Installer
Married , lives with spouse and children
Medications
Caltrate Plus D(600MG/400IU ) ( CALCIUM 600mg + Vitamin D(400IU )) 1 TAB PO BID
Labetalol Hcl 300 MG ( 300MG TABLET Take 1 ) PO BID x 90 days #180 Tablet ( s ) Lasix ( FUROSEMIDE ) 80 MG ( 80 MG TABLET Take 1 ) PO BID #1 Month ( s ) Supply
Lisinopril 20 MG ( 20 MG TABLET Take 1 ) PO QD #Tablet ( s )
Miconazole Nitrate 2% Powder 1 APPLICATION ( 2% POWDER ) TOP TID #1 month ( s ) SupplyOmeprazole 20 MG ( 20 MG CAPSULE DR Take 1 ) PO BID #60 Tablet ( s )
Allergies
Penicillins - Rash
ROS
Negative except noted in HPI
Physical Examination
Vitals : BP 142/67 , HR 87 , R 18 , T 99 , O2 sat 99 rm air
Patient is in no apparent distress , good attention to hygiene and body habitus .
Oriented to person , place and time .
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["06/08/2074"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Floor Covering Installer"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Chest Clear to auscultation bilaterally .
Cor PMI at 5th ICS , MCL .
RRR nl s1 , s2 without m/r/g .
Abdomen NT/ND , no HSM .
Normal active bowel sounds .
Extrem All pulses palpable , no loss of hair , cap refill excellent .
Feet are warm , no trauma or infection
Musc skel No bony deformities .
Assessment and plan Recheck HCT today .
Follow-up with Dr . Duarte re issue of anticoagulation and BiV pacing .
RTC in 3-4 months for annual physical exam .
Disposition
Signed electronically by Fagan , Kory on Jun 11 , 2096
Record date : 2098-03-16
EDVISIT^ 28297534 ^ OGRADY , MICHAEL ^ 03/16/98 ^ OCASIO , GEORGE OJAS
I saw this patient with resident Dr . Elijah Parker .
Please see
his note for further details .
I confirm that I have interviewed
and examined the patient , reviewed the resident's documentation
on the patient's chart , and discussed the evaluation , plan of
care , and disposition with the patient .
HISTORY OF PRESENT ILLNESS : The patient is a 69 -year-old male
with a history of hypertension , diabetes , coronary artery
disease , previous MI , and esophageal cancer with mets to lung ,
status post VATS , and a recent hemothorax and chest tube .
He was
discharged 2 days ago , now presenting with increasing cough .
He
had been seen in an outside hospital earlier today and diagnosed
with a right lower lobe pneumonia .
He was also given 1 g of
ceftriaxone .
His complaints prior to presentation had been chest
pain as well as shortness of breath , abdominal discomfort , and
palpitations .
On reviewing his chart , he had had his diltiazem
<|output|>{"AGE": ["69"], "CONTACT": [], "DATE": ["03/16/98", "Jun 11 , 2096", "2098-03-16"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["28297534"], "LOCATION": [], "NAME": ["Duarte", "OCASIO , GEORGE OJAS", "Elijah Parker", "Fagan , Kory", "OGRADY , MICHAEL"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Drugs : no drug abuse .
Tobacco : none .
Family : single .
Work : Senior Manager of Goods Production .
REVIEW OF SYSTEMS : Constitution : Constitution : good general health , no fever , no change in weight .
Respiratory : no cough , no wheezing or dyspnea .
Cardiovascular : no palpitations , no chest pain or dyspnea .
Gastrointestinal :
( denies ) abdominal pain , decreased appetite , no change in bowel habits ,
( denies ) diarrhea ,
( denies ) dysphagia and
( denies ) hematemesis .
Gastrointestinal :
( denies ) nausea ,
( denies ) rectal bleeding , normal stools and
( denies ) vomiting .
Urinary :
( denies ) dysuria ,
( denies ) hematuria and
( denies ) frequent urination
VITAL SIGNS :
Date/Time : 12/01/2089 04:09 PM - ostrowski
Pulse 1 : 70 bpm
Blood Pressure 1 : 120 / 80 mmHg
Weight : 299 lbs .
EXAMINATION :
[Neck] - supple no lymphadenopathy or thyromegaly and
[Respiratory] - clear breath sounds bilaterally , no accessory muscle use , normal percussion .
[CV] - Heart : normal rate and regular rhythm .
[GI] - Abdomen : no tenderness , (-) rebound , (-) guarding , normal bowel sounds , (-) hepatomegaly , (-) splenomegaly and no abdominal mass .
Labs/Studies : _____ .
WBC 13.5 CT diverticulosis / Diverticulitis w some bowel loops
CONSTITUTIONAL : Appears properly developed for stated age , in no apparent distress .
The patient appears severely obese .
IMPRESSION : Hypertension
Obesity
GI bleed SP polypectomy
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["12/01/2089"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["ostrowski"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Senior Manager of Goods Production"], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
As this relapse coincided with development of a strong delayed-type hypersensitivity response to tuberculin and improved after treatment with the anti-inflammatory agent oxpentifylline , it was probably caused by restoration of pathogen-specific cellular immunity .
<|output|>{"drugs": [{"name": "tuberculin", "reaction": ["hypersensitivity response"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
THE GEORGIA CENTER FOR YOUTH
A 56 yr old IDDM man s/p CABG in 21 with IDDM and CHF admitted after elective cardiac cath which revealed new RCA occlusion for post hydration/Mucomyst/bicarb .
Cardiac history began in 2126 with inappropriate sinus tachycardia .
An 2102 University Park Blvd MIBI 6/25 revealed inferior and PL ischemia and he was taken to the cath lab .
3/26 he noted progressive DOE with upper chest discomfort and was brought to the cath lab .
An 2102 University Park Blvd MIBI 2/28 showed an EF of 60% w small PB scar & inferior-lateral ischemia .
Echo 4/28 revealed new LA enlargement with EF of 62% .
He was admitted 3/29 with HF exacerbation/acute renal failure in the setting of rapid out-patient diureses with zaroxolyn .
An exercise adenosine MIBI was done 8/14 which revealed an EF of 75% with mild anterior and IPL ischemia .
He was admitted for a cardiac cath 8/20 , however due to a creatinine of 2.4 only a right heart cath was done .
remote ulcer #NAME ?
CABG 26 with LIMA to LAD , radial artery to RPDA , VG to LCX
father mild MI age 56
divorced , quit smoking in 05-17-1978 , sober x 10 yrs , retired Administrator , sports
75 RBBB #NAME ?
25/10/30 4.8 46 1.6
24/09/30 100 30.9 263 9.2
23/06/30 4.1
07/16/30 7.4 93 0.4 22 26
24/02/30 33.1 4.14 11 221
24/02/30 12 1
18/10/29 23.3
09/16/27 10.9
21/12/30 11.4
09/10/30 37 8.9
PFT's 9/26 VC 66% , FEV1/VC 109%
64 yo diabetic male admitted after cardiac catheterization for post hydration
Dynasty Virge RN , Georgia # 10-08-1994
u100 NPH insulin Start : 25/10/2130
Atrovent 18 mcg/spray inh tid Start : 25/10/2130
furosemide 80 mg qam in the and 80 mg in the qpm Start : 08/29/2130
Signed electronically by Dynasty Virge RN , NP on Sep 26 , 2130
Record date : 2078-08-08
Patient Name : " Quadarius Secor [ 71696789 ( WHIDBEY GENERAL HOSPITAL ) ]
Date of Visit : 08/08/2078
Colonic adenoma 28/12/76
<|output|>{"AGE": ["21", "56", "64"], "CONTACT": [], "DATE": ["2126", "24/02/30", "08/08/2078", "23/06/30", "21/12/30", "2/28", "9/26", "25/10/2130", "3/26", "6/25", "09/16/27", "05-17-1978", "26", "25/10/30", "2078-08-08", "3/29", "Sep 26", "09/10/30", "28/12/76", "8/20", "18/10/29", "4/28", "08/29/2130", "10-08-1994", "8/14", "24/09/30", "07/16/30"], "DEVICE": [], "DLN": [], "HOSPITAL": ["WHIDBEY GENERAL HOSPITAL", "THE GEORGIA CENTER FOR YOUTH"], "ID": ["71696789"], "LOCATION": ["2102 University Park Blvd", "Georgia"], "NAME": ["Quadarius Secor", "Dynasty Virge"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Administrator , sports"], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
IMPRESSION :
1 .
Sleep stage/arrousal dysfunction ( 780.56 ): Manifested by subjective complaints of nonrestorative sleep , increased daytime fatigue and alternating hypersomnia , and recurrent polysomnographic evidence of " lightened " sleep pattern , with increased predominance of non-REM stages 1-2 sleep , and with the presence of " alpha " intrusions and " alpha delta " component to deeper sleep .
These latter EEG findings have been described in association with subjective complaints of nonrestorative sleep , as well as clinical setting of chronic pain related complaints , depressive or anxiety disorder or intercurrent psychotropics agents used ( but more usually associated with benzodiazepine or barbituate usage ).
2 .
Sleep disordered breathing : As evidenced during prior polysomnographic evaluations , mostly of obstructive and or mixed hypopnea .
The patient appears largely refractory to a trial of CPAP therapy , particularly in so far as he demonstrates associated claustrophobic symptoms in association with it's usage , despite relatively modest CPAP water pressures ( 6 cm ).
In addition , he has tried various nasal CPAP face mask , including the Mallinckrodt " Breeze " supportive head gear with " nasal pillows " and with limited success .
One might consider repeating a polysomnographic evaluation in the future , and if so , utilizing a potential trial of BIPAP titration , which may help to improve claustrophobic symptoms , but the patient will still be left with the issues referable to " tangled tubing at night " and issues referable to nasal face mask usage , as noted above .
3 . Relative difficulties in sleep reinitiation and maintenance : The patient describes at least 2-4 early morning awakenings with difficulty in sleep reinitiation and maintenance , thereby compounding his current sleep problem .
While there would logically be a relationship between his current sleep exacerbations and the recent death of his wife from pancreatic cancer last year , there may also be evidence of other nocturnal sleep disturbances for which a repeat polysomnographic evaluation ;
i.e . in particular looking for the presence of increased spontaneous arousals or limb associated arousals or periodic limb movements of sleep may be of a special clinical benefit .
PLAN :
1 .
In the short course , in so far as the patient describes himself as being exceedingly tired , and unable to perform the routine daily tasks of work and managing a family in the absence of his deceased wife , I have suggested initiation of PRN Zolpidem tartrate therapy , 5 mg tablets , utilizing one to two tablets p.o . q .
h.s .
PRN for difficulties of sleep reinitiation and maintenance .
2 .
The patient is advised to take Zolpidem tartrate therapy no more than 2-3 times per week , in an effort to avoid any issues of physiologic dependency .
3 .
The patient was advised against potential adverse behavioral and or systemic side effects of Zolpidem tartrate therapy including hypersomnolence , gastric upset , loose stools , diarrhea , and or cardiac palpitations .
Pending his clinical response of his Zolpidem tartrate therapy , I then might seek direct treatment for his sleep disordered breathing issues which may include a repeat sleep study with potential trial of BIPAP therapy ( in an effort to modify or attenuate claustrophobic symptoms ).
If he proves poorly responsive to trial of BIPAP therapy however , I might consider supplemental O2 therapy at night and , with this in mind a follow up sleep study should have associated end-tidal CO2 monitoring as well .
4 .
In the meantime , the patient was advised to contact the sleep disorders clinic for any acute sleep related concerns in the interim .
5 .
The patient may also benefit from nonpharmacologic approaches with regards to sleep reinitiation such as hypnotherapy , but I will hold off on these strategies pending follow up sleep disorders clinic evaluation ( in approximately four months time ).
Once again , thank you again for allowing me to share in the medical care of Mr . Harlan Valdez .
I hope this letter finds you well .
Sincerely yours ,
Yovani Vergara , M.D .
Sleep Clinic
Doctors Hospital North
cc : Sleep Clinic DHN
DD : 09/14/09
DT : 09/15/09
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["09/15/09", "09/14/09"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Doctors Hospital North", "DHN"], "ID": [], "LOCATION": [], "NAME": ["Yovani Vergara", "Harlan Valdez"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Daughter lives nearby
EXAM :
BP 193/69 HR 62 T 98F
Hands : no clubbing
H+N : no elevated JVP , erythema and injection elft eye ?
conjunctivitis , no nodes
CVS : normal S1 and S2 , no added.murmurs/rubs heard
Chest : dull right abse , creps bibasally
Abdo : SNT , distended , BS present
Legs : no odema , Calves soft
LABS :
02/12/2098 NA 139 , K 6.2 ( H ), CL 94 ( L ), CO2 29.2 , BUN 37 ( H ), CRE 3.47 ( H) 02/12/2098 NA 135 , K 6.6 ( H ), CL 93 ( L ), CO2 26.1 , BUN 38 ( H ), CRE 3.56 ( H) 02/12/2098 CA 10.1 02/12/2098 CA 9.9 , ALB 4.2 , LIPS 22 02/12/2098 aPO2 96 , aPCO2 52 ( H ), aPH 7.4 , K-PL 5.2 ( H) 02/12/2098 ALT/SGPT 32 ( H ), AST/SGOT 87 ( H ), ALKP 233 ( H ), TBILI 0.5 02/12/2098 WBC 9.6 , HGB 13.7 , PLT 297 02/12/2098 PT-INR 1.2
A/PLAN :
Nausea+Vomiting
Concerning in light of history of colon ca , but did not appear to have large intraluminal lesion from what I can see .
Note plan for CT tonight per ED management
ESKD
K from ABG was 5.2
No immediate need to dialyse tonight
Will schedule for HD first shift tomorrow
Treat K medically overnight as needed ;
please limit IV fluids
Anaemia
Hb above target , hold EPO for now
Bone
Please check phosphate and iPTH
Will dose adjust binders and Vit based on results
HTN
Need to assess complaince with meds
Consider prn iv labetalol as needed for severe HTN
Perhaps add nitrate if needed for longer-term management
Pleural effusions
Consider tapping if not done recently in light of malignancy in history
Calvin Stanley Tripp
Renal Fellow
# 94122
Renal Staff Addendum
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["02/12/2098"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Calvin Stanley Tripp"], "ORGANIZATION": [], "PHONE": ["94122"], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
140/70 and a pulse of 80 and regular .
HEENT is unremarkable , neck
supple without thyromegaly , no jugular venous distention , carotids full
without bruits , chest clear to auscultation and percussion.Cardiac exam :
regular rate and rhythm , PMI nondisplaced , normal heart sounds , no
murmurs or rubs .
Abdomen benign nontender without hepatosplenomegaly or
CVA tenderness .
No clubbing cyanosis or edema .
Pulses full .
Impression : Mr . Narvaez has evidence of decreased left ventricular
function by echocardiogram .
By report he has no evidence of coronary
artery disease , although I have not seen this report myself .
If indeed
it is true that he has no coronary artery disease , then my guess is that
this represents a primary cardiomyopathy or cardiomyopathy secondary to
his diabetes or even his history of alcohol abuse .
In any case , this
puts them at increased risk for an operation , although probably less so
than if he had significant coronary disease .
I see no reason why you
should not proceed with the biopsy that is planned immediately .
Prior
to his operation , he should be placed on ACE inhibitor and diuretic .
I'll be happy to continue to see him should he care to transfer his care
to South Side Hospital .
Sincerely yours ,
Kevin Y . Kirkpatrick , M.D .
_______________________________
Kirkpatrick , Kevin
DD : 12/29/72
DT : 12/30/72
DV : 12/29/72
******** Not reviewed by Attending Physician ********
Record date : 2123-11-25
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["12/30/72", "2123-11-25", "12/29/72"], "DEVICE": [], "DLN": [], "HOSPITAL": ["South Side Hospital"], "ID": [], "LOCATION": [], "NAME": ["Kirkpatrick , Kevin", "Narvaez", "Kevin Y . Kirkpatrick"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
VS as noted
NAD
carotids 2+ symmetrical
chest clear to ausc .
RR 12
cardiac normal s1/s2 no m/s3/s4 HR 70 reg
extremities no peripheral edema DP and PT full bilaterally
sl tenderness at right femoral artery , scarred area corresponds to where the discomfort begins no warmth , fluid collection , ecchymosis
reviewed all data from recent hospitalization
Assessment - cardiovascular status - stable
r/o peripheral artery disease
Plan influenza vaccine per RN
samples dispensed of zetia for 6 weeks .
will check fasting lipids and ALT .
if effective , will contact her insurance for prior authorization
non-invasive arterial studies of lower extremities
continue regimen per medication list
RV 12/05/80
letter for work
J . Needham , MD
Record date : 2105-01-17
SDU TEAM JAR ADMISSION NOTE
PATIENT : Fredrick , Walter D .
MR# : 7359485
SDU ATTENDING : Urwin Orosco , M.D .
PCP : Tara Phipps , M.D .
FAMILY CONTACT : Wife , Francisca Duong ( C: 516 532-0945 );
( H: 553 594-2217 )
SOURCE : Patient ;
Physician pass-off
CODE STATUS : FULL CODE
SDU ADMIT DATE : 01/17/05
REASON FOR SDU ADMIT : NSTEMI ;
Awaiting cardiac catheterization
CC : 55 y.o . male w/ DM type 2 , hyperlipidemia , positive family history for CAD , and hx of XRT to chest for Hodgkin's lymphoma , who p/w NSTEMI
HPI :
<|output|>{"AGE": ["55"], "CONTACT": [], "DATE": ["2105-01-17", "12/05/80", "01/17/05"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["7359485"], "LOCATION": [], "NAME": ["Francisca Duong", "Fredrick , Walter D .", "J . Needham", "Tara Phipps", "Urwin Orosco"], "ORGANIZATION": [], "PHONE": ["553 594-2217", "516 532-0945"], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2080-07-03
History of Present Illness
POD # 3
Procedure femoral-femoral bypass graft
Surgeon U. Needham
Narrative History
This gentleman has type 2 DM diagnosed in 2078. At that time he was seen at the ED with urinary frequency and was not feeling well. He was admitted to the hospital for BG's of 400's. He was discharged on NPH insulin 30 units q am and 15 units q pm. He has followed up with Dr. Xan Dunn from our Diabetes department.
His latest home DM regimen consists of NPH insulin 25 units q am and 10 units q hs.
His home BG's are usually 130 or less.
He has hypoglycemia unawareness.
He has PVD s/p fem-fem bypass graft 6/30/80, ulcer on R big toe, (+)peripheral neuropathy.
Past Medical History
Morbidly obese, + sleep apnea, +BPH, h/o gastric reflux, h/o pseudotumor cerebri, s/p hip surgery
Family History
no diabetes
Social History
Smoking (+)
Medications Text
Meds now:
NPH insulin 25 units q am and 10 units q hs
regular insulin SS 201-250--4 units
simvastatin, lasix, levaquin, clindamycin, lisinopril, ECASA, lopressor, pepcid
Physical Exam
BP 140/73 PR 72/min T 98.7
General Appearance
morbidly obese
HEENT
anicteric sclerae
Neck
trachea midline
Chest
CTA
Cor/Cardiac
RRR
Abdomen
Soft, obese
Extremity
dressing intact on ulcer, R big toe
Neurological
alert, oriented
Skin
(+) acanthosis nigracans
Laboratory Data
A1c 6.1 in 03/80
FS's 7/02 65 (treated with OJ)--110 91 238 165
7/03 101 119
s. creatinine 1.4
LFT wnl
WBC 13.7
Assessment
Type 2 DM complicated by PVD and neuropathy. He was not eating well 7/01-7/02 but says his appetite has now recovered.
Recommendation
1. Continue NPH insulin 25 units q am and 10 units q hs.
2. Suggest to change regular insulin sliding scale to humalog as this is more physiologic (acts faster and clears faster as well). Give only half doses of this at hs since he will not be eating then.
3. Please get a Hemoglobin A1c. This will help us assess blood glucose control for the past 2-3 months and can help in discharge planning.
4. He should folow-up with Dr. Dunn from Diabetes.
Thank you.
U. Natalyn Gold, M.D., M.P.H.
b26494
(beeper for weekend: 65860)
<|output|>{"AGE": [], "CONTACT": ["26494", "65860"], "DATE": ["2080-07-03", "2078", "6/30/80", "03/80", "7/02", "7/03", "7/01", "7/02"], "ID": [], "LOCATION": [], "NAME": ["U. Needham", "Xan Dunn", "Dunn", "U. Natalyn Gold"], "PROFESSION": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Hypertension develops in most patients after transplantation when immunosuppression is based on cyclosporine and prednisone .
<|output|>{"drugs": [{"name": "cyclosporine", "reaction": ["Hypertension"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
2 .
Ativan 1-2mg IV q1h PRN
3 .
Insulin gtt ( currently 4u/hr )
4 .
Clindamycin 600mg IV q6h for aspiration pneumonitis
5 .
Pepcid 20mg IV QD
6 .
Dilantin 100mg IV q8h
7 .
IV NTG 5mcg/min during transfer
Allergies : NKDA per OSH
Soc Hx : Lives with Mother in Waycross , and works in a store ( unclear type ).
He leaves home for He does not smoke , but does have drinking binges reported by his mother when he associates with several groups of friends .
Mother is not aware of drug use , but also cannot rule it out .
FH : HTN mother and father
Exam : VS : T 99 HR 92 BP 182/80 RR 20 O2sat 95-98% FIO2 RA
General : Responds /localizes pain , moving all extremities .
HEENT : NCAT , pupils small but reactive , eyes conjugate
Chest : CTA B
CVS : S1 S2 +S3 , no murmurs .
Abd : +BS , soft , non-tender , non-distended .
Subcutaneous indurated tissue mid Left upper abdomen , 4x5cm .
Extr : Normal bulk/tone .
Multiple round dark lesions right arm ; indurated 3x4cm subcutaneous areas on bilateral thighs anteriorly .
No edema BLE ; 2+DP .
DATA ( 08/25/61 ):
Unspecified pH 7.42 ( 7.32-7.45 )
Unspecified PCO2 35 ( 35-50 ) mm/Hg
Unspecified PO2 74 ( 40-90 ) mm/Hg
WBC 22.6 H ( 4.5-11.0 ) th/cmm
HCT 42.1 ( 41.0-53.0 ) %
HGB 14 ( 13.5-17.5 ) gm/dl
RBC 5.03 ( 4.50-5.90 ) mil/cmm
PLT 677 H ( 150-350 ) th/cumm
MCV 84 ( 80-100 ) fl
<|output|>{"AGE": [], "CONTACT": [], "DATE": ["08/25/61"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["Waycross"], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Date of Admission : 8/09/2121
Attending : Thomas Wyatt
PCP : Ulisses Xuan ( Santa Barbara General Hospital )
Source of History : Patient and medical record
CC/RFA : SOB , extremity edema , abdominal discomfort
HPI : This 53 yoM with a hx of morbid obesity , CHF , COPD , Diabetes and OSA reports a increase in his weight from 395 lb to 450 lb over the last 2-4 weeks .
This occurred despite his efforts to lose weight and his active participation in a weight watchers weight reduction program .
The weight gain was accompanied by abdominal distension and bloating , increased leg swelling and increasing SOB .
He also reports severe DoE , with a maximal walking distance of 5-6 steps , as well as a deteriorating a scrotal edema with some dysuria , and rectal incontinence .
Since the recent weight gain , he also developed an extensive itchy erythema in his groins .
He denies CP , diarrhea , HA , fever , chills , cough .
His PCP prescribed metoclopramid and protonix for his abdominal complaints ;
however , the patient felt dizzy and dehydrated after taking these medications and decided to discontinue those .
He also stopped taking his regular lasix medication about a week ago .
Because of his increasing SOB , he called EMS , who found him cyanotic in his apartment with an Sa02 of 73% on RA .
ED Course : On arrival in the ED , his VS were : T98 , BP108/65 , RR24 , HR100 , O2Sa 92% on 4L
2 . He received one dose of lasix 80mg iv , urine output unrecorded .
He was transferred to Internal Medicine for further management .
PMH/PSH :
Obstructive sleep apnea
COPD
CHF ( EF in 2117 : 53% )
Hyperlipidemia
Pulmonary hypertension
HTN
NIDDM
Venous stasis with chronic leg ulcers
Morbid obesity
Peripheral neuropathy
S/p PNAx2
Medications :
Aspirin 325 QD
Verapamil 60mg TID
Glybyride 5mg QD
Lasix 80mg QD
Protonix 40mg QD
Metoclopramide 5mg QD
<|output|>{"AGE": ["53"], "CONTACT": [], "DATE": ["2117", "8/09/2121"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Santa Barbara General Hospital"], "ID": [], "LOCATION": [], "NAME": ["Thomas Wyatt", "Ulisses Xuan"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
-- --
2135/09/03 15:06 - PT .
.
.
12.8 sec
2135/09/03 15:06 - PT-INR .
.
.
1.1
2135/09/04 08:28 - APTT .
.
.
48.7 sec ( H )
Problems and Plans
1 : Cardiac - Asymptomatic & ;
hemodynamically stable
- Today's troponin , slightly elevated to 0.24
- Last dose of plavix on 09/01
- Portable surface echocardiogram scheduled for today to further assess the degree of MR
2 : Conduit - Portable vein mapping ordered for today to evaluate ( B ) GSV's as suitable conduit
3 : Preop Issues - Preop labs , u/a , urine c& ;
s ordered
- Cardiac Surgical consent obtained
4 : Cardiac Surgery Preop Checklist - Preop checklist started today ;
09/04
Signed by Quatisha Long APRN , BC on 09/04/2135 11:53
Record date : 2075-02-25
CC : presents to urgent care for return to work letter
HPI : Pt is a 55 yo g1p0 who previously worked as an investment consultant who has
not worked recently secondary to caring for her ill mother who has recently
passed away .
Ms . Hardy was last seen for an annual exam in 10/73 after which
she has neglected her f/u appts .
Of note , pt was recently seen in ED for c/o
" it felt like my BP was high ".
Pt had sl HA , but o/w denies confusion ,
<|output|>{"AGE": ["55"], "CONTACT": [], "DATE": ["09/04", "09/01", "2075-02-25", "2135/09/04", "10/73", "2135/09/03", "09/04/2135"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Hardy", "Quatisha Long"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["investment consultant"], "ZIP": []} |
<|input|>
### Template:
{"drugs": [{"name": "", "reaction": []}]}
### Text:
Severe osteomalacia was present in two epileptic patients who were under long-term treatment with congeners of phenytoin , phenobarbital , and acetazolamide .
<|output|>{"drugs": [{"name": "acetazolamide", "reaction": ["Severe osteomalacia"]}]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Susan Ximena Elias , M.D ., M.M.S.C .
/ alvarado
******** Not reviewed by Attending Physician ********
Record date : 2059-04-08
EDVISIT^ 43471375 ^ KIMBROUGH , AMELIA ^ 04/08/59 ^ PHILLIPS , URHO
I have reviewed the resident's note on the record and seen and
examined the patient personally .
I concur with the resident's
findings .
HISTORY OF PRESENT ILLNESS : Briefly , this is an extraordinarily
complex 47-year-old patient with renal insufficiency , nephrotic
syndrome , and severe anemia who was scheduled to receive some
intravenous iron today but the presence of multiple abnormalities
in her blood prompted her to be referred here instead for
admission .
She herself complains of generalized weakness but
does not have any localizing or acute new symptoms .
Remainder of
history and physical examination were reviewed and verified and
are as noted .
PHYSICAL EXAMINATION : The patient is awake and alert .
Speech is
normal in rate , rhythm , and quality .
Skin is warm and dry .
She
is in no distress .
She has some bibasilar moist rales but heart
sounds are completely normal .
LABORATORY DATA : As noted and have multiple abnormalities .
It
was reflected on the record .
Calcium is 5.5 , albumin is 1.7 ,
creatinine is 7 , and the remainder as noted .
Electrocardiogram
does not show any acute changes .
IMPRESSION : This patient has anemia , hypocalcemia , and
hypomagnesemia .
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### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Hereditary spherocytosis s/p splenectomy at age 18 ;
S/P Pneumonia 12/2078 .
H/O Kidney stone inactive problem
Free text diagnosis venous stasis/edema , R>L secondary to old injury ;
Sleep apnea obstructive ;
on c-pap ;
Degenerative joint disease bilateral knees ;
Gout
VITAL SIGNS
BLOOD PRESSURE 128/70
He has been doing very well , feeling well
1 .
Obesity - he got up over 400 lbs over thanksgiving and has been watching his weight since Dec 24 . Down to about
389 .
2 .
Nephrotic syndrome - proteinuria had decreased off Naprosyn .
He is due for appt with Dr . Fry
but pedal edema has resolved and he has had no more problems with ulcers .
3 .
Diabetes - sugar has been in good range on his home checks : 130-160 in the morning but 90-100 on later checks during the day .
Will check HGBAIC , lipids .
He does see the eye doctor yearly .
4 .
BP in good range .
ROS otherwise neg in detail
Habits : no smoking , no alcohol , no exercise
SH : enjoying new grandson
FH : no change
Exam : looks well , obese P 72 reg skin ok ( stasis dermatitis on legs )
PERRL mouth ok poor teeth , no adenopathy or thyromegaly
lungs clear cor S1S2 abd obese minimal pedal edema
normal genitalia , rectal normal prostate normal stool guaiac neg
HM : needs colon ca screening
f/u 3 months
Record date : 2124-09-28
NPH 20
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### Template:
{"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []}
### Text:
Record date: 2084-08-25
61 yo man with CAD and PVD referred by Dr. Short for pre-operative evaluation prior to vascular surgery.
He has a long hx of ischemic ulcer of the second toe of the right foot. He was admitted to the vascular service on 8/09 and had an arteriogram that showed complete occlusion of the SFA with reconstitution of the popliteal and single vessel run off. His pre-operative EKG raised the possibility of old ASMI although it was unchanged for a number of years. He underwent dobutamine MIBI which showed a moderate area of severe ischemia in the LAD territory. His LV was normal with EF of 59%. He underwent cath which showed complete occlusion of the LAD with collaterals from a fairly large diagonal that also had a tight stenosis. There were lower grade occlusions in the RCA territory and the LCX. He had been asymptomatic. The LAD lesion was long and totalled and not felt to be amenable to angioplasty. There were no indications to have him undergo CABG so the decision was made to PTCA the diagonal lesion to improve flow to the anterior wall. He tolerated this well. Returns today feeling well and has been active painting his fence and going up and down stairs without any chest pains or unusual SOB. Has had a hematoma in the groin.
MEDICATIONS: Serevent. Flovent. Enalapril. Colchicine. Alopurinol.
Albuterol. Viagra.
ALLERGIES: None.
FAMILY HISTORY: Father died at 57 after his 8th MI. He had his
first one at age 48. Mother had a stroke in her early 50s. His brother, Shields,
died a miserable death with recurrent, inoperable laryngeal cancer.
SOCIAL HISTORY: Married. Continues to work as a sales representative. He
has an adopted child, Xiao who is now 14 and doing very well in school. Quit smoking and drinking a number of years ago.
ROS: No chest pains. Chronic shortness of breath. No bowel problems. No bladder problems. Does not exercise. Last cholesterol was 175/42. The rest of the review of systems was negative.
PE: General: Looks well.
================ Vital signs ================
Blood Pressure: 150/80 142/80 130/78
Pulse: 84 [Regular, Radial]
Weight: 222 [Pounds]
Skin: Chronic ischemic ulcer on the medial aspect of his second toe of the right foot.
HEENT: EOMI. PEERL. No scleral icterus. Bilateral cataracts. Benign pharynx.
Neck: No lymphadenopathy. No thyromegaly. No cartotid bruits.
Lungs: Decreased breath sounds. Wheezes.
Cor: JVP is normal. PMI is not displaced. Heart sounds barely audible No murmurs. No gallops.
Abd: Normal bowel sounds. No hepatomegaly. No splenomegaly. No masses. No tenderness.
He has a small echymosis of the left inguinal area. Bilateral femoral bruits. 1+ right femoral pulse. I cannot palpate the left pulse.
Extremities: No pedal edema. Ulcer as above.
EKG done in the office shows NSR at 74. Axis 90. Normal intervals. He has Q's in V1-V2 c/w possible OASMI. He has low volts in the precordial leads c/w chronic pulmonary disease. No changes from previous.
================ Problems ================
PRE-OP EVALUATION He has rest ischemia of the toe. He has three vessel coronary disease that is asymptomatic. There are no indications at this time to push for CABG. He underwent angioplasty to try to improve flow to the anterior wall. His EKG suggests OASMI but his ventriculogram is normal without evidence of MI and EF of 59%. There are studies showing increased risk of in-stent thrombosis, MI, death in patients who have had Plavix stopped for non-cardiac surgery within two weeks of stent. He will be beyond the two week period and Dr. Short is willing to operate on him while continuing Plavix and aspirin. I believe he is an acceptable risk for surgery.
PVD Will need surgery for ischemic ulcer.
COPD Doing well and is stable. Instructed to use his inhalers faithfully in the preop period.
GOUT No flares this year.
HYPERTENSION Better when rechecked. He gets nervous with the initial measurements.
IMPOTENCE Discussed the fact that, now that he has documented CAD, there is increased risk with Viagra use. He understands that but indicates that he feels that for him personally the benefits outweigh the risks.
______________________________
Welch, Xzavior Charles, M.D.
cc: Dr. Farris Short
Vascular Surgery
<|output|>{"AGE": ["61", "57", "48", "50s", "14"], "CONTACT": [], "DATE": ["2084-08-25", "8/09"], "ID": [], "LOCATION": [], "NAME": ["Short", "Shields", "Xiao", "Short", "Welch, Xzavior Charles", "Farris Short"], "PROFESSION": ["sales representative"]} |
<|input|>
### Template:
{"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []}
### Text:
Sinus rhythm with PACs , LAE , incomplete RBBB – ;
unchanged from prior
ASSESSMENT AND PLAN
Mr .
Uribe is a 56 yo man with a history of CHF ( EF 61% ), COPD , OSA , PulmHTN , HTN , DMII , chronic venous stasis , and morbid obesity presenting with shortness of breath likely secondary to CHF exacerbation from right sided failure .
Appears to have class IV disease with symptoms at rest .
BNP is elevated from baseline ( 584 ) at 1625 confirming acute exacerbation .
Exacerbation may be from increased Na intake , medicine non-compliance and increased po fluid intake , could also be from anemia .
## : CHF exacerbation – ;
patient responded well to 40mg IV lasix with UOP of 1 L
Lasix 40mg IV BID titrate to TBB goal of at least - 1 L ( will likely require more as patient required 80 mg IV TID last admission for CHF )
Monitor strict I/O’ ;
s
Daily weight ( dry weight )
Na restrict to 2gm , fluid restrict to 2L/day
Continue lisinopril and verapamil for rate control
O2 therapy , titrate as indicated
If fails to improve with aggressive diuresis , consider PE CT given history of immobility
## : Anemia – ;
iron studies last done in 2116 .
Check Fe , TIBC , ferritin , retic count
## : Diabetes
Hold metformin
AC and HS finger sticks
Regular insulin sliding scale
## : Venous stasis ulcer
Continue BID ace wraps with calcium algenate and ABDs per vascular surgery
Patient has appt Thursday .
w/Dr .
Roe – ;
will notify of admission
## : OSA
CPAP will inpatient ;
will attempt to assist patient obtaining working machine for at home
FEN : Low fat , low cholesterol , no concentrated sweets , 2gm sodium , 2L fluid diet
PROPHYLAXIS
GI : None
<|output|>{"AGE": ["56"], "CONTACT": [], "DATE": ["Thursday", "2116"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Roe", "Uribe"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []} |