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<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: At FMC , his diuretics were titrated ( lasix 20 mg - > 40 mg ), and psychiatry weighed in on his posthypoxic encephalopathy . He is transferred back to NAMC today in preparation for CABG , planned 3/07/33 . PMH : V-fib arrest on 02/04/33 due to severe CAD Severe coronary artery disease , 3-vd Hypertension Hyperlipidemia Resolving postcardiac arrest hypoxic encephalopathy History of smoking Bipolar disorder Depression Schizophrenia H/o abnormal SPEP Vitamin B12 deficiency Gallstones : 2074 Pancreatitis : 2110 Dermatitis : seborrheic Chronic fatigue syndrome Humerus fracture : L arm . s/p fall Tonsillectomy H/o Adenomatous polyp : tubular adenoma with high grade dysplasia . Skin cancer : Basal cell CA . L cheek . S/P MOHs , 2129 Medications : 1 . Trazodone 100 mg at bedtime 2 . Olanzapine 10 mg at bed 3 . Fragmin 2500 units sub cu daily 4 . Lasix 40 mg daily 5 . Darvocet-N 100 1 tablet po q4 hours prn pain <|output|>{"AGE": [], "CONTACT": [], "DATE": ["3/07/33", "2129", "2110", "2074", "02/04/33"], "DEVICE": [], "DLN": [], "HOSPITAL": ["FMC", "NAMC"], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: He did not require transfusion . The bleeding sounds as though it was self-limiting and has not recurred . Otherwise , his health is unchanged . He remains fairly limited due to his osteoarthritis but continues to perform all ADLs successfully . Changes to Allergies BRIMONIDINE TARTRATE #NAME? reaction : Unknown [reviewed] Latex #NAME? reaction : Rash [reviewed] no known allergies : He has no current allergies #NAME? reaction : Unknown [reviewed] Physical examination : #NAME? Pulse : 50 , which is strong and regular #NAME? resp . rate : 12 . He is saturating 100% at room air #NAME? Extremities : There is trace dependent 1+ lower extremity swelling , which is stable . #NAME? Abdomen : Soft and nontender . #NAME? Cardiac : Regular with nondisplaced PMI , 1-2/6 systolic ejection murmur heard best at the base with the crisp S2 . #NAME? Chest : His lungs are clear . #NAME? Neck : Jugular venous pressure is 7 cm of water with normal AV contour . He has 2+ carotids with brisk upstrokes . #NAME? Heent : Normocephalic . #NAME? General : He is alert and appropriate in no apparent distress #NAME? BP : 138/72 in the right arm seated EKG : Sinus bradycardia at 50 . Delayed R-wave progression . Leftward axis . Nonspecific ST-T wave abnormalities . Selected recent labs : Impression : 1 .) Nonobstructive CAD 2 .) Neurocardiogenic syncope 3 .) Hypertension Assessment and plan : Overall he is doing well his cardiovascular issues are stable . His blood pressure slightly above goal but given his past syncopal tendencies with aggressive lowering will hold off on any med changes for now . I will see him back in six months , sooner if new issues arise . Medication List <|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: Record date : 2060-05-21 HESS , CLARENCE 64365595 05/21/2060 Robert Y . Gordon , M.D . WMNH Internal Medicine Olney 494 Fairhaven Road Olney , OH 23751 Dear Dr . Gordon : I had the pleasure of seeing Mr . Hess in followup in Cardiology today . As you know , he is a 54 -year-old gentleman who underwent implantation of a permanent pacemaker on 02/11/2060 for his presyncope and pauses on Holter monitoring . His past medical history is significant for hyperlipidemia , gastroesophageal reflux disease , and asthma . Prior to his pacemaker placement , an exercise stress test was performed because of a history of exertional chest pain . He was able to exercise for 8 minutes and 4 seconds . The test was terminated for 7/10 substernal chest pain , but no hypotension or overt ECG changes were noted . We proceeded to pacemaker implant and Mr . Hess has done well since that time . He remarks that his intermittent symptoms of lightheadedness have resolved . However , he occasionally still has nocturnal palpitations as well as occasional exertional chest discomfort . He tells me that he underwent testing at Wheatland Memorial consisting of a stress test with MIBI imaging that perhaps showed an abnormality , though the report of this test is not available to me today for review . Interrogation today of his Medtronic Kappa CTE 226 pacemaker reveals that his underlying rhythm is sinus tachycardia with intact AV conduction . The estimated longevity on the battery life is 95 months . The atrial impedance is 544 ohms and the ventricular impedance is 519 ohms . The P-wave in the atrium is 5.6 mV and the R-wave in the ventricle is 31 mV . The threshold in the atrium is stable at 0.5 V at 0.4 msec , and the threshold in the ventricle is also stable at 0.5 V at 0.4 msec . In summary , the pacemaker appears to be working quite well . However , Mr . Hess persists in a perplexing sinus tachycardia that has been present since his last pacemaker interrogation . I have therefore ordered an echocardiogram to rule out any ill effects of the sinus tachycardia or any structural heart disease that may be causing the sinus tachycardia . In addition , I have performed a 12-lead ECG , which appears to show sinus mechanism rather than an atrial tachycardia . Today in the office , his sinus rate is 109 beats per minute with stable blood pressure . Mr . Hess and I have checked thyroid studies in the recent past and those have been unremarkable . I have discussed this case with Dr . Quatrell Swanson who has agreed to assist in Cardiology care for Mr . Hess in the near future , since Dr . Law is moving his practice to the NCHC . I plan to see Mr . Hess in followup in three months ' time for his pacemaker . If any issues arise in the interim , please do not hesitate to contact me . Sincerely , ______________________________ Una Trujillo , MD eScription document : 4-3989721 UFFocus transcriptionists <|output|>{"AGE": ["54"], "CONTACT": [], "DATE": ["2060-05-21", "02/11/2060", "05/21/2060"], "DEVICE": ["CTE 226"], "DLN": [], "HOSPITAL": ["WMNH", "Wheatland Memorial", "NCHC"], "ID": ["64365595", "4-3989721"], "LOCATION": ["OH", "494 Fairhaven Road", "Olney"], "NAME": ["Quatrell Swanson", "Gordon", "Robert Y . Gordon", "Una Trujillo", "HESS , CLARENCE", "Hess", "Law"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["23751"]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Retics were depressed at presentation and iron studies were c/w ACD and he was started on epogen . Initially it was felt that his thrombocytosis was most certainly reactive ; CRP was >150 with ESR >100 . He left the ICU and at this point his WBC trended down and he was afebrile and more clinically stable . But his platelets kept climbing to nearly 1.5 million . A bone marrow biopsy was done showing no cytogenetics to suggest CML and there were elevated megakaryocytes read as concerning for a myeloproliferative process . As well , he suffered a DVT in his subclavian/IJ on the same side as a central venous catheter . Given his thrombocytosis and elevated plt count , he was platelet pheresed twice in the hospital . As well , hydrea was started at this time , initially at 500mg bid and then escalated to 1000mg bid when his counts were up to 800-900 despite the medication . As well , he suffered a small GI bleed due to an ulcer . For this reason he was not anticoagulated but placed upon daily ASA . He was discharged from the hospital two weeks ago and has done fairly well since then . His energy has been good . He denies any fevers/chills/sweats . No bleeding/bruising . No further swelling in his arms/legs . He does have some occasionally blurryness in eyes immediately after taking his anti-hypertensives but no numnbess/weakness/dizziness . Problems/PMH : DM type 1 since age 12 no recollection of any abnormal blood counts prior to this admit New diagnoses on this admit renal insufficiency nephrotic proteinuria malignant hypertension thrombocytosis GI bleed - upper with ulcer visualized on EGD small embolic appearing CVA's Medications : Diovan lisinopril Hydrea 1000 bid ASA 81 qod lopressor procardia clonidine nexium insulin : am 25 regular/34 NPH , pm 20 regular/28 NPH Allergies : <|output|>{"AGE": ["12"], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2094-12-16 CARDIOLOGY OXFORD DELTA CLINIC Reason for visit: s/p Coronary angiogram with placement Cypher stent to LAD Interval History: The patient is a 70 yo male with a history of HTN, hyperlipidemia, DM, CAD and CABG September 2092 which was c/b premature graft failure of the SVG to LAD. Cardiac catheterization was performed in Jan 93 and underwent POBA of likely diffusely diseased, intramyocardial LAD, but never really improved. He was admitted to ODC in May 94 and cath demonstrated severe native disease with a mid-LAD lesion which was treated with PTCA/ Taxus stent. He had symptomatic relief until about one month ago when he began to experience exertional discomfort and dyspnea which has now progressed to symptoms at rest despite an aggressive medical regimen. He presented today for cath which revealed a new stenosis distal to the prior LAD stent which was patent. The lesion was stented with a 2.25 x 13 mm Cypher stent. he is now admitted to the Cardiology department for post procedure monitoring and arrived to cardio clinic pain free and hemodynamically stable. Past medical history: DM HTN Hyperlipidemia CAD -CABG x 3 September 2092 WMMC (LIMA to D2, SVG to RCA, SVG to LAD) s/p PCI prox LAD Jan 2093, s/p Taxus stent to LAD 5/94 GERD s/p H pylori eradication several years ago Left rotator cuff injury s/p CABG Anxiety hernia repair Changes to Allergies ACE Inhibitor - reaction: cough [reviewed] METFORMIN - reaction: GI Intolerance [reviewed] ROSUVASTATIN - reaction: myalgia [reviewed] SIMVASTATIN - reaction: myalgias [reviewed] VALSARTAN - reaction: fatigue [reviewed] Social history: Lives with wife in Lagrange,KS. Retired. Former heavy smoker-quit x 30 yrs. Rare ETOH. Review of systems: negative in detail other than mentioned in HPI Physical examination: -Pulse: -resp. rate: -height: 67 in. -weight: 175 lbs. -General: No acute distress. -Skin: No rashes, anicteric. -Neck: 2+ carotid pulses with normal upstrokes, no bruits, JVP 5-6 cm -Chest: Clear to auscultation anteriorly -Cardiac: Left ventricular impulse discrete and nondisplaced. Regular rate and rhythm, normal S1 and S2, with no S3 or S4. There were no murmurs, clicks or rubs. -Abdomen: Normal bowel sounds, soft and nontender, with no hepatosplenomegaly or masses appreciated. -Extremities: No cyanosis, clubbing or edema. 2+ femoral pulses without bruits. 2+ pedal pulses. -BP: -temp: -Pain scale (0 to 10): 0 EKG: SB @ 55, LAD, RBBB no acute changes Selected recent labs: 11/29/94 WBC 6.7, Hct 45, Plts 287 Na 144, K 4.5, Cl 106, BUN 17, Cr 1.2 Impression: 70 yo male with CAD s/p CABG with early LAD graft failure s/p LAD stenting 5/94 now with recurrent symptoms found to have a new LAD stenosis that was Cypher stented today. Assessment and plan: CV:Pain free and hemodynamically stable, HR and BP in good range continue current medical regimen and monitor DM:Diet controlled, monitor FSBS and cover as needed Further plans per Dr Paulson Medication List CONFIRMED - amlodipine besylate 10 MG PO daily - ASPIRIN ENTERIC COATED (ASA ENTERIC COATED ) 325 MG PO daily - atorvastatin 40 MG PO QPM - clopidogrel bisulfate 75 MG PO daily - escitalopram 40 MG PO daily - fenofibrate 200 MG PO daily - furosemide 20 MG PO daily - isosorbide mononitrate extended release 60 MG PO daily - KCL SLOW RELEASE TAB 10 MEQ PO daily - metoprolol tartrate 12.5 MG PO BID - NITROGLYCERIN 1/200 (0.3 MG) 1 TAB SL Q 5 mins X 3 doses PRN - pantoprazole 40 MG PO daily - ranolazine 1000 MG PO daily Catherine L. Uresti, NP pager #28333 Transcribed by: Catherine L Uresti Signed electronically by Catherine L. Uresti, NP Document Status: Final <|output|>{"AGE": ["70", "70"], "CONTACT": ["28333"], "DATE": ["2094-12-16", "September 2092", "Jan 93", "May 94", "September 2092", "Jan 2093", "5/94", "11/29/94", "5/94"], "ID": [], "LOCATION": ["OXFORD DELTA CLINIC", "ODC", "WMMC", "Lagrange", "KS"], "NAME": ["Paulson", "Catherine L. Uresti", "Catherine L Uresti", "Catherine L. Uresti"], "PROFESSION": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Hepatotoxicity Hepatotoxicity associated with choline magnesium trisalicylate : case report and review of salicylate -induced hepatotoxicity . <|output|>{"drugs": [{"name": "choline magnesium trisalicylate", "reaction": ["Hepatotoxicity"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: See HPI Skin No rashes , itching Neuro No paralysis , paraesthesias , Physical Exam General nad , alert oriented Constitutional SEE nursing notes Chest/Respiratory Clear to auscultation and percussion , no crackles , wheezes or rhonchi Cardiovascular Regular rate and rhythm , normal S1 & S2 , no murmurs , gallops or rubs GI/Abdomen soft nontender Musculoskeletal Back exam - no tenderness , able to do forward flexion to 90 DEG , lat flexion to 20 DEG , unable to heel toe walk on L leg , circulation/sensation to legs intact , dtr's 2 thru out , SLR neg , unable to wt bear on L leg due to hip/thigh pain , rectal exam nl tone and sensation - WILKES Skin No rash , no lesions of significance X-ray Interpretation hip , pelvis plain films L hip , femur , pelvis , LS spine - prelim read no fracture- WILKES Impression/Plan L leg pain - discussed with attending , hx and exam suggest radiculopathy . Pain controlled in the ER with morphine and ibuprofen . He reports he would not tolerate a closed MRI tonight even with suggestion . There are no red flags tonight for cauda equina and will discharge with pain medication and follow up with his schedule LS spine MRI in open machine on Thursday . - WILKES Consults Teresa Law ED Attending Physician Note HPI See NP note for full details . Briefly , this patient has history of back pain , L buttock and leg pain for which he has been scheduled for an outpt open MRI next week . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["Thursday"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Teresa Law", "WILKES"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: The oligohidrosis caused by zonisamide was reversible in that the patient regained the ability to sweat within 2 weeks of the cessation of drug administration . <|output|>{"drugs": [{"name": "zonisamide", "reaction": ["oligohidrosis"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: constipation - using senekot and metamucil with good results . 5 . Lipids - LDL 59 , HDL 37 in February . Continue zocor . 6 . HCM-UTD . The patient will f/u with me in 12-16 weeks , or sooner prn . ______________________________ Xenakis , Tracy T . , M.D . Record date : 2077-02-09 BRENNAN CONVALESCENT HOME Reason For Visit Cough . History Of Present Illness 68 year-old male presents with complaint of cough productive of white-to-clear sputum for two days . He feels minimal chest tightness , with no shortness of breath . No dyspnea on exertion or PND . He denies wheeze . He is able to tolerate exercise on treadmill without chest pain . He denies fever or chills . Presently , self-treating with Robitussin DM and Halls cough drops . Has clear rhinorrhea . No ear pain , no throat pain . No sinus pain or pressure . Past Medical History CAD , status post stent x2 . MI . Hypertension . Hyperlipidemia . CVA . BPH . Elevated PSA . Tobacco use in the past . Physical Exam Temperature : 97.9 degrees Pulse : 64 <|output|>{"AGE": ["68"], "CONTACT": [], "DATE": ["February", "2077-02-09"], "DEVICE": [], "DLN": [], "HOSPITAL": ["BRENNAN CONVALESCENT HOME"], "ID": [], "LOCATION": [], "NAME": ["Xenakis , Tracy T ."], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: NEURO : unilateral weakness/paresthesia/dysphasia/dysphagia/visual change . Past Medical/Surgical History : DM2 C/b neuropathy , CRI , gastroparesis Denies retinopathy F/b Dr . Quintanar HTN Foot Ulcers - 1/71 amputation of R1 , R2 toes . - 6/71 development of neuropathic ulcer at metatarsal head of R2 . R heart failure TTE : 6/71 EF 70% ; mod/severe TR , RAD , IVC/hepatic veins dilated . Dilated RV , RVSP 51mmHg Anemia of Chronic Disease Allergies : NKDA Medications : ASA 81 qd Reglan 10 qd Amlodipine 10 qd Lipitor 10 qhs Atenolol 125 qd Lisinopril 40 qd HCTZ 25 qd Folate 2 qd Insulin 20N qam , 10R qam 10R qpm Lasix 120mg prn for wt gain K prn w/ lasix Social History : Lives in Estherville w/ sister . Translator . TOB : none ETOH : none ILLICITS : none Family History : <|output|>{"AGE": [], "CONTACT": [], "DATE": ["6/71", "1/71"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["Estherville"], "NAME": ["Quintanar"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Translator"], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Serious phenytoin hypersensitivity reactions may appear as dermatologic , lymphoid , or hepatic syndromes . <|output|>{"drugs": [{"name": "phenytoin", "reaction": ["hypersensitivity reactions"]}]}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Polymyositis after propylthiouracil treatment for hyperthyroidism . <|output|>{"drugs": [{"name": "propylthiouracil", "reaction": ["Polymyositis"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: I confirmed her history and physical . I also interviewed and examined the patient . Please see her note for more details . HISTORY OF PRESENT ILLNESS : This is a 77 -year-old female with a several-week history of nausea , vomiting , abdominal pain , which has worsened over the past 3 days , per the patient and her son . These episodes are gassy feeling " in the epigastrium associated with nausea and vomiting and lightheadedness . No chest pain , no shortness of breath . Of note , the patient has a history of coronary artery disease with atypical symptoms . She has also had a history of pancreatitis . PHYSICAL EXAMINATION : She is awake and alert , in no distress at this time . Afebrile with a pulse of 62 , blood pressure 140/60 , and O2 sat 100% on room air . Neck is supple with no signs of meningismus . Head is atraumatic . Moist mucous membranes . Lungs are clear to auscultation bilaterally . Heart has regular rate and rhythm . Abdomen is soft with mild epigastric tenderness to palpation . No guarding or rebound on my exam . Extremities are warm and well perfused . EMERGENCY DEPARTMENT COURSE : The patient's IV access was established . Labs were drawn revealing white count of 8 , hematocrit of 39 . BUN and creatinine of 36 and 1.5 , which is <|output|>{"AGE": ["77"], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Captopril is known to be associated with dermatologic , hematologic , and pulmonary adverse effects . <|output|>{"drugs": [{"name": "Captopril", "reaction": ["dermatologic , hematologic , and pulmonary adverse effects"]}]}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2083-02-26 Attending Admission Note HPI: 54 year old woman with h/o DM, HTN, and depression who is transferred to PSH from Missouri Baptist Hospital after being admitted from 2/15-2/20/83 and then readmitted on 2/22 with abdominal pain, nausea, and vomiting. She has a h/o several admisions to the hospital for abdominal pain attributed to diabetic gastroparesis. She has had an extensive GI work-up in the past including multiple abdominal CT scans, gastric emptying study, colonoscopy, upper endoscopy, and small bowel follow through. All studies were negative except for the gastric emptying study. She has been treated with multiple medications, including Reglan, Ativan, Compazine, and Zelnorm without much effect. She is currently taking Neurontin and Cymbalta to treat neuropathic pain, and her PCP started her on MS Contin in December since nothing else seemed to be helping. The pt states that the MS Contin helped during the month of December, but then it did not seem to be working as well. The pt is distraught over her symptoms because the pain is severe and frequent. She has been unable to return to work for 2 years because of the pain, and she would like to be able to do so. The pain is not necessarily related to eating. Yesterday, she felt well and was able to eat. Today, she was doing fine until she had to drink the gastrografin, and then it escalated to an 8/10. She received some IV morphine, and now it is down to 4/10. At Missouri Baptist Hospital, her MS Contin was held, but when her BP went up, she was restarted on it. They also started clonidine BID for her uncontrolled HTN. It appears that a AFP level was drawn and was elevated at 11.1. However, it is written multiple times in the transfer materials that she had an elevated CEA level of 11.1. Problems Diabetes mellitus : since 2060's, poorly controlled Hypertension Gastroparesis : N/V due to diabetes Retinopathy : due to AODM, s/p first laser treatment 3/81, found to have swelling of the optic discs in 8/82 and evaluated at PCH S/P cholecystectomy S/P TAH/BSO : menopause at age 46 Medications (on transfer) Heparin 5000 u SQ BID Reglan 10 mg IV Q 6 hours Hydrochlorothiazide 25 MG (25MG TABLET take 1) PO QAM , for high blood pressure Insulin 70/30 HUMAN 70-30 U/ML VIAL SC as directed , 25u SQ before breakfast and 15u before dinner. Nexium 40 mg po QD Lisinopril 20MG TABLET PO QAM Medications (as an outpatient) Asa (ACETYLSALICYLIC ACID) 325 MG (325MG TABLET take 1) PO QD Cymbalta (DULOXETINE) 60MG CAPSULE DR PO QAM x 30 days Hydrochlorothiazide 25 MG (25MG TABLET take 1) PO QAM , for high blood pressure Insulin 70/30 HUMAN 70-30 U/ML VIAL SC as directed , 60u SQ before breakfast and 40u before dinner. Lipitor (ATORVASTATIN) 10MG TABLET PO QHS Lisinopril 40MG TABLET PO QAM Ms CONTIN (MORPHINE CONTROLLED RELEASE) 15MG TABLET SA PO Q12H Neurontin (GABAPENTIN) 300 MG (300MG CAPSULE take 1) PO TID Potassium CHLORIDE SLOW REL. (KCL SLOW RELEASE) 40 MEQ (10MEQ CAPSULE SA take 4) PO QD Allergies PERCOCET - GI upset, Social History Works as bio technician at Yale but has not worked x 2 years due to abdominal pain; Born in Herzegovina, but in Canada x yrs. Sister in area is local support; no smoking or Etoh. Family History Mother-died in car accident. Father-alive in Herzegovina, in good health. Review of Systems Negative unless noted in HPI. Physical Exam BP: 229/103--> 195/95 Tmax: 99.5 P: 72 RR: 18 Pulse ox=98% RA GENERAL: Tearful when talking about her pain; appears comfortable. SKIN: NL turgor, no abnormal lesions NECK: No thyromegally, no nodes CHEST: Clear lungs, NL frame COR: NL S1S2, no murmur, rubs, or gallops. BACK: No spinal tenderness. ABD: NL BS; soft, tender over umbilical region and LLQ; no guarding or rebound; NO HSM RECTAL: Guaiac neg., no masses. EXT: No edema, clubbing, or cyanosis NEURO: NL MS, NL gait Results Date/Time NA K CL CO2 02/25/2083 138 3.4 102 28.4 Date/Time BUN CRE GLU 02/25/2083 10 1.1 169 (H) Date/Time CA MG TBILI DBILI 02/25/2083 8.3 (L) 1.1 (L) 0.2 0.1 Date/Time TP ALB GLOB LACT 03/04/2007 0.9 02/25/2083 5.8 (L) 2.7 (L) 3.1 Date/Time AMY LIPS 02/25/2083 98 2.3 Date/Time ALT/SGPT AST/SGOT ALKP TBILI 02/25/2083 9 11 67 0.2 Date/Time DBILI 02/25/2083 0.1 Date/Time WBC RBC HGB HCT 02/25/2083 5.3 3.73 (L) 11.0 (L) 30.3 (L) Date/Time MCV MCH MCHC PLT 02/25/2083 81 29.5 36.3 235 Date/Time RDW 02/25/2083 13.0 Date/Time DIFFR METHOD %NEUT %LYMPH 02/25/2083 RECEIVED Auto 57 36 Date/Time %MONO %EOS %BASO 02/25/2083 5 2 0 Results Endoscopy Report Number: 28618552 Report Status: Final Type: Upper Endoscopy Date: 06/16/2081 Gastrointestinal Endoscopy Unit Patient Name: Nicole Frantz Gender: F Patient ID: 2360719 Exam Date: 6/16/2081 02:50 PM Procedure: Upper GI endoscopy Indications: Epigastric abdominal distress/pain Findings: The esophagus was normal. The stomach was normal. The examined duodenum was normal. Impression: - Normal esophagus. - Normal stomach. - Normal examined duodenum. Recommendation: medical management of gastroparesis Report Number: 67659198 Report Status: Final Type: Colonoscopy Date: 02/14/2081 Gastrointestinal Endoscopy Unit Patient Name: Nicole Frantz Gender: F Patient ID: 2360719 Exam Date: 2/14/2081 10:00 AM Procedure: Colonoscopy Findings: The colon (entire examined portion) was normal. Unabel to successfully enter into the terminal ileum. Impression: - The colon is normal. Recommendation: SBFT to visualize TI. Radiology Exam Number: 2873517 Report Status: Final Type: AbdCT + PelCT + Date/Time: 08/09/2082 22:38 Exam Code: GMKUN+ Ordering Provider: UGALDE, JAZZLYNN HISTORY: S/S ABD PAIN, NAUSEA/VOM, PLS ASSESS FOR OBSTRUCTION REPORT: This study was reviewed by Dr. Yee and Dr. Janssen. HISTORY: As provided in the header. COMPARISON: 10/31/2081 TECHNIQUE: Contiguous axial CT scans of both the abdomen and pelvis were performed from the lung bases to the proximal femora to assess for obstruction. Imaging was continued into the pelvis because a charge can affect both cavities. Abdominal and pelvic images were obtained following administration of both oral and intravenous contrast. FINDINGS: LUNG BASES. Linear densities in the lung bases likely represents atelectasis. HEPATOBILIARY. Liver. The liver is normal in appearance without evidence of biliary ductal dilatation or focal lesion. Gallbladder and Bile Ducts. Patient status post cholecystectomy. Pancreas. Normal in appearance. BOWEL. There is no evidence of the obstruction or bowel wall thickening. A moderate amount of stool seen in the colon and rectum. GENITOURINARY: Kidneys. Normal in appearance without evidence of renal calculus or hydronephrosis. Ureters and bladder. Normal in appearance. Adrenal glands. Normal in appearance. Pelvic organs. Vascular calcifications are noted the pelvis. PERITONEUM:No evidence of fluid collection, free air or peritoneal mass lesions. RETROPERITONEUM: Lymph nodes. There are a few small bilateral inguinal lymph nodes present without bulk. Vessels. Unremarkable. BONES AND SOFT TISSUES. Partial sacralization of L5. IMPRESSION. No evidence of obstruction. Exam Number: 3436658 Report Status: Final Type: Gastric Emptyng Date/Time: 06/22/2081 12:42 Exam Code: 224 Ordering Provider: FARLEY, ERIC HISTORY: GASTROPERISIS, NAUSEA AND VOMITING REPORT: A gastric emptying study was performed using eggs labeled with 17 MBq technetium 99m sulfur colloid. There was no evidence of gastroesophageal reflux over 60 minutes of observation. Gastric emptying was reduced, showing only 9% emptying at 60 minutes and 29% emptying at 90 minutes. Impression Reduced gastric emptying with 29% emptying of a solid meal at 90 minutes after ingestion. Exam Number: 2048395 Report Status: Final Type: SmallBowel only Date/Time: 02/16/2081 13:40 Exam Code: 204QY Ordering Provider: SHEEHAN, XIMENA HISTORY: iddm, htn, n/v and abdominal pain x 6 weeks, negative coloscopy, but could not enter terminal ileum assess for mass, TI thickening REPORT: Image interpretation reviewed by Dr. Narvaez. TECHNIQUE: A single contrast small bowel series. FINDINGS: On small bowel follow through, the small bowel loops are normal in caliber and distribution. Spot compression views of the terminal ileum are normal. The transit time was normal. IMPRESSION NORMAL SMALL BOWEL SERIES. Assessment and Plan 54 yo woman with DM, HTN, and depression who has had severe chronic abdominal pain x 2 years. Extensive GI w/u has been negative except for gastric emptying study. 1. GI: Pain is responsive to morphine. Will continue MS contin and treat with IV morphine prn for breakthrough pain. Gastroparesis has been a working diagnosis since all other testing has been negative. She has other complications of DM which does put her at increased risk for autonomic dysfunction of the GI tract. Other diagnoses to consider are bowel ischemia, although colonoscopy and CT scans in the past have not shown any changes in the bowel consistent with this diagnosis. We will order CTA of the abdomen to rule this out. She did have a negative anti-endomysial Ab in 2081, but I think it would be worth checking both anti-endomysial Ab and anti-gliadin Ab to r/u celiac sprue again. We will send both an AFP and CEA levels to f/u on the unclear laboratory abnormality from Missouri Baptist Hospital. 2. HTN: BP is very elevated today, and this may in part be due to stopping the clonidine (which may have been given to help with GI motility). Will continue her on her 40 mg dose of Lisinopril and 25 mg of HCTZ. In addition, we will treat her with hydralazine until we can get the BP down. 3. DM: Will treat with Insulin NPH 25 u Q am, 20 u Q pm and with sliding scale regular insulin. Will monitor BS. 4. Pain management: Will continue Cymbalta and Neurontin along the the MS Contin and prn IV morphine. _____________________________________________ Mildred D. Yunker, M.D. <|output|>{"AGE": ["54", "46", "54"], "CONTACT": [], "DATE": ["2083-02-26", "2/15", "2/20/83", "2/22", "December", "December", "2060's", "3/81", "8/82", "02/25/2083", "02/25/2083", "02/25/2083", "02/25/2083", "02/25/2083", "02/25/2083", "02/25/2083", "02/25/2083", "02/25/2083", "02/25/2083", "02/25/2083", "02/25/2083", "06/16/2081", "6/16/2081", "02/14/2081", "2/14/2081", "08/09/2082", "10/31/2081", "06/22/2081", "02/16/2081", "2081"], "ID": ["28618552", "2360719", "67659198", "2360719", "2873517", "GMKUN+", "3436658", "224", "2048395", "204QY"], "LOCATION": ["PSH", "Missouri Baptist Hospital", "Missouri Baptist Hospital", "PCH", "Yale", "Herzegovina", "Canada", "Herzegovina", "Missouri Baptist Hospital"], "NAME": ["Nicole Frantz", "Nicole Frantz", "UGALDE, JAZZLYNN", "Yee", "Janssen", "FARLEY, ERIC", "SHEEHAN, XIMENA", "Narvaez", "Mildred D. Yunker"], "PROFESSION": ["bio technician"]}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2094-06-12 June 12, 2094 Miles Echeverria, M.D. Spencer Internal Medicine Associates Spencer State Hospital 16 Burrit St Fayetteville, MI 31474 RE: Vicente, Kadeem F. MRN: 948-59-58-0 Dear Miles: I had the pleasure of seeing Mr. Vicente in Cardiovascular Care today. This lovely 77-year old man has had past medical history notable for coronary artery disease, hypertension, benign prostatic hypertrophy, depression, insomnia, osteoarthritis status post total knee replacement. He presents today because of a recent exacerbation of symptomatic coronary artery disease. His history of coronary artery disease begins with his presentation following his total knee replacement in June of 2091. In 10/91 he had an episode of profound weakness and sat down. He had no clear substernal chest pressure, loss of consciousness or edema. Workup at that time included a thallium test which did not clearly demonstrate ischemia and an echocardiogram with an ejection fraction of 50%. He began therapy at that point in time with aspirin, niacin, vitamin E, Lasix, Zestril, Zantac, Minipress, Amitriptyline, and Digoxin. He had been free of exertional neck, chest, arm and jaw pain, paroxysmal nocturnal dyspnea, orthopnea, palpitations, claudication and TIA until this past spring. He actually had done very well with risk factor reduction including completing cardiac rehab at MJH and following a stringent weight reduction program and decreasing his weight. In March of 2094 he began noticing that when he was going up the 19 steps in his house he began having mid-sternal chest discomfort and some dyspnea at the top of the stairs. He stopped working with the physiotherapist at that point and was initiated on nitrate therapy. Since that time he has noted that he has had significant decrease in symptoms and over the past week has actually had no need to take sublingual nitroglycerine and has been taking the full flight of stairs without difficulty. He does note fatigue and insomnia such that he is sleeping only 2 to 3 hours a night. He does continue to be free of paroxysmal nocturnal dyspnea, orthopnea, palpitations or lightheadedness. Medical regimen includes Ambien, Paxil, Isordil 20 t.i.d., Atenolol, Digoxin, Zantac and aspirin. He has no known drug allergies. On physical exam blood pressure when he first arrived at Clinic was noted to be 220/100. At the present time it is 180/100 with a Vicente, Kadeem F. MRN: 948-59-58-0 June 12, 2094 Page Two heart rate of 55 and a respiratory rate of 10. There is no increase in jugular venous pressure. His carotids are free of bruits. His lungs are entirely clear to auscultation throughout, and cardiac exam is notable for a non-displaced PMI, S1 and physiologically-split S2 with no murmur, rub or gallop. Abdominal exam is notable for a ventral hernia. There is no organomegaly and neither are there bruits present. Lower extremities are notable for 2+ femoral, popliteal, dorsalis pedis and posterior tibial pulses with no edema. Skin exam is notable only for the senile angioma. Electrocardiogram is notable for a left bundle branch block which is new since prior tracing available here of 4/03/94. MIBI was notable only for a potential fixed anteroseptal defect and no significant ischemia on 5/6/94. The ejection fraction on a gated spect was 57%. In summary, it appears that Mr. Vicente may have experienced a new myocardial infarction resulting in a left bundle branch block in March of 2094. He could, however, also have developed his progressive conduction system disease and have the fixed defect on his MIBI attributable only to a left bundle branch block. I will be reviewing the primary images to make my final decision. In either regard he is now free of symptoms on his current medical regimen despite his increased weight and his increased blood pressure. I certainly agree with further assistance from nutrition and weight loss and proceeding with Imdur therapy which I would increase to 60 mg p.o. q.d. I also would consider further decrease of his LDL with statin therapy but would only consider this after assessing his response to re-initiation his nutrition program. Given his lack of symptoms at the present time with his usual daily activity, I would prefer to proceed on the medical therapy route. I think that he could be reintroduced to rehab at MJH with the hopes that further education can get him back on line in terms of risk factor reduction. I certainly look forward to discussing this case further with you. It's certainly a pleasure to participate in his care. Sincerely, Gwen K. Xique, M.D. DD: 06/12/94 DT: 06/17/94 DV: 06/12/94 /jackman ******** Not reviewed by Attending Physician ******** <|output|>{"AGE": ["77"], "CONTACT": [], "DATE": ["2094-06-12", "June 12, 2094", "June of 2091", "10/91", "spring", "March of 2094", "June 12, 2094", "4/03/94", "5/6/94", "March of 2094", "06/12/94", "06/17/94", "06/12/94"], "ID": ["948-59-58-0", "948-59-58-0"], "LOCATION": ["Spencer", "Spencer State Hospital", "16 Burrit St", "Fayetteville", "MI", "31474", "MJH", "MJH"], "NAME": ["Miles Echeverria", "Vicente, Kadeem F.", "Miles", "Vicente", "Vicente, Kadeem F.", "Vicente", "Gwen K. Xique", "jackman"], "PROFESSION": []}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2070-02-24 February 24, 2070 Leon F. Craft, M.D. North Penn Hospital 169 Tamworth Place Garnett, CA 47749 RE: Peter Joshi MR #453-39-84-4 Dear Dr. Craft: I had the pleasure of meeting Peter Joshi in the Cardiology Clinic on February 24th. Mr. Joshi presents with a complaint of dyspnea and oxygen requirement. The patient does relate that he has had breathing problems in the past and in fact, markedly worse several years ago. However, with the treatment of his coronary artery disease, he had been doing somewhat better until he underwent surgery for a carotid artery stenosis. Since that surgery several months ago, he has had a prolonged period of time during which he has required supplemental oxygen. At the same time, the patient is being treated for congestive heart failure and in fact, has had a recent increase in his dose of standing Lasix. The patient relates that during his hospitalization, he did have what sounds like a pleural effusion, which a physician did try to drain, however, unsuccessfully. At the current time, Mr. Joshi is feeling slowly better and feels as though he is able to take a deep breath, which he was unable to do several months ago. In fact, he was told recently that he does not need supplemental oxygen. He denies a chronic cough, although he does occasionally have some difficulty swallowing which leads to coughing. His past medical history includes diabetes, carotid artery stenosis, coronary artery disease with both angioplasty and stent placement, congestive heart failure, bladder cancer, hypertension, hypercholesterolemia, gastroesophageal reflux, and upper GI bleed. RE: Peter Joshi MR #453-39-84-4 -2- 02/24/70 His medications include aspirin, Lasix, Isordil, Zestril, Lopressor, simvastatin, Norvasc, Prevacid, a multi vitamin, potassium, albuterol, Atrovent, Serevent, and insulin. He has no known drug allergies. He discontinued cigarette smoking years ago. On exam today, he had a blood pressure of 122/60. His pulse was 56, afebrile. O2 sat on room air initially was at 90%, but when I rechecked it, it was 95%. His weight was 221 lbs. He is in no respiratory distress at rest. His oropharynx had dry mucosa and a somewhat small posterior pharyngeal air space. His neck had no enlarged lymph nodes. Chest had diminished breath sounds in the left base with crackles. His right lung was clear. His heart was in a regular bradycardic rhythm with a II/III systolic murmur. His abdomen was protuberant, but benign. His extremities are with 1+ pitting edema and no clubbing. Pulmonary function testing had been performed in December and was repeated again today, which demonstrates that he has a combined restrictive and obstructive ventilatory defect. His current vital capacity was improved approximately 10% from that of December. He has no bronchodilator response. I took Mr. Joshi for a short walk and he never desaturated below 92% and that includes after walking up one flight of stairs. In summary, I believe that Mr. Joshi has dyspnea which is likely mostly related to congestive heart failure and deconditioning. However, I do believe he might have a pleural effusion based on my exam and based on his history and therefore, I have referred him to have a decubitus chest film taken. Mr. Joshi had several questions related to his metered dose inhaler use and I have recommended that he use only Combivent 4x a day regularly. I do not believe there is any benefit to be gained from an inhaled corticosteroid for this gentleman. I do recommend that he get daily exercise. He certainly needs to continue his diuresis and I will certainly check his chest x-ray on the outside chance that he may benefit from a pleural effusion. I have also confirmed to him that he no longer requires supplemental oxygen. His pulmonary function testing also had demonstrated a reduced defusion capacity, however, it does correct when accounting for albuterol volume and therefore do not believe that he is likely to have either an interstitial lung disease or pulmonary RE: Peter Joshi MR #453-39-84-4 -3- 02/24/70 vascular disease. However, we will certainly reassess this after his initial work-up. Thank you for referring this interesting patient. If you have any questions, please don't hesitate to call. Sincerely, John Riggs, M.D. /quandt cc: Corrine James, M.D. Hospital Regional Universitario/Cardiology 28 Aberdeen Lane Etowah, CA 62884 ******** Not reviewed by Attending Physician ******** <|output|>{"AGE": [], "CONTACT": [], "DATE": ["2070-02-24", "February 24, 2070", "February 24th", "02/24/70", "December", "December", "02/24/70"], "ID": ["453-39-84-4", "453-39-84-4", "453-39-84-4"], "LOCATION": ["North Penn Hospital", "169 Tamworth Place", "Garnett", "CA", "47749", "Hospital Regional Universitario", "28 Aberdeen Lane", "Etowah", "CA", "62884"], "NAME": ["Leon F. Craft", "Peter Joshi", "Craft", "Peter Joshi", "Joshi", "Joshi", "Peter Joshi", "Joshi", "Joshi", "Joshi", "Peter Joshi", "John Riggs", "quandt", "Corrine James"], "PROFESSION": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: TRENGEREID , MontanaNebraska , 37628 DD : 12/12/73 DT : 12/13/73 DV : 12/12/73 Record date : 2084-02-15 For example : Fri check before and after breakfast ; Sunday - lunch ; Monday - supper,etc . For urgent problems or questions about your blood sugar or insulin call 315-1761 and ask for the page operator . Have beeper # 60737 paged ( the diabetes specialist on-call will call you back if you leave a message ). You may also try my pager anytime ( 10626 ) but I am not always available . Octavian McFadden Grania , ACNP , CDE HOSPITAL BUEN SAMARITANO Record date : 2071-07-04 MR # 9485462 July 04 , 2071 Samuell Kerilyn Tajanay comes in for followup of hospitalization on Jun 22 , for coronary artery disease and he had This was done by Dr . Wash Honorine / Alphonse Asal Record date : 2080-08-19 Surgeon U . This gentleman has type 2 DM diagnosed in 2079 . He has followed up with Dr . He has PVD s/p fem-fem bypass graft 8/16/80 , ulcer on R big toe , ( +)peripheral neuropathy . A1c 6.1 in 5/80 FS's 26/03 65 ( treated with OJ)--110 91 238 165 23/04 101 119 He was not eating well 23/02 26/03 but says his appetite has now recovered . This will help Netherlands assess blood glucose control for the past 2-3 months and can help in discharge planning . b 70350 ( beeper for weekend : 09381 ) Record date : 2116-10-12 HPI : 56 y/o caucasian female with hx as bellow here for follow up . s/p left leg surgery 2098 Cerebrovascular accident : 1/16 Fragmin ( DALTEPARIN SODIUM ) 8500 UNITS SC Q12H , Anticoagulation as per Neurology - Uchechi Hose MD . <|output|>{"AGE": ["56"], "CONTACT": [], "DATE": ["26/03", "5/80", "Fri", "12/12/73", "Monday", "2080-08-19", "23/04", "2084-02-15", "2116-10-12", "Sunday", "1/16", "July 04", "2098", "2079", "Jun 22", "12/13/73", "8/16/80", "2071-07-04", "23/02"], "DEVICE": [], "DLN": [], "HOSPITAL": ["HOSPITAL BUEN SAMARITANO"], "ID": ["9485462"], "LOCATION": ["MontanaNebraska", "Netherlands", "TRENGEREID"], "NAME": ["Octavian McFadden Grania", "Wash Honorine", "Samuell Kerilyn Tajanay", "Uchechi Hose", "Alphonse Asal"], "ORGANIZATION": [], "PHONE": ["70350", "10626", "60737", "315-1761"], "PROFESSION": [], "ZIP": ["37628", "09381"]}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: However , 1 eye had vitreous hemorrhage after repeated injections of tPA . <|output|>{"drugs": [{"name": "tPA", "reaction": ["vitreous hemorrhage"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Due to the patient's size it was difficult to identify perforators . In summary , we have a morbidly obese gentleman with mild to moderate reflux on examination and severe stasis dermatitis and discoloration . Thus there is a mismatch between the degree of physical findings and objective laboratory data . I believe that this is the case primarily because the patient cannot lie flat and often sleeps with his legs in a dependent position . Thus he has an ongoing stasis in his legs due to inactivity and dependency . This in addition to his morbid obesity , that is a girth of 385 pounds that presses on his abdomen 24 hours a day , seven days a week and compresses the vena cava as well as the lymphatic drainage of his legs . All of these factors taken into account contribute to his discoloration , ulceration and lower extremity swelling . The solution to this problem is not an easy one . With his obstructive sleep apnea and abdominal girth the chances of him objectively putting his legs up so they are higher than his belly or heart are nonexistent . Certainly it is not unreasonable to use a Lymphapress machine to help remove some of the swelling and edema that this patient experiences in his legs , however a Lymphapress is not a maintenance device but is an interventional device . If we do not have a plan as to what to put on his legs after the Lymphapress is removed in between treatments it will be of no long-term benefit . I would recommend that he use a Lymphapress machine and intermittent wraps with 6 to 8 inch ACE wraps . I would always make the tension in the ACE wraps at the level of the ankle and heel greater than the midcalf . I have given him a prescription for a Lymphapress machine as well as ACE wraps and discussed the relevant components of his care , which are important . I hope that these interventions will help him with his lower extremity edema and swelling . It is unlikely that any intervention at the level of his veins will overcome the terrible hydrostatic pressure of his abdomen and total body girth . If I can provide any additional information regarding Mr . Uribe , please let me know . Sincerely , Michael D . Roe , M.D . MR / martin 60-38574514 .doc Record date : 2079-01-24 Mr . Sparks is a 74 yr . M who was seen by me as a new patient in Nov . 10 and again in Dec . 10 . He RTC . HPI : This visit was supposed to be a preoperative visit prior to his scheduled Feb . 2 right inguinal hernia repair with Dr . Yamaguchi . However , when I saw him in Dec he had inadequate BP control despite Dr . Arias doubling his Lisinopril . I DCed Atenolol and switched him to Labetalol 100 mg BID . Despite some confusion I believe he has done this . He had also been switched from Crestor to Lipitor due to safety concerns . Labs done pre-operatively are notable for : Creatinine 3.4 LDL 184 nct . 35% Problems Adenomatous polyp : May 2078 Gastritis : H . pylori positive <|output|>{"AGE": ["74"], "CONTACT": [], "DATE": ["2079-01-24", "Feb . 2", "May 2078", "Dec", "Dec . 10", "Nov . 10"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["60-38574514"], "LOCATION": [], "NAME": ["martin", "Uribe", "Yamaguchi", "Sparks", "Arias", "MR", "Michael D . Roe"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Today was sent to SHELBY BAPTIST MEDICAL CENTER given concern for his left upper extremity as well as bilateral low extremity swelling and wt gain with concern for possible CHF flare . Of note , on day of d/c from SHELBY BAPTIST MEDICAL CENTER , patient had negative LUE U/S for DVT . - starting in 11/86 requiring chest tube placement for loculated pleural effusion FAMILY HISTORY : Mother - Died age 92 , Father-Died age 65 Colon cancer SOCIAL HISTORY : Retired Insurance claims handler / Radio broadcast assistant , Insurance claims handler alone in private home near wife and daughters . CURRENT STUDY COMPARED TO THE RADIOGRAPH OF 19/8/87 . 7.5 lbs since 5/20 &amp ; Garrett Kallman Pager # 60156 Record date : 2080-09-04 EDVISIT ^ 15379432 ^ Karmen Pa ^ 09/04/80 ^ Gregrey Amandie HISTORY OF PRESENT ILLNESS : The patient is a 79 - year-old female with history of a left MCA stroke , atrial fibrillation , transferred from NORTH CENTRAL SURGICAL CENTER Radiology for atrial been in NORTH CENTRAL SURGICAL CENTER for the last several weeks . Given the difficulty that NORTH CENTRAL SURGICAL CENTER has had ____ here to RIDGEVIEW INSTITUTE for further management and INITIAL IMPRESSION AND PLAN : The patient is a 79 - year-old female with history of atrial fibrillation , and recent left MCA stroke who was transferred from NORTH CENTRAL SURGICAL CENTER for management to be admitted to SAINT ALPHONSUS EAGLE HEALTH PLZ-ER Cardiology . The case was then discussed with the SAINT ALPHONSUS EAGLE HEALTH PLZ-ER cardiologist on call . SAINT ALPHONSUS EAGLE HEALTH PLZ-ER Cardiology and to a monitor bed . page Dr . admission to SAINT ALPHONSUS EAGLE HEALTH PLZ-ER Cardiology . DISPOSITION : The patient was admitted to SAINT ALPHONSUS EAGLE HEALTH PLZ-ER Gregrey Amandie M.D . D : 09/04/80 T : 09/04/80 Dictated By : Gregrey Amandie eScription document : 7-6147092 BFFocus Record date : 2067-10-22 Internal Medicine Andrea Banda 95747340 07-20-1983 surgery in 12-11-1970 . The surgery was performed by Dr . She is a Research officer , political party that uses her hands <|output|>{"AGE": ["92", "79", "65"], "CONTACT": [], "DATE": ["12-11-1970", "07-20-1983", "2080-09-04", "2067-10-22", "19/8/87", "11/86", "09/04/80", "5/20"], "DEVICE": [], "DLN": [], "HOSPITAL": ["RIDGEVIEW INSTITUTE", "SHELBY BAPTIST MEDICAL CENTER", "NORTH CENTRAL SURGICAL CENTER", "SAINT ALPHONSUS EAGLE HEALTH PLZ-ER"], "ID": ["95747340", "15379432", "7-6147092"], "LOCATION": ["NORTH CENTRAL SURGICAL CENTER"], "NAME": ["Gregrey Amandie", "Garrett Kallman", "Karmen Pa", "Andrea Banda"], "ORGANIZATION": [], "PHONE": ["60156"], "PROFESSION": ["Research officer , political party", "Radio broadcast assistant", "Insurance claims handler"], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: - Cardiac : Bradycardic rate , Normal S1 and S2 , I/VI systolic murmur . - Abdomen : Soft , nontender . - Extremities : Bilateral femoral artery bruits , right has systolic and diastolic component and may be c/w AVF , the left fem has a systolic bruit . Left foot with trace DP and 1+ PT , warm to touch , decreased mobility with downward deflection of toes . Right pulse 1+ DP/PT . There is no pedal edema . Mild tenderness to palpation over left DIP joint . - BP : 140/65 EKG : Sinus Bradycardia 55 . 15/.02/.44 , normal EKG Selected recent labs : Metabolic Date BUN CRE 06/03/79 20 1.43 Impression : 64 y.o . male with CAD , PVD who present now with left leg/foot discomfort and chest discomfort . Found to have same coronary anatomy earlier today on angiography . Peripheral angiography noted above stenosis for which he underwent noted interventions . Plan will be for ASA and plavix x 3 months or more with plan for discharge in the morning . He should follow up with Kathy Flaherty PA in 6-8 weeks with exercise ABI's and duplex SFA and proximal trifurction/distal popliteal . He continues to have tenderness to palpation over left DIP joint which may be consistent with reperfusion issues . It does not appear to be c/w gout , will check uric acid for completeness . Verna P . Kahn , NP Signed electronically by Verna P . Kahn , NP Document Status : Final Record date : 2093-01-13 EDVISIT ^ 32612454 ^ Barr , Nicky ^ 01/13/93 ^ IP , CARRIE I saw this patient in conjunction with Dr . Xue . 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 . CHIEF COMPLAINT : A 57 -year-old with back pain . HISTORY OF PRESENT ILLNESS : The patient is a young woman with a complicated past medical history , presents with a chronic history of low back pain , worse over the last week . She states that 3 years ago , she had a motor vehicle accident . <|output|>{"AGE": ["57", "64"], "CONTACT": [], "DATE": ["2093-01-13", "01/13/93", "06/03/79"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["32612454"], "LOCATION": [], "NAME": ["Verna P . Kahn", "IP , CARRIE", "Xue", "Kathy Flaherty", "Barr , Nicky"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Nabumetone -associated interstitial nephritis . <|output|>{"drugs": [{"name": "Nabumetone", "reaction": ["interstitial nephritis"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: lisinopril 10 mg po daily Niaspan Plavix 75mg po daily Toprol XL 25 mg PO daily Physical examination : - Pulse : 50 regular - weight : 268 lbs . - General : Looks well , overweight , pleasant - HEENT : Jugular venous pressure 7cm , carotids 2+ bilaterally without bruits - Chest : CTAB - Cardiac : Point of maximal impulse is midclavicular ; Distant , regular , S1 and S2 , no murmurs or rubs - Abdomen : Soft , obese , non-tender - Extremities : No lower extremity edema , 2+ posterior tibial pulses bilaterally - BP : 130/75 both arms EKG : Baseline artifact , Sinus bradycardia at 50 bpm , clockwise rotation , minor nonspecific T wave changes ; compared to 16-June-2135 , the heart rate is slightly decreased , otherwise no important change . Assessment and plan : 60 year old man with CAD status post inferior STEMI 11/34 treated with 3 bare metal stents to the RCA territory , Hypertension , Hyperlipidemia , and Ankylosing spondylitis who is overall doing well with secondary prevention efforts for his coronary disease , although he does report a chest pain syndrome for the past several days . 1 ) Coronary artery disease : Bare metal stents only are in place in the RCA territory , and he has now completed over a 12 month course of Plavix therapy . Given that the main treatment plan at this time for his ankylosing spondylitis is NSAIDs ( i.e . Motrin ), he will stop Plavix to help minimize the bleeding risk and since there is no absolute indication for him to continue it at this point . He will continue the medical regimen of ASA 81mg daily , Lipitor 20mg daily , Toprol XL 25mg daily and Lisinopril 10mg daily . His heart rate and blood pressure are well controlled . The chest pain syndrome that he has been having for the past several days is reassuring in the sense that it is not exertion related and it seems similar to March when he had an ETT-MIBI without ischemia on perfusion images . He does have a known 70% stenosis in a non-dominant LCx , but two imaging studies have not shown ischemia in that territory . His ECG today is unchanged from priors . However , given his history we will be vigilant for any change or persistence in symptoms . I will call the patient in several days time , and if he continues to have symptoms he can have a repeat ETT . 2 ) Secondary prevention : Most recent Lipid panel in 10/35 on Lipitor 20mg daily shows TC 126 , LDL 62 , HDL 25 and TGs 195 . His LDL has been well controlled however his HDL has been very low on several readings . Given this , along with an elevated TG value , we will start Niaspan . He can start with 500 mg qhs for the first 2-3 weeks to help get through the common adverse effects ( i.e . flushing ). He should take the medication with a glass of cold water and may take his daily aspirin 30 minutes before to help minimize side effects . After a few weeks , he can increase to the maintenance dose of 1000 mg qhs . He has quit smoking completely since the time of the MI and plans to continue this forward . <|output|>{"AGE": ["60"], "CONTACT": [], "DATE": ["March", "10/35", "16-June-2135", "11/34"], "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: Cerebrovascular disease : Multiple strokes on MRI Cerebrovascular accident : 11/15 Hypertension Hyperlipidemia knowlege deficits multiinfarct dementia ? sedentary lifestyle poor dentition : multiple cavities Medications Fragmin ( DALTEPARIN SODIUM ) 8500 UNITS SC Q12H , Anticoagulation as per Neurology - Thomas Javier MD . Stop on 12/17 , 12/18 , 12/19 , 12/20 for breast biopsy on 12/20 . Lipitor ( ATORVASTATIN ) 20 MG ( 20MG TABLET take 1 ) PO QHS , For high cholesterol . One pill every night . Glucotrol ( GLIPIZIDE ) 5 MG ( 5MG TABLET take 1 ) PO BID , For diabetes . One pill twice per day . Fluoxetine HCL 20 MG ( 20MG TABLET take 1 ) PO QD , Take one pill per day . Metformin 500 MG ( 500MG TABLET take 1 ) PO BID Ciprofloxacin 500 MG ( 500MG TABLET take 1 ) PO Q12H Lisinopril 20 MG ( 20MG TABLET take 1 ) PO QD , For blood pressure . Allergies NKA FAMILY HX : No changes . SOCIAL HX : No tobacco , alcohol , or drug use . Denies domestic violence . Uses seat belts . PE : Vital Signs BP : 118/74 P-72 GEN : NAD HEENT : PERRL , no icterus or scleral injection OP : clear , no erythema or exudate . poor dentition but no abscess noted . Lungs : CTA bilaterally LNs : no cervical lymphadenopathy . Heart : RRR , no MRG . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["12/19", "12/18", "12/20", "12/17", "11/15"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Thomas Javier"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: COMMUNITY CARE HOSPITAL 4040 North Blvd . , Suite 46 East John , TX 64353 RE : Dezarae Piedad REHABILITATION HOSPITAL OF FORT WAYNE GENERAL PAR : 912-25-83 I am writing to inform you that I am seeing Mr . He was admitted in early November and stayed until early December . Record date : 2097-05-17 Date of Service : 05/17/2097 14:37 Surgeon : Corita Diego Staff Cardiologist : Alaura Bardo Referring Physician : Britton Cane Lennice Quivers is a 66 year old female with a history of peripheral arterial disease , aortic stenosis , diabetes , hypertension , hyperlipidemia , and coronary artery disease . A recent echocardiogram in April revealed an ejection fraction of 71% , mild mitral regurgitation , aortic stenosis with a peak gradient of 45mmHg , mean of 29mmHg , and a valve area of 0.8 sq cm . A stress test in April revealed a reduced exercise capacity with a small area of mild apical ischemia and ejection fraction of 77% . A cardiac catheterization on 19/9 revealed 50% left main stenosis , 40-50% left anterior descending , 30% circumflex and 50% right coronary artery stenosis . She was referred to Dr . Peripheral Arterial Disease-extensive disease followed by Dr . - s/p left common femoral endarterectomy with bovine patch , and profunda femoral endarterectomy with Dr . - s/p percutaneous angioplasty of right popliteal artery with Dr . Raynaud's Syndrome mixed connective tissue disease , followed by Dr . Stop : 20/9/2097 Stop : 5/30/2097 SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES 4/2097 Report Number : MM219471 Report Status : Final Date : 19/09/2097 09:15 Report Number : GXI712929 Report Status : Final Date : 08/04/2096 09:00 Other Notes : She lives in Poike , Idaho with husband . Other notes : Mother-rheumatic heart disease , had 3 valve surgeries , died at age 48 from complications of a urinary tract infection in setting of strokeFather-cirrhosis , died age 42 , alcoholicSister alive and well . SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES 5/17/2097 1 : Aortic Stenosis and Coronary Artery Disease Plan AVR and Coronary Artery Bypass Grafting with Dr . - EL CAMPO MEMORIAL HOSPITAL 19/9 Informed Dr . 7 : Informed Consent Cardiac surgical consent obtained from Dr . Signed by Valda Garnet on 05/17/2097 14:37 <|output|>{"AGE": ["48", "42", "66"], "CONTACT": [], "DATE": ["20/9/2097", "December", "08/04/2096", "19/9", "05/17/2097", "April", "2097-05-17", "5/17/2097", "November", "5/30/2097", "4/2097", "19/09/2097"], "DEVICE": [], "DLN": [], "HOSPITAL": ["COMMUNITY CARE HOSPITAL", "SOUTHERN NEVADA ADULT MENTAL HEALTH SERVICES", "REHABILITATION HOSPITAL OF FORT WAYNE GENERAL PAR", "EL CAMPO MEMORIAL HOSPITAL"], "ID": ["GXI712929", "912-25-83", "MM219471"], "LOCATION": ["Poike", "4040 North Blvd", "Idaho", "East John"], "NAME": ["Dezarae Piedad", "Lennice Quivers", "Alaura Bardo", "Britton Cane", "Valda Garnet", "Corita Diego"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["64353"]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: CF related Diabetes Mellitus Hypertension Nephrotic syndrome ( baseline creatinine 1.1 "), chart dx at CHB of GN , unclear source of dx Gout Cataracts Allergies : NKDA Medications : Accolate 20 MG PO BID Allopurinol 300 MG daily Aspirin 81 MG PO QD Azithromycin 500 MG po Q Thursday / Saturday / Monday Colchicine 0.6 MG PO Q thu / sat / monday HCTZ 25 mg daily Humalog SS q AC ( approx 20 units ) Lantus 15 UNITS SC QHS Lopressor 50 MG PO BID Pancrecarb MS 8 ( PANCRELIPASE "8,000 UNITS ( PANCRECARB MS 8 )) 8 TABS PO QAC and snacks Probenecid 250 MG PO QD Prednisone 15 MG daily Protonix 40 mg PO QD Simvastatin 20 MG po q hs Symbicort 80/4.5 2 PUFF INH BID Pulmozyme 2.5 mg nebulized bid Hypertonic Saline 4mL inhaled bid FH/SH : lives on long island with partner of 5 years , she is a Notary . Works in shoe repair . Denies tobacco , usually drinks daily glass of grand marnier . notes prior daily marajuana smoking , now 3-4 times per month recently . Review of systems : Denies sick contacts . denies reflux symptoms . states urine output regular , but had several day period of constipation and abdominal that he was able to resolve with prune juice and Activia yogurt . PHYSICAL EXAM ( in CDIC ): Vitals : see nursing flowsheet GEN:NAD . Pleaseant male . Nad . HEENT : PERRL , op moist , with no exudates , no sinus pain or tendernes , no LAN <|output|>{"AGE": [], "CONTACT": [], "DATE": ["Monday", "thu", "Saturday", "monday", "sat", "Thursday"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["long island"], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["shoe repair", "Notary"], "ZIP": []}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2083-07-18 July 18, 2083 Vincent Ventura, M.D. 4971 Edmatteric Drive Cheney, TX 37523 RE: Peggy Tinsley MR #236-67-03-3 Dear Dr. Ventura: Peggy Tinsley was seen in the renal clinic today. This patient with end stage renal disease secondary to diabetes was initiated on hemodialysis 2 weeks ago in MH. She has been doing well except for the complaint of fevers and rigors intermittently for the past week. There is no history of cough, dyspnea, or chest pain. She denies any dysuria, urgency, or frequency. Her blood sugars at home have been between 120 and 180. Her current medications include Tums 5 to 6 tabs with meals, Erythropoietin, Premarin and Provera, Nephrox 150 mg tid, insulin NPH 10 units qam. On July 17, after hemodialysis, Ms. Tinsley was given a partial dose of Vancomycin and developed pruritus. CBC at the time revealed a white count of 6.2 with a hematocrit of 25.2. Blood cultures were sent. On examination today this lady appeared well with a BP of 110/60 and a pulse of 88. She was afebrile. Head and neck examination was unremarkable and chest was clear to IPPA. On cardiovascular examination JVP was at the sternal angle and there was no peripheral edema. Heart sounds were normal. Urinalysis did not reveal and white cells and contained 3+ protein and 2+ glucose. Miss Tinsley should be followed up at her dialysis center. There does not appear to be any evidence of a graft infection. She should also have a urine sent for culture to rule out urinary tract infection. Because of her early satiety she has been eating poorly and we might suggest that she be started on a gastroprokinetic agent such as Cisapride 10 mg qid. Vincent Ventura, M.D. -2- RE: Peggy Tinsley MR #236-67-03-3 Thank you for allowing us to be involved in the care of this patient. Yours sincerely, Martin Y. Pruitt, M.D. Renal Fellow Y. Quinton Xanders, M.D. Attending Physician DD: 07/18/83 DT: 07/23/83 DV: 07/18/83 /bradford cc: Dr. Uriel Palmer Dr. Isaac Upson, Cheney, TX 37523 <|output|>{"AGE": [], "CONTACT": [], "DATE": ["2083-07-18", "July 18, 2083", "July 17", "07/18/83", "07/23/83", "07/18/83"], "ID": ["236-67-03-3", "236-67-03-3"], "LOCATION": ["4971 Edmatteric Drive", "Cheney", "TX", "37523", "MH", "Cheney", "TX", "37523"], "NAME": ["Vincent Ventura", "Peggy Tinsley", "Ventura", "Peggy Tinsley", "Tinsley", "Tinsley", "Vincent Ventura", "Peggy Tinsley", "Martin Y. Pruitt", "Y. Quinton Xanders", "bradford", "Uriel Palmer", "Isaac Upson"], "PROFESSION": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Dear Doctor Trejo : I had the pleasure of seeing our mutual patient , Mr . Tyler Pearson , in follow up evaluation in our vascular surgery clinic here today . As you will remember he recently underwent right carotid endarterectomy with Dacron patch angioplasty after treatment of a severe underlying pneumonia . He returns today reporting that he is doing well from a neurologic standpoint . He has had no focal , motor , sensory deficits , and no amaurosis fugax . A follow up duplex examination performed in our vascular laboratory reveals mild right ICA disease after his carotid endarterectomy with moderate left ICA stenosis which should be followed over time . Assessment and plan : Overall , I am extremely pleased with Mr . Pearson's outcome given his high risk pulmonary status . It would be prudent to see him again in follow up evaluation in six months ' time with a repeat carotid duplex examination . I would be happy to assist in the management of this or any of your other patients as you deem necessary in the future . Thank you again for allowing me to assist in his care . If I can be of any further assistance , please feel free to contact either myself or one of my partners directly . Sincerely , Steven E . Land , M.D . SEL : kerns #NAME? Record date : 2092-03-17 INTERNAL MEDICINE ASSOCIATES HOLDEN DISTRICT HOSPITAL Reason for visit Three months of followup for multiple medical problems . History of present illness Since his last visit , he has started to resume exercising on his treadmill , but has not been watching his weight or diet . Major Problems Hyperlipidemia His most recent labs are within reasonable range with an LDL of 76 and fasting triglycerides 263 , which improved from his previous values . He has been intolerant to Lopid which resulted in pancreatitis . He has not lost any weight , but has begun to exercise . Allergic rhinitis He has chronic postnasal drip and nasal congestion for which he uses Nasonex on a regular basis with some improvement . He has had no sinus pains , headache , or recent sinusitis . Cerebrovascular accident The patient has had no recent neurological symptoms or changes . He had a mild aphasia which has totally resolved . He has had no headaches or any focal symptoms . Gastroesophageal reflux disease The patient continues on his ranitidine at night with improvement in his intermittent epigastric discomfort . Sleep apnea The patient had a sleep study in November 2091 due to excessive fatigue and snoring . He was noted to have sleep apnea , and CPAP was prescribed . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["November 2091", "2092-03-17"], "DEVICE": [], "DLN": [], "HOSPITAL": ["HOLDEN DISTRICT HOSPITAL"], "ID": [], "LOCATION": [], "NAME": ["SEL", "kerns", "Trejo", "Steven E . Land", "Tyler Pearson"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2103-09-02 September 02, 2103 Odessia Kay, M.D. Willow Pointe Assisted Living Center 600 Cherry Street Aumsville, IA 63482 Re: Dalila Haynes 783-61-34-3 Dear Dr. Kay: I saw Dalila Haynes today in consultation concerning the possibility of neurosarcoidosis. She comes with her daughter who assists with the history. I will review her history for the record. She is a 69-year-old right-handed woman who was hospitalized at the Promptcare in July 2103 for evaluation of mental and motor slowing, memory loss, and weight loss. Her daughter notes that she had deteriorated over the course of a month or two. Her movements slowed down, and she became unsteady on her feet, and her memory deteriorated. This culminated in a fall in July prompting her hospitalization. During that hospitalization a head CT on 7/25/03 was reported unremarkable. (There is mild ventriculomegaly on it.) An MRI of the brain on 7/28 showed a few dots of restricted diffusion in the left thalamus. There was no abnormal enhancement. This was consistent with small vessel stroke. EEG showed generalized slowing of the background in the theta and delta range with no epileptiform features. An LP showed normal glucose (74), elevated protein (102), lymphocytic pleocytosis (18-20 WBC, 56-69% lymphocytes, 29-40% monocytes, and 2-4% neutrophils) and 0-1 RBC. CSF ACE was normal. Cultures were negative. CSF VDRL was negative. Because she has a history of sarcoidosis, it was thought that this likely represented neurosarcoidosis. She was started on prednisone 40 mg daily. Her daughter has noted some improvement in her movements and cognition since starting the prednisone, but she remains abnormal. She has lowered the prednisone to 10 mg daily now. Reviewing the laboratory studies today, I see that although an RPR was non-reactive, a TA-IgG was positive, and the confirming treponemal tests (FTA) was also positive at the state lab. She and her daughter are aware of no prior history of syphilis. Other studies during her hospitalization included low serum Na (133) and Mg (1.3), normal vitamin B12, folate, TSH, and ESR (20). CSF HSV PCR was negative. HbA1C was elevated at 8.6. She has a history of asthma going back many years. According to her daughter, she had a skin lesion excised from near her left eye about two years ago. Apparently, this showed noncaseated granuloma, and that is when the diagnosis of sarcoidosis was first made. She then had a mediatinoscopy on 4/10/02. Biopsy of mediastinal nodes showed granulomatous inflammation without caseating necrosis, supporting the diagnosis of sarcoidosis. She has type II DM, HTN, hypercholesterolemia, GERD, and she has had a thyroid adenoma. Her current medications are prednisone 10 mg daily, aspirin 81 mg daily, troglitazone, metformin, glyburide, sisinoril, pravastatin, vitamin D, calcium CO3, Colace, and an inhaler for her asthma as needed. She is allergic to sulfa agents and to fluticasone nasal spray. There is no history of allergy to PCN. Her parents both died of some type of cancer. There is no family history of sarcoidosis or of neurologic disease. She is a widow. She has four children. She used to work for Lowe's. She now lives with a daughter. She has had no recent fever or chills. Her weight has been stable and her appetite good. There is no history of exertional chest pain or palpitations. There is no history of cough, dyspnea, nausea, vomiting, or diarrhea. She has had no rash or joint symptoms. Pulse 126, regular. BP 126/66. She is obese. Ears, nose, and throat are clear. There are no cranial bruits. The neck is supple with full carotid pulses and no bruits. There are wheezes bilaterally. The heart is regular with no murmur. The abdomen is benign. The extremities are normal. There is general psychomotor slowing. She is oriented to time, expect that she gets the date off by two days as Aug 31. She is oriented to place. She is inattentive. She is able to recite the months in order, but she gets lost trying to recite them in reverse. She has trouble registering 4 words, and she recalls only 2 of 4 after three minutes. There is no aphasia. She cannot copy interlocking pentagons and her copy of a 3D cube shows poor spacial representation. The visual fields are full. The pupils are 3 mm and normally reactive. The fundi are poorly visualized. . The eye movements are full and conjugate with no nystagmus; pursuit movement are saccadic. Facial sensation is intact. Facial power is normal and symmetric. Hearing is grossly intact. Weber and Rinne tests are normal. The palate elevates normal. Gag is present. The sternocleidomastoid and trapezius power are normal. The tongue protrudes in the midline. Muscle bulk, tone, and power are normal. There is a low-amplitude, high-frequency tremor in action and rest. Temperature and pinprick sensation are diminished in the lower extremities with a distally-predominant gradient. Reflexes are normal (2/4) and symmetric in the upper extremities and at the knees and absent at the ankles. Plantar responses are flexor. Coordination is intact. Romberg is negative. Gait and station are normal. Her treponemal test for syphilis came back positive from the hospitalization in July. Since syphilis, too, could cause noncaseating granulomas, and she has clearly has syphilis at some point in the past which was probably untreated, this raises some doubt about the diagnosis of sarcoidosis. I will review that issue with you and with Dr, Villalpando. She had CSF pleocytosis in July. With that and the positive treponemal test (FTA), she will need a full course of intravenous penicillin for presumed neurosyphilis. I will discuss arrangements for possible outpatient management of hatt with a PICC line and outpatient VNA services. Concerning her need for prednisone, I think that will depend on our interpretation of the diagnosis of sarcoidosis in light of this new diagnosis. If the evidence of sarcoidosis is not strong with this alternative diagnosis, then we can plan to complete the course of penicillin and taper and discontinue the prednisone and then follow her clinical course, her CSF, and her syphilis serologies. Finally, from the MRI of 7/28, shows a couple of tiny foci of restricted diffusion in the left thalamus. These are most consistent with small vessel ischemic strokes. She has multiple risk factors for common small vessel disease and stroke, but in the context of her inflammatory CSF and evidence of prior syphilis, we must also consider cerebrovascular syphilis as the likely cause of this. I would recommend treatment now with a 14-day course of high-dose (20-24 million units a day) penicillin. She is already on prednisone which might help to prevent any possible Jarisch-Herxheimer reaction. I think that if she remains stable after the initiation of her PCN therapy, then we can plan to taper and then discontinue the prednisone, to follow her clinically and with repeated LP, and determine any need for future corticosteroid therapy on her course. Thank you for this consultation. Sincerely, Keondre Viera, M.D. <|output|>{"AGE": ["69"], "CONTACT": [], "DATE": ["2103-09-02", "September 02, 2103", "July 2103", "July", "7/25/03", "7/28", "4/10/02", "Aug 31", "July", "July", "7/28"], "ID": ["783-61-34-3"], "LOCATION": ["Willow Pointe Assisted Living Center", "600 Cherry Street", "Aumsville", "IA", "63482", "Promptcare", "Lowe's"], "NAME": ["Odessia Kay", "Dalila Haynes", "Kay", "Dalila Haynes", "Villalpando", "Keondre Viera"], "PROFESSION": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Paradoxical precipitation of tonic seizures by lorazepam in a child with atypical absence seizures . <|output|>{"drugs": [{"name": "lorazepam", "reaction": ["Paradoxical precipitation of tonic seizures"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: ROS : General : Energy level fair , has gained 20 lbs since discharge Skin : No rashes , lesions HEENT : No eye pain , spots , flashes of light , no new ear pain Cardiac : no chest discomfort no palpitations Pulmonary : No DOE , no chronic cough GI : little constipation no , no diarrhea GU : 4-5x nocturia . Not worsening . Will f/u at FHV with urologist . Musculoskeletal : no significant pains Neurological : no motor/sensory problems PMH : 1 . NIDDM . Had had DM for >15 yrs 2 . HTN x yrs 3 . Hyperlipidemia 4 . BPH 5 . Diverticulosis ( noted on abd CT ) 6 . Basal cell carcinoma excisions on chest : followed by dermatologist 7 . Carotids Stenosis 8 . Claudication : walks a couple blocks before begins feeling cramps in leg 9 . Glaucoma 10 . Inguinal Hernia : 9/93 pending surgery 11 . ? Ventral hernia <|output|>{"AGE": [], "CONTACT": [], "DATE": ["9/93"], "DEVICE": [], "DLN": [], "HOSPITAL": ["FHV"], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: No explanation for this delay was found , other than the possibility that magnesium sulfate treatment impeded lactogenesis . <|output|>{"drugs": [{"name": "magnesium sulfate", "reaction": ["impeded lactogenesis"]}]}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Other upper tract neoplasms after cyclophosphamide are reviewed . <|output|>{"drugs": [{"name": "cyclophosphamide", "reaction": ["upper tract neoplasms"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Stool Guaiac 28/06/2081 one trace postiive out of three Done - positive Pneumovax 27/08/75 Done Smoking status 29/03/2081 Never a smoker UA-Protein 10/17/2081 1+ Johannes Amada Record date : 2087-04-25 Vonne Guarneri 70786754 20/10/2087 Talyah Malavika , M.D . CYPRESS FAIRBANKS MEDICAL CENTER 671 Hoes Lane West HALLTORP , NJ 49201 We saw Vonne Guarneri in the Internal Medicine at the HOSPITAL BUEN SAMARITANO on 20/10/2087 . He underwent orthotopic heart transplant at the HOSPITAL BUEN SAMARITANO on 05/16/2084 and returns now for his annual evaluation . His last annual evaluation at REX HOSPITAL revealed an ejection fraction of 55% by echocardiography and no coronary disease , although left anterior descending was tortuous . Argentina Kugel , MD eScription EOFHQRFX:5-8832549 IFFocus CC : Brunhilde Jaysa M.D . ELLINWOOD DISTRICT HOSPITAL 111 North 49Th Street HALLTORP , Utah , 82641 CC : Arita Belch M.D . REX HOSPITAL 820 Third Avenue New iberia , Utah , 58309 DD : 20/10/87 DT : 20/10/87 DV : 20/10/87 Record date : 2076-04-04 Patient Name : Adama Perni MRN ( OKLAHOMA SURGICAL HOSPITAL , LLC ): 40768088 Attending : Dr . 48 year old man with longstanding diabetes and neuropathy presented to OKLAHOMA SURGICAL HOSPITAL , LLC ED for right foot ulcer . He had laparoscopic Roux-en-Y on 22/09/2074 . BROWARD HEALTH NORTH <|output|>{"AGE": ["48"], "CONTACT": [], "DATE": ["10/17/2081", "28/06/2081", "29/03/2081", "2076-04-04", "05/16/2084", "2087-04-25", "20/10/2087", "20/10/87", "22/09/2074", "27/08/75"], "DEVICE": [], "DLN": [], "HOSPITAL": ["OKLAHOMA SURGICAL HOSPITAL , LLC", "REX HOSPITAL", "BROWARD HEALTH NORTH", "CYPRESS FAIRBANKS MEDICAL CENTER", "ELLINWOOD DISTRICT HOSPITAL", "HOSPITAL BUEN SAMARITANO"], "ID": ["70786754", "40768088", "EOFHQRFX:5-8832549"], "LOCATION": ["671 Hoes Lane West", "New iberia", "111 North 49Th Street", "HALLTORP", "820 Third Avenue", "Utah"], "NAME": ["Brunhilde Jaysa", "Adama Perni", "Talyah Malavika", "Argentina Kugel", "Johannes Amada", "Vonne Guarneri", "Arita Belch"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["49201", "58309", "82641"]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Nitroglycerin 0.3 mg ( nitroglycerin 1/200 ( 0.3 mg )) 1 tab SL prn Synthroid ( levothyroxine sodium ) 100 microgram PO DAILY Tegretol-xr ( carbamazepine extended release ) 500 mg PO Bid Current Medications Acetylsalicylic acid ( aspirin ) 325 MG PO QAM Atorvastatin ( lipitor ) 80 MG PO QPM Atropine sulfate 0.5-1 MG IV PUSH DAILY Carbamazepine ( tegretol ) 500 MG PO BID Docusate sodium ( colace ) 100 MG PO BID Furosemide ( lasix ) 20 MG PO DAILY Glyburide 5 MG PO QAM BEFORE BREAKFAST Heparin cardiac sliding scale iv 500-1500 Units/Hr IV CONTINUOUS INFUSION Insulin regular inj Sliding Scale SC BID BEFORE BREAKFAST AND BEFORE SUPPER Isosorbide dinitrate 10 MG PO TID Kcl immediate release ( potassium chloride immed . rel . ) 20 MEQ PO Q4H Kcl immediate release ( potassium chloride immed . rel . ) 40 MEQ PO Q4H Levothyroxine sodium 100 MCG PO DAILY Metoprolol tartrate ( lopressor ) 12.5 MG PO TID Nitroglycerin 1/200 ( 0.3 mg ) 1 TAB SL Q 5 mins X 3 doses Potassium chloride sustained release tab 40 MEQ PO Q4H Potassium chloride sustained release tab 20 MEQ PO Q4H Pregabalin ( lyrica ) 75 MG PO at 5 PM Pregabalin ( lyrica ) 75 MG PO in am Pregabalin ( lyrica ) 150 MG PO bedtime Ranitidine hcl ( zantac ) 150 MG PO BID Sodium chloride 0.9% flush 3 ML IV Q2H Sodium chloride 0.9% flush 3 ML IV Q8H Preop Cardiac Status Myocardial Infarction : ( 08/30/2135 , 09/03/2135 ) When : &gt ; 6 Hours and &lt ; 24 Hours Heart Failure NYHA Classification : NYHA CLASS III Cardiac Presentation : NSTEMI , Unstable Angina Preoperative Hemodynamics and Diagnostic Testing <|output|>{"AGE": [], "CONTACT": [], "DATE": ["08/30/2135", "09/03/2135"], "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: SHx : Pt lives with his wife in Guatemala City . He has five children . Former communications manager ; currently works part time in securities Tob : minimal past use EtOH : 1 drink/wk Illicits : none FHx : Mother : CAD s/p CABG ROS : Ten point review of systems negative except as noted in HPI . Exam : Pt is a well appearing middle-aged man lying comfortably in bed VS : T #NAME? 97 , HR #NAME? 95 , BP #NAME? 141/63 , RR #NAME? 18 HEENT : MMM , w/o exudates . Neck : supple , NT , full ROM Chest : CTAB ; no crackles , no wheezes CV : RRR ; normal S1S2 , no m/r/g appreciated ; JVP 7cm ; 2+ carotids without bruit ; 2+ radial and DP pulses ; R groin dressing w/ small amount of blood , pulse 2+ , no obvious hematoma Abd : bruising across lower abdomen , NABS ; soft , non-tender , distended ; no organomegaly Nodes : no cervical LAD Extr : 1+ bilateral lower extremity edema to knees with chronic erythematous skin changes , non tender Neuro : AOx3 , MS nl , CN II through XII intact , motor and sensory nonfocal EKG : NSR , RBBB ________________________________________________________________________________ I/P : 61M w/ CAD , DM , HTN , hyperlipidemia and atrial flutter s/p flutter ablation Atrial flutter : NSR s/p ablation Groin check every four hours ; monitor for signs of tamponade ; anticoagulation with Heparin/Coumadin bridge Ischemia Continue ASA , Atenolol HTN Continue Lisinopril <|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": ["Guatemala City"], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["communications manager", "securities"], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: The authors describe a case of combined lithium and haloperidol toxicity characterized by hyperpyrexia , severe rigidity , mutism , and development of irreversible tardive dyskinesia . <|output|>{"drugs": [{"name": "haloperidol", "reaction": ["hyperpyrexia"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: 9 . gastroesophageal reflux disease 10 . positive PPD on rifampin . Medications : Lisinopril , Norvasc , Nephrocaps , Nexium , Humulin , Neurontin , ketoconazole , Lac-Hydrin , Pulmicort , Bupropion , Epogen , albuterol inhaler , Synthroid , quinine , folate , rifampin . Allergies : Potassium Iod ( OBSOLETE ) #NAME? Unknown : Allergy entered as IODINE SOLN Iv Contrast #NAME? Unknown METFORMIN #NAME? diarrhea , ISONIAZID #NAME? Hepatitis , : LFTs returned to normal after INH d/c'd . FH : Not obtained SH : Not obtained ROS : Not obtained ED : Vitals 1538 : T : p70 BP 190/80 up to 265/108 rr 22 O2 General : eyes fixed shut , NAD HEENT : Anicteric , MMM without lesions , Neck : Supple CV : Reg rhythm , normal s1s2 , no m/r/g , no carotid bruits , 2+ radial pulses Resp : CTAB and and lat no wheeze Abd : Soft/NT/ND Ext : No C/C/E MS : Responds by grunting " Ouch to sternal rub , does not follow simple commands , does not answer y/n questions , mute , CN : I #NAME? not tested ; "II,III #NAME? pupils round reactive to light bilaterally 4->3mm , VFF by confrontation ",; "III,IV,VI #NAME? no gaze preference , no nystagmus ; V-unable to assess VII #NAME? no facial asymmetries , y , VIII #NAME? hears finger rub 2 feet away B ; "IX,X #NAME? voice normal , palate elevates symmetrically , gag intact ; XI #NAME? SCM/Trapezii 5/5 B ; XII #NAME? tongue protrudes midline . Motor : normal bulk and tone . His arms and legs occasionally flail about in the bed in a nonrhythmic fashion.When he is agitated by being examined the adventitious movements are more pronounced . Occasionally he is coaxed into relaxing his legs and they shake minimally to none <|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: Mother died in her 34's . The patient had one brother who died in his 48's from diabetic complications . LABORATORY DATA : Review of previous laboratory tests of 09-16-2000 , BUN 36 , creatinine 1.7 , glucose 310 . 10-19-2003 , TSH normal . 12-12-2001 , B12 normal . The patient said he was tested negative for HIV in 2143 , and 2144 . MRI of the brain in 2143 and 2144 revealed bilateral white matter changes in the cerebral hemisphere without any intracranial mass lesion . ASSESSMENT AND PLAN : In summary , we have a 71-year-old diabetic man who appears to have significant sensorimotor polyneuropathy with autonomic involvement . The patient does have a history of traumatic cervical herniated disk in 2126 . Thank you again for referring Mr . Trudi Fus , M.D . DD : 09/29/45 DT : 10/03/45 HI:34373 : 578 Record date : 2114-05-02 May 02 , 2114 Ramon Burn , M.D . 2815 S Seacrest Blvd Robbi Childs , OK 97847 MRN : 84128208 is a 79 year old , right-handed man with an extensive past medical briefly , is that he was diagnosed with lupus in 2104 and at that that after medications were added by Dr . bipolar II with ____________ diagnosed in 2111 , hypothalamic MRN : 13887195 09-02-2000 Social history : He is a former Administrator . Overall impression : 79 year old , right-handed male with a history Beaver Soha MRN : 97471855 Orma Blacker 710 South 13Th Street East Ariel , OK 01586 WY:BR:4935 / DD : 09-02-2000 / DT : 04-23-2005 Record date : 2095-06-08 EDVISIT ^ 52174715 ^ Rasha Derriey ^ 06/08/95 ^ Nevai Leasa Marty <|output|>{"AGE": ["71-year-old", "48's", "34's", "79"], "CONTACT": [], "DATE": ["2111", "2126", "10-19-2003", "10/03/45", "2144", "09/29/45", "09-16-2000", "2143", "2114-05-02", "04-23-2005", "06/08/95", "12-12-2001", "2095-06-08", "09-02-2000", "May 02", "2104"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["13887195", "84128208", "WY:BR:4935", "HI:34373 : 578", "97471855", "52174715"], "LOCATION": ["710 South 13Th Street", "Robbi Childs", "2815 S Seacrest Blvd", "East Ariel"], "NAME": ["Beaver Soha", "Orma Blacker", "Nevai Leasa Marty", "Rasha Derriey", "Trudi Fus", "Ramon Burn"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Administrator"], "ZIP": ["97847", "01586"]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Metformin 500 mg po BID . Check microalbumin . Re-emphasized importance of bringing in glucometer and BG log book along with all meds to each and every visit . Check on referrals to ophthalmologist , podiatry , diabetic teaching nurse , nutrition . 2 ) HTN : Add Lisinopril 5 mg po qd . 3 ) CVD s/p CVA : Stable . Cont . Fragmin 8500 units SQ BID as per neurology . Follow up with neurology . 4 ) Hyperlipidemia : Add lipitor 20 mg po qhs . 5 ) Left breast masses : Biopsy on 12/20/15 . She is to stop Fragmin on 12/17/15 for this . 6)Poor dentition : Referral to dentistry . 7 ) HM : Health Maintenance Cholesterol 11/25/2115 207 DESIRABLE : <200 M-alb/creat ratio 12/14/2115 47.8 Mammogram 11/27/2115 BilDigDxMamoAll Pap Smear 10/05/2115 2000 Smoking status 10/05/2115 as teen-once UA-Protein 11/25/2115 NEGATIVE HBA1C 12/14/2115 11.8 Urine Culture 11/25/2115 see report in Results Triglycerides 11/25/2115 131 Cholesterol-LDL 11/25/2115 121 DESIRABLE : <130 Microalbumin 12/14/2115 6.5 Bone Density 11/30/2115 BMD-Hip Hct ( Hematocrit ) 11/27/2115 37.3 Domestic Violence Screening 10/05/2115 denies Complete Physical Exam 10/05/2115 Unremarkable Cholesterol-HDL 11/25/2115 60 Hgb ( Hemoglobin ) 11/27/2115 12.9 RTC 6 weeks _____________________________________________ Richard A . Verlin-Urbina , M.D . Record date : 2081-03-30 Asked by Dr Dunn and Dr . Needham to comment on DM management in this 58 y/o man admited for amputation site debridement . <|output|>{"AGE": ["58"], "CONTACT": [], "DATE": ["11/27/2115", "2081-03-30", "12/17/15", "12/20/15", "12/14/2115", "11/30/2115", "10/05/2115", "11/25/2115"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Dunn", "Richard A . Verlin-Urbina", "Needham"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: several months and sooner if he has new problems or concerns . I have advised him about increasing his level of activity and about maintaining his diet and I have also asked him to contact me if he should have any symptoms of hypoglycemia and to obtain his fingerstick glucose reading at that time as well . _________________________ Xaiden Roberson , M.D . PZ:WX: 4138 DD: 12-21-88 DT: 12-23-88 DV: 12-21-88 ******** Approved but not reviewed by Provider ******** Record date : 2081-02-13 PACU Overnight Admission H&amp ; P Patient Name : Ray , Patricia L MR# : 8744185 Date : 2/13 Time : 6 pm Diagnosis : left knee prosthesis infection , s/p left knee prosthesis removal and antibiotic spacer insert Admitting Service : History of Present Illness : 72 yo F hx AS x/p AVR , MR , MI , HTN , DM , HLD , interstitial lung disese , and PE . She had TKR 7 yr ago , and now ESR and CRP elevated with severe knee pain ,? infection in left knee . She has been afebrile . She had left knee prosthesis removal and antibiotic spacer insert 2/13 . Intraoperative Course : Airway : easy mask , gd1 view I/O : EBL 200 ML , UO 900 ml , LR 2000 ml Access : PIV Abnormal issues : no Antibiotics : vancomycin 1 gm 10 AM Pain control : ( 1 ) Aortic stenosis - s/p redo-AVR in 4/80 . Rocky postoperative course notable for respiratory failure requiring prolonged ventilator support and sepsis . <|output|>{"AGE": ["72"], "CONTACT": [], "DATE": ["2081-02-13", "12-23-88", "4/80", "2/13", "12-21-88"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["4138", "8744185"], "LOCATION": [], "NAME": ["Ray , Patricia L", "Xaiden Roberson"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: CONCLUSIONS : This case describes the clinically significant increase of INR in an elderly patient after adding a chemotherapy regimen of levamisole and 5-FU to a previous regimen of warfarin alone . <|output|>{"drugs": [{"name": "5-FU", "reaction": ["increase of INR"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: CONFIRMED - Advair HFA 250 bid - aspirin 325 mg daily - Prilosec po daily take one hour before the first meal of the day - simvastatin 80mg po qpm - Ventolin HFA PRN ------------------------------------------------------------ REMOVED - Lipitor 40 mg daily DX Tests Ordered : TTE without bubbles It was a pleasure seeing Ms . Xuereb in followup today . Please do not hesitate to call with any further questions/concerns . Sincerely , Floyd Fong MD Transcribed by : Clara D Decker Signed electronically by Floyd Fong , MD pager # 81895 Document Status : Final Record date : 2078-12-14 December 14 , 2078 Xan Dillon , M.D . 88 Guilford Lane Nouakchott , GA 95269 RE : Urania Yerger MR # 583-48-90-0 Dear Dr . Dillon : I had the pleasure of seeing Urania Yerger today for the first time in Titonka Care Center in follow-up of her coronary artery disease and coronary artery bypass grafting in October of this year . Though you know her history well , I will recount it for the purposes of record keeping . Ms . Yerger is presently 81 years old . Her vascular risk factors include diabetes , hypertension , dyslipidemia . She had no prior diagnosis <|output|>{"AGE": ["81"], "CONTACT": [], "DATE": ["December 14 , 2078", "October", "2078-12-14"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Titonka Care Center"], "ID": ["583-48-90-0"], "LOCATION": ["88 Guilford Lane", "Nouakchott", "GA"], "NAME": ["Urania Yerger", "Dillon", "Clara D Decker", "Yerger", "Floyd Fong", "Xan Dillon", "Xuereb"], "ORGANIZATION": [], "PHONE": ["81895"], "PROFESSION": [], "ZIP": ["95269"]}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2109-09-14 September 14, 2109 Vicente Blair, M.D. Internal Medical Doctors Hospital North Omak, Georgia 72196 RE: VALDEZ, Harlan DHN#: 7672624 DATE OF BIRTH: 11/09/2062 CURRENT CLINIC VISIT DATE: 09/14/2109 Dear Vicente, Thank you in advance for allowing me to share in the medical care of Mr. Harlan B. Valdez, a 46-year-old male patient with prior polysomnographic evidence of sleep disordered breathing, as well as a history of difficulty in sleep, reinitiation and maintenance and increased early morning awakenings, as well as mixed systemic medical conditions. HISTORY OF PRESENT ILLNESS: As you already know, Mr. Valdez who demonstrates a history of difficulties of sleep reinitiation and maintenance, as well as increased early morning awakenings, has noted an exacerbation of these sleep difficulties, occurring in temporal association with his loss of his wife from pancreatic cancer last year. He is now placed in the unfortunate situation of being a single parent to a 15-year-old son and a 10-year-old daughter and describes a modification of his current employment duties of a set designer. In particular, Mr. Valdez describes undergoing on frequent international travelling which has bee markedly curtailed as he is tending to his family situation closer to home. He described a history of intermittent snoring symptomatology but is unaware of specific nocturnal respiratory pauses. He is unaware of a "restless" lower limb sensory complaints which may impact on his ability to initiate or reinitiate sleep. He denies a history of a " night owl" personality or circadian rhythm dysfunction which may have played a role with respect to nocturnal sleep disruptions or sleep difficulties. He denies a history of paroxysmal abnormal disturbances or associated narcoleptic symptoms. Mr. Valdez underwent an initial formal polysomnographic evaluation at the center for sleep diagnostics at Holy Cross on 11/26/05, during which time he was noted to demonstrate a respiratory disturbance index of 81/hour, particularly exacerbated in the supine position and characterized predominantly by hypopneas, with equal distribution during non-REM and stage REM sleep and with associated O2 desaturation Nadir of 88% The respiratory disturbances were predominantly obstructive or mixed hypopneas. In addition, loud snoring was noted. There was evidence of a sleep efficiency of 88% and a short sleep onset latency of 4 minutes. There was a predominance of "light" non-REM stages I-II sleep, and a concomitant inability to achieve significant "slow-wave" or stage REM sleep. There was also "alpha intrusions and alpha delta sleep" evident during the initial sleep study. In addition premature ventricular contractions were noted. The patient underwent a CPAP titration on 01/15/06, also at the Tenacre Foundation Nursing Home in Boxborough, during which time there was a marked reduction in the frequency of hypopneas (respiratory disturbance index equals 2/hour) with CPAP titrations between 4-6 cm. Sleep efficiency improved to 91%, a short sleep onset latency was also noted (3 minutes). There was once again an increased predominance of "light" non-REM stage I-II sleep, with concomitant inability to achieve sustained "slow wave sleep". Since his initial trial of nocturnal CPAP titration (at 6 cm of water pressure) and with various CPAP mask modifications (including CPAP nasal face mask and a Mallinckrodt "Breeze" supportive head gear with "nasal pillows". The patient describes associated claustrophobic symptomatology, relative difficulties with sustained nocturnal home CPAP use, and difficulties with regards to CPAP to being and complications by the bulkiness of the CPAP machine in general. As a result, he has not utilized nocturnal CPAP therapy for a period of time, although he still maintains the CPAP equipment in his house. Of particular note, and exacerbation of the past year, the patient demonstrates increased early morning awakenings (averaging 2-4 in number) with typical awakenings occurring approximately two hours after sleep initiation at 9:30 p.m. (the patient describes one awakening at 11:30 p.m. and the second awakening at 11:45 a.m., of unclear causative etiology). The patient then might awaken at 3 a.m. and be "ready for the day". If he is able to reinitiate sleep thereafter, the patient may demonstrate additional two early morning awakenings after a final awakening at 6 a.m. The patient is noted to have a history of mixed systemic conditions including diabetes, coronary artery disease, depressive disorder, as well as a relatively stable gastrointestinal condition, with no upper GI evidence of gastroparesis. MEDICATIONS: 1. Provigil 200 mg p.o. q. a.m. PRN. 2. Lithium. 3. Valproate. 4. Glucophage 850 mg t.i.d. 5. Humulin 15 units at night. 6. Folate. 7. Metoprolol. 8. Cardia. 9. Vitamin E. 10. Coated aspirin. ALLERGIES/ADVERSE REACTIONS: The patient describes an enhancement to suicidal tendencies in association with prior Prozac usage. SOCIAL HISTORY: The patient denies active tobacco or alcoholic beverage usage. He has lost 15-20 pounds over the past several years. His current weight is 195 pounds. He is desirous of losing some additional weight with regards to more regular exercise, but his hectic social situation makes this somewhat difficult at the present time. On examination, the patient demonstrates a blood pressure of 146/88, (seated, left arm), respiratory rate 16. HEENT EXAMINATION: Borderline small posterior oropharyngeal aperture, with slightly increased redundant tissue evident posteriorly and a slightly elongated uvula noted. The patient appears awake, alert, with speech clear and fluent and receptive language function essentially intact. He is presently wearing dental braces. No obvious cranial nerve deficits are appreciated. No focal, sensory, motor or neurologic deficits are noted. No significant appendicular dystaxias or dysmetrias are currently in evidence. The routine gait appears to be normal based, without evidence of significant gait dystaxias. No current clinical ictal manifestations are present. No acute evidence of "micro-sleeps" are noted. 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:09/14/2109 DT:09/15/2109 TX:24217 :1991 <|output|>{"AGE": ["46", "15", "10"], "CONTACT": [], "DATE": ["2109-09-14", "September 14, 2109", "11/09/2062", "09/14/2109", "11/26/05", "01/15/06", "09/14/2109", "09/15/2109"], "ID": ["7672624", "TX:24217 :1991"], "LOCATION": ["Doctors Hospital North", "Omak", "Georgia", "72196", "DHN", "Holy Cross", "Tenacre Foundation Nursing Home", "Boxborough", "Doctors Hospital North", "DHN"], "NAME": ["Vicente Blair", "VALDEZ, Harlan", "Vicente", "Harlan B. Valdez", "Valdez", "Valdez", "Valdez", "Harlan Valdez", "Yovani Vergara"], "PROFESSION": ["set designer"]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: artery disease and therefore underwent a multi-vessel coronary bypass graft operation including a left internal mammary artery to her LAD and reverse saphenous vein grafts to her PDA , D1 and obtuse marginal branch . She underwent repeat catheterization in February of 2073 at the Comfrey Clinic which showed diffuse native disease but apparently no significant bypass graft pathology . She underwent repeat cardiac catheterization in May of 2074 because of a current angina and at this time she had evidence for a 60% proximal LAD stenosis , a proximal severe circumflex artery stenosis with no occlusion at the origin at a first obtuse marginal branch and a 70% stenosis in the mid right coronary artery . The saphenous vein graft to the diagonal branch was patent with a significant stenosis at its distal and astigmatic site , a saphenous vein graft to the second obtuse marginal branch was patent as was the saphenous vein graft to the posterolateral branch . The left intramammary artery to the LAD was a small vessel without discrete stenoses . Left ventriculogram demonstrated a moderate area of posterior basal akinesis with a global ejection fraction of 60% . She therefore was transferred to the Midwest Eire Center in early June where she underwent successful PTCA of her vein graft to her diagonal artery . She tolerated this uneventfully and was Olivier , Christine MR # 652-33-21-5 - 2 - July 5 , 2074 discharged and since then has not had significant exertional chest discomfort . Her primary complaint is one of fatigue and mild exertional dyspnea . She has undergone extensive pulmonary evaluation in the past including pulmonary function tests which have revealed an FEV1 of 1.3 which is 59% predicted , and an FVC of 1.5 which is also 55% predicted giving her a pattern consistent with restrictive rather than obstructive pulmonary disease . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["May of 2074", "July 5 , 2074", "February of 2073", "June"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Comfrey Clinic", "Midwest Eire Center"], "ID": ["652-33-21-5"], "LOCATION": [], "NAME": ["Olivier , Christine"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Health maintenance . Mammogram was done in 06/2086 . Pap smear was done in 04/2083 . Colonoscopy was done in 08/2081 . 10 . ? Depression . She seemed a little sad . Has had a tough time with her medical problems and never adjusted that well to Pecos . Will have her come back and discuss further . ______________________________ Qiana Solomon , MD eScription document:9-2784353 KUQlhv Egq DD : 03/06/87 DT : 03/07/87 DV : 03/06/87 #NAME? Record date : 2084-06-09 Medicine Attending Admit Note June 9 , 2084 1340 h I interviewed and examined the patient on rounds this morning with Dr . Lilly and with Team E and we reviewed the relevant data and discussed the case in detail . I agree with the findings and recommendations in Dr . Lilly 's note , with any small exceptions or points of emphasis noted below . Please refer to it for details of HPI , PMH , medications and allergies , family and social history , laboratory and other data , and ROS . I would only add/emphasize the following : Mr . Gillespie is a 53 year-old man with medical history that includes : h/p Hodgkin&#8217 ; s lymphoma , 2070 - 2071 , treated with local resection , bleomycin , adriamycin , and other agents , XRT to a wide chest field Atrial fibrillation #NAME? diagnosed in 3/84 ; on warfarin , metoprolol Pectus excavatum &#8211 ; repair failed as a child Pneumonia several times in the past Central obesity &#8211 ; weighs about 315# , down from a high of 360# Type II diabetes mellitus , last A1C 6.4 , on metformin only , 1000 mg BID Hypertension , on lisinopril 10 mg , Toprol XL Elevated lipids #NAME? on statin <|output|>{"AGE": ["53"], "CONTACT": [], "DATE": ["03/07/87", "2084-06-09", "03/06/87", "3/84", "2070", "06/2086", "2071", "June 9 , 2084", "08/2081", "04/2083"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["document:9-2784353 KUQlhv Egq"], "LOCATION": ["Pecos"], "NAME": ["Qiana Solomon", "Gillespie", "Lilly"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: very anxious , worried about having to be placed in nursing home because cannot do own med preparation , test fingersticks . says she is having some sob at rest but no doe , orthop , pnd , cp . ankle swelling is also a little more . Allergies * Haldol - Unknown Medications Asa ( CHILDRENS ) ( ACETYLSALICYLIC Acid ( C . . . 81MG , 1 Tablet ( s ) PO QD Mvi ( MULTIVITAMINS ) 1 CAPSULE PO QD Pericolace ( DOCUSATE W/casanthranol ) 1 CAPSULE PO QD AMIODARONE 200MG , 1 Tablet ( s ) PO QD Lasix ( FUROSEMIDE ) 40MG , 1 Tablet ( s ) PO BID Premarin ( CONJUGATED Estrogens ) 0.625MG , 1 Tablet ( s ) PO QD Provera ( MEDROXYPROGESTERONE ) 2.5MG , 1 Tablet ( s ) PO QD Celexa ( CITALOPRAM ) 40MG , 1 Tablet ( s ) PO QD ATENOLOL 25MG , 1 Tablet ( s ) PO QD Tylenol ( ACETAMINOPHEN ) 500MG , 2 Tablet ( s ) PO TID PRN arthritis pain Advil ( IBUPROFEN ) 200MG , 1 Tablet ( s ) PO BID PRN pain not relieved by tylenol Protonix ( PANTOPRAZOLE ) 40MG , 1 Tablet ( s ) PO QD PRN . Glucophage ( METFORMIN ) 500MG , 2 Tablet ( s ) PO BID Neurontin ( GABAPENTIN ) 100MG , 2 Capsule ( s ) PO TID Problems Hypertension <|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: The exophthalmos improved dramatically within 72 hours of the withdrawal of lithium . <|output|>{"drugs": [{"name": "lithium", "reaction": ["exophthalmos"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Gen : Very pleasant , appears comfortable in bed , in NAD , talking in full sentences . No increased use of accessory mm . HEENT : Surgical pupils bilaterally . EOMI , sclera anicteric . OP clear . Neck : Supple , no carotid bruits . 2cm lipoma below L mandible . Nodes : No cervical or subclavicular LAD . Cor : RRR S1 , S2 nl . 2/6 crescendo-decrescendo SEM , best heard at apex . JVP 5cm . Chest : CTAB . Abdomen : #NAME? soft , NT , ND . Guaiac negative . Ext : R ankle : swellings , warm , effusion . Tender w/ movement . Limited ROM . Neuro : Alert and oriented x3 . CN 2-12 intact . Motor strength 5/5 bilaterally in all extremities , except in L dorsi and plantarflexion limited 2/2 pain on L ankle . Sensation intact to light touch . No tremors . Gait difficult to test because of the tenderness on pressure of L foot . Labs and Studies : CBC : WBC 9.6 ( 4.5-11.0 ) th/cmm HCT 44.1 ( 41.0-53.0 ) % HGB 15.4 ( 13.5-17.5 ) gm/dl RBC 4.77 ( 4.50-5.90 ) mil/cmm PLT 184 ( 150-350 ) th/cumm MCV 93 ( 80-100 ) fl MCH 32.2 ( 26.0-34.0 ) pg/rbc MCHC 34.9 ( 31.0-37.0 ) g/dl RDW 13 ( 11.5-14.5 ) % Poly 85 H ( 40-70 ) % Lymphs 10 L ( 22-44 ) % Monos 4 ( 4-11 ) % <|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2072-12-29 December 30, 2072 Ulanda B. Huynh, MD South Side Hospital Thoracic Surgery 92 Cleveland Street Morris, MO 95412 RE: Otis Narvaez MR #04561326 Dear Dr. Huynh: I had the pleasure of seeing your patient Mr. Oscar Narvaez in consultation. As you know he is a 63-year-old gentleman with a history of diabetes, high blood pressure and obesity. Recently, he underwent evaluation prior to intestinal bypass surgery in which he underwent dobutamine stress echocardiography. The echocardiogram revealed reduced left ventricular dysfunction with ejection fraction of 35 to 40 percent. There was no evidence of ischemia. He subsequently underwent coronary catheterization. I do not have those results, but he claims that he was told that he had no arterial blockages. Symptomatically, he is significantly short of breath with minimal exertion. He has attributed this to his weight. He was started on an ACE inhibitor and diuretic, although he has not been taking either of these medications. Prior to his catheterization a chest x-ray revealed a 1.5 cm nodule in the left upper lobe of the lung that was not present in 2067. This was confirmed subsequently on CT scan, suggesting that this was most likely a primary lung malignancy. He is therefore scheduled for mediastinoscopy with you. His past medical history is remarkable for diabetes, hypertension, low back pain, and obesity. Current medications include glucophage 1000 mg po q.d., Ritalin 80 mg po q.d., Celexa 10 mg po q.d., Neurontin. No drug allergies Family history is remarkable for heart disease in his father. Social history: he works as a consultant in the Morris area. He smoked for 40 years but quit approximately three years ago. He drinks rarely, although drank heavily in the past. RE: Otis Narvaez MR #04561326 -2- December 30, 2072 Review of systems is remarkable for shortness of breath. He denies gastrointestinal complaints. On physical exam he is obese but well appearing with a blood pressure of 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 ******** <|output|>{"AGE": ["63"], "CONTACT": [], "DATE": ["2072-12-29", "December 30, 2072", "2067", "December 30, 2072", "12/29/72", "12/30/72", "12/29/72"], "ID": ["04561326", "04561326"], "LOCATION": ["South Side Hospital", "92 Cleveland Street", "Morris", "MO", "95412", "Morris", "South Side Hospital"], "NAME": ["Ulanda B. Huynh", "Otis Narvaez", "Huynh", "Oscar Narvaez", "Otis Narvaez", "Narvaez", "Kevin Y. Kirkpatrick", "Kirkpatrick,Kevin"], "PROFESSION": ["consultant"]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: No claudication . No edema . No nausea Has had chest pain since heart surgery . Not related to activity . Always present . Has MIBI schedueld for 5/80 . 2 . DM - home gou 120-150 . Followed at Skiff . Endocrine : No polydipsia , polyphagia , weight change , sweats, heat intolerance. Stable nocturia x3 . GI - No nausea . No vomitting . No dyspepsia . No reflux . No abdo pain . No diarrhea . No constipation . No melena . No BRBPR . 3 . With persistent neck an dright shoulder pain . 4 . Anxious . , Verys stressed/tensed . With depression.Memory is not as good . Alprazolam is very helpful . Flowsheets BLOOD PRESSURE 102/70 PULSE 76 WEIGHT 203 lb WD,WN,NAD Neck - limited lateral movment . No JVD . No bruit . No LAN . No thyromegaly <|output|>{"AGE": [], "CONTACT": [], "DATE": ["5/80"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Skiff"], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: urinary tract infection : Reoccurrent S/P cardiac bypass graft surgery : 100% obstr of LPC and mid RCA , 70% obstr LAD on cath 11/92 . Medications Ecotrin ( ASPIRIN ENTERIC COATED ) 325MG TABLET EC take 1 Tablet ( s ) PO QD , Take as directed Ntg 1/150 ( NITROGLYCERIN 1/150 ( 0.4 MG )) 1 TAB SL x1 , USE AS DIRECTED Nystatin POWDER TOPICAL TOP BID Lipitor ( ATORVASTATIN ) 20MG TABLET take 1 Tablet ( s ) PO QD , Take as directed Acetaminophen W/CODEINE 30MG 1 TAB PO Q4H PRN pain , Take as directed Bactroban ( MUPIROCIN ) TOPICAL TOP BID Plavix ( CLOPIDOGREL ) 75 MG PO QD Lopressor ( METOPROLOL TARTRATE ) 50MG TABLET take 1 Tablet ( s ) PO BID Nexium ( ESOMEPRAZOLE ) 40MG CAPSULE EC take 1 Capsule ( s ) PO QD Avapro ( IRBESARTAN ) 150MG TABLET take 1 Tablet ( s ) PO QD Clonazepam 0.5MG TABLET take 1 Tablet ( s ) PO BID PRN anxiety Procardia XL ( NIFEDIPINE ( SUSTAINED RELEA . . . 60 MG ( 60MG TABLET take 1 ) PO QD Furosemide 40MG TABLET take 1 Tablet ( s ) PO BID Kcl SUSTAINED RELEASE ( 20MEQ TABLET CR take 2 Tablet ( s ) PO QD , take 2 tabs in am and 2 tab in pm Follow up visit . Doing well , lives alone , independent with ADL's . Has nocturia X 5 , urinates 3-4 X during the day . Has 1 c tea qd , no coffee or ETOH . Drinks 5 bottles of water qd , 16 oz cranberry juice . Never started macrobid . Denies CP , SOB , GI sx . Quit smoking 11/92 . Walks 30 min qd . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["11/92"], "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: BUN ( Stat Lab ) 16 ( 8-25 ) mg/dl Creatinine ( Stat Lab ) 0.9 ( 0.6-1.5 ) mg/dl Glucose ( Stat Lab ) 274 H ( 70-110 ) mg/dl 09-Feb-2081 21:21 Total Protein 7.9 ( 6.0-8.3 ) g/dl Albumin 3.7 ( 3.3-5.0 ) g/dl Globulin 4.2 H ( 2.6-4.1 ) g/dl Direct Bilirubin 0.1 ( 0-0.4 ) mg/dl Total Bilirubin 0.4 ( 0.0-1.0 ) mg/dl Alkaline Phosphatase 78 ( 30-100 ) U/L Transaminase-SGPT 12 ( 7-30 ) U/L Amylase 103 H ( 3-100 ) units/L Lipase 7.8 H ( 1.3-6.0 ) U/dl Transaminase-SGOT 15 ( 9-32 ) U/L 09-Feb-2081 21:08 WBC 5.9 ( 4.5-11.0 ) th/cmm HCT 41.3 ( 36.0-46.0 ) % HGB 14.3 ( 12.0-16.0 ) gm/dl RBC 5 ( 4.00-5.20 ) mil/cmm PLT 300 ( 150-350 ) th/cumm MCV 83 ( 80-100 ) fl MCH 28.6 ( 26.0-34.0 ) pg/rbc MCHC 34.6 ( 31.0-37.0 ) g/dl RDW 12.8 ( 11.5-14.5 ) % Poly 56 ( 40-70 ) % Lymphs 38 ( 22-44 ) % Monos 4 ( 4-11 ) % EOS 1 ( 0-8 ) % Basos 1 ( 0-3 ) % Abd CT : The liver , spleen , pancreas , adrenal glands and kidneys are unremarkable on this unenhanced CT . There is diverticulosis of the sigmoid colon without CT evidence of diverticulitis . There is no evidence of bowel obstruction . There is a segment of terminal ileum demonstrates thickened wall . No significant surrounding inflammatory change . There is <|output|>{"AGE": [], "CONTACT": [], "DATE": ["09-Feb-2081"], "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: pavix ; reglan currently on D5 1/2NS at 100 ml/hr Family History NC Social History Smoking none EtOH 1-2 beers daily Other widowed recently Review of Systems NA Physical Exam VS 98.4 ; 126/58 ; 94% sat on RA ; 72 General Appearance Well/ post op HEENT MM moist , sclera anicteric Neck no thyromgally , trachea midline Chest Resp unlabored Cor/Cardiac RRR Edema : none Abdomen Soft Extremity Skin intact , no deformity Musc Skel Nl build , no joint deformity Neurological A/O Sensory exam : diminished to touch Skin <|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: Long term treatment will be dependent on the underlying diagnosis and its treatment . I think she will need corticosteroids for her sarcoidosis and I expect this will improve the hypercalcemia , but we need definitive diagnosis first . The cardiac murmur is impressive , but likely unrelated to the pulmonary disease . We need echocardiogram to better define valvular function . The minimally elevated troponins are not felt to be of clinical significance at this point . Appreciate Cardiology input on this finding . Suggest : 1 . Stop "HCTZ,avoid diuretics until fully volume repleted . 2 . IV normal saline . May need rates in the 150-200 range to control her hypercalcemia acutely , but she has had this for some time , so can be conservative with fluids approach . 3 . Agree with check PTH , vitamin D levels . 4 . Follow lytes , creatinine , calcium , Hct . 5 . Agree with check echocardiogram . 6 . We should ask the Pulmonary Service to see her in consultation . Bronchoscopy with biopsy may be the best way to obtain confirmatory tissue for diagnosis of sarcoidosis . _____________________________________________ Edmond I . Utterback , M.D . Pager #57863 Internal Medicine B Attending #NAME? Record date : 2096-10-04 Graydon Harold Jean , MD Nevada Hospital Internal Medicine 72 Dan Chan Angels City , NH 31731 Dear Dr . Jean : Your patient Henry Oswaldo was seen today by myself at the Atmore Community Hospital today following coronary artery bypass on August 15 , 2096 . He has had a relatively unremarkable recovery with out complication . Today , Mr . Oswaldo looks and feels well , and complains of no issues . On examination , the lungs are clear , cardiac rate and rhythm are normal . The incision is healing very nicely . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["August 15 , 2096", "2096-10-04"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Atmore Community Hospital", "Nevada Hospital"], "ID": [], "LOCATION": ["NH", "72 Dan Chan", "Angels City"], "NAME": ["Graydon Harold Jean", "Edmond I . Utterback", "Jean", "Oswaldo", "Henry Oswaldo"], "ORGANIZATION": [], "PHONE": ["#57863"], "PROFESSION": [], "ZIP": ["31731"]}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2104-04-14 Willow Pointe Assisted Living Center 839 Cherry Street Aumsville, IA 63482 (296) 003-4642 HAYNES, DALILA 78361343 04/14/2104 HISTORY OF PRESENT ILLNESS: Ms. Haynes is a 69-year-old woman who comes in followup of her recent hospitalization and rehabilitation. She is here with her daughter. She notes that she is mostly feeling tired lately. She is able to walk with help and is even unable to walk upstairs with assistance. She is here in a wheelchair and says she is kind of tired and lets her daughter gives most of the history even when asked simple questions. She has been checking her blood sugars and she shows me the results. In the morning, the sugars have been fairly low in the 57-100 range, around noontime high at 144 up to 398, and in the evening high again 176-245. She is taking Lantus 38 units at 9:00 p.m. and she is on NovoLog coverage less than 25-0 units, 125-152 units, 151-204 units, 201-256 units, 251-308 units and greater than 310 units. She would like to switch over her Lantus to the Pens since the pen is so much easier for her. She complains of hemorrhoids, although she says they are actually getting better, she had previously had four now she has two. There is no bleeding. There is no pain, kind of itchy and uncomfortable. She is in fact not having any problem with constipation at this time. She is having bowel movements every day. She is not having any chest pain, no trouble breathing, no fevers, sweats or chills. No abdominal symptoms. She notes her stomach is really fine and it just not causing any trouble at all. MEDICATIONS: Aspirin, lisinopril 40 daily, Lantus 38, NovoLog coverage, omeprazole 40 daily, metoprolol, potassium chloride, Lasix 40 daily, Pravachol 40 nightly, and Symbicort. ALLERGIES: Bactrim GI intolerance, fluticasone, cough and sucralfate unknown. SOCIAL HISTORY: She has never smoked, no alcohol, no street drugs. PHYSICAL EXAMINATION: Well developed, well nourished, no acute distress. Blood pressure 121/65, pulse 106, weight 169.8, and temperature 98.6. A delightful woman, English speaking and sitting in a wheelchair. Quite alert, did know the president, could not recall the vice-president or against whom the president ran in the last election. She did know the day of the week and she knew where she was. She also remembered to remind me about a prescription when both her daughter and I almost forgot. She is an absolutely delightful woman, appears well and alert despite the fact that she lets her daughter provides most of the history and responses. She appears comfortable, breathing easily, no use of accessory muscles of inspiration, speaking in full sentences, no cough, no spine or flank tenderness. Heart sounds S1, S2, regular rate and rhythm, no murmur, rub or gallop. Chest is clear to auscultation anteriorly and posteriorly with no rales, wheezes, or rhonchi. She is clear to percussion. Extremities: Without edema, cyanosis or clubbing, no calf tenderness. IMPRESSION AND PLAN: 1. Diabetes. Her A1c today was 6.6, which represents excellent control despite a fairly high glucoses she was recording. I therefore did not want to increase her regimen despite the high glucoses. We will continue for now. I did give her an appointment with the diabetes nurse for help in management of her diabetes. 2. Hypertension. Her blood pressure is fine. We will continue current regimen. We will check electrolytes. 3. Tachycardia actually improved relative to her last visit. She is asymptomatic in this regard except for some fatigue. 4. Fatigue. This is most likely due to stepping down from the prednisone 60-40. This is what the patient and her daughter believe. She was somewhat fatigued before, but they note that it is worse with this. She does need to come off the prednisone and Dr. Villalpando who she just saw is going to try to come up with another plan for her. Check cbc. 5. Acid associated symptoms well controlled with omeprazole. 6. Right knee mild osteoarthritis, not a problem today. 7. CNS syphilis status post treatment. 8. Question of CNS sarcoid currently on 40 mg of prednisone and hopefully she will be able to come off of that and perhaps get started on something else. 9. Cholesterol. We will recheck her cholesterol today and will check an SGPT. 10. Thyroid nodules. Ultrasound in July 2103 showed stability. 11. Adrenal adenoma. Her CAT scan in May 2102 showed stability and some adenopathy consistent with sarcoid. 12. Lichen simplex chronicus. Dermatology diagnosis from 2101. Not addressed today. Hopefully, she will be stronger at her next visit and we can recheck. 13. Osteopenia. She will continue calcium and vitamin D. I encouraged weightbearing exercise as tolerated. 14. Glaucoma suspect, not addressed today. 15. Small vessel ischemic disease. MRI from July showed changes consistent with small vessel ischemic stroke. She is currently on aspirin and stable. 16. Hemorrhoids - anusolHC given. Given no bleeding and no pian, this hopefully will fuffice. Recommended avoiding constipation, as she is doing, with lots of dietary fruits and vegetables. HgA1C 6.6 CBC slightly elevated WBC likely due to prednisone SGPT, lytes o.k. CHOL LDL 1124 elevated but HDL also high, protective, cntu pravachol and rercheck letter sent ______________________________ Odessia Q Kay, M.D. eScription document:3-89996385 JSSten Tel DD: 04/15/04 DT: 04/15/04 DV: 04/14/04 <|output|>{"AGE": ["69"], "CONTACT": ["(296) 003-4642"], "DATE": ["2104-04-14", "04/14/2104", "July 2103", "May 2102", "2101", "July", "04/15/04", "04/15/04", "04/14/04"], "ID": ["78361343", "3-89996385"], "LOCATION": ["Willow Pointe Assisted Living Center", "839 Cherry Street", "Aumsville", "IA", "63482"], "NAME": ["HAYNES, DALILA", "Haynes", "Villalpando", "Odessia Q Kay"], "PROFESSION": []}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2094-08-11 INTERNAL MEDICINE ASSOCIATES ROSELAND COMMUNITY HOSPITAL Major Problems Health maintenance Up-to-date. Pneumococcal vaccine given in 2093. Declines a sigmoidoscopy or colonoscopy. Diabetes mellitus Blood sugars have been very good. Here today, it is 156. She met with Camp who discussed extensively about her diabetes. She found it very helpful. Diet issues reinforced. Sebaceous cyst Resolved. Hypertension Blood pressure much improved, 130/60 after increasing her medications. This is a great improvement. When Camp checked, her blood pressure was also considerably better at that visit, 132/70. Having her watch her salt and also her sugar in her diet. Active Medications glyburide 5mg po 2 tabs bid metformin hydrochloride 500 mg po bid lisinopril 20 mg po qd atenolol 100mg po qd Ecotrin 325 mg po qd hydrochlorothiazide 25 mg po qd Norvasc 5mg po qd Physical examination Blood pressure 130/60 Weight 171 pounds Chest Lungs are clear Cor Unremarkable Extrem Clear Disposition Return is to see me in the fall. Note transcribed by outside service Transcription errors may be present. Signed electronically by Ruba M Neil on Aug 14, 2094 <|output|>{"AGE": [], "CONTACT": [], "DATE": ["2094-08-11", "2093", "Aug 14, 2094"], "ID": [], "LOCATION": ["ROSELAND COMMUNITY HOSPITAL"], "NAME": ["Camp", "Camp", "Ruba M Neil"], "PROFESSION": []}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2083-12-30 Lantus and Novolog Insulin Guidelines 1. Check blood sugars before meals and at bedtime. In addition, some meals you may want to check your blood sugar (blood glucose or BG) 1 hour after taking your Novolog. If it is over 150 you may need to take more Novolog with meals or decrease your carbohydrate intake. You do not have to do this at every meal and you can alternate meals and/or days. For example: Sat check before and after breakfast; Friday - lunch; Thursday - supper,etc. 2. Be careful of the amount of carbohydrates (breads, pasta, cereal, fruit, etc) you eat at each meal and between meals. Try to average about 60 gms. per meal and 15 gms. for snacks. 3. The goal for your blood sugars when you get up in the morning and before meals is 80-110, 1 hour after taking Novolog (at the start of the meal) it is less than 140, and at bedtime 100 to 140. 4. Your insulin may need adjusting several times before those goals can be met. When exercising you may need more carbs or less Novolog with meals. Long-acting insulin: Lantus (insulin glargine) Take _14_ units at bedtime. Do not mix with any other insulin. Lantus starts to work in about 1 hr and lasts about 24 hours. It has no peak. If your fasting blood sugar for two or more mornings is more than 120, increase your Lantus by 2 units at the next dose. If it is more than 140 for two mornings then increase by 4 units at the next dose. If your fasting blood sugar is less than 70 then decrease your next dose of Lantus by 2 to 4 units. Short-acting insulin: Novolog Take 16 units of novolog with breakfast, 6 units with lunch, and 10 units with supper (called "standing dose") within 15 minutes of starting eat your meals. Do not take standing dose if not eating. Novolog starts to work in 15 minutes and lasts about 2 hours. It peaks in about 1 hour. You need to eat enough carbs to cover this insulin or you will have a low blood sugar. If blood sugar is < 80 take your standing dose or sliding scale. If < 60 do not take standing dose. Take Novolog sliding scale (below) in addition to standing dose Novolog at mealtime If Blood sugar is 125 - 150 take 2 units more 150 - 200 take 3 units more 201 - 250 take 4 units more 251 - 300 take 6 units more 301 - 350 take 8 units more >351 take 10 units more and call MD if blood sugar has not decreased or has increased after 2 hours. Bedtime High Blood Sugar: If your blood sugar at bedtime is greater than 200 take Novolog by the sliding scale below in addition to Lantus. Do not mix the two insulins. Do not take standing dose insulin at bedtime. Have your blood sugar checked 1 to 2 hours after taking novolog at bedtime to make sure you haven't gone too low. If you are below 80 then have a snack and juice to hold you over until morning. If bedtime blood sugar is 201 - 250 take 2 units 251 - 300 take 3 units 301 - 350 take 4 units Please follow up with your endocrinologist or primary care practitioner in 1-2 weeks. Bring this paper and your blood sugar results from the time you were discharged. For urgent problems or questions about your blood sugar or insulin call 387-8267 and ask for the page operator. Have beeper #68537 paged (the diabetes specialist on-call will call you back if you leave a message). You may also try my pager anytime (30568) but I am not always available. Olive Tripp, ACNP, CDE Dixmont State Hospital Diabetes Management Service <|output|>{"AGE": [], "CONTACT": ["387-8267", "68537", "30568"], "DATE": ["2083-12-30", "Sat", "Friday", "Thursday"], "ID": [], "LOCATION": ["Dixmont State Hospital"], "NAME": ["Olive Tripp"], "PROFESSION": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: A 16-year-old white male with acute biphenotypic leukemia developed evidence of the eosinophilia myalgia syndrome associated with total parenteral nutritional support with solutions containing tryptophan , which were given during his initial induction chemotherapy and also after autologous marrow transplantation . <|output|>{"drugs": [{"name": "tryptophan", "reaction": ["eosinophilia myalgia syndrome"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: THERE WERE OCCASIONAL PVC'S AND COUPLETS AND TWO 3 BEAT RUNS OF VT . HAD BEEN ACCEPTABLE ALBEIT ON AN ELABORATE REGIMEN THAT HAD EVOLVED . SUBOPTIMAL WITH ADDITIONAL WEIGHT GAIN 5/23/86 . WILL RECHECK 6-8 WEEKS AFTER 8-10 LB WEIGHT LOSS . ETT THAL SCHEDULED , GIVEN ABNL ECG , RISK FACTORS , AND HIS CONTINUING DESIRE TO EXERCISE . 5/86 EXCELLENT EXERCISE CAPACITY TO 9 METS , ECG NONDIAGNOSTIC DUE TO BASELINE ABNORMALITIES BUT THALLIUM NL . 150/74 7/86 AND WILL ACCEPT THIS FOR NOW BUT STILL NEEDS TO LOSE WEIGHT . 140/78 9/86 WO WEIGHT LOSS . REDISCUSSED IT WOULD MAKE IT POSSIBLE TO SIMPLIFY HIS REGIMEN CONSIDERABLY . HE REMAINS ON VERY ELABORATE REGIMEN THAT HE HAD BEEN ON FOR YEARS BY DR . TITUS . ( 8/8/87 ) [ 08/28/88 ] REASONABLE CONTROL ON REGIMEN , BUT STILL NEEDS WEIGHT LOSS . 78-9 really not adequate control with his mild diabetes ; increased Cardura to 8 mg without help . Change Procardia XL to Norvasc with increase from 15 to 20 mg . BP control acceptable . 7/91 still a bit suboptima and Lisinopril increased from 40mg to 60mg per day . Continue to emphasize weight loss . hyperglycemia BS WAS APPARENTLY 190 FASTING 2/82 BUT THEN LOST 10 LBS . 3 HR PC BS IS 91 3/3/82 . RBS 118 AND HBA1C 5.06 = 83 4/22/83 . 121 4/84 . DAUGHTER DID RBG 9/18/84 ABOUT 2 HR PP AND WAS 208 . 134 IN OFFICE 9/22/84 AND HBA1C 8.16 . 5.59 4/85 . 2-1/2 HR PC 179 5/86 . FBS 120 7/86 . 12/86 FBS 145 AND HGB A1C 4.57 = 66 . FBS 154 AND HBA1C 6.44 = 129 ON 4/87 , DONE BY HPLC METHODS SINCE THERE HAD BEEN A DISCREPANCY BETWEEN BLOOD SUGARS AND HBA1C LEVELS , AND THIS WAS IN AGREEMENT WITH RESULT BY AFFINITY . DISCUSSED DIETARY CHANGE AT LENGTH . 8/87 VISIT . ( 8/8/87 ) A1C 6.1 = 117 . BLOOD SUGARS BECAME HIGHER , HE DID EXCEPT NUTRITION REFERRAL , BEGUN ON METFORMIN 500 BID WITH GI SXS WHEN 3RD DOSE ADDED . 5/88 A1C 7.04 = 149 . AT THAT POINT HAD LOST 14 POUNDS . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["4/22/83", "4/87", "7/86", "9/22/84", "5/23/86", "4/84", "12/86", "2/82", "9/18/84", "7/91", "8/8/87", "5/88", "08/28/88", "4/85", "9/86", "8/87", "5/86", "3/3/82"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["TITUS"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: There was a patent spinal canal and lack of impingement on the thoracic cord . Pt . received dilaudid 1-3 mg q4hours prn back pain . As per psych notes , she did not wish to change medications to methadone or fentanyl . A CT guided bx of the thoracic spine took place on 8/15/02 and was non-diagnostic . A neurosurgery consult reported that an open bx might destabilize her given the locationo f the pedicle and recommended that the biopsy be done at GCH . A repeat MRI was done on 8/20/02 due to increasing c/o back pain and showed a 50% compression fx of T4 , persitent abnl marrow signal in L . pedicle of T11 , and overall heterogenous marrow signal pattern throughout the visualized vertebral bodies . Immunoelectrophoresis was ordered to r/o myeloma . Right Breast Mass : A firm R . breast mass was noted at the 7 o/clock position of R . breast at site of lumpectomy scar and the thickening was thought to be 2/2 to previous sx by surgeous at OSH . A mammogram on 8/5/02 showed innumerable benign appearing calcifications in both breasts . The R . Breast was significantly smaller and a heterogeneously dense parenchymal pattern was identified . An u/s of R . breast showed no discrete mass . A biopsy was delayed 2/2 to bacteremia . Renal failure : Pt . developed renal failure while on vancomycin with an increase of cr from 1.1 to 2.4 . Her vancomycin level was noted to be >60 on 8/13/02 and vanco was discontinued . Repeat blood cultures were negative for S . aureus . Anemia : On admission to Rafael Hospital , Hb/Hct : 11.6/35.5 . She was started on procrit by hematology . She was transfused on unit of PRBCs in the hospital . TIA : Pt . has a hx of TIAs with one episode while hospitalized significant for difficulty with speech and R . hand tingling . An MRI that day showed new increased signal w/in the ventricles and subarachnoid space noted diffusely . This finding was likely due to prior IV contrast administration of gadolinium , though an underlying hemorrhage or infection could not be excluded . A brain MRI on 8/18/02 showed resolution of abnl signal w/in the ventricles , decrease in high signal in the subarachnoid space , likely representing resolution of sequelae from prior IV gadolinium . No findings of meningitis but persisting increased signal w/in the L . lope , which may represent vitreal hemorrhage . HTN : Pt . required adjustments in her meciations during her hospital stay to control hypertension . MEDICAL HISTORY Recurrent syncope : 2086 - 2100 , 3-4 events per year , last event prior to hospitalization Seizure disorder : first sz in 2090s with unresponsive , staring , mouth movements ; often occurred in clusters once a year , last sz prior to admission . COPD , asthma Frequent UTIs Elevated LFTs thought to be 2/2 to anti-epileptics CAD HTN ( since adolescence ) <|output|>{"AGE": [], "CONTACT": [], "DATE": ["8/20/02", "8/15/02", "2090s", "8/5/02", "2086", "8/13/02", "8/18/02", "2100"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Rafael Hospital", "GCH"], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: A/P : 64 yo F w/h/o DM and HTN who presented with several weeks of worsening bilateral LE burning pain exacerbated by movement and pressure . A slide was prepared and examined under the microscope by myself , Dr . Agustus Raelin Larenda , MS4 x 41364 Patient seen with Dr . Flynn Maryclare , MD Record date : 2070-04-27 counselling w/ Stoll Ilbert Krause . HbA1c 01/04/2070 6 Home glucose monitoring Hypoglycemia Assessment/Counseling M-alb/creat ratio 08/30/2069 4.1 Microalbumin 08/30/2069 0.6 Nutrition Referral Ophthal Exam 02/02/2070 Appointment scheduled Podiatry exam Abd u/s notable for enlarged spleen in June #NAME ? Labs Monday Addictions : Has fol at EAST TEXAS MEDICAL CENTER TRINITY where he gets his methadone ( 90mg ) Problems EtOH : last drink 6/13/63Hepatitis C Htn H/O hepatitis B : 15 years ago after episode of jaundice with HCV two years agoH/O drug abuse : IV drug user stopped heroin 2 years ago-methadone maintenence 95 mg qdfracture : thumb age 51Hernia repair : bilateral inguinal hernia repair Obesity abnormal SPEP : could be from Hep C but needs fol esp in light of periph neuropathy #NAME ? ( s)Allergies Sulfa #NAME ? ( estimated ) 01/07/2070 >60 Abnormal if HbA1c 01/04/2070 6 HBsAB 21/05/2063 NEG HBsAG 21/05/2063 NEG Hct ( Hematocrit ) 01/07/2070 38.4 Hep A Vaccine 12/30/2063 Hep B Vaccine 12/30/2063 Hgb ( Hemoglobin ) 01/07/2070 13.3 Influenza Vaccine 11/16/2069 M-alb/creat ratio 08/30/2069 4.1 Microalbumin 08/30/2069 0.6 Ophthal Exam 02/02/2070 Appointment scheduled PPD 11/06/2066 Negative 0mm induration Smoking status 21/09/2068 Current smoker Td Booster 17/08/2062 Triglycerides 02/12/2069 181 TSH 02/12/2069 1.67 UA-Protein 01/04/2070 NEGATIVE Vital Signs BLOOD PRESSURE 128/68 WEIGHT 210 lbAGE 51 y0.5mPhysical Exam Stable fatigued appearance NAD DM : Doing much better , repeat labs Monday . Record date : 2075-02-06 EDVISIT ^ 38377939 ^ Mliss Anderson ^ 02/06/75 ^ Sulamith Alyn Wenz Rotberg Keita is a 65-year-old man with diabetes and a 2-week history of increasing dyspnea on exertion . Sulamith Alyn M.D . D : 02/06/75 T : 02/06/75 Dictated By : Sulamith Alyn eScription document : 1-6109604 BFFocus Record date : 2079-06-08 Norvasc 5mg po qd QTY:30 Refills:3 Start : 19/1/2076 Discussed w/ Dr Yaneth Khalik by phone . Appt w/ Dr Yaneth Khalik 6/14/79 I was present during key portions of the evaluation of the patient and agree with Heymann Clarice findings and plan as written . Antonya Adur Maximilian Signed electronically by Rickford Charnley RN on Jun 08 , 2079 Antonya Adur Maximilian MD on Oct 06 , 2079 Record date : 2079-11-14 APPLING HEALTHCARE SYSTEM EMERGENCY DEPT VISIT " Rockwood Messiah Cerelly 540-98-11-9 VISIT DATE : 11/14/79 HISTORY OF PRESENTING COMPLAINT : In brief , this is a 79 - year-old gentleman with morbid obesity . <|output|>{"AGE": ["79", "51", "51Hernia", "65-year-old", "64"], "CONTACT": [], "DATE": ["Jun 08", "Oct 06", "2070-04-27", "02/12/2069", "01/04/2070", "2079-11-14", "2075-02-06", "Monday", "12/30/2063", "11/14/79", "6/13/63Hepatitis", "01/07/2070", "08/30/2069", "19/1/2076", "11/06/2066", "21/09/2068", "6/14/79", "2079-06-08", "June", "17/08/2062", "11/16/2069", "02/02/2070", "21/05/2063", "02/06/75"], "DEVICE": [], "DLN": [], "HOSPITAL": ["APPLING HEALTHCARE SYSTEM", "EAST TEXAS MEDICAL CENTER TRINITY"], "ID": ["1-6109604", "38377939", "540-98-11-9"], "LOCATION": [], "NAME": ["Mliss Anderson", "Yaneth Khalik", "Wenz Rotberg Keita", "Heymann Clarice", "Rockwood Messiah Cerelly", "Rickford Charnley", "Stoll Ilbert Krause", "Flynn Maryclare", "Antonya Adur Maximilian", "Agustus Raelin Larenda", "Sulamith Alyn"], "ORGANIZATION": [], "PHONE": ["41364"], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: We report a case of cough following the administration of quinapril , with complete resolution after changing to the alternative ACE inhibitor fosinopril in a patient with essential hypertension . <|output|>{"drugs": [{"name": "quinapril", "reaction": ["cough"]}]}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Self-limited edema is a well-recognized complication of insulin therapy . <|output|>{"drugs": [{"name": "insulin", "reaction": ["Self-limited edema"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Mixed dyslipidemia 4 . Depression 5 . Obesity 6 . Back pain 7 . Fourier's gangrene as above 8 . Hyponatremia on HCTZ ALL : NKDA MEDS PTA : 1 . ASA 81 daily 2 . Atenolol 100 qam , 50 qpm 3 . Celexa 60 daily 4 . Fenofibrate 145 daily 5 . Glipizide 10 bid 6 . Klonopin 1 prn 7 . Lantus insulin 50 units bedtime 8 . Lipitor 80 daily 9 . Lisinopril 40 daily 10 . Losartan 25 daily 11 . Metformin 1000 bid Current MEDS : 1 . <|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: D : 10/22/69 T : 10/22/69 Dictated By : VOLLMER , NATHAN eScription document: 1-3286211 BFFocus Record date : 2069-05-06 INDEPENDENT EMERGENCY DEPT VISIT JOSHI,KATHY 158-42-11-2 The resident's note was reviewed . The patient was interviewed and examined by me . I concur with the workup and evaluation of the patient in the emergency department . For a more detailed note on this patient , please review the resident's note . Please review the resident's note for past medical history , surgical history , review of systems , medications , allergies , social history and family history . HISTORY OF PRESENTING COMPLAINT : This patient is a 63 -year-old female who presents to Independent Living Center Emergency Department with complaints of dyspnea on exertion . The patient also complains of paroxysmal nocturnal dyspnea . She also complains of a cough . She also complains of having fluid on her lower extremities . She denies any other acute complaints . She denies chest pain . She denies nausea or vomiting or diaphoresis . PHYSICAL EXAMINATION : HEENT : Normocephalic , atraumatic . Pupils are equal , round and reactive . Fundi was positive for AV-nicking . NECK : Mild jugular venous distention . CHEST : Rales audible bilaterally . <|output|>{"AGE": ["63"], "CONTACT": [], "DATE": ["1-3286211", "10/22/69", "2069-05-06"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Independent Living Center", "INDEPENDENT"], "ID": ["158-42-11-2"], "LOCATION": [], "NAME": ["VOLLMER , NATHAN", "JOSHI,KATHY"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: We report two cases of neutropenia following captopril use in cardiac patients with trisomy 21 . <|output|>{"drugs": [{"name": "captopril", "reaction": ["neutropenia"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: UA-Albumin NEGATIVE ( NEG ) UA-Glucose NEGATIVE ( NEG ) UA-Ketones NEGATIVE ( NEG ) UA-Occult Blood NEGATIVE ( NEG ) EKG : SR @90 BPM , low voltage , 1 . degree heart block , right axis deviation Radiology : CXR ( portable ): Low lung volumes . Pulmonary vascular redistribution cannot be excluded on this semi upright film . CXR ( pa/lat ): Mild pulmonary congestion with cardiomegaly . Small right pleural effusion . Stable elevated right hemidiaphragm . Assessment and Plan : 53 yoM with hx of morbid obesity , CHF , HTN , COPD , DM type 2 , OSA , p/w increasing SOB and abdominal discomfort . SOB : Most likely related to a combination of CHF flare ( due to lasix discontinuation , BNP 1326 ) and COPD ( PFT in 2120 indicated severe obstructive and restrictive deficit ). CXR showing cardiomegaly and right-sided pleural effusion , consistent with CHF . Started on oxygen , lasix , combivent nebs . Will reevaluate cardiac function with TTE . In the absence of CP , PE unlikely . Cardiac enzymes negative . CHF : Currently treated with Verapamil for afterload reduction . Will consider to switch Verapamil to ACEI . Reinitiated Lasix . HTN : patient here normotensive . Currently taking verapamil , however , 1 . degree heart block . Will consider switching to ACEI . OSA : Patient on home oxygen . Will suggest CPAP/BiPAP Diabetes : Currently taking Glybyride , will obtain HBA1c here , keep on RISS while inpatient . Abdominal discomfort/bloating : Most likely related to recent weight gain of 30 lbs , diabetic gastroparesis might also be contributing . Patient unable to tolerate metoclopramide . Discussed possibility of gastric bypass , patient rejects . Rectal incontinence : Might be related to diabetic neuropathy . Patient also unable to perform anal hygiene because of obesity . Groin erythema : Suggestive of fungal infection . <|output|>{"AGE": ["53"], "CONTACT": [], "DATE": ["2120"], "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: UA-pH 5 ( 5.0-9.0 ) UA-WBC Screen NEGATIVE ( NEG ) UA-Nitrite NEGATIVE ( NEG ) UA-Albumin NEGATIVE ( NEG ) UA-Glucose NEGATIVE ( NEG ) UA-Ketones NEGATIVE ( NEG ) UA-Occult Blood 2+ ( NEG ) UA-SED-RBC 3-5 ( 0-2 ) /hpf UA-SED-WBC 0-2 ( 0-2 ) /hpf UA-SED-Bacteria NEGATIVE ( NEG ) /hpf Hyaline Cast 0-2 ( 0-5 ) /lpf Squamous Cells NEGATIVE ( NEG ) /hpf Radiology : CXR : neg Adenosine Stress Test 11/78 The ECG response to pharmacological stress was nondiagnostic for ischemia . The myocardial scans are within normal limits and do not demonstrate evidence of myocardial ischemia or infarction . Echo 11/78 : MITRAL VALVE There is systolic anterior motion ( SAM ) of the chordal apparatus which is a normal variant . mild MR . mild AI . EF is 67 % . mild TI . RVSP is 43 mmHg . EKG : sinus at 81 bpm , no ST changes , biphasic Ts in V1/V2 ?, qs in III , AV2 ASSESSMENT & PLAN 53 y/o female with CHF/diastolic dysfunction , HTN who presents with 2 day history of chest pain concerning for ACS . Chest pain-concerning for ACS given symptoms . Does have HTN , HL , past smoking hx . R/o MI with CE Cont on telemetry Cont metoprolol and titrate as BP/HR permits <|output|>{"AGE": ["53"], "CONTACT": [], "DATE": ["11/78"], "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: 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 . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["2110", "3-16-14"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["26649180"], "LOCATION": [], "NAME": ["Craft , Lloyd", "Brice Short"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["stage manager"], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: He had a Holter monitor which did not reveal any dysrhythmias . His cholesterol level was 152 with an HDL of 23 . It was felt that his stroke was most likely due to atherosclerosis of the middle cerebral artery , involving either one or possibly several lenticulostriate arteries . He did not have any evidence of a flow limiting MCA stenosis . He had been on aspirin prior , Plavix was added to his regimen . Since his discharge from the hospital , he has been in rehabilitation for the last two months . He has had no further episodes of weakness , numbness , tingling , ataxia , dysarthria , or dysphagia . He has no symptoms of aphasia . He has been left with some dysarthria from his initial event , which he feels has improved . I would agree with him . He also has regained some strength in the left leg , and is currently working on using a walker with assistance . Unfortunately , he has not regained any use of the left arm . He has not had any problems with spasms . His past medical history is significant for hypertension and type II diabetes mellitus . He had an inferior myocardial infarction in 2060 . He had a quadruple bypass in 2083 . His last stress test in 2087 showed moderate inferolateral ischemia in the region of a prior myocardial infarct . He has pulmonary disease due to asbestosis . He has chronic renal failure and neuropathy secondary to his diabetes . He has also had laser surgery for diabetic retinopathy . His medications currently include clonidine . 1 mg . p.o . b.i.d "., Plavix 75 mg . p.o . q.d "., aspirin 325 mg . p.o . q.d "., Neurontin 300 mg . p.o . q.h.s "., Gemfibrozil 600 mg . p.o . b.i.d "., Isordil and Lasix . He had been on Captopril earlier , but he has since been taken off that medicine . He was managed with insulin during his prior admission . I assume he is still on this medicine , although he did not specifically state so . He has an allergy to sulfa drugs . The patient lives with a friend who works at Marble Slab Creamery . The patient quit smoking 15 years ago and only rarely drinks alcohol on social occasions . There is a history of coronary artery disease in his father and at least one of his brothers , but no family history of stroke . On examination , he was a pleasant gentleman in no apparent distress . His blood pressure was 150/90 . His language was intact . His speech was somewhat dysarthric , although this was improved from his admission . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["2083", "2060", "2087"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": ["Marble Slab Creamery"], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2085-03-21 21 March 2085 Liam K. Mcmahon, MD Division of Cardiology Osteopathic Medical Center Re: Bill FAIR OMC 220-41-86-4 Dear Dr. Mcmahon: I had the pleasure of caring for Mr. Fair at OMC 03/20-21/05. He is a 61-year-old man with CAD, DM, high cholesterol, HTN, and family history of early CAD, who had a stress test that showed peri-infarct ischemia in the left circumflex and PDA. Angiography showed a codominant system, a 100 percent left circumflex occlusion, an 85 percent RC lesion, and nonobstructive LAD lesions. The left circumflex was recanalized and a Taxus 2.5mm by 32mm stent was placed. The procedure was done with Angiomax and the sheath was pulled manually. There were no complications. He spent an uneventful evening without complaints or complications, ambulating without difficulty. His groin was soft and tender with ecchymosis but no hematoma. Extremities were warm with 1+ edema to the ankles; pulses were 2+ throughout. Morning labs included cholesterol of 114, triglycerides 109, HDL 34 and LDL 58. He was discharged home on NPH insulin; Mucomyst, 600mg bid; aspirin, 325mg qd; atenolol, 25mg qd; Lasix, 60mg qd; glyburide, 10mg qd; lisinopril, 40mg qd; Lipitor, 40mg qd; Diovan, 80mg qd; Plavix, 75mg qd; metformin, 500mg bid to be restarted on 03/23/85; and sublingual nitroglycerin, prn chest pain. He will require aspirin for life and Plavix for six months; he will not stop either medication unless told to do so by you. His HDL is low and given his degree of atherosclerosis, you may wish to start gemfibrozil or Niaspan. He will see you in follow-up in the next two weeks. Thank you for allowing us to share in his care. Please call if you have questions. Sincerely, Rodger Lester, MD RL/ferreira cc: Uriel Lim, MD, 2192 Manatee Street, Plymouth, IN 74489 DS: 03/21/85 DD: 03/21/85 DT: 03/25/85 <|output|>{"AGE": ["61"], "CONTACT": [], "DATE": ["2085-03-21", "21 March 2085", "03/20", "21/05", "03/23/85", "03/21/85", "03/21/85", "03/25/85"], "ID": ["220-41-86-4"], "LOCATION": ["Osteopathic Medical Center", "OMC", "OMC", "2192 Manatee Street", "Plymouth", "IN", "74489"], "NAME": ["Liam K. Mcmahon", "Bill FAIR", "Mcmahon", "Fair", "Rodger Lester", "RL", "ferreira", "Uriel Lim"], "PROFESSION": []}

<|input|> ### Template: {"AGE": [], "CONTACT": [], "DATE": [], "ID": [], "LOCATION": [], "NAME": [], "PROFESSION": []} ### Text: Record date: 2087-02-06 FPM EMERGENCY DEPT VISIT TINSLEY,PEGGY R 236-67-03-3 VISIT DATE: 02/06/87 PRESENTING COMPLAINT: The patient is a 48-year-old female who has had a kidney transplant as well as an extensive cardiac history who comes in complaining of fatigue and shortness of breath. HISTORY OF PRESENTING COMPLAINT: She was seen primarily by Dr. Robert Villasenor. She also complains of pleuritic chest pain and a cough. PAST MEDICAL HISTORY: Are as documented in the written chart by Dr. Villasenor. MEDICATIONS: Are as documented in the written chart by Dr. Villasenor. ALLERGIES: Are as documented in the written chart by Dr. Villasenor. SOCIAL HISTORY AND FAMILY HISTORY: Are as documented in the written chart by Dr. Villasenor. PHYSICAL EXAMINATION: Her temperature is 99. Her other vital signs are stable. Her O2 sat is 96% on room air. Her exam is as noted in the written chart. Of note, on her cardiovascular exam: She has a regular rate and rhythm with a 2/6 systolic murmur. The lungs show left lower lobe crackles. LABORATORY EVALUATION: Are notable for a white blood cell count of 12.5 and a hematocrit of 45.3. Chest x-ray shows an infiltrate in the superior segment of the left upper lobe. FINAL DIAGNOSIS: This is a 48-year-old female status post a kidney transplant who now has a left upper lobe pneumonia. DISPOSITION (including condition upon discharge): The plan is to admit the patient for IV antibiotics. Condition on admission is satisfactory. ___________________________________ JD545/5915 SARINA BOOTH, M.D. SB17 D:02/06/87 T:02/07/87 Dictated by: SARINA BOOTH, M.D. SB17 <|output|>{"AGE": ["48", "48"], "CONTACT": [], "DATE": ["2087-02-06", "02/06/87", "02/06/87", "02/07/87"], "ID": ["236-67-03-3", "JD545/5915"], "LOCATION": ["FPM"], "NAME": ["TINSLEY,PEGGY R", "Robert Villasenor", "Villasenor", "Villasenor", "Villasenor", "Villasenor", "SARINA BOOTH", "SB17", "SARINA BOOTH", "SB17"], "PROFESSION": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Insulin syringes ( u 100 ) labetalol hcl tablets 600 mg po bid Lancets Lipitor 40mg po qd lisinopril 40mg po qd Nephrocaps 1 po q d Nexium 40mg po bid nifedipine xl 90mg sr po qhs Onetouch test strips potassium chloride 10meq po qd regular insulin 25 units qam sc 20 units qpm ALL : NKDA SH : Lives with : Mother . Used to work at Bebo in Geologist , currently unemployed . No EtOH , Illicits , Tobacco . FH : HTN in parents , Mother with Stroke , Father on HD , DM1 , DM2 , CKD in other family members . Physical Exam : V : T 99.9 BP 210/90 P 110 R 20 SaO2 100% RA Gen : WDWN American male following commands intermittently . HEENT : NCAT , PERRL , EOMF , sclera anicteric . Neck : Supple , no thyromegaly , no carotid bruits , JVP flat Nodes : No cervical or supraclavicular LAN Cor : Tachy , RR S1 , S2 nl . No m/r/g . + S3 , prominent PMI . Chest : CTAB anteriorly Abdomen : +BS Soft , NT , ND . No HSM , No CVA tenderness . L para-umbilical bruit , no pulsatile mass . Ext : No C/C/E , warm , well-perfused , subcutaneous mass on anterior R thigh , R AV fistula with thrill . 3+ DP and PT pulses b.l . Has indwelling L arterial line . Skin : No rashes . Neuro : A , O x 1 , PERRL , EOMF , Smile symmetric , Sensation grossly intact to light touch , Strength 5/5 in flexion and extension in upper and lower extremities . Reflexes 2+ , toes downgoing . Labs and Studies : <|output|>{"AGE": [], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": ["Bebo"], "PHONE": [], "PROFESSION": ["Geologist"], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Theophylline intoxication Theophylline intoxication following viloxazine induced decrease in clearance . <|output|>{"drugs": [{"name": "Theophylline", "reaction": ["Theophylline intoxication"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Extremities : Negative . Neurologic : Symmetric . Alert and oriented times two . Reflexes normal , strength normal . LABORATORY EVALUATION : WBC 28 . THERAPY RENDERED/COURSE IN ED : The patient was given IV antibiotics and will be admitted to the medical service for workup . PROCEDURES : CONSULTATIONS ( including PCP ): FINAL DIAGNOSIS : Urosepsis . DISPOSITION ( including condition upon discharge ): She was admitted in poor condition . ___________________________________ ZD548/6212 D: 10/21/65 T: 10/21/65 Dictated by : RUBEN ZACARIAS , M.D . RZ1 ******** Not reviewed by Attending Physician ******** Record date : 2095-10-23 RAH EMERGENCY DEPT VISIT DUVALL,BRADY C 425-03-15-1 VISIT DATE : 10/23/95 HISTORY OF PRESENTING COMPLAINT : The patient is an unfortunate 73 year old man who has had two myocardial infarctions in the past , including an IMI , and ventricular tachycardia and ventricular fibrillation who has an AICD in who presents today with his AICD firing multiple times . The patient's AICD actually fired multiple times while he was in the Emergency Department . REVIEW OF SYSTEMS : The patient has no chest pain , syncope , or shortness of breath . He presents in ventricular tachycardia with his AICD firing . PAST MEDICAL HISTORY : The patient has a significant coronary artery disease history and recently had his pacer placed , approximately a month ago . He has had two myocardial infarctions . <|output|>{"AGE": ["73"], "CONTACT": [], "DATE": ["2095-10-23", "10/21/65", "10/23/95"], "DEVICE": [], "DLN": [], "HOSPITAL": ["RAH"], "ID": ["425-03-15-1", "ZD548/6212"], "LOCATION": [], "NAME": ["RZ1", "RUBEN ZACARIAS", "DUVALL,BRADY C"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: UA-Protein 05/05/2074 NEG Pt states he had prostate biopsy at UNIVERSITY OF ILLINOIS HOSPITAL 7yrs ago , which was apparently negative . Fasting lipids WNL 6/73 ( LDL=70 ), pt did not check at last visit , check this wk . Last HgbA1C=6.5 in 6/73 , pt did not check at last visit , check this wk . Urine microalbumin <30 in 7/73 , repeat at next visit . Record date : 2079-01-22 HPI : He says he's been seen at KINDRED HOSPITAL EAST HOUSTON for > 10 years , but his physician was fired and he has not seen anyone regularly for > 1 year ; PEACHFORD HOSPITAL Internal Medicine has been taking care of him . He had colonoscopy and EGD in July for hemoccult positive stools . Diabetes : good A1c in Jan . Record date : 2151-10-29 October 29 , 2151 Toderick Kema Ashbey SAINT ANDREWS HOSPITAL AND HEALTHCARE CENTER 040 45 91 " angina " - ETT MIBI negative 4/2149 Colonic polyps removed 6/7/2149 by Dr . Barretts esophagitis - last endoscopy 3/2151 with Dr . 2837 Ernest St,Ste A Barrett's esophagus followup endoscopy negative 3/2151 . Ancalin Celin Record date : 2150-06-06 June 06 , 2150 Gombach Gustave , MD 721 E Court Street Wa keeney , OK 36859 Re : Cheree Latravius Hallock MRN : 9234144 DOB : 25/7/2075 Rupert Counts was seen in general neurology clinic today following her recent admission for complex migraine . HPI : As you know , Ms . CAD s/p LAD stent 2145 Social History : Lives at home with husband , mother of 4 children , works as Actuary . Family History : Father with history of asbestosis , Publishing copy . Impression and Recommendations : 78 yo RH woman with history of HTN , hyperlipidemia , CAD s/p LAD stent ( 2145 ), migraine s/p recent episode of transient aphasia and headache thought most likely to represent complex migraine given clinical presentation and after largely unremarkable stroke/TIA work-up . She will follow-up with Netherlands in 4-6 months or sooner if the need arises . Rosco Companion <|output|>{"AGE": ["78"], "CONTACT": [], "DATE": ["6/73", "Jan", "6/7/2149", "2079-01-22", "2145", "4/2149", "June 06", "July", "October 29", "3/2151", "7/73", "2150-06-06", "05/05/2074", "2151-10-29", "25/7/2075"], "DEVICE": [], "DLN": [], "HOSPITAL": ["PEACHFORD HOSPITAL", "UNIVERSITY OF ILLINOIS HOSPITAL", "SAINT ANDREWS HOSPITAL AND HEALTHCARE CENTER", "KINDRED HOSPITAL EAST HOUSTON"], "ID": ["9234144", "040 45 91"], "LOCATION": ["2837 Ernest St,Ste", "721 E Court Street", "Netherlands", "Wa keeney"], "NAME": ["Rupert Counts", "Rosco Companion", "Ancalin Celin", "Toderick Kema Ashbey", "Gombach Gustave", "Cheree Latravius Hallock"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": ["Actuary", "Publishing copy"], "ZIP": ["36859"]}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Physicians should be aware of the potential for the development of RS among children who are receiving long-term aspirin therapy for the treatment of systemic inflammatory illnesses . <|output|>{"drugs": [{"name": "aspirin", "reaction": ["RS"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: I discussed the risks and benefits of the procedure with the patient and all his questions were answered . A surgical consent was obtained . The plan is to perform the surgery on 08/31/2135 . Prior to proceeding , I would like to obtain a dedicated brain MRI with fine cuts through the posterior fossa to better assess the neurovascular anatomy . I thank you very much and look forward to hearing from you in the future . ___________________________ Joshua U . Jett , M.D . cc : DD : 07/11/2135 TD : 07/11/2135 21:50:44 TR : 8885698 BackJob ID : 785715 VoiceJob ID : 88198140 Record date : 2091-03-19 CCU Admission Note Patient Name : Justus , Quiana MR# 9814048 Location : Internal Medicine PCP : Xayachack , Ida , M.D . Date of Admission : 3/18/91 CC : STEMI HPI : 79 yo lady with DM , HTN , HL who presented with new onset chest pain and shortness of breath and was found to have lateral STEMI . It began last Sunday , when she noticed the new onset of back pain , which progressed and was associated with shortness of breath by Monday . She apparently called EMS on Tuesday then and en route she had a long run of VT , which responded to 50mg of Lidocaine IV . She was intubated on arrival in the ED for progressive respiratory distress . ECG showed lateral ST elevations and a CT scan of her chest was negative for any signs of aortic dissection . Of note , she was also noticed to have elevated blood sugars in the 500s in the ED with an AG of 20 , that came down to 16 . On immediate LHC , a 100% occlusion of her OM1 was found and recannalized as well as stented with a Vision BMS , resulting in TIMI 2 flow . Her LAD was found to be patent but and her RCA showed diffuse atherosclerosis up to 60% stenosis at most . LV ventriculogram showed inferior hypokinesis with moderate MR . An IABP was placed with her initial augmented diastolic pressures recorded in the 80s , which led to the initiation of Levophed , Dobutamine and Dopamine . A PAC was placed in the cath lab as well with her initial Wedge reported as 19-20 , PAPs in the 50s . On transfer to the CCU , she was intubated , sedated , being on IV Levophed at 20/hr , Dobutamine at 200/hr and Dopamine at 300/hr . Her CO was recorded as 6 , her CI 3.5 with an initial SVR of 1012 . Her Temp . <|output|>{"AGE": ["79"], "CONTACT": [], "DATE": ["2091-03-19", "Monday", "07/11/2135", "3/18/91", "Sunday", "Tuesday", "08/31/2135"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["8885698", "785715", "88198140", "9814048"], "LOCATION": [], "NAME": ["Xayachack , Ida", "Joshua U . Jett", "Justus , Quiana"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: ischemia . The myocardial perfusion scans show a small size , mild intensity , primarily fixed inferolateral defect consistent with prior infarct with substantial residual viable myocardium but only minimal stress induced ischemia . Compared to the study of 01/26 with treadmill exercise ( RPP ~24K ) the previously noted anterior wall defect is less apparent in the present exam . CARDIAC CATH OF 12/09/2082 : Successful PTCA of the mid RCA with a 3 mm balloon with 20 to 30 per cent residual plaque and a hazzines consistent with possible small dissection . Pt referred by Dr . YARBROUGH , underwent catheterization for unstable angina , a positive exercise text and recent myocardial infarction . PROCEDURE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY was performed on the Mid RCA using a maximum balloon size of 3 mm advanced through a 9YS7EZ guiding catheter . Assessment : Pt is a 59 year old female with h/o SLE , interstitial nephritis , GERD , h/o positive stress s/p RCA angioplasty 2082 , and chronic abdominal pain who presents with c/o two weeks of intermittent chest pain reproducible upon palpation who is admitted to rule out MI with one set of negative cardiac enzymes and no EKG changes . Plan : 1 . Chest Pain : Likely musculoskeletal in nature given reproducibility of pain on palpation . However , given pt's cardiac history , will obtain two more sets of cardiac markers . Adenosine stress test scheduled for a.m . with echocardiogram pending , as well . Pt's Atenenlol switched to Lopressor during admission . Pt Dilatrate-SR changed to Isordil . Continuing home meds of Nifedipine and ASA . Pt to be NPO after midnight for am cardiac testing . 2 . SLE : Continuing home dose of prednisone , as well as Vitamins C and D . Will notify Dr . Xie that pt is in-house per request of PCP , to determine if any further Rheum w/u is necessary . 3 . GI : Will repeat amylase and lipase . Prednisone is a known cause of pancreatitis and pt's continued abdominal complaints may be pancreatic in origin . although unlikely as elevation is minimal . Olivia H . Grant pager 933 Record date : 2094-05-18 Uriah Oliver NYSH # 791-60-07 Medications : simvastatin 20 mg qd <|output|>{"AGE": ["59"], "CONTACT": [], "DATE": ["01/26", "2082", "12/09/2082", "2094-05-18"], "DEVICE": ["9YS7EZ"], "DLN": [], "HOSPITAL": ["NYSH"], "ID": ["791-60-07"], "LOCATION": [], "NAME": ["Olivia H . Grant", "YARBROUGH", "Xie", "Uriah Oliver"], "ORGANIZATION": [], "PHONE": ["933"], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Admits to SSCP-radiating to L side and back , nonpleuritc , nonpositional , similar to anginal equivalent ; multiple episodes beginning at rest , lasting minutes . Chronic palpitations , LH dness , +/ - nausea . + PND , LE edema stable . Chronic abdominal pain associated with colostomy . Patient denies the following symptoms . CONSTIUTIONAL : f/c/r/sweats , anorexia/weight-loss HEENT : h/a/ear pain/sore throat/rhinorrhea PULM:cough/SOB/DOE CV:LOC ABD : constipation/diarrhea/melena/BPR/ bloating GU : dysuria/frequency/urgency SKIN : rash NEURO : unilateral weakness/paresthesia/dysphasia/dysphagia/visual change . Past Medical/Surgical History : Paraplegia 2066 Thrown from amusement park ride partial T4 paraplegia ( confined to wheelchair , able to stand/xfer ) ruptured bladder , S/p ileal loop conduit ( 2066 ) recurrent pyelonephritis , candidal infections Complete laminectomy c3-c7 , C5-6 , c6-7 R foraminotomy in 2081 Laminectomy L4-5 , L5-s2 in 2081 11/2095 paraplegia at T8 after spinal cord infarction from cholesterol emboli after cardiac cath CAD 2087 CABG x3 2095 : Cath stent in L Cx artery 1/96 NSTEMI PVD S/p bilateral iliofemoral and renal artery stent 11/95 H/o TIA Bilateral CEA in 2081 CRI 2/2 DM , bilateral RAS Hypercholesterolemia DM2 PUD 12/95 EGD w/ nonbleeding gastric ulcers COPD <|output|>{"AGE": [], "CONTACT": [], "DATE": ["2066", "11/95", "2081", "11/2095", "1/96", "12/95", "2087", "2095"], "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: Hgb 14.3 13.5-17.5 gm/dl 08/29/62 17:12 HCT 41.2 41.0-53.0 % 08/29/62 17:12 MCV 106H 80-100 fl 08/29/62 17:12 106(H ) 08/29/62 17:12 MCH 36.8H 26.0-34.0 pg/rbc 08/29/62 17:12 36.8(H ) 08/29/62 17:12 MCHC 34.7 31.0-37.0 g/dl 08/29/62 17:12 PLT 839H 150-350 th/cumm 08/29/62 17:12 839(H ) 08/29/62 17:12 RDW 17.1H 11.5-14.5 % 08/29/62 17:12 17.1(H ) 08/29/62 17:12 Blood Differential % Differential ... RECEIVED 08/29/62 17:09 Diff Method Auto 08/29/62 17:13 Neutrophils 88H 40-70 % 08/29/62 17:13 88(H ) 08/29/62 17:13 Lymphs 8L 22-44 % 08/29/62 17:13 8(L ) 08/29/62 17:13 Monos 3L 4-11 % 08/29/62 17:13 3(L ) 08/29/62 17:13 Eos 1 0-8 % 08/29/62 17:13 Basos 0 0-3 % 08/29/62 17:13 Blood Diff - Absolute Neutrophil # 13.14H 1.8-7.7 th/cmm 08/29/62 17:13 13.14(H ) 08/29/62 17:13 Lymph# 1.16 1.0-4.8 th/cmm 08/29/62 17:13 Mono# 0.45H 0.2-0.4 th/cmm 08/29/62 17:13 0.45(H ) 08/29/62 17:13 Eos# 0.09L 0.1-0.3 th/cmm 08/29/62 17:13 0.09(L ) 08/29/62 17:13 Baso# 0.03 0.0-0.3 th/cmm 08/29/62 17:13 Smear Morphology Anisocytosis 1+H None 08/29/62 17:13 1+(H ) 08/29/62 17:13 Hypochromia None None 08/29/62 17:13 Macrocytes 3+H None 08/29/62 17:13 3+(H ) 08/29/62 17:13 Microcytes None None 08/29/62 17:13 Coagulation Routine Coagulation PT 12.1 11.1-13.6 sec 08/29/62 17:26 PT-INR 1 08/29/62 17:26 PTT 24.9 22.1-34.0 sec 08/29/62 17:26 Toxicology +ve for Ephedrine . Hypercoagulation Studies Act Prot C Re . . <|output|>{"AGE": [], "CONTACT": [], "DATE": ["08/29/62"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: A mentally retarded 23-year-old woman with myoclonic astatic epilepsy developed an abnormal posture of extreme forward flexion , called camptocormia , during valproate monotherapy . <|output|>{"drugs": [{"name": "valproate", "reaction": ["abnormal posture of extreme forward flexion"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Pt had renal angiogram in 6/95 which showed patent renal arteries . ? need for hematology consult at some point - will discuss with Dr . 97989 Record date : 2087-08-02 Mrs Pattie Thevenot Crellen is here today to follow up on HTN , DM I saw her 4/12/87 for HTN and DM . Her LDL is 116 ono 4/87 and has DM , goal <100 . Started walking daily around 1008 Minnequa Avenue,Suite 6100 about 3.5 miles and has lost 7 pounds since I saw her . She had it done few 11/86 . 26/09/85 R breast u/s with likely lipoma and simple cyst at 8 o'clock , repeat u/s in 6 months and mammography in 03/2086 Record date : 2083-03-18 TOMAH MEM HSPTL Unit No : 211-94-17 Date : March 18 , 2083 79 - year-old male for follow-up of blood pressure . Regarding his inguinal hernia , Mr . 97 . Will get 1625 Cold Water Creek Drive VNA to come and see him regarding physical therapy evaluation . Tessi Avelardo Dennie / Makaylee Timesha Cressy / Ma Saupe Record date : 2097-07-26 Durwood Gilmore , M.D . CC/ID : Asked to assit in the mangement of Raviv Shah with hypertension , nausea and vomiting . She is a 78 year old lady with ESRD who has been admitted in the past with nausea , vomiting and severe hypertension . On HD Mon / Cusack Linnet / Henri Loft . Lives in ST . MARY'S MEDICAL CENTER , SAN FRANCISCO . Plasma Sodium 136 ( 135-145 ) mmol/LPlasma Potassium 3.9 ( 3.4-4.8 ) mmol/LPlasma Chloride 91 L ( 100-108 ) mmol/LPlasma Carbon Dioxide 29.1 ( 11-04-2003.9 ) mmol/LPlasma Anion GAP 16 H ( 3-15 ) mmol/LCalcium 10 ( 04-16-2004.5 ) mg/dlPhosphorus 4.6 H ( 2.6-4.5 ) mg/dlMagnesium 2 ( 1.4-2.0 ) meq/LPlasma Urea Nitrogen 50 H ( 8-25 ) mg/dlPlasma Creatinine 3.93 H ( 0.603-25-1982 ) mg/dleGFR 12 mL/min/1.73m2Plasma Glucose 132 H ( 70-110 ) mg/dlTotal Protein 8 ( 6.0-8.3 ) g/dlAlbumin 3.6 ( 3.3-5.0 ) g/dlGlobulin 4.4 H ( 2.6-4.1 ) g/dlDirect Bilirubin 0.2 ( 0-0.4 ) mg/dlTotal Bilirubin 0.4 ( 0.0-1.0 ) mg/dlAlkaline Phosphatase 345 H ( 30-100 ) U/LTransaminase-SGPT 9 ( 7-30 ) U/LAmylase 54 ( 3-100 ) units/LTransaminase-SGOT 19 ( 9-32 ) U/LLipase 18 ( 13-60 ) U/L WBC 15.9 H ( 03-28-1994.0 ) th/cmmHCT 39 ( 10-07-1990.0 ) %HGB 12.4 ( 01-11-1975.0 ) gm/dlRBC 4.39 ( 4.01-04-2000 ) mil/cmmPLT 558 H ( 150-400 ) th/cummMCV 89 ( 80-100 ) flMCH 28.2 ( 02-07-2008.0 ) pg/rbcMCHC 31.9 ( 12-03-1970.0 ) g/dlRDW 20.9 H ( 02-23-1984.5 ) %Poly 82 H ( 40-70 ) %Lymphs 8 L ( 22-44 ) %Monos 4 ( 4-11 ) %EOS 6 ( 0-8 ) %Basos 0 ( 0-3 ) %Absolute Neuts 13.18 H ( 1.8-7.7 ) th/cmmAbsolute Lymphs 1.2 ( 1.0-4.8 ) th/cmmAbsolute Monos 0.58 ( 0.2-1.2 ) th/mm3Absolute EOS 0.88 H ( 0.1-0.3 ) th/cmmAbsolute Basos 0.02 ( 0.0-0.3 ) th/cmmAniso 2+ H ( None)Hypo 3+ H ( None)Macrocytes None ( None)Microcytes 1+ H ( None ) Janiya Talia Estee is a 79 year old lady with ESRD admitted with hypertension and nausea as well as vomiting . Durwood Gilmore , M.D . Record date : 2096-04-09 RE : Karianna Dorla TRISTAR SKYLINE MADISON CAMPUS # 40814481 04/09/2096 Abdias Jannett Norrie , M.D . ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL 18688 Jeb Stuart Highway Lincoln city , MN 85631 <|output|>{"AGE": ["78", "79"], "CONTACT": [], "DATE": ["2097-07-26", "03/2086", "4/12/87", "12-03-1970.0", "10-07-1990.0", "04-16-2004.5", "04/09/2096", "02-23-1984.5", "Mon", "26/09/85", "03-28-1994.0", "March 18", "11-04-2003.9", "2096-04-09", "01-11-1975.0", "6/95", "11/86", "2087-08-02", "2083-03-18", "4/87", "02-07-2008.0"], "DEVICE": [], "DLN": [], "HOSPITAL": ["TRISTAR SKYLINE MADISON CAMPUS", "ST . MARY'S MEDICAL CENTER , SAN FRANCISCO", "TOMAH MEM HSPTL", "ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL"], "ID": ["40814481", "97989", "211-94-17"], "LOCATION": ["1625 Cold Water Creek Drive", "1008 Minnequa Avenue,Suite 6100", "18688 Jeb Stuart Highway", "Lincoln city"], "NAME": ["Karianna Dorla", "Ma Saupe", "Janiya Talia Estee", "Henri Loft", "Cusack Linnet", "Tessi Avelardo Dennie", "Makaylee Timesha Cressy", "Raviv Shah", "Durwood Gilmore", "Pattie Thevenot Crellen", "Abdias Jannett Norrie"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["85631"]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Absa Kyala Record date : 2090-08-28 Name : Kearston Channah Hertz MRN : 03833383 23/1/91 Intern : Nieves Rahkeem Scheryl Cushing HPI : Patient is a 63 year-old female w/ h/o CAD , hyperlipidemia , NIDDM , and chronic pancreatitis who presents with four days of epigastric pain . Pt has had four days constant epigastric pain , 01-28-2003 intermittently increasing to 8/10 , characterized as " just pain , with occasional radiation to the back , and which is made worse by PO intake . Recurrent pancreatitis ( last episode 12/89 ) s/p R TKA in 2084 , L TKA in 6/88 Contact : Aurelea Nathasha ( daughter ): 291-916-6060 ASSESSMENT : 63 yo woman h/o chronic pancreatitis , CAD , hyperlipidemia here with likely acute on chronic pancreatitis . Contact her gastroenterologist , Dr . Andrade Shary Klayton , MD , PGY-1 ( pager 04599 ) Record date : 2094-02-14 Shera Ferne Atalia presents with his significant other , Meldon Danicia , for review of peripheral vascular disease , hypertension , renal insufficiency , diabetes mellitus , hyperlipidemia , rib pain , and gout . They going back to New Norfolk Island . Last hemoglobin A1c was August 2093 , and it was 6.8 . Renal dysfunction : He has seen Dr . Gout : The patient had an episode of gout on his right wrist 2 weeks ago while in New Norfolk Island . He lives in New Norfolk Island and is living at times in the MISSINGDORF area . He will follow up with Dr . Vendetta Rai Cyd Record date : 2132-11-17 69 year old right handed man with pure motor hemiparesis synrdrome on right from L IC stroke in 8/32 . Valerio Gathers comes to the stroke clinic today for an initial visit and second opinion for left-sided weakness starting in 8/11/32 . He went to ANTHONY MEDICAL CENTER , where they checked his blood pressure , and found it to be 220/140 ( per his report ). He went to the STURGIS HOSPITAL at LAUREL OAKS BEHAVIORAL HEALTH CENTER 2 days later , his BP was still elevated , and they started him on clonidine . PROPRANOLOL ( PROPRANOLOL HCL ) 40MG PO BID Start Date : 26/2/32 HCTZ ( HYDROCHLOROTHIAZIDE ) 12.5MG PO QD Start Date : 26/2/32 CLONIDINE HCL 0.2MG PO BID Start Date : 26/2/32 ZESTRIL ( LISINOPRIL ) 40MG PO QD Start Date : 26/2/32 ASA ( ACETYLSALICYLIC ACID ) 81MG PO QD Start Date : 26/2/32 lives in Great barrington . <|output|>{"AGE": ["69", "63"], "CONTACT": [], "DATE": ["12/89", "2094-02-14", "2132-11-17", "6/88", "2090-08-28", "26/2/32", "8/11/32", "2084", "8/32", "August 2093", "23/1/91", "01-28-2003"], "DEVICE": [], "DLN": [], "HOSPITAL": ["LAUREL OAKS BEHAVIORAL HEALTH CENTER", "ANTHONY MEDICAL CENTER", "STURGIS HOSPITAL"], "ID": ["03833383"], "LOCATION": ["Great barrington", "MISSINGDORF", "Norfolk Island"], "NAME": ["Kearston Channah Hertz", "Absa Kyala", "Nieves Rahkeem", "Shera Ferne Atalia", "Vendetta Rai Cyd", "Aurelea Nathasha", "Meldon Danicia", "Andrade Shary Klayton", "Scheryl Cushing", "Valerio Gathers"], "ORGANIZATION": [], "PHONE": ["04599", "291-916-6060"], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: One explanation for the noted increase in the theophylline level theophylline level is that metabolism occurs mainly by cytochrome P450 ( CYP 1A2 ) , an enzyme that is known to be inhibited with high concentrations of zafirlukast . <|output|>{"drugs": [{"name": "theophylline", "reaction": ["increase in the theophylline level"]}]}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: Unusual pigmentary changes associated with 5-fluorouracil therapy . <|output|>{"drugs": [{"name": "5-fluorouracil", "reaction": ["pigmentary changes"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: s admission , but up from his baseline ; BUN/Cr ratio appears c/w pre-renal picture , will check urine lytes , assess response to IVF ** FEN -- Regular no salt added diet w/ Aspiration precautions ; gentle IVF as above -- S+S consult ** Ppx / Other -- heparin sc , PPI , bowel regimen -- Full code for now , re-assess w/ son tomorrow _______________________________ Howard G . Xiong , MD PGY-1 Pager # 17730 Record date : 2081-04-13 CARDIOLOGY ALGIERS MEDICAL CENTER Nicholas Osuna M.D . Internal Medicine Algiers Medical Center , Dear Dr . Osuna : I had the pleasure of seeing Mr . Nicholas Cortez in my office today in Cardiology for followup on coronary artery disease . As you know , he is a 61-year-old white male who has a history of myocardial infarction approximately six years ago and had stenting at that time and subsequently had another stent placed in 2076 . He has done well since that time without any exertional angina , dyspnea on exertion , PND , orthopnea , or pedal edema . He has been followed here by Dr . Opal Garner and has been noted to have an anteroapical aneurysm . He underwent surgery for hip replacement of his left hip last summer and has recovered from that . He did get on to about 220 pounds before the surgery , but has gained 20 pounds back and is now at about 240 pounds . He says that most of this is because of inactivity . He likes to work in his yard in Barnstable and plans to increase his activity and try and drop off some of that weight this summer . Past medical history : Significant for diabetes , large anteroseptal myocardial infarction , sleep apnea , diverticulosis , tubular adenoma of the colon , and diverticulitis . Current Medications : Imdur 30 mg qd Lasix 10 mg qd Lipitor 20 mg qd lisinopril 40 mg qd <|output|>{"AGE": ["61-year-old"], "CONTACT": [], "DATE": ["summer", "2081-04-13", "2076"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Algiers Medical Center", "ALGIERS MEDICAL CENTER"], "ID": [], "LOCATION": ["Barnstable"], "NAME": ["Howard G . Xiong", "Osuna", "Nicholas Cortez", "Opal Garner", "Nicholas Osuna"], "ORGANIZATION": [], "PHONE": ["17730"], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: This progressed to tracheal compression with stridor after he had taken some aspirin for relief of the neck pain . <|output|>{"drugs": [{"name": "aspirin", "reaction": ["tracheal compression"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: He asked that I see him again in six months for routine re-evaluation , and I would be happy to do so . If any problems develop in the interim please don't hesitate to contact me . Thank you for allowing me to participate in his care . Kenneth Umstead MR# 401-10-87-8 - 2 - Jun 4 , 2074 With best regards . Sincerely , Marshall O . Lehman , M.D . Wilson Medical Center 30 Whipple St Tonkawa , WA 67495 DD : 06/04/74 DT : 06/08/74 DV : 06/04/74 MOL / farrar ******** Approved but not reviewed by Attending Provider ******** Record date : 2079-02-13 PMH EMERGENCY DEPT VISIT WESTYN-NUEL,KELLI 898-97-85-6 VISIT DATE : 02/13/79 This patient was seen with Dr . Quilla Uehara , an Emergency Medicine resident . The PRESENTING COMPLAINT , HISTORY OF PRESENTING COMPLAINT , PAST MEDICAL HISTORY , MEDICATIONS , ALLERGIES , SOCIAL HISTORY , FAMILY HISTORY , and REVIEW OF SYSTEMS : As noted on the record by Dr . Uehara , and as reviewed with the patient and with Dr . Uehara . Briefly , the patient is a pleasant 64 -year-old woman , who has had episodes of severe left-sided pressure-like chest pain off and on through the course of this week . This has occurred with exertion and has always cleared with rest . She is pain-free at <|output|>{"AGE": ["64"], "CONTACT": [], "DATE": ["02/13/79", "2079-02-13", "Jun 4 , 2074", "06/08/74", "06/04/74"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Wilson Medical Center", "PMH"], "ID": ["898-97-85-6", "401-10-87-8"], "LOCATION": ["30 Whipple St", "Tonkawa", "WA"], "NAME": ["MOL", "Quilla Uehara", "WESTYN-NUEL,KELLI", "Marshall O . Lehman", "Uehara", "farrar", "Kenneth Umstead"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": ["67495"]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: Eva Pearson , MD Pager # 45803 Record date : 2060-07-25 EDVISIT^ 32707420 ^ GIPSON , ALEC ^ 07/25/60 ^ YERGER , DESEAN The patient was seen with Dr . Godfrey . I confirmed her history and physical . I also interviewed and examined the patient . Please see the note for more details . HISTORY OF PRESENT ILLNESS : This is a 71-year-old gentleman with a history of hypertension , non-insulin-dependent diabetes , and 2 weeks of intermittent chest pain for which he was evaluated with stress test a week prior to ED visit , which was abnormal . The patient had a plan for cardiac catheterization the day after this ED visit but presented on this day for an episode of chest discomfort which occurred at rest , which was unlike his previous episodes of chest discomfort which usually occurred with activity . He took nitroglycerin with relief and then presented for further evaluation and treatment . MEDICATIONS : Metformin , Toprol , Cozaar , nitro , aspirin , and Altace . PHYSICAL EXAMINATION : He is awake and alert , in no distress , chest pain free . Afebrile with pulse 72 , blood pressure 129/69 , and O2 saturation 98% on room air . His lungs are clear to auscultation . Heart : Regular rate and rhythm . Abdomen is soft and nontender . Extremities are warm and well perfused . No elevated JVP . EMERGENCY DEPARTMENT COURSE : An EKG was done revealing right bundle-branch block , but sinus rhythm at 67 with no ischemic <|output|>{"AGE": [], "CONTACT": [], "DATE": ["2060-07-25", "07/25/60"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": ["32707420"], "LOCATION": [], "NAME": ["GIPSON , ALEC", "YERGER , DESEAN", "Godfrey", "Eva Pearson"], "ORGANIZATION": [], "PHONE": ["45803"], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: I also saw the patient and reviewed Dr . Collier's history . HISTORY OF PRESENTING COMPLAINT : This 62 year-old woman comes from dial where she developed substernal chest pain radiating to her left arm near the end of the run . She also complains of shortness of breath . She noted some nausea , but no vomiting . She had no other related symptoms . She has had no previous history of chest pain . She was given Nitroglycerin x 3 and this eventually relieved her pain . PAST MEDICAL/SURGICAL HISTORY : Includes end-stage renal disease , coronary artery disease with a bypass graft but without any chest pain at the time , and insulin dependent diabetes mellitus which may account for her previous cardiac history without chest pain . ALLERGIES : PENICILLIN AND CODEINE MEDICATIONS : Aspirin and Xanax . PHYSICAL EXAMINATION : VITAL SIGNS : Blood pressure 164/94 , pulse 94 , respirations 24 , oxygen saturation 96% . GENERAL : The patient is comfortable in no acute distress . HEAD AND NECK : Normocephalic , atraumatic . Pupils equal and reactive . Pharynx benign . Tongue is of normal shape and contour . Neck is supple . No jugular venous distention . LUNGS : Are clear bilaterally . CARDIAC : Regular rate and rhythm . S1 , S2 , with no murmurs , rubs or gallops . <|output|>{"AGE": ["62"], "CONTACT": [], "DATE": [], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": ["Collier's"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: because of her diabetes history . The patient's daughter and the nutritionist are aware of her issues with vitamin K and Coumadin , and they will discuss this further when she sees Nutrition Clinic in two days . 2 . Cerebrovascular disease . Followed closely by Neurology . No acute change in neuro status today . Will continue Coumadin . Being followed closely by Internal Medicine for this . Recent INR 1.4 . Will adjust Coumadin as advised by IM nurse . 3 . SIADH . I need to review these records more closely , and try to make sure there is no other underlying disorder . In the meantime , her sodiums have been quite good recently . 4 . Diabetes . Recent hyperglycemia , with sugars in the 300 to 350 range . Most recently , with sugars in the 100 to 200 range over the past few days . Continue glyburide 5 mg p.o . b.i.d . Finger-sticks three to four times daily . Further adjustments PRN . Our current goal is simply to maintain her sugars between 120 and approximately 220 to 250 . Once her dietary issues are stabilized , we can aim for slightly tighter control . Wish to avoid hypoglycemia , given her <|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: Phosphorus 5.5 H ( 2.6-4.5 ) mg/dl Magnesium 1.7 ( 1.4-2.0 ) meq/L Plasma Urea Nitrogen 11 ( 8-25 ) mg/dl Plasma Creatinine 1 ( 0.6-1.5 ) mg/dl Plasma Glucose 405 H ( 70-110 ) mg/dl Creatine Kinase Isoenzymes 3.7 ( 0.0-6.9 ) ng/ml CPK Isoenzymes Index ( 0.0-3.5 ) Troponin-T 0.65 H ( 0.00-0.09 ) ng/ml Creatine Kinase 94 ( 60-400 ) U/L FIO2/Flow UNSPEC . FIO2/L Temp 37 deg C Unspecified pH 7.29 L ( 7.32-7.45 ) Unspecified PCO2 53 H ( 35-50 ) mm/Hg Unspecified PO2 204 H ( 40-90 ) mm/Hg Potassium 4.2 ( 3.5-5.0 ) mmol/L Glucose 439 H ( 70-110 ) mg/dL WBC 13.5 H ( 4.5-11.0 ) th/cmm HCT 37.3 L ( 41.0-53.0 ) % HGB 12.8 L ( 13.5-17.5 ) gm/dl RBC 4.29 L ( 4.50-5.90 ) mil/cmm PLT 324 ( 150-350 ) th/cumm MCV 87 ( 80-100 ) fl MCH 29.9 ( 26.0-34.0 ) pg/rbc MCHC 34.3 ( 31.0-37.0 ) g/dl RDW 14.3 ( 11.5-14.5 ) % PT 20.7 H ( 11.3-13.3 ) sec PT-INR 2.9 APTT 27.7 ( 22.1-34.0 ) sec Studies EKG-NSR , dynamic t-wave changes anterior , ~1mm ST elevation worse than prior v4-v5 CXR : Vascular congestion . Impression and Plan : 58 year old man with PVD , likely CAD but no available ischemic work-up . Resp decompensation likely secondary to pulmonary edema in the setting of volume load . There is some question as to what to do about EKG changes and mild troponin elevations . No definite ST elevations , but elevation in troponin does seem to be too soon to be directly attributable to flash pulmonary edema and resultant demand . Follow enzymes , heparinize both for ? ischemia and for PVD with sheath in place . <|output|>{"AGE": ["58"], "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: on EKG and a normal set of cardiac enzymes . Awake , alert , and in no acute distress . Vital signs in the ED this a.m . were grossly within normal limits . No chest pain this a.m . PHYSICAL EXAMINATION : HEENT : Normocephalic , atraumatic . Pupils equal , round , and reactive . Fundi benign . Neck : Supple . Chest is clear to auscultation and percussion . No rales , wheezes , or rhonchi . Heart notes a normal S1 , S2 , no S3 , S4 , no murmur . Abdomen is benign , soft , nontender , no masses , guarding , rebound , or organomegaly . Extremities : Grossly within normal limits . Neurologic : Awake , alert , able to follow commands . Negative Babinski . She had a second set of cardiac enzymes done in the observation portion of the ED , which were negative . PLAN : Do ETT this a.m . If negative , to home to be followed by her PMD , to return to the Emergency Department at Zucker Hillside Hospital if her problems persist or worsen . ______________________________ GAY , G . VERNAL M.D . D : 06/30/86 T : 06/30/86 Dictated By : GAY , G . VERNAL eScription document: 3-9073761 BFFocus ******** Not reviewed by Attending Physician ******** Record date : 2099-09-27 EDVISIT ^ 43634211 ^ LEON , MAURICE ^ 9/27/2099 ^ HALEY , BEVERLY ADDENDUM : The patient had dizzy spells since 12/2099 , which resolved after <|output|>{"AGE": [], "CONTACT": [], "DATE": ["9/27/2099", "2099-09-27", "12/2099", "06/30/86"], "DEVICE": [], "DLN": [], "HOSPITAL": ["Zucker Hillside Hospital"], "ID": ["43634211", "3-9073761"], "LOCATION": [], "NAME": ["LEON , MAURICE", "GAY , G . VERNAL", "HALEY , BEVERLY"], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: %BASO 0 ANEUT 15.20(H ) ALYMP 1.85 AMONS 0.63 AEOSN 0.07(L ) ABASOP 0.03 ANISO None HYPO None MACRO None MICRO None 11/16/77 11/15/77 12:11 11:09 UA-COLOR Yellow Yellow UA-APP Clear Clear UA-GLUC Negative Trace UA-BILI Negative Negative UA-KET Trace Negative UA-SPGR 1.008 1.011 UA-BLD 3+ 1+ UA-PH 5.5 7.5 UA-PROT 1+ 1+ UA-UROBI Negative Negative UA-NIT Negative Negative UA-WBC Negative Negative UAS-RBC &gt ; 100 0-2 UAS-WBC 3-5 0-2 HCAST 10-20 0-2 GCAST 5-10 UAS-MUC PRESENT UAS-COM see detail see detail <|output|>{"AGE": [], "CONTACT": [], "DATE": ["11/16/77", "11/15/77"], "DEVICE": [], "DLN": [], "HOSPITAL": [], "ID": [], "LOCATION": [], "NAME": [], "ORGANIZATION": [], "PHONE": [], "PROFESSION": [], "ZIP": []}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: We experienced 2 cases of mequitazine -induced photosensitivity reaction in patients who took mequitazine for their dermatologic problems . <|output|>{"drugs": [{"name": "mequitazine", "reaction": ["photosensitivity reaction"]}]}

<|input|> ### Template: {"drugs": [{"name": "", "reaction": []}]} ### Text: BACKGROUND : Fluoxetine , a highly specific serotonin reuptake inhibitor , has been reported to cause sexual dysfunction in a minority of patients . <|output|>{"drugs": [{"name": "Fluoxetine", "reaction": ["sexual dysfunction"]}]}

<|input|> ### Template: {"DATE": [], "NAME": [], "ID": [], "AGE": [], "LOCATION": [], "PROFESSION": [], "CONTACT": [], "HOSPITAL": [], "PHONE": [], "ZIP": [], "ORGANIZATION": [], "DEVICE": [], "DLN": []} ### Text: I will keep you informed as to the status of this very nice patient . Thank you for allowing me to participate in his management . If I can be of any further assistance and management of this or any of your patients with cerebrovascular , aortic , renovascular or low peripheral vascular disease , particularly those in need of a minimally invasive vascular procedure , please feel free to contact me directly . Sincerely , Shane R . Herring , M.D . cc : Dirk O . Reece , M.D "., PCP , Pune , ME SRH/valdovinos 19-35905660.doc #NAME? Record date : 2082-06-13 SDU ADMISSION NOTE PATIENT : XAYAVONG , BRANDON MRN : 7826250 ADMIT DATE : 6/13/2082 PCP : DR . ERNEST EDGE ATTENDING PHYSICIAN : DR . ASHLEI TYSON OUTPATIENT CARDIOLOGIST : DR . BRIAN MOSS ( 772-261-4350 ) CHIEF COMPLAINT : fatigue , lightheadedness HISTORY OF THE PRESENT ILLNESS Mr . Xayavong is a 61 M h/o CAD ( anterior STEMI 2077 , stents x2 to LAD , 4 stents since then , last 2080 "), DM , CHF unknown EF , HTN , who p/w ~3 days of nonspecific symptoms of fatigue , nausea , and poor sleep . He receives most of his care at Duluth Clinic-Hermantown ( Dr . Moss ). Two weeks ago , he had BiV/ICD placement , as well as left heart catheterization that showed , per verbal report , &#8220 ; multivessel disease difficult for CABG . &#8221 ; He says he also had a chemical stress study but is unsure of the results . He reports that he was then referred to GNC for high-risk CABG ( Dr . U . Wyatt ) and potential heart transplant evaluation ( Dr . A . Tyson ). He feels that since the BiV/ICD placement he has been feeling more tired , specifically in the past 3 days , wherein he reports fatigue , nausea , poor sleep , exertional lightheadedness . He has not had chest pain ( he did have chest pain with prior two MIs "), palpitations , vomiting , diarrhea . He does have some orthopnea , but no PND and LE swelling intermittently , but not at present . To his knowledge , he has never had a tachyarrhythmia . However , he does note that he was started on digoxin a few weeks ago , tried it for 1 week , then had fatigue , nausea , GI upset , and that the medication was then discontinued . On arrival , he had HR 135 , BP 106/73 with some drops to low of 80/50 . Felt to be VT versus Afib with aberrancy . EP was consulted , interrogated his device , and confirmed that he was in Afib ( and that it had never fired or detected VT/VF ). He was given amio load 300 and drip at 1mg/min , with some HR response to 100-120s . For hyperkalemia to 5.1 , he was given calcium gluconate , insulin , D50 , bicard ; and his Mg was repleted . Given his persistent symptoms , per EP recs , he was started on heparin drip with 5000 units bolus . <|output|>{"AGE": ["61"], "CONTACT": [], "DATE": ["2077", "6/13/2082", "2080", "2082-06-13"], "DEVICE": [], "DLN": [], "HOSPITAL": ["GNC", "Duluth Clinic-Hermantown"], "ID": ["19-35905660.doc", "7826250"], "LOCATION": ["ME", "Pune"], "NAME": ["U . Wyatt", "ASHLEI TYSON", "SRH/valdovinos", "Shane R . Herring", "Moss", "Dirk O . Reece", "Xayavong", "ERNEST EDGE", "A . Tyson", "XAYAVONG , BRANDON", "BRIAN MOSS"], "ORGANIZATION": [], "PHONE": ["772-261-4350"], "PROFESSION": [], "ZIP": []}