artifacts/testset2-cleaned.csv

dialogue_id,testset_index,dialogue_index,ID,section_header,section_text,dialogue
2:0,2,0,0,CC,Congestion and cough.,"Doctor: Hello, how are you today?
Patient: Not good. 
Doctor: What happened? 
Patient: I have a lot of congestion. I also am coughing a lot. It feels like I am choking on something."
2:2,2,2,2,GENHX,"A 51-year-old white male diagnosed with PTLD in latter half of 2007.  He presented with symptoms of increasing adenopathy, abdominal pain, weight loss, and anorexia.  He did not seek medical attention immediately.  He was finally hospitalized by the renal transplant service and underwent a lymph node biopsy in the groin, which showed diagnosis of large cell lymphoma.  He was discussed at the hematopathology conference.  Chemotherapy with rituximab plus cyclophosphamide, daunorubicin, vincristine, and prednisone was started.  First cycle of chemotherapy was complicated by sepsis despite growth factor support.  He also appeared to have become disoriented either secondary to sepsis or steroid therapy. The patient has received 5 cycles of chemotherapy to date.  He did not keep his appointment for a PET scan after 3 cycles because he was not feeling well.  His therapy has been interrupted for infection related to squamous cell cancer, skin surgery as well as complaints of chest infection. The patient is here for the sixth and final cycle of chemotherapy.  He states he feels well.  He denies any nausea, vomiting, cough, shortness of breath, chest pain or fatigue.  He denies any tingling or numbness in his fingers.  Review of systems is otherwise entirely negative. Performance status on the ECOG scale is 1.","Doctor: Good afternoon, sir. My chart here says that you are a fifty one year old white male, is that correct?
Patient: Good afternoon, doctor. Yes, all of that is correct. 
Doctor: Great, thank you. Please, walk me through the history of your symptoms, when did everything begin. 
Patient: Well, I was diagnosed with P T L D towards the end of two thousand seven. 
Doctor: What symptoms were you experiencing? 
Patient: I had swollen lymph nodes, stomach pain, I was losing a lot of weight, and I wasn't really eating. 
Doctor: How have you been treated for this?
Patient: Well, I didn't go to the doctor right away, but eventually I went to the hospital, and they did a biopsy of my groin lymph nodes, and they found large scale lymphoma. 
Doctor: Who's care were you under in the hospital? 
Patient: Um, it was the renal transplant services. Oh yeah, they talked about my case at the hematopathology conference. 
Doctor: That's interesting. After you were diagnosed, what treatments were you given?
Patient: Um, I started chemo with, um, I have it written down, cyclophosphamide, daunorubicin, vincristine, and prednisone. 
Doctor: Did you have any complications with chemo? 
Patient: Um, yeah, I had sepsis during my first cycle, they said that I had it even with growth factor support. I was also disoriented. 
Doctor: How many cycles of chemo have you completed? 
Patient: I've done five to date. 
Doctor: Did you have your P E T Scan after your first three cycles? 
Patient: No, I wasn't feeling well at all, so I didn't go. 
Doctor: Has your chemotherapy been interrupted for any other reason? 
Patient: Yeah, I had an infection related to the skin cancer, and a chest infection, sir. 
Doctor: Did you have surgery for the skin cancer? 
Patient: Yes, I did. 
Doctor: Okay, and you're here for your sixth round of chemo, correct? 
Patient: Yes, that's correct. 
Doctor: How are you feeling today?
Patient: Overall, I feel pretty well. 
Doctor: Are you having any cold or flu like symptoms today? 
Patient: No. 
Doctor: Any shortness of breath, or chest pain?
Patient: No, doctor. 
Doctor: Finally, your E C O G score is one according to the nurse, is that correct? 
Patient: Yes, doctor. That's correct."
2:5,2,5,5,PASTMEDICALHX,None.,"Doctor: Are there any major medical conditions in your past that I should be aware of? 
Patient: No, but what do you mean by that?
Doctor: Well, anything from high blood pressure, to cancer, to depression. Do any of those sound familiar?
Patient: Oh, no I don't have any of those."
2:6,2,6,6,ROS,"RESPIRATORY: No history of shortness of breath, no history of asthma, no history of chronic obstructive pulmonary disease, no history of obstructive sleep apnea.","Doctor: Do you feel any shortness of breath?
Patient: No.
Doctor: Any snoring or sleep disorder like interrupted breathing? 
Patient: Um, no.
Doctor: Any history of asthma or lung disease?
Patient: No."
2:7,2,7,7,PASTSURGICAL,"In 1985, he had removal of a testicle due to enlarged testicle, he is not quite sure of the cause but he states it was not cancer. REVI","Doctor: Have you ever had surgery, sir? 
Patient: Yeah, I had one of my testicles removed int he summer of eighty five. 
Doctor: Do you remember the reason it needed to be removed? 
Patient: They just told me it was enlarged, but I don't know much more. 
Doctor: Was it cancerous? 
Patient: No, they weren't sure what was the cause, but they told me it wasn't cancer."
2:8,2,8,8,PASTMEDICALHX,"Her past medical history is significant for injury to her left shoulder, gastroesophageal reflux disorder, diabetes, anxiety, and osteoporosis.","Doctor: Hello, miss. Before we begin, I just want to confirm some information with you. 
Patient: Sounds good. 
Doctor: You had this injury on your left shoulder recently, right? 
Patient: Yeah, that's correct. 
Doctor: Are you still experiencing G E R D? 
Patient: Oh, yeah. I can't drink coffee anymore. 
Doctor: That's awful. Coffee is what keeps me alive. Are you still experiencing anxiety? 
Patient: Yeah, I am. 
Doctor: Two more questions. Is your blood sugar still high?
Patient: I think so. 
Doctor: You currently have osteoporosis, correct? 
Patient: That's correct."
2:9,2,9,9,PASTMEDICALHX,Pulmonary embolism in 1997 which had been treated with thrombolysis in Germany. She reported that she had been on warfarin for 6 months after her diagnosis.  Recurrent venous thromboembolism in 1999 at which time an IVC filter had been placed.  Psoriasis.  She denied any history of miscarriage.,"Doctor: Please fill me in regarding your past medical history.  
Patient: I had a blood clot in my lung. This was back when I was living in Germany.  
Doctor: How long ago was that? 
Patient: Um, nineteen ninety seven. I think? 
Doctor: How did they treat you for the blood clot? 
Patient: I believe they used thrombolysis and I took Warfarin for six months. 
Doctor: Have you experienced any other blood clotting issues? 
Patient: Yes. I have had recurring clotting problems since nineteen ninety nine. They had to put a I V C filter in.  
Doctor: Are there any other health problems I should know about? 
Patient: I have Psoriasis. 
Doctor: Any history of miscarriage? 
Patient: No."
2:11,2,11,11,FAM/SOCHX,"The patient denies tobacco, alcohol or illicit drug usage.","Doctor: Let's go over your social history, shall we? 
Patient: Go for it. 
Doctor: Do you drink? 
Patient: Nope. 
Doctor: How about smoke? 
Patient: Nope. 
Doctor: And any illegal drug use? 
Patient: Definitely not."
2:12,2,12,12,FAM/SOCHX,"The patient lives at Life Care Center. She does not smoke, drink or use intravenous drugs.","Doctor: So, as you mentioned, you live in adult care center?
Patient: Yes, Life Care Center.
Doctor: Okay.
Patient: It is a nice place.
Doctor: Okay. Do you drink or smoke?
Patient: No, I quit a long time back.
Doctor: Drugs?
Patient: No, I have never done that.
Doctor: Okay.
Patient: Yeah."
2:13,2,13,13,MEDICATIONS,None.,"Doctor: Do you take any medication? 
Patient: You mean prescriptions?
Doctor: I mean anything at all?
Patient: No, I don't."
2:14,2,14,14,FAM/SOCHX,"Marital status:   Married.   Smoking history: Smoked 1 PPD, quit 5 years ago and after smoking for 15 years.  Alcohol history: Drinks socially.   Denies any history of drug abuse.","Doctor: Good morning. 
Patient: Good morning, doctor. 
Doctor: I'm just going to need some background information before we begin. So, are you married?
Patient: Yes, to my lovely wife. 
Doctor: Great, do you smoke? 
Patient: Well, I used to smoke about a pack a day, but I quit five years ago. 
Doctor: Congratulations on quitting, that's great. How long did you smoke that pack a day?
Patient: I did for about fifteen years. 
Doctor: Well, its good that you quit. Do you drink?
Patient: I'd say I drink socially, like if I'm at a party or a football game, something like that.
Doctor: I understand. Is there any history of drug abuse?
Patient: No, absolutely not."
2:15,2,15,15,GYNHX,Spontaneous miscarriage at 3 months approximately 30 years ago.,"Doctor: Any history of pregnancies or miscarriages? 
Patient: I had a miscarriage about thirty years ago. 
Doctor: How far along were you when you miscarried? 
Patient: About twenty weeks."
2:16,2,16,16,GENHX,"Briefly, the patient is an 83-year-old woman with a history of progression of dysphagia for the past year, dysarthria, weakness of her right arm, cramps in her legs, and now with progressive weakness in her upper extremities.","Doctor: Hello, how are you doing? How old are you?
Patient: I am an eighty three year old woman, how do you expect me to do?
Doctor: Tell me, what is happening with you, what bought you here today?
Patient: I feel a lot of weakness in my both hands. 
Doctor: Is it something new or old?
Patient: I had difficulty in swallowing and some problems with speech too in the past. I used to have cramps in my legs and weakness only in my right arm but now it is continuously increasing in both arms."
2:17,2,17,17,DISPOSITION,Stable.,"Doctor: How are you feeling today?
Patient: Good.
Doctor: Is there any issue that I should be worried of?
Patient: No.
Doctor: Are you feeling condifent of your health? 
Patient: Yes."
2:21,2,21,21,PASTSURGICAL,IVC filter placement 1999.   Tubal ligation.,"Doctor: Any surgical history? 
Patient: I had a I V C filter placed for a blood clot and a tubal ligation. 
Doctor: When was your I V C filter placed? 
Patient: Nineteen ninety nine."
2:23,2,23,23,ASSESSMENT,Possible insect bite with lymphangitis.,"Doctor: Your lymph node is swollen. There are many reasons why a lymph node can become swollen. Since it has only been swollen for two days, I would like to monitor it.  
Patient: Okay. So, is it not a spider bite? 
Doctor: It is possible. Let's monitor it for now."
2:24,2,24,24,PASTMEDICALHX,"MI in the past and atrial fibrillation, he said that he has had one stent put in, but he is not sure.  The last cardiologist he saw was Dr. X and his primary doctor is Dr. Y.","Doctor: Did you have any heart issues in the past? 
Patient: Ah yes, I had a heart attack. 
Doctor: Anything else? 
Patient: My heart doctor said that I have something like a irregular or fast heartbeat. 
Doctor: Who is your heart doctor? Whom did you see last?
Patient: It is Doctor X.
Doctor: So, did he put anything inside your heart or something?
Patient: Yeah, I think I have one stent put in but I don't remember properly.
Doctor: Okay, and who is your primary doctor? 
Patient: My primary doctors name is Doctor Y?"
2:28,2,28,28,CC,coughing up blood and severe joint pain.,"Doctor: Hi there! What brings you into see me today? 
Patient: I have been having this bad cough. My joints started hurting really bad. I have never felt this kind of joint pain before. This morning I coughed up some blood. 
Doctor: Okey. I would like to start with a sputum culture, bloodwork and then a C T scan. 
Patient: Okay."
2:29,2,29,29,FAM/SOCHX,"Single, lives with sister, and denies Tobacco/ETOH/illicit drug use.","Doctor: How are you doing today?
Patient: I am good, thank you.
Doctor: Are you married?
Patient: No, I'm single.
Doctor: Do you live alone or with family?
Patient: I live with my sister.
Doctor: Have you ever taken any kind of illegal drugs?
Patient: Nope.
Doctor: What about alcohol or smoking?
Patient: No."
2:34,2,34,34,PROCEDURES,Laparoscopic cholecystectomy.,"Doctor: We are planning laparoscopic surgery to take out your gall stones. 
Patient: Okay. Will that be covered by my insurance?
Doctor: Let me ask the staff.
Patient: Okay."
2:35,2,35,35,FAM/SOCHX,No ill contacts.  No travel or changes in living condition.,"Doctor: Are you married?
Patient: Yes. I have a caring wife.
Doctor: At any point did you have more than one sexual partner?
Patient: I love my wife. So no, to answer your question. 
Doctor: Did you travel anywhere in the recent past?
Patient: Nope. 
Doctor: Any changes in your living status? 
Patient: No, I'm still in my sweet Casa.
Doctor: Have you had any contact with anyone sick recently?
Patient: Not that I am aware of."
2:37,2,37,37,FAM/SOCHX,"She lives with mom, sister, and her grandparent.","Doctor: Do you live alone?
Patient: No. I have a whole family with me. 
Doctor: Who all lives with you? 
Patient: My grandparents, mom, and my sister."
2:40,2,40,40,MEDICATIONS,The patient is 100% compliant with her meds.  She reports she does not miss any doses.,"Doctor: Have you had any acne flare ups? 
Patient: No. 
Doctor: Do you have any left over medication? 
Patient: No. I took all of my pills and didn't miss any days."
2:41,2,41,41,ASSESSMENT,1.  Diabetes mellitus. 2.  Neuropathy. 3.  Status post cerebrovascular accident.,"Doctor: So, I asked you to follow-up on your cerebrovascular accident, right?
Patient: Hm, yeah. 
Doctor: Okay, how are you feeling?
Patient: I am bit better but still don't feel one hundred percent. 
Doctor: Yeah, I understand. I am looking at your blood sugar report and-
Patient: And is it okay?
Doctor: Well, you have diabetes and that explains your nerve pain. Basically, high blood sugar can cause the neuropathy."
2:44,2,44,44,PASTMEDICALHX,"Illnesses:  The patient had a diagnosis in 2005 of an acoustic neuroma.  It was benign, but treated neurosurgically.  In February 2004 and again in August 2009 he has had additional treatments for recurrence and he currently has some skull markers in place because radiation is planned as a followup, although the tumor was still indicated to be benign. Operations: He has a history of an old mastoidectomy.  He has a past history of removal of an acoustic neuroma in 2005 as noted. Medications:  The patient takes occasional Tylenol and occasional Aleve. Substance Use: Tobacco:  He does not smoke cigarettes. Alcohol:  He drinks about five beers a week.","Doctor: Do you have any conditions that I should know about? 
Patient: Yes, um, I had an acoustic neuroma in two thousand five. 
Doctor: Did you have surgery on this? 
Patient: Yes, it was benign, but they still wanted to take it out. 
Doctor: Yeah, that happens. What other treatments have you had? 
Patient: Um, in February of two thousand four, and August of two thousand nine I had treatments for recurrence. 
Doctor: Do you have skull markers in place? 
Patient: Yeah, they're planning on doing radiation. 
Doctor: Aside from the acoustic neuroma removal, have you had any other surgeries? 
Patient: Yeah, I had a mastoidectomy in the past.  
Doctor: What medications are you taking?
Patient: Um, I just take Tylenol and Aleve occasionally for pain. 
Doctor: Do you smoke?
Patient: No, I don't. 
Doctor: How about alcohol, do you drink?
Patient: Yes, um, I'd say about five beers a week."
2:45,2,45,45,FAM/SOCHX,No neurologic disease in family.,"Doctor: Is there any medically related disease in the family? 
Patient: Nope. 
Doctor: What about things like depression or Alzheimer's or other nerves related disorders?
Patient: Nothing that I'm aware of."
2:48,2,48,48,PASTMEDICALHX,Diabetes and high blood pressure.,"Doctor: Do you have any major health conditions I should be aware of? 
Patient: Yes, I actually have the sugar. 
Doctor: What about anything to do with the heart? 
Patient: Yes, I forgot about that, um, I have high blood pressure too."
2:49,2,49,49,FAM/SOCHX,"Denies any smoking or alcohol.  She is married since 44 years, has 3 children.  She used to work as a labor and delivery nurse up until early 2001 when she retired.","Doctor: Do you live alone?
Patient: I live with my husband. Forty four years and counting.
Doctor: That's incredible. Do you have any children?
Patient: We have three kids. 
Doctor: Do you work currently?
Patient: I worked as a L and D nurse before I retired in early two thousand and one. 
Doctor: How's retirement been?
Patient: Wonderful. I get to spend quality time with my grandkids.
Doctor: Great to hear. And do you smoke or drink?
Patient: No smoking or drinking for me. Happy as a clam."
2:50,2,50,50,PASTMEDICALHX,He has coronary artery disease and has received five stents.  He has hypertension and hypercholesterolemia.  He states that he was diagnosed with diabetes based on the results of an abnormal oral glucose tolerance test.  He believes that his glucose shot up to over 300 with this testing.  He does not take any medications for this and his blood glucoses are generally normal when he checks it.  He has had plastic surgery on his face from an orbital injury.  He also had an ear graft when he developed an ear infection during his honeymoon.,"Doctor: Welcome to the clinic, sir. I am Doctor Frank. 
Patient: Thank you. It is nice to meet you. 
Doctor: Let's start with your medical history. 
Patient: I have high blood pressure and high cholesterol. I have heart disease. I have had five stents put in. I also was told that I have diabetes. My other doctor did an oral glucose tolerance test and the results were not normal. 
Doctor: Do you know what the results from the glucose test was? 
Patient: I believe my sugar shot up to over three hundred with the test they gave me. 
Doctor: Do you take any medications for your blood glucose levels? 
Patient: No. My glucoses are generally normal when I check it.
Doctor: Have you had any surgeries other than the stents? 
Patient: I had plastic surgery on my face from an injury near my eye. I also had an ear graft from when I developed an ear infection during my honeymoon."
2:52,2,52,52,GENHX,The patient is a 72-year-old gentleman who was diagnosed with chronic lymphocytic leukemia in May 2008.  He was noted to have autoimmune hemolytic anemia at the time of his CLL diagnosis.  He has been on chronic steroids to control his hemolysis and is currently on prednisone 5 mg every other day.  He comes in to clinic today for follow-up and complete blood count.  At his last office visit we discontinued this prophylactic antivirals and antibacterial.,"Doctor: Good afternoon, sir. My chart here says that you're seventy two years old, is that correct? 
Patient: Yes, that's correct sir. 
Doctor: Great, can you tell me about your medical history? 
Patient: Well, I was diagnosed with chronic lymphocytic leukemia in May of two thousand eight. 
Doctor: Do you have any doctor's notes about this diagnosis?
Patient: Yes, here you go doctor. 
Doctor: Thank you, so this shows that you had autoimmune hemolytic anemia at the time of your diagnosis. 
Patient: Yes, that rings some bells. 
Doctor: What medications have you been taking for your hemolysis? 
Patient: Um, I've been taking five M G of prednisone every other day. 
Doctor: Great, so we'll follow up on everything today, and do a complete blood count. 
Patient: That sounds good, doctor. 
Doctor: We discontinued your prophylactic antivirals and antibacterial at your last visit, correct?  
Patient: Yes, I haven't taken them for a while now."
2:54,2,54,54,FAM/SOCHX,"He smokes one-and-one-half-packs of cigarettes per day and drinks alcohol at least several days per week. He is employed in sales, which requires quite a bit of walking, but he is not doing any lifting. He had been a golfer in the past.","Doctor: How's it going? Are you ready for your physical today, sir? 
Patient: I am, but can we hurry? I have to get to work soon.
Doctor: Oh, what do you do for work?
Patient: I work in sales. I walk quite a bit from house to house to sell some products. They won't sell on their own. That's why I'm in a hurry. 
Doctor: Oh, wow. Do you have to lift any heavy products?
Patient: Nope. I just walk around with my tablet. Could we start the physical, please?
Doctor: Yeah, let's get started. I'll ask some basic background questions to get the physical started?
Patient: Sounds good. 
Doctor: Do you smoke?
Patient: I do. I'll smoke like one and a half pack of cigarettes every day. I get stressed at work.
Doctor: I see. Do you also drink alcohol?
Patient: Oh, yeah. I'll drink several days out of the week. 
Doctor: Are you currently active?
Patient: No, not really. I used to golf in the past, but work has been busy. I miss golfing. I could get away from my wife for a bit and drink with the boys."
2:57,2,57,57,CC,Perioperative elevated blood pressure.,"Doctor: Hm do you normally have high blood pressure? 
Patient: This is the first time in my life that I've been told to see a doctor for my blood pressure. 
Doctor: And when did you notice it reading higher than normal? 
Patient: Around the time of my surgery. Not sure if that has anything to do with it. Do I need to start taking blood pressure medicine?"
2:60,2,60,60,FAM/SOCHX,10+pack-year h/o Tobacco use; quit 2 years ago. 6-pack beer/week. No h/o illicit drug use.,"Doctor: Hello. Looks like you're here for your physical today. I'll start by asking you some basic questions. 
Patient: Sounds good to me.
Doctor: Do you currently smoke?
Patient: I stopped two years ago. 
Doctor: How much would you say you smoked before?
Patient: Maybe like ten packs a year. Who knows? I lost track.
Doctor: Do you drink alcohol?
Patient: Oh, yeah. I kill a six pack of beer every week. 
Doctor: Do you use any illegal substances?
Patient: No. I don't go that hard."
2:64,2,64,64,DIAGNOSIS,Bronchitis.,"Doctor: You have a lung problem called bronchitis.
Patient: What does that mean?
Doctor: Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs.
Patient: Okay.
Doctor: But don't worry with proper medication we can fix it.
Patient: Okay."
2:65,2,65,65,PLAN,As tolerated.,"Doctor: Have you been able to move around at all? 
Patient: I do what I can. Most of the time I lay on the couch, but I'll sometimes find it in me to get up and do things.
Doctor: What type of activities are you able to do without pain? 
Patient: Knitting and folding laundry for the most part."
2:70,2,70,70,PLAN,"Low-fat, low-salt, cardiac diet.","Doctor: Did the nurse give you the handout for a cardiac diet? 
Patient: Yes. 
Doctor: It is important for you stick to the cardiac diet. The cardiac diet emphasizes low fat foods such as vegetables, whole grains, and fish. I would like for you limit processed foods that are high in sugar and sodium, as these increase the risk of heart disease. 
Patient: Okay."
2:72,2,72,72,GENHX,"40 year old Hispanic male presented to the emergency room complaining of generalized weakness, fatigue and dark urine for one week. In addition, he stated that his family had noticed yellowing of his skin and eyes, though he himself had not noticed. He did complain of subjective fever and chills along with occasional night sweats during the prior week or so and he noted anorexia for 3-4 weeks leading to 26 pound weight loss (213 lbs. to 187 lbs.). He was nauseated but denied vomiting. He did admit to intermittent abdominal discomfort which he could not localize. In addition, he denied any history of liver disease, but had undergone cholecystectomy many years previous.","Doctor: Hello! I would like to get some background on what brings you in today. What symptoms have you been having? 
Patient: I am exhausted. I get lightheaded when I stand up. My family noticed that my skin and eyes are yellow. I have not been feeling well. I had a fever about a week ago. There has been a few nights where I woke up all sweaty with chills.  
Doctor: Have you had any trouble drinking or eating? 
Patient: Yeah. I have not been able to eat normally for that last three to four weeks. I lost twenty six pounds. 
Doctor: Have you experienced any nausea or vomiting? 
Patient: I have been nauseous, but I have not vomited.
Doctor: Any pain anywhere in the abdomen or low back area? 
Patient: Yes, there has been some pain.  
Doctor: Can you tell me or show me where the pain is coming from? 
Patient: It comes and goes. It hurts all around my stomach. Oh, my pee has been a vary dark color for about a week now. 
Doctor:  Do you have a history of liver disease? 
Patient: No but I did have a cholecystectomy a long time ago."
2:73,2,73,73,FAM/SOCHX,The patient is employed in the finance department.  He is a nonsmoker.  He does consume alcohol on the weekend as much as 3 to 4 alcoholic beverages per day on the weekends.  He denies any IV drug use or abuse.,"Doctor: So, what do you do for a living sir? 
Patient: Right now, I work in the finance department. 
Doctor: That's great. Do you smoke? 
Patient: No, I never do that. 
Doctor: What about alcohol, do you drink? 
Patient: Well, on the weekends I do, not during the week though. 
Doctor: How many drinks do you have on the weekends? 
Patient: Per day, I'll have three or four. 
Doctor: Okay, what about harder substances, do you do any harder drugs? 
Patient: No, absolutely not."
2:77,2,77,77,PASTMEDICALHX,"None. No history of hypertension or of cardiac, renal, lung, or liver disease.","Doctor: Do you have any history of high blood pressure or cardiac disease? 
Patient: No.  
Doctor: Any renal, lung, or liver disease history? 
Patient: No."
2:79,2,79,79,FAM/SOCHX,Noncontributory.,"Doctor: Does arthritis run in your family? 
Patient: No, not that I know of. 
Doctor: So, you can't remember anything with your grandparents, or parents? 
Patient: No, it doesn't ring any bells."
2:82,2,82,82,ROS,"Positive for diarrhea and abdominal pain, otherwise main other complaints are weakness.  She denies any cough, sputum production, or dysuria at this time.  Otherwise, a 10-system review is essentially negative.","Doctor: So, how long has your stomach been hurting?
Patient: It started two days back.
Doctor: Any nausea or vomiting?
Patient: No.
Doctor: Okay, any diarrhea?
Patient: Yes, I am having severe cramping with diarrhea. 
Doctor: Oh, okay. Any dizziness or weakness?
Patient: Yes, I am feeling very weak and tired all the time.
Doctor: Any cough with sputum? 
Patient: No cough at all.
Doctor: Okay. Are you having any pain or burning while passing urine?
Patient: No, I am fine.
Doctor: Hm, everything else looks fine. No problem there with your eyes, nose, throat, and other systems.
Patient: It's just my tummy which is hurting.
Doctor: Don't worry we will take care of it."
2:84,2,84,84,GENHX,"She is a 79-year-old female who came in with acute cholecystitis and underwent attempted laparoscopic cholecystectomy 8 days ago.  The patient has required conversion to an open procedure due to difficult anatomy.  Her postoperative course has been lengthened due to a prolonged ileus, which resolved with tetracycline and Reglan.  The patient is starting to improve, gain more strength.  She is tolerating her regular diet.","Doctor: My nurse wrote on your chart that you're seventy nine years old, is that correct, ma'am? 
Patient: Yes, doctor, that's right. 
Doctor: Your surgery was eight days ago, right? 
Patient: Yeah, I'm recovering now. 
Doctor: Are you aware of the details behind your surgery? 
Patient: Honestly, all the details are pretty foggy. 
Doctor: Okay, well you had acute cholecystitis, so we tried a laparoscopic cholecystectomy. 
Patient: Did everything go well, doctor? 
Doctor: Well, we had to do an open procedure due to some difficult anatomy. You were a tough case. How are you doing today?
Patient: I'm improving, I guess.
Doctor: How is your strength? 
Patient: It's getting better. 
Doctor: Are you eating well?
Patient: Yeah, I'm back to having my regular diet now. 
Doctor: Are you going to the bathroom regularly? What medicines are you taking for this prolonged ileus?
Patient: Well, I wasn't, but it's gotten with the tetracycline and Reglan."
2:88,2,88,88,DISPOSITION,The patient was discharged in good and stable condition.,"Doctor: After going over your most recent test results from this morning and the progress in your mobility, I would like to send you home today. 
Patient: That's great news. I would love to go home. 
Doctor: How are you feeling right now? 
Patient: I feel good!
Doctor: Do you have any questions before we let you go home today? 
Patient: Where can I get the medications that we discussed? 
Doctor: I will send them to your pharmacy. 
Patient: Okay."
2:89,2,89,89,GENHX,"The patient is a 58-year-old female, referred to therapy due to left knee osteoarthritis.  The patient states that approximately 2 years ago, she fell to the ground and thereafter had blood clots in the knee area.  The patient was transferred from the hospital to a nursing home and lived there for 1 year.  Prior to this incident, the patient was ambulating independently with a pickup walker throughout her home.  Since that time, the patient has only been performing transverse and has been unable to ambulate.  The patient states that her primary concern is her left knee pain and they desire to walk short distances again in her home.","Doctor: Good afternoon, ma'am, how are you today, my dear?
Patient: It's good to see you too, doctor. I'm in some pain today. 
Doctor: Before we begin, refresh my memory, how old are you? 
Patient: Doctor, I'm fifty eight years young. 
Doctor: Yes, what seems to be the problem today?
Patient: Well, about two years ago I had a fall, and then I had blood clots in my left knee. 
Doctor: How were you treated for this? 
Patient: I went to the hospital, and then to a nursing home. I had to live there for a year.
Doctor: Did you have any problems before your fall? 
Patient: Nope, not at all, I was mostly doing everything by myself. I used a pickup walker around the house, but that's it. 
Doctor: Have you been to P T for this?
Patient: Yes, they referred me to P T because of the arthritis in this knee.  
Doctor: Since the injury, have you been able to walk?
Patient: Not really, I spend most of my time laying down or seated. My knee is in so much pain, I just want to be able to walk around my house again."
2:91,2,91,91,IMAGING,"EKG, normal sinus rhythm.  Chest x-ray unremarkable.","Doctor: I have your reports.
Patient: Okay.
Doctor: Your E K G is normal, with normal sinus rhythm. This means your heart is beating normal.
Patient: Okay!
Doctor: And your chest x ray, too, looks normal.
Patient: Nice."
2:93,2,93,93,FAM/SOCHX,"Patient is married and lives with her husband and 2 children. Works in a business office. Denies any tobacco, alcohol, or illicit drug use of any kind. No history of sexually transmitted diseases. Denies exposures to asbestos, chemicals, or industrial gases. No recent travel. No recent sick contacts.","Doctor: Hi, how are you, miss?
Patient: I am well, how about you?
Doctor: Good. Are you married and do you have kids?
Patient: Sure. I am married. I have two kids and we all live together with my husband.
Doctor: That's great. Do you smoke cigarettes?
Patient: No, I don't smoke or drink alcohol.
Doctor: How about any drugs?
Patient: No, I have never done that.
Doctor: Okay. What do you do for a living?
Patient: I work in a business office.
Doctor: Okay that is good. Okay, have you ever been diagnosed with any type of sexually transmitted diseases?
Patient: Oh, you mean syphilis and stuff? No, I haven't.
Doctor: Okay. Have you ever got exposed to asbestos, chemicals, or industrial gases. Maybe you could have been exposed at work or elsewhere? Not sure if your business office has anything like that.
Patient: Um, not that I am aware of. 
Doctor: Have you travelled anywhere recently?
Patient: Oh no, nor I am planning to.
Doctor:  Great. Any sick contacts at home or outside?
Patient: Oh, no."
2:94,2,94,94,GENHX,"A 70-year-old female who was diagnosed with diabetes mellitus last fall.  She has been checking her Accu-Cheks generally once a day, and they range from 82 to a high of 132.  She feels well.  She walks 1-2 miles most days.  If the weather is bad, they go to a local mall.  Otherwise they walk outside.  She does complain of some sinus congestion and drainage for the last several days.  She is up-to-date on her mammogram that she had at the Baylis Building.  She sees Dr. Cheng for her gynecological care.  She is a nonsmoker.  Denies abdominal pain, nausea, vomiting, diarrhea, constipation, blood in her urine, blood in her stools.  She has nocturia x 1.  Denies swelling in her ankles.  She checks her feet regularly.","Doctor: How old are you? 
Patient: I'm seventy. 
Doctor: When did you get diagnosed with diabetes? 
Patient: It was last fall. 
Doctor: Are you keeping a tab of your sugar? 
Patient: Yeah, I'm checking with Accu Cheks. Mostly, once a day. 
Doctor: How are your numbers coming? 
Patient: They are ranging from eighties to as high as one hundred and thirty two. 
Doctor: How are you feeling overall?
Patient: It's good. I go for a walk, almost daily. 
Doctor: How far do you go? 
Patient: Normally, we go like one to two miles. Sometimes the weather, when the weather is not favorable, we just go to the local mall, but mostly it's like I'm walking outside. 
Doctor: Any other issues? 
Patient: For the last several days, I do have this feeling of congestion. Looks like everything is congested and sometimes it's like something is coming out. 
Doctor: Where did you have your last mammogram? 
Patient: I had it in the Baylis Building. It was, it was last month, I think. 
Doctor: Who is the gynecologist?
Patient: I go to Doctor Cheng. 
Doctor: Do you smoke? 
Patient: Nope. Never in my life. 
Doctor: Any pain in your tummy, nausea, or vomiting, diarrhea or constipation? Any changes with the bowel movements? 
Patient: Nope. 
Doctor: Did you ever notice any blood in your urine or in your stools? 
Patient: Nope. 
Doctor: Do you check ankles for swelling? Have you ever noticed any swelling there? 
Patient: Yeah, I check my feet regularly and no swelling as such. I do wake up at night at least one time to go to the bathroom."
2:96,2,96,96,PASTMEDICALHX,"Seasonal allergies, possible food allergies, chronic sinusitis, hypertension and history of weight change.  She is currently 180 pounds.","Doctor: Hello, ma'am. How are you doing today? 
Patient: Not well. My allergies have been acting up again. 
Doctor: I see. Have you ever seen a doctor for your allergies? 
Patient: I have. My main doctor provided me with a report so that I could give it to you. Here is the report. 
Doctor: Thank you. Let me take a look at it.  I see you have a history of weight change. What is your current weight? 
Patient: I think I weigh in at one hundred and eighty pounds. 
Doctor: Thank you. I see your report says you have high blood pressure, correct? 
Patient: Yeah, that's correct. 
Doctor: I also see you have chronic issues with nasal inflammation, correct? 
Patient: Yeah, I do. It's really annoying when it comes back. 
Doctor: I can provide you with some medications to alleviate the chronic issues, but before I can, do you have any food allergies? 
Patient: I have some food allergies, but I'm not completely sure what foods I'm allergic too."
2:98,2,98,98,GENHX,"28 y/o male presented with a 3 month history of progressive right sided numbness; now anesthetic to pain. In addition, he experienced worsening balance, and episodes of aspiration while eating.","Doctor: How old are you, sir? 
Patient: I am twenty eight years old. 
Doctor: I understand that you are having some difficulties that brings you in today.
Patient: Yes, I have lost some feeling on my right side. 
Doctor:  Numbness? How long have you been experiencing the loss of feeling? 
Patient: It has been about three months now. It's strange I have had pain and numbness at the same time. 
Doctor: Have you had any other symptoms associated with this? 
Patient: I have been having some balancing problems. It has been getting worse. I don't know if this is related but I have been having trouble breathing while eating. I feel like I am choking on my food, but I am not, and I gasp for air. It is scary."
2:101,2,101,101,GENHX,"This is a 56-year-old obese female with a history of bilateral degenerative hip arthritis.  She underwent a right total hip arthroplasty by Dr. X in the year of 2000, and over the past three years, the symptoms in her left hip had increased tremendously especially in the past few months. Because of the increased amount of pain as well as severe effect on her activities of daily living and uncontrollable pain with narcotic medication, the patient has elected to undergo the  procedure.  All risks as well complications were discussed with the patient including but not limited to infection, scar, dislocation, need for further surgery, risk of anesthesia, deep vein thrombosis, and implant failure.  The patient understood all these risks and was willing to continue further on with the procedure.","Doctor: Good afternoon, ma'am. Before we begin, I just need a few pieces of information. 
Patient: Sure, no problem, doctor.
Doctor: First, how old are you?
Patient: I'm fifty six, doctor. 
Doctor: Good, did the nurses talk to you about the weight they took today?
Patient: No, they did not. 
Doctor: Well, ma'am, you're obese. That's posing a serious danger to your health. 
Patient: Yes, I know. I've been trying to lose weight. 
Doctor: Good, so, what seems to be troubling you today?
Patient: Well, I have a history of degenerative arthritis in my hips, so my other doctors have said.
Doctor: How have you been treated for this?
Patient: I had a right hip replacement with Doctor X in two thousand. 
Doctor: Did this help the pain?
Patient: Yes, on the right, but over the last three years or so the pain on the left hip has been getting worse. 
Doctor: Has it gotten worse faster recently?
Patient: Yeah, over the last few months it's gotten really bad. 
Doctor: What kind of medications are you taking for this?
Patient: Honestly, it's gotten so bad, its uncontrollable pain at this point. I'm taking narcotics now because it's so bad. 
Doctor: Are you able to do any activities?
Patient: No, the pain is messing with my daily living, activities are out of the question. 
Doctor: I think we should do another hip replacement on the left, ma'am. 
Patient: Me too, can you remind me the risk of infection from this surgery?
Doctor: Well, historically it's less than one percent. We use antibiotics to control for infection. 
Patient: Good, and will I be asleep for this?
Doctor: Yes, the whole time. You won't feel a thing. 
Patient: Good, yes, I want to do this procedure.
Doctor: The other risks include scar, dislocation, need for further surgery, deep vein thrombosis, and implant failure. I would not worry about any of these things since you have had a replacement before with no issues."
2:105,2,105,105,GENHX,"The patient reports that when seated and at rest, her knee pain is 0/10.  The patient states that with active motion of the left knee, the pain in the anterior portion increases to 5/10.","Doctor: With ten being the worst pain ever, out of ten, how would you rate your knee pain at rest? 
Patient: At rest, um, I'd have to say there's no pain. 
Doctor: Okay, what about when you move the left knee? We call this active motion, how would you rate it then?
Patient: When I move it, um, the front of the knee hurts. I'd say its about a five out of ten."
2:107,2,107,107,GENHX,"She is a very pleasant 59-year-old nurse with a history of breast cancer.  She was initially diagnosed in June 1994.  Her previous treatments included Zometa, Faslodex, and Aromasin.  She was found to have disease progression first noted by rising tumor markers.  PET/CT scan revealed metastatic disease and she was enrolled in clinical trial of CTSU/C40502.  She was randomized to the ixabepilone plus Avastin.  She experienced dose-limiting toxicity with the fourth cycle.  The Ixempra was skipped on day 1 and day 8.  She then had a dose reduction and has been tolerating treatment well with the exception of progressive neuropathy.  Early in the month she had concerned about possible perforated septum.  She was seen by ENT urgently.  She was found to have nasal septum intact.  She comes into clinic today for day eight Ixempra.","Doctor: Good afternoon, ma'am, I just need some information before we get started today. 
Patient: Absolutely, good afternoon, doctor. 
Doctor: My chart says here that you're fifty nine years old, is that correct? 
Patient: Yes, that's correct. 
Doctor: I also see that you have a history of breast cancer, is that correct as well?
Patient: Yes, that's also correct. 
Doctor: When were you diagnosed initially? 
Patient: Um, I was diagnosed in June of nineteen ninety four. 
Doctor: How has this been managed in the past, ma'am? 
Patient: Um, I've taken Zometa, Faslodex, and Aromasin. 
Doctor: How has the cancer progressed since you were diagnosed? 
Patient: The doctors said I had rising tumor markers. 
Doctor: What imaging have you done to evaluate the cancer? 
Patient: I've had a P E T C T Scan done. 
Doctor: What did that scan show?
Patient: It showed that the cancer was metastatic. 
Doctor: I see here that you were involved in a clinical trial for your breast cancer, can you tell me more about that, please? 
Patient: I was in the C T S U C four zero five zero two trial, and I was randomized into the ixabepilone plus Avastin group. 
Doctor: How did you respond to this treatment? 
Patient: Um, I had something called dose limiting toxicity with the fourth cycle. I skipped the Ixempra on the first and eighth days. 
Doctor: How did they respond once this happened? 
Patient: They just reduced the dose I was given. 
Doctor: How did you handle this reduced dose? 
Patient: Honestly, I've been tolerating the treatment pretty well. I only have some neuropathy. 
Doctor: Do you have any other concerns of note? 
Patient: Um, I thought that I had a perforated septum earlier this month, and I went to my E N T right away, but everything was okay. There was no perforation. 
Doctor: Okay, so, you're here for your eighth day of Ixempra, correct? 
Patient: Yes, doctor, that's correct."
2:108,2,108,108,EXAM,"LYMPH: No lymphadenopathy was appreciated in the neck, axillae or groin.","Doctor: I have to check for any swollen lymph nodes. I will go through different areas like in your neck, in your armpit, and in your groin. 
Patient: Yeah, that's okay. 
Doctor: Your neck looks clear. I cannot find any kind of swelling or abnormality there. 
Patient: That's good, right? 
Doctor: Yeah, it's true. Other parts also look clear."
2:109,2,109,109,EXAM,"SKIN: Inspection of the skin reveals no rashes, ulcerations or petechiae.","Doctor: I will check your skin for anything abnormal, okay? 
Patient: I'm okay with that. 
Doctor: Hm, I don't see any rashes or any red spots."
2:111,2,111,111,ALLERGY,None known.,"Doctor: Do you have any allergies?
Patient: Not that I know. 
Doctor: Any adverse reaction to any kind of medications?
Patient: No."
2:112,2,112,112,GENHX,"The patient is a 62-year-old white female with multiple chronic problems including hypertension and a lipometabolism disorder.  She follows with Dr. XYZ on her hypertension, as well as myself.  She continues to gain weight.  Diabetes is therefore a major concern.  In fact, her dad had diabetes and she has a brother who has diabetes.  The patient also has several additional concerns she brings up today.  One is that her left knee continues to bother her and it hurts.  She cannot really isolate where the pain is, it just seems to hurt through her knee.  She has had this for some time now and in fact as we reviewed her records, her left knee has been x-rayed in 1999.  There was some minimal narrowing of the weightbearing joint with some minor hypertrophic spurring medially.  She would like to have this x-rayed again today.  She is certainly not interested in any surgery.  She has noted that it particularly hurts to kneel.  In addition, she complains of her stools being a baby-yellow.  She has rectal bleeding off and on.  It is bright red.  She had a colonoscopy done in 1999.  She does have a family history of colon cancer questionable in her mother, who is deceased.  She complains of some diffuse abdominal pain off and on.  She has given up fast foods and her pop and this has not seemed to help.  She does admit however, that she is not eating right.  Sometimes her stools are hard.  Sometimes they are runny.  The blood does not really seem to be related to necessarily a hard stool.  It is always bright red and will sometimes drip into the toilet.  Over the last couple of days, she had also been sneezing and has had an itchy throat.  She tried some Claritin and this did not help.  She has had some body aches.  She is finally feeling better today with this.  She also is questioning whether she has some sleep apnea.  She will awaken suddenly in the middle of the night.  She was told that she does snore.  She does not smoke.  As stated, she has gained significant weight.","Doctor: Hello, miss. What brings you into our clinic today? Also, before we start, it looks like you forgot to fill out your ethnicity on the new patient paperwork. Do you mind telling me what you identify as?
 Patient: Hello, doctor. I am white and I am a young sixty two years old. I have a list of issues I would like to talk about. 
Doctor: Let's begin. I know that you have been dealing with hypertension and lipometabolism disorder. Doctor X Y Z and I follow you on the hypertension. What else do we have going on?
Patient: First off I have a history of diabetes in my family. My father had it and my brother has it currently. I am afraid because I know I have gained some weight. My knee also has been hurting for a long time. The left knee. 
Doctor: Can you locate where the pain is?
Patient: I think it is everywhere in the knee. It hurts to kneel. I had imaging done on it a while ago. Can you check to see the results?  
Doctor: Ah, yes. We have on file that you had an X Ray done in nineteen ninety nine. I see that a joint is narrowing. We can talk about possible surgery. 
Patient: Can I have it x rayed again? I don't want any surgery, but I want to know what is going on. I am afraid of surgery. 
Doctor: Let's see what else I can do. Any other issues?
Patient: Yes. I am very concerned because my poop is baby yellow and I have some rectal bleeding occasionally. It is always bright red and drips into the toilet. My last colonoscopy was in nineteen ninety nine. 
Doctor: Do you have any history of colon cancer?
Patient: I do not, but I think my mother did. She is gone now, so I cannot check. Do you think my poop is baby yellow because of my stomach pain? I have some stomach pain and have been laying off the fast food and soda, but it doesn't seem to work. Sometimes my poop is hard or runny. It is always random. 
Doctor: Do you bleed when the stool is hard?
Patient: Not really. Oh, and lastly, I had cold symptoms. Like a sore throat and I was sneezing a lot. I think it was a cold or flu because Claritin did not work. I think the body aches were also from this illness. I feel okay today, but I wanted to bring this up just in case it had to do with my stool being discolored. During this sick period I also am wondering if I have sleep apnea because I wake up in the middle of the night randomly. 
Doctor: Do you snore? That is a sign of sleep apnea. Smoking also can contribute to restlessness.
Patient: No I do not snore and I do not smoke."
2:113,2,113,113,FAM/SOCHX,"Pertinent for father who died of an inoperable brain tumour.  Mother is obese, but otherwise negative history.","Doctor: Did anyone in your family have any medical issues? 
Patient: Well, you see, my father died of a brain tumor. Doctors tried their best, but no surgery was possible for him. 
Doctor: What about your mother? 
Patient: She's just a little obese, otherwise there is no medical issue."
2:116,2,116,116,PASTMEDICALHX,DM II-HbA1c unknown,"Doctor: Have you ever had your glucose levels measured? 
Patient: No.  
Doctor: I would like to test your levels today. 
Patient: Okay."
2:119,2,119,119,FAM/SOCHX,Widowed; lives alone. Denied ETOH/Tobacco/illicit drug use.,"Doctor: Do you consume alcohol, tobacco, or recreational drugs? 
Patient: No. 
Doctor: Are you married? 
Patient: I am a widowed. 
Doctor: I am so sorry to hear that. Do you live on your own? 
Patient: Thank you. Yes. I live by my self now."
2:120,2,120,120,GENHX,"I am asked to see the patient today with ongoing issues around her diabetic control.  We have been fairly aggressively, downwardly adjusting her insulins, both the Lantus insulin, which we had been giving at night as well as her sliding scale Humalog insulin prior to meals.  Despite frequent decreases in her insulin regimen, she continues to have somewhat low blood glucoses, most notably in the morning when the glucoses have been in the 70s despite decreasing her Lantus insulin from around 84 units down to 60 units, which is a considerable change.  What I cannot explain is why her glucoses have not really climbed at all despite the decrease in insulin.  The staff reports to me that her appetite is good and that she is eating as well as ever.  I talked to Anna today.  She feels a little fatigued.  Otherwise, she is doing well.","Doctor: Good afternoon, Anna. 
Patient: Good afternoon, doctor. 
Doctor: We've been pretty aggressive with downwardly adjusting both your Lantus and your Humalog insulins, how is your blood sugar today?
Patient: Well, it's still pretty low. 
Doctor: You've been taking the Lantus at night? 
Patient: Yes, and the sliding scale Humalog before I have meals. 
Doctor: When is your blood sugar the lowest? 
Patient: Um, it's worst in the mornings. 
Doctor: Do you remember your levels at that time? 
Patient: It's in the seventies usually. 
Doctor: We decreased your Lantus from eighty four to sixty units, right? 
Patient: Yes, doctor. 
Doctor: That's a pretty considerable change in dosage. 
Patient: What do you think, doctor? 
Doctor: Well, I can't really explain why your glucose have not climbed despite the decrease in insulin. 
Patient: That's strange, doctor. 
Doctor: My staff tells me that your appetite is good, and you're eating as well as ever, is that correct? 
Patient: Yeah, I'm just a little fatigued, but otherwise, I'm doing well."
2:123,2,123,123,PLAN,"The patient is now six months out from his injury. He had negative lab studies. There were no physical findings that were suggestive of disease transmission. He was counseled on ways to prevent exposure in the future including use of protective gear including gloves, which he states that he always does. He was counseled that ways to prevent transmission or exposure to intimate contacts.","Doctor: All your labs are negative, and it's been six months from your injury, is that right, sir?
Patient: Yes, that is correct. What is your plan of action here?
Doctor: Okay so I do not see any physical findings that might suggest any type of contamination. Your labs were negative, but I would like you to take precautions going forward to keep yourself protected. Try to avoid these situations in future by being informed. Always wear gloves.
Patient: I will try to educate myself and be vigilant on that part. I will try to prevent any such transmission. I will not expose myself to any intimate contacts."
2:127,2,127,127,FAM/SOCHX,"Diabetes, Hypertension, Father had a Coronary Artery Bypass Graph (CABG) at age 34.","Doctor: Okay I would like to know if these illnesses are in your family? 
Patient: Okay shoot.
Doctor: Diabetes, hypertension, any heart diseases, cancers?
Patient: Yeah, my family have a few individuals with diabetes and hypertension. My dad underwent a heart surgery bypass at the age of thirty four."
2:133,2,133,133,PLAN,"No added salt, no concentrated sweets, thin liquids.","Doctor: Ma'am, you need to work on your diet. Specially avoid food and drinks with high sugar content and no extra salt. 
Patient: What do you suggest I eat?
Doctor: For now, you can start with clear thin fluids, like broth or clear soups. 
Patient: Okay!"
2:134,2,134,134,FAM/SOCHX,"retired truck driver. smokes 1-3 packs of cigarettes per day, but denied alcohol use. He is divorced and has two sons who are healthy. He lives with his mother.","Doctor: Are you working? 
Patient: I'm retired now, I worked as a truck driver before. 
Doctor: Do you smoke? 
Patient: Yeah, I do. 
Doctor: How many do you take in a day? 
Patient: Around one to three packs. 
Doctor: Do you drink? 
Patient: Nope. 
Doctor: Are you married? How many kids do you have? 
Patient: I'm divorced, and I have two sons. They both are into sports. They are healthy.
Doctor: So, you live with the kids? 
Patient: No, they visit me on weekends. I live with my mother."
2:135,2,135,135,GENHX,"The patient is a 39-year-old African-American female status post repair of septal deviation but unfortunately, ultimately ended with a large septal perforation.  The patient has been using saline nasal wash 2-3 times daily, however, she states that she still has discomfort in her nose with a ""stretching"" like pressure.  She says her nose is frequently dry and she occasionally has nosebleeds due to the dry nature of her nose.  She has no other complaints at this time.","Doctor: Good afternoon, ma'am. Can you confirm your age for me, please? 
Patient: I'm thirty nine years old, doctor. 
Doctor: Good, and you identify as African American, correct?
Patient: Yes, that's correct. 
Doctor: Great, are you familiar with the details of your operation? 
Patient: Someone told me, but I don't really remember what happened. 
Doctor: Okay, well, we did a repair of septal deviation, but unfortunately, we ended up with a large septal perforation. 
Patient: Okay, that's what I remember, thank you.
Doctor: Have you been using your saline nasal wash? 
Patient: Yeah, I have. 
Doctor: How many times per day have you been using it? 
Patient: Um, usually two or three times a day. 
Doctor: Have you had any discomfort? 
Patient: Yeah, I feel a stretching kind of pressure in my nose. 
Doctor: Is your nose dry? 
Patient: Yeah, and it bleeds because of it. 
Doctor: Other than what you've mentioned, do you have any other complaints at this time?  
Patient: No, everything else is pretty good."
2:136,2,136,136,GENHX,"Patient is a 50-year-old white male complaining of continued lower back pain.  Patient has a history of chronic back pain, dating back to an accident that he states he suffered two years ago.  He states he helped a friend unload a motorcycle from a vehicle two-and-a-half days ago, after which he ""felt it"" in his lower back.  The following day (two days ago), he states he rode to Massachusetts and Maine to pick up clients.  He feels that this aggravated his chronic back pain as well.  He also claims to have a screw in his right hip from a previous surgery to repair a pelvic fracture.  He is being prescribed Ultram, Celebrex, gabapentin, and amitriptyline by his PCP for his chronic back pain.  He states that his PCP has informed him that he does not prescribe opiate medications for chronic back pain. The patient did self-refer to another physician, who suggested that he follow up at a pain clinic for his chronic back pain to discuss other alternatives, particularly the medications that the patient feels that he needs.  Patient states he did not do this because he was feeling well at that time. The patient did present to our emergency room last night, at which time he saw Dr. X.  He was given a prescription for 12 Vicodin as well as some to take home last night.  The patient has not picked up his prescription as of yet and informed the triage nurse that he was concerned that he would not have enough to last through the weekend.  Patient states he also has methadone and Darvocet at home from previous prescription and is wondering if he should restart these medicines.  He is on several medications, the list of which is attached to the chart.","Doctor: What race and gender do you identify with?
Patient: I'm white, and I identify as male. 
Doctor: Okay, and how old are you? 
Patient: I'm fifty years old. 
Doctor: How long have you had lower back pain? 
Patient: It's been continuous for about two years. I was in an accident. 
Doctor: Has there been another accident since this one two years ago? 
Patient: About two and a half days ago I threw out my back while I was unloading my buddy's motorcycle. I really felt it when it happened.  
Doctor: Has your pain gotten worse over the last couple days? 
Patient: Yeah, I rode up to Massachusetts and Maine to pick up some clients the day after, and I think that aggravated my chronic back pain too. 
Doctor: Have you ever had surgery in the past? 
Patient: I broke my pelvis before, and I have a screw in my right hip. 
Doctor: What kind of treatments have you had for your back pain?
Patient: Um, I have them written down, um, Ultram, Celebrex, gabapentin, and amitriptyline. 
Doctor: Who prescribed you those? 
Patient: My P C P. He doesn't give opiates for chronic back pain. 
Doctor: Have you seen another doctor? 
Patient: I went to another doctor for another opinion, and he recommended that I follow up at a pain clinic to talk about more treatment options, um, like medicine. I think that's what I need.  
Doctor: Did you seen the pain management specialist? 
Patient: No, I wasn't feeling well at that time, so I came to the E D and I saw Doctor X. 
Doctor: How did Doctor X treat you?
Patient: He gave me a prescription for twelve Vicodin and he gave me some more to take home when I left the E D last night. 
Doctor: Did you fill that prescription? 
Patient: No, not yet. I told the nurse too, but I don't think I'll have enough to last through the weekend. 
Doctor: Do you have any medicine at home?
Patient: I have, um, methadone and Darvocet from previous prescriptions, should I restart those? 
Doctor: Let me write down the medicines you are taking and attach it to the chart."
2:138,2,138,138,ROS,"GENITOURINARY: No dysuria, hematuria, frequency, incontinence or colic.","Doctor: Any stomach pain? 
Patient: No. 
Doctor: Any pain while passing urine? 
Patient: No, no. 
Doctor: And no issues with bladder control, right?
Patient: Yeah, its fine. 
Doctor: Okay, good. And how about urine frequency, did you notice any increase or decrease?
Patient: No, seems normal to me. 
Doctor: Any blood in urine? 
Patient: Nothing like that."
2:139,2,139,139,PASTMEDICALHX,Asthma Allergic Rhinitis,"Doctor: Do you suffer from any allergies? 
Patient: I do. I struggle with asthma and hay fever. 
Doctor: Do you carry an inhaler around with you? 
Patient: Always."
2:140,2,140,140,GENHX,"Mr. XYZ is 41 years of age, who works for Chevron and lives in Angola.  He was playing basketball in Angola back last Wednesday, Month DD, YYYY, when he was driving toward the basket and felt a pop in his posterior leg.  He was seen locally and diagnosed with an Achilles tendon rupture.  He has been on crutches and has been nonweightbearing since that time. He had no pain prior to his injury.  He has had some swelling that is mild.  He has just been on aspirin a day due to his traveling time.  Pain currently is minimal.","Doctor: Good afternoon, Mister X Y Z, how are you today?
Patient: Well doctor, I wouldn't be here if I was doing well. 
Doctor: That's a good point, sir. Refresh my memory, how old are you?
Patient: I'm forty one years old now. 
Doctor: Where are you working now, sir?
Patient: I'm working for Chevron now, actually. 
Doctor: Very good, and are you still living in Angola?
Patient: Absolutely, yes sir.
Doctor: I hear it's beautiful there. So, what happened to this leg?
Patient: Well, um, I was playing basketball in Angola last Wednesday Month DD, YYYY when I was driving to the hoop, and I felt a pop in the back of my leg. 
Doctor: Oh no, have you seen another doctor for this?
Patient: Yeah, I got seen by another doctor around here. He said that I ruptured my Achilles tendon. 
Doctor: How have you been treated for this so far?
Patient: As you can see, I've been on crutches, and I've been keeping my weight off it since. 
Doctor: Did you have any pain before the injury?
Patient: No sir, none at all. 
Doctor: Have you taken any medicine for this?
Patient: I just take an aspirin a day, because I've been traveling so much. 
Doctor: That's a good point. Finally, how would you rate your pain today?
Patient: Well, I'd say its minimal today, just slightly swollen."
2:142,2,142,142,FAM/SOCHX,"Lives in a 1-story home with 1 step down; wife is there.  Speech and language pathology following with current swallowing dysfunction.  He is minimum assist for activities of daily living, bed mobility.","Doctor: Can you tell me more about your living situation at home, sir? 
Patient: Sure, I live with my wife. 
Doctor: Do you have stairs at home? 
Patient: Yeah, we have a one story house, but we have one step down on the porch. 
Doctor: Does she assist you with your daily activities? 
Patient: Well, some, I'd say she gives me minimal assistance. 
Doctor: I see. What symptoms are you having today? 
Patient: Well, I have some swallowing problems right now and problems with my speech and language, doctor."
2:143,2,143,143,GENHX,"Pain.  The patient is status-post surgery, he could not straighten his leg, pain in the back of the knee.","Doctor: The surgery went well, sir. How are you doing today?
Patient: I'm still having some pain today. 
Doctor: Well, you couldn't straighten that leg before the surgery, so some pain is not too bad, that's normal. 
Patient: Yeah, I was having that pain in the back of the knee too."
2:146,2,146,146,MEDICATIONS,Ritalin 50 a day.,"Doctor: What medications do you take?
Patient: I am on Ritalin. 
Doctor: How much do you take per day?
Patient: Fifty M G."
2:147,2,147,147,GENHX,This is a 51-year-old female had left shoulder pain of chronic nature who has had undergone prior rotator cuff debridement in May with partial pain relief and has had continued pain in the left shoulder.  MRI shows partial rotator cuff tear.,"Doctor: Hello, miss. How are you doing today? 
Patient: My shoulder is killing me. 
Doctor: I see. Which shoulder is it? 
Patient: My left one. 
Doctor: Hm. Did you get any previous procedures done? 
Patient: I did. Here's the report from the doctor who did my surgery. 
Doctor: Let me take a look. So, it looks like you underwent a prior rotator cuff removal, correct? 
Patient: Yeah, that's right. 
Doctor: When did that happen? 
Patient: Back in May. 
Doctor: I see. Would you say you've had chronic shoulder pain? 
Patient: Sure. 
Doctor: Did the procedure help? 
Patient: It took some pain away, but that's why I'm here now. 
Doctor: I understand. Did you get a M R I done? 
Patient: Oh, yeah. I forgot to give it to you. Here you go.
Doctor: It looks like you have a partial tear in your rotator cuff.
Patient: Aw. Nothing ever goes away when you turn fifty one. I guess I'll get it fixed."
2:149,2,149,149,ASSESSMENT,"1.  Palpitations, possibly related to anxiety. 2.  Fatigue. 3.  Loose stools with some green color and also some nausea.  There has been no vomiting, possibly a touch of gastroenteritis going on here.","Doctor: Okay let me see what we can do here. 
Patient: Okay
Doctor: You do have a stomach infection but no vomiting, right?
Patient: Yes none. But I do have nausea.
Doctor: Okay. So basically, diarrhea and green stools?
Patient: Yeah.
Doctor: Plus, palpitations that could be related to your anxiety.
Patient: Hm.
Doctor: Lastly fatigue.
Patient: Yes.
Doctor: I believe there could be some gastroenteritis in your stomach."
2:150,2,150,150,OTHER_HISTORY,unremarkable.,"Doctor: Hello. Looks like you're a new patient. How are you doing today?
Patient: I'm doing fine. My back has been hurting lately. 
Doctor: I see. Before we begin, I want to confirm some information with you. 
Patient: Sounds good. 
Doctor: Do you smoke or drink? 
Patient: Never have never will. 
Doctor: Does anyone in your family have a history of medical problems? 
Patient: Nope. 
Doctor: Thank you. Back to your injury. Have you ever had back pain before?
Patient: I've never. This is my first time."
2:151,2,151,151,PASTMEDICALHX,"Includes hyperlipidemia, hypothyroidism, history of migraines, acid reflux symptoms, mitral valve prolapse for which she takes antibiotic prophylaxis.","Doctor: So, do you have any other conditions that I should be aware of?
Patient: Let me check my notes here, um, I have hyperlipidemia and hyperthyroidism. 
Doctor: What about neurological symptoms? 
Patient: What do you mean by that?
Doctor: Anything like headaches, changes in vision, or dizziness. Does that ring any bells?
Patient: Actually, yes, I have a history of migraines. 
Doctor: Thank you. What about the stomach, anything going on there?
Patient: I have some heartburn, like when I eat junk food. 
Doctor: Good, thank you. Is your heart good?
Patient: Wait, I have something written down, um, I have mitral valve prolapse. 
Doctor: Okay, and how is this managed?
Patient: I take antibiotic prophylaxis every day."
2:160,2,160,160,PASTMEDICALHX,Aplastic crisis during childhood requiring splenectomy and a cholecystectomy at age 9.,"Doctor: You mentioned that you had two surgeries in the past. 
Patient: Yeah, I had two when I was nine.  
Doctor: Which two surgeries? 
Patient: I had my gallbladder and spleen taken out after they discovered that my body wasn't making enough new red blood cells to replace the ones I already had.  
Doctor: Do you remember experiencing any complications post op? 
Patient: Not that I can remember, no."
2:162,2,162,162,GENHX,"The patient is a 45-year-old African-American female whose symptoms first started some one and a half years ago with pain in the left shoulder and some neck pain.  This has subsequently resolved.  She started vigorous workouts in November 2005.  In March of this year, she suddenly could not feel her right foot on the bathroom floor and subsequently went to her primary care physician.  By her report, she had a nerve conduction study and a diagnosis of radiculopathy was made.  She had an MRI of lumbosacral spine, which was within normal limits.  She then developed a tingling sensation in the right middle toe.  Symptoms progressed to sensory symptoms of her knees, elbows, and left middle toe.  She then started getting sensory sensations in the left hand and arm.  She states that she feels a little bit wobbly at the knees and that she is slightly dragging her left leg.  Symptoms have been mildly progressive.  She is unaware of any trigger other than the vigorous workouts as mentioned above.  She has no associated bowel or bladder symptoms.  No particular position relieves her symptoms. Workup has included two MRIs of the C-spine, which were personally reviewed and are discussed.  She saw you for consultation and the possibility of surgical decompression was raised.  At this time, she is somewhat reluctant to go through any surgical procedure.","Doctor: Good afternoon, ma'am. Before we begin, how old are you?
Patient: Good afternoon, doctor, I'm forty five years young. 
Doctor: Great, and with what race do you identify?
Patient: I'm an African American. 
Doctor: Thank you, what seems to be the problem today?
Patient: It started a while ago. I've had this pain in my left shoulder and neck for the last year and a half.
Doctor: I see, have these symptoms been persistent for the last year and a half? Or do they come and go?
Patient: The pain actually went away all on its own once, but now I have pain in my right foot.
Doctor: Is there any injury that you can remember?
Patient: No, but I started working out really hard in November of two thousand and five. 
Doctor: Have these symptoms progressed? 
Patient: Well, in March of this year I couldn't feel my right foot on the bathroom floor one day, so I immediately called my P C P. 
Doctor: How did your P C P handle this?
Patient: She scheduled an, um, a nerve conduction study. 
Doctor: Do you remember the results of that study?
Patient: I have the report right here, take a look, please.
Doctor: Ah yes, radiculopathy, do you have any numbness or tingling into the legs or feet? 
Patient: Yes, it started tingling in my right middle toe, and then it began in my knees and left middle toe. Then, it even moved into my elbows, which was really concerning. 
Doctor: Did you have any other imagine done? 
Patient: Yes, I had an MRI of the lower back, take a look. 
Doctor: Yes, I see, everything looks normal here, and the report supports that. Okay, do you have any weakness or feelings of instability in the legs? 
Patient: Yes, my legs feel kind of wobbly, like at the knees, and I feel like I can't totally pick up my left leg. 
Doctor: Are these symptoms getting worse?
Patient: Yes, a little bit at a time, but it's definitely getting worse. 
Doctor: Okay, going back to the workouts you were doing, are you sure you can't remember anything that would have set this pain off? 
Patient: No, nothing there. 
Doctor: Are you having any trouble going to the bathroom?
Patient: No, absolutely not, everything is normal. 
Doctor: When you lay in bed, are any positions more comfortable than others?
Patient: No, honestly every position makes it hurt.
Doctor: Okay, and we've already done two M R I s of the neck, and I've talked about those with you, correct?
Patient: Yes, I remember that. 
Doctor: Have you seen another doctor for this pain?
Patient: Yes, I saw another surgeon who wanted to do, um, a decompression procedure. 
Doctor: Do you want to go forward with the surgery?
Patient: No, not really. I'm pretty reluctant to do any kind of surgery."
2:167,2,167,167,PLAN,"Endocrinology Consult, complete CBC.","Doctor: I think you need to see an endocrinologist. I am going to put a referral for endocrinology consult. 
Patient: Okay!
Doctor: Meanwhile I need you to get some blood tests.
Patient: Which blood tests?
Doctor: Just get the complete blood panel for now. I will put an order for that too.
Patient: Alright, thank you!"
2:171,2,171,171,FAM/SOCHX,"Diabetes, hypertension, stroke, Parkinson disease, and heart disease.","Doctor: Any chronic illnesses in your family?
Patient: What do you mean?
Doctor:  Like diabetes, hypertension, stroke, and heart disease?
Patient: Yes, I think so.
Doctor: How about Parkinson disease?
Patient: Yeah, someone had it.
Doctor: Can you tell me if that was a blood related relative?"
2:172,2,172,172,PASTMEDICALHX,"Negative for chronic medical problems.  No local physician.  Has had previous back surgery and appendectomy, otherwise generally healthy.","Doctor: Do you have a P C P? 
Patient: I just moved here so not yet. 
Doctor: Any medical problems? 
Patient: No. 
Doctor: Any past surgeries? 
Patient: I had my back operated on a few years ago and my appendix taken out. 
Doctor: But otherwise healthy? 
Patient: Yes."
2:174,2,174,174,FAM/SOCHX,The patient is widowed and a retired engineer.  He denies cigarettes smoking or alcohol intake.,"Doctor: I'm so sorry to hear about the loss of your beloved wife. 
Patient: Thank you. I am, too. She passed away way too soon. 
Doctor: How have you been coping? 
Patient: I've been taking longer walks with my dog. I haven't resorted to alcohol or cigarettes yet so kudos to me. 
Doctor: Are you still working? 
Patient: I retired years ago. 
Doctor: What was your profession? 
Patient: Engineer."
2:175,2,175,175,PASTMEDICALHX,Sciatica and melanoma.,"Doctor: Have you been treated for any conditions in the past? 
Patient: Um, yes, I used to have pain down my legs. 
Doctor: Yes, that's called sciatica. Is there anything else you know about?
Patient: Yeah, I had a melanoma too."
2:178,2,178,178,GENHX,This is a 36-year-old Caucasian female with a long-standing history of right knee pain.  She has been diagnosed in the past with chondromalacia patella.  She has failed conservative therapy.  It was discussed with her the possibility of a arthroscopy lateral release and a tubercle transfer (anterior medialization of the tibial tubercle) to release stress from her femoral patellofemoral joint.  She elected to proceed with the surgical intervention.  All risks and benefits of the surgery were discussed with her.  She was in agreement with the treatment plan.,"Doctor: Good morning, ma'am. 
Patient: Good morning, doctor. 
Doctor: Before we begin today, I just need to confirm a few pieces of information I got from the nurse. 
Patient: Absolutely, no problem. 
Doctor: Great, so you're thirty six years old, correct? 
Patient: Yeah, that's right. 
Doctor: And you identify as Caucasian? 
Patient: Yes, doctor. 
Doctor: Thank you, young lady. So, what seems to be the problem today. 
Patient: Well, I've had pain in this right knee for a long time. 
Doctor: Have you been treated for this before? 
Patient: Yes, and I've been diagnosed with, um, chondromalacia. 
Doctor: How have you been treated so far? 
Patient: I've taken antiinflammatories, rested, changed my activities, all of that. 
Doctor: Has there been any improvement? 
Patient: No, none at all. 
Doctor: Have you discussed surgery with anyone before. 
Patient: No, nobody's said anything yet. 
Doctor: Well, I think you'd be a good candidate for an arthroscopy lateral release and tubercle transfer. 
Patient: What will the surgery do?
Doctor: This will help take some stress off of the knee joint. It should help you feel a lot better. 
Patient: What are the risks of infection from the surgery, doctor?
Doctor: Well, you'll be relieved to know that it's less than one percent. We use prophylactic antibiotics the entire time. 
Patient: Will I be asleep for this?
Doctor: Yes, you won't feel a thing. 
Patient: Okay, yes. I agree, we should do the surgery."
2:182,2,182,182,ASSESSMENT,1.  Urinary dysuria. 2.  Left flank pain. 3.  Pharyngitis.,"Doctor: Hi there. How are you today? 
Patient: I am not felling well at all.  
Doctor: I am sorry to hear that.  What is going on? 
Patient: It started with a painful burning feeling when I pee.  Then I started having a pain in my left side.  Now my throat hurts."
2:185,2,185,185,GENHX,"This is a 62-year-old right-handed now left-handed white female with tremor since 5th grade.  She remembers that the tremors started in her right hand around that time subsequently later on in early 20s she was put on propranolol for the tremor and more recently within the last 10 years she has been put on primidone and clonazepam.  She thinks that her clonazepam is helping her a lot especially with anxiety and stress, and this makes the tremor better.  She has a lot of trouble with her writing because of tremor but does not report as much problem with other activities of daily living like drinking from a cup and doing her day-to-day activity.  Since around 6 to 7 years, she has had a head tremor, which is mainly ""no- no"" and occasional voice tremor also.  Additionally, the patient has been diagnosed with migraine headaches without aura, which are far and few apart.  She also has some stress incontinence.  Last MRI brain was done in 2001 reportedly normal.","Doctor: Happy belated birthday! I see that you recently turned sixty two years old.
Patient: Thank you so much. I appreciate the birthday wishes.
Doctor: You're very welcome. I have a few questions to ask before we begin. Are you right or left handed?
Patient: Interesting story. I used to be right handed but now I write with my left. 
Doctor: I see. And you identify as a white female?
Patient: Yes. 
Doctor: When were you first diagnosed with tremors?
Patient: Fifth grade so a long, long time ago. They actually started in my right hand. They placed me on Propranolol for tremors in my early twenties. 
Doctor: Are you taking propranolol currently?
Patient: I'm now taking primidone and clonazepam.
Doctor: When did you switch?
Patient: Within the last ten years or so.
Doctor: Have you noticed any improvement?
Patient: I'd say so. Clonazepam has been helping my anxiety and stress. I think it's improved my tremors as a result. But I'm still having a lot of difficulties writing due to my tremors. 
Doctor: Are you finding that your tremors are interfering with other daily living activities, such as drinking or washing the dishes?
Patient: Um not so much. I'm able to do day-to-day activities without as great of trouble. I'm wondering if it's because I need to keep an extra steady hand while writing. For about six to seven years now, I've developed a head tremor. I shake my head back and forth.
Doctor: Do you have any voice tremors?
Patient: I do.
Doctor: I see here that you were recently diagnosed with migraine headaches without aura. How often do you experience these migraines?
Patient: Once in a blue moon. Unrelated, but I forgot to mention that I experience stress incontinence here and there, too.
Doctor: I see. When did you last have an M R I?
Patient: Two thousand one.
Doctor: Do you remember if it was normal or abnormal?
Patient: Normal from what I recall. Nothing crazy."
2:186,2,186,186,FAM/SOCHX,Noted and reviewed today.  They are on the health care flow sheet.  She has significant anxiety which has been under fair control recently.  She has a lot of stress associated with a son that has some challenges.  There is a family history of hypertension and strokes.,"Doctor: How have you been feeling recently? 
Patient: Pretty good actually. My anxiety has calmed down a bit. I've gotten back into painting again, which I really enjoy. 
Doctor: Wonderful to hear. How are things at home? 
Patient: Honestly, that part of my life isn't so great. I've had a lot of trouble with my son recently. He spends a lot more time playing video games than he does on school. 
Doctor: Have you spoken to him about it? 
Patient: Oh all the time. He doesn't listen. 
Doctor: I'd recommend trying to reach a compromise with him so that he's able to get his work done as well. 
Patient: Yeah, his dad and I are planning to have another talk with him this weekend. 
Doctor: Hopefully, he'll realize the importance of setting aside time to get his work done.  
Patient: Fingers crossed. 
Doctor: Any family history of anxiety? 
Patient: Not that I know of. High blood pressure and strokes in the family, but nothing else."
2:189,2,189,189,FAM/SOCHX,Otherwise noncontributory.,"Doctor: Do you have a family history of arthritis? 
Patient: No, nobody that I know of. 
Doctor: What about other things, like high blood pressure? 
Patient: No, nothing like that either."
2:195,2,195,195,CC,Renal insufficiency.,"Doctor: Welcome back. How have you been feeling? 
Patient: I am not doing so well.  My symptoms have become worse. 
Doctor: I am sorry to hear that. I would like to discuss dialysis treatments with you again. I think it is time. 
Patient: Okay."