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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY 2. Valcyte (valGANciclovir) 500 mg oral DAILY 3. Senna 8.6 mg PO DAILY RX *sennosides [senna] 8.6 mg 1 tablet by mouth at bedtime Disp #*60 Tablet Refills:*1 4. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 1 dose by mouth DAILY Refills:*1 5. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Do not drink or drive while taking narcotics. RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 6. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 7. Cephalexin 500 mg PO Q6H Duration: 4 Doses Take for 1 more day - 1 tab every 6 hours RX *cephalexin 500 mg 1 tablet(s) by mouth every six (6) hours Disp #*4 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Large ventral hernias Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you here at ___ ___. You were admitted to our hospital after undergoing repair of your ventral hernia. You have recovered from surgery and are now ready to be discharged to home with services. Please follow the recommendations below to ensure a speedy and uneventful recovery. ACTIVITY: - Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. - You may climb stairs. - You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. - Don't lift more than 10 lbs for 6 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. - You may start some light exercise when you feel comfortable. - Heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. - You may resume sexual activity unless your doctor has told you otherwise. HOW YOU MAY FEEL: - You may feel weak or "washed out" for 6 weeks. You might want to nap often. Simple tasks may exhaust you. - You may have a sore throat because of a tube that was in your throat during surgery. - You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. - You could have a poor appetite for a while. Food may seem unappealing. - All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: - Your incision may be slightly red around the edges. This is normal. - If you have steri strips, do not remove them for 2 weeks. (These are the thin paper strips that are on your incision.) But if they fall off before that that's okay). - You may gently wash away dried material around your incision. - It is normal to feel a firm ridge along the incision. This will go away. - Avoid direct sun exposure to the incision area. - Do not use any ointments on the incision unless you were told otherwise. - You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. - You may shower, but do not bathe you are seen in clinic for follow-up. YOUR BOWELS: - Constipation is a common side effect of medicine such as Percocet or codeine. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. - If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. - After some operations, diarrhea can occur. If you get diarrhea, don't take anti-diarrhea medicines. Drink plenty of fluitds and see if it goes away. If it does not go away, or is severe and you feel ill, please call your surgeon. PAIN MANAGEMENT: - It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". - Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. -You will receive a prescription from your surgeon for pain medicine to take by mouth. It is important to take this medicine as directied. - Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. - Your pain medicine will work better if you take it before your pain gets too severe. - Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. - If you are experiencing no pain, it is okay to skip a dose of pain medicine. - Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the folloiwng, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: - Take all the medicines you were on before the operation just as you did before, unless you have been told differently. - If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen (Liquid) 650 mg PO Q6H:PRN Pain - Mild Reason for PRN duplicate override: Alternating agents for similar severity 2. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 3. Docusate Sodium 100 mg PO BID 4. Donepezil 10 mg PO QHS 5. Heparin 5000 UNIT SC BID ___ d/c after ambulatory 6. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 7. Multivitamins W/minerals Liquid 15 mL PO DAILY 8. Nystatin Oral Suspension 5 mL PO QID:PRN swish may diconstinue when no signs or symptoms 9. OxycoDONE Liquid ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg/5 mL ___ mg by mouth every four (4) hours Disp ___ Milliliter Refills:*0 10. Senna 8.6 mg PO BID:PRN constipation 11. Warfarin 2.5 mg PO 2X/WEEK (WE,SA) ON HOLD UNTIL ___ WITH ___. ___ 12. amLODIPine 5 mg PO DAILY 13. Aspirin 81 mg PO DAILY 14. Atorvastatin 10 mg PO QPM 15. Fish Oil (Omega 3) 1000 mg PO BID 16. irbesartan 300 mg oral DAILY 17. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 18. Metoprolol Succinate XL 50 mg PO DAILY 19. Omeprazole 20 mg PO DAILY 20. Warfarin 5 mg PO 5X/WEEK (___) ON HODL UNTIL FOLLOW UP WITH ___. ___ ___ Disposition: Extended Care Facility: ___ Discharge Diagnosis: retropharyngeal hematoma C4 vertebral body fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after walking into a door and hitting your face. You sustained a left eyelid injury. You were seen by the paramedics and declined admission to the emergency room. Shortly afterward, you felt short of breath and felt like your "airway was closing" prompting arrival to emergency room. You had an airway placed for airway protection. You had an elevated INR of 1.8 and was given medication to lower the level. You underwent imaging and you were reported to have a retro-pharyngeal hematoma and an isolated fracture to your neck. You were evaluated by Neurosurgery and no surgery was indicated. Your vital signs have been stable and you are preparing for discharge to a rehabilitation center to further regain your strength and mobility. You are being discharged with the following instructions: return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please return to the emergency room if you have a recurrence of neck pain, headache, and throat pain. If you begin to have difficulty swallowing it is important to return here. You will see Dr. ___ prior to resuming your coumadin</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H:PRN pain 2. Allopurinol ___ mg PO QPM 3. Aspirin 81 mg PO DAILY 4. Digoxin 0.125 mg PO DAILY 5. Insulin SC Sliding Scale Insulin SC Sliding Scale using REG Insulin 6. Metoprolol Tartrate 50 mg PO BID 7. PredniSONE 10 mg PO DAILY 8. Sodium Chloride Nasal ___ SPRY NU QID:PRN nasal dryness 9. Torsemide 20 mg PO DAILY 10. Vancomycin Oral Liquid ___ mg PO Q6H 11. Warfarin 3 mg PO DAILY16 12. Docusate Sodium 100 mg PO BID 13. Ferrous Sulfate 325 mg PO DAILY 14. Finasteride 5 mg PO DAILY 15. Gabapentin 300 mg PO QPM 16. Gabapentin 600 mg PO BID 17. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q4H:PRN pain 18. Pravastatin 40 mg PO DAILY 19. Omeprazole 40 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: e. coli septicemia e coli uti gi bleeding ischemic colitis acute blood loss anemia chronic systolic chf Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>you were hospitalized for gi bleeding that was from ischemic colitis. you underwent biopsy of your pancreas that did not show cancer. you received transfusion of blood. blood thinner was resumed. you were treated for bacterial infection and are undergoing treatment for C. diff infection. You will need a repeat ERCP in 6 weeks and repeat CT scan of your pancreas in 4 weeks to follow up findings in your pancreas.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY Duration: 30 Days 2. Amitriptyline 10 mg PO QHS 3. Verapamil SR 120 mg PO Q24H Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS/ES: ==================== -Supraventricular tachycardia due to atrioventricular node re-entrant tachycardia (AVNRT) SECONDARY DIAGNOSIS/ES: ======================== -Troponin elevation (demand myocardial infarction) -Hypertrophic cardiomyopathy -Hypertension -Ulcerative colitis -Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, WHY WERE YOU ADMITTED TO THE HOSPITAL: -You were having burning and palpitations in your chest -You had an abnormal, fast rhythm of the heart. This is called supraventricular tachycardia (SVT) WHAT WAS DONE FOR YOU WHILE IN THE HOSPITAL: -You were given medications to slow your heart rate down -You were monitored closely on a heart rhythm monitor -You were seen by the electrophysiologists (electrical doctors of the ___ -Your medications were adjusted to help prevent further episodes of SVT WHAT SHOULD YOU DO AFTER LEAVING THE HOSPITAL: -Please continue taking your medications as prescribed -Please follow-up with your outpatient doctors as ___ Thank you for allowing us to participate your care. We wish you the best of luck! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN pain or fever > 101.4 2. Docusate Sodium 100 mg PO BID 3. Famotidine 20 mg PO DAILY 4. LeVETiracetam 500 mg PO BID 5. Lisinopril 2.5 mg PO DAILY 6. Metoprolol Tartrate 12.5 mg PO BID 7. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: intraparenchymal hemorrhage IVH Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Take your pain medicine as prescribed. ¨ Exercise should be limited to walking; no lifting, straining, or excessive bending. ¨ Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. ¨ Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. ¨ If you were on a medication such as Coumadin (Warfarin), or Plavix (clopidogrel), or Aspirin prior to your injury, you may not resume taking this until you have been seen in follow up by Dr. ___. ¨ You have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING ¨ New onset of tremors or seizures. ¨ Any confusion, lethargy or change in mental status. ¨ Any numbness, tingling, weakness in your extremities. ¨ Pain or headache that is continually increasing, or not relieved by pain medication. ¨ New onset of the loss of function, or decrease of function on one whole side of your body.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Nephrocaps 1 CAP PO DAILY RX *B complex with C 20-folic acid [Mynephrocaps] 1 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*3 3. Percocet (oxyCODONE-acetaminophen) 1 tab mg oral TID:PRN pain 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 80 mg PO QPM 6. Gabapentin 100 mg PO TID:PRN pain 7. Omeprazole 20 mg PO DAILY 8. Senna 17.2 mg PO DAILY 9. sevelamer HYDROCHLORIDE 1600 mg oral TID W/MEALS Discharge Disposition: Home Discharge Diagnosis: PERIPHERAL VASCULAR DISEASE CHRONIC RENAL FAILURE GANGRENE, dry Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you at ___ ___. During your hospitalization, you had surgery to remove unhealthy tissue on your lower extremity. You tolerated the procedure well and are now ready to be discharged from the hospital. Please follow the recommendations below to ensure a speedy and uneventful recovery. LOWER TRANSMETATARSAL AMPUTATION DISCHARGE INSTRUCTIONS ACTIVITY •You should keep your amputation site elevated and straight whenever possible. This will prevent swelling of the stump and maintain flexibility in your joint. •It is very important that you put no weight or pressure on your stump with activity or at rest to allow the wound to heal properly. •You may use the opposite foot for transfers and pivots, if applicable. It will take time to learn to use a walker and learn to transfer into and out of a wheelchair. MEDICATION •Before you leave the hospital, you will be given a list of all the medicine you should take at home. If a medication that you normally take is not on the list or a medication that you do not take is on the list please discuss it with the team! •You will likely be prescribed narcotic pain medication on discharge which can be very constipating. If you take narcotics, please also take a stool softener such as Colace. If constipation becomes a problem, your pharmacist can suggest an additional over the counter laxative. •You should take Tylenol ___ every 6 hours, as needed for pain. If this is not enough, take your prescription narcotic pain medication. You should require less pain medication each day. Do not take more than a daily total of 3000mg of Tylenol. Tylenol is used as an ingredient in some other over-the-counter and prescription medications. Be aware of how much Tylenol you are taking in a day. BATHING/SHOWERING: •You may shower when you feel strong enough but no tub baths or pools until you have permission from your surgeon and the incision is fully healed. •After your shower, gently dry the incision well. Do not rub the area. WOUND CARE: •Please keep the wound clean and dry. It is very important that there is no pressure on the stump. If there is no drainage, you may leave the incision open to air. •Your staples/sutures will remain in for at least 4 weeks. At your followup appointment, we will see if the incision has healed enough to remove the staples. •Before you can be fitted for prosthesis (a man-made limb to replace the limb that was removed) your incision needs to be fully healed. CALL THE OFFICE FOR: ___ •Opening, bleeding or drainage or odor from your stump incision •Redness, swelling or warmth in your stump. •Fever greater than 101 degrees, chills, or worsening incisional/stump pain NO OTHER PROVIDER, EXCEPT YOUR VASCULAR SURGEON, SHOULD DETERMINE IF YOUR STAPLES ARE READY TO BE REMOVED FROM YOUR SURGICAL SITE. IF THERE ARE ANY QUESTIONS, THE PROVIDER SHOULD CALL THE VASCULAR SURGERY OFFICE AT ___ TO DISCUSS. THE STAPLES/SUTURES WILL BE REMOVED IN THE OFFICE AT YOUR FOLLOWUP APPOINTMENT WHEN IT IS DETERMINED BY THE VASCULAR SURGEON THAT THE WOUND HAS SUFFICIENTLY HEALED.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing 2. Acetaminophen 325-650 mg PO/PR Q4H:PRN Pain RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours as needed for pain Disp #*50 Tablet Refills:*0 3. Lorazepam 0.5 mg PO Q4H:PRN anxiety RX *lorazepam 0.5 mg 1 tab by mouth once every 4 hours as needed for anxiety/pain Disp #*24 Tablet Refills:*0 4. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every 6 hours as needed for pain Disp #*28 Tablet Refills:*0 5. Tamsulosin 0.4 mg PO DAILY RX *tamsulosin 0.4 mg 1 capsule(s) by mouth once daily Disp #*5 Capsule Refills:*0 6. Metoclopramide 10 mg PO Q8H:PRN nausea RX *metoclopramide HCl 10 mg 1 tab by mouth every 8 hours as needed for nausea Disp #*21 Tablet Refills:*0 7. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron 4 mg 1 tablet(s) by mouth every 8 hours as needed for nausea Disp #*21 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Renal colic Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure participating in your care at ___. You were admitted with severe abdominal pain that was most likely due to a small kidney stone, though it was not visualized on CAT scan and UA was negative. Your pain has improved, and as we discussed, you will be discharged with a short course of oxycodone, tylenol and ibuprofen, as well as Reglan and Zofran. Finally, you are given a prescription for a medicine to help the stone pass if it has not already. Please sip fluids to stay hydrated as you recover.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 3. Dexamethasone 3 mg PO Q8H Duration: 6 Doses Taper 1 This is dose # 2 of 4 tapered doses 4. Dexamethasone 1 mg PO Q8H Duration: 6 Doses Taper #3 This is dose # 4 of 4 tapered doses 5. Dexamethasone 2 mg PO Q8H Duration: 6 Doses Taper #2 This is dose # 3 of 4 tapered doses 6. Docusate Sodium 100 mg PO BID:PRN constipation 7. Heparin 5000 UNIT SC BID 8. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Moderate 9. Neutra-Phos 2 PKT PO BID 10. NiMODipine 60 mg PO Q4H 11. Senna 17.2 mg PO QHS:PRN constipation 12. TiCAGRELOR 90 mg PO BID 13. Acetaminophen-Caff-Butalbital ___ TAB PO Q8H:PRN Pain - Moderate Reason for PRN duplicate override: switching tyelenol 14. Aspirin 81 mg PO DAILY 15. Atorvastatin 20 mg PO QPM 16. Calcium Carbonate 500 mg PO BID 17. Fluticasone Propionate NASAL 2 SPRY NU DAILY 18. Loratadine 10 mg PO DAILY 19. Vitamin D 400 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Subarachnoid hemorrhage Right ICA pseudoaneursym Hypertension Headache Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Activity · You may gradually return to your normal activities, but we recommend you take it easy for the next ___ hours to avoid bleeding from your groin. · Heavy lifting, running, climbing, or other strenuous exercise should be avoided for ten (10) days. This is to prevent bleeding from your groin. · You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. · Do not go swimming or submerge yourself in water for five (5) days after your procedure. · You make take a shower. Medications · Resume your normal medications and begin new medications as directed. · It is very important to take the medication your doctor ___ prescribe for you to keep your blood thin and slippery. This will prevent clots from developing and sticking to the stent. · You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. · If you take Metformin (Glucophage) you may start it again three (3) days after your procedure. Care of the Puncture Site · The small bandage over the site was removed. · Keep the site clean with soap and water and dry it carefully. · You may use a band-aid if you wish. What You ___ Experience: · Mild tenderness and bruising at the puncture site (groin). · Soreness in your arms from the intravenous lines. · The medication may make you bleed or bruise easily. · Fatigue is very normal. When to Call Your Doctor at ___ for: · Severe pain, swelling, redness or drainage from the puncture site. · Fever greater than 101.5 degrees Fahrenheit · Constipation · Blood in your stool or urine · Nausea and/or vomiting Call ___ and go to the nearest Emergency Room if you experience any of the following: · Sudden numbness or weakness in the face, arm, or leg · Sudden confusion or trouble speaking or understanding · Sudden trouble walking, dizziness, or loss of balance or coordination · Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Baclofen 10 mg PO TID 2. Betamethasone Dipro 0.05% Cream 1 Appl TP BID 3. Citalopram 40 mg PO DAILY 4. ClonazePAM 1 mg PO TID 5. Cyanocobalamin 1000 mcg PO DAILY 6. Docusate Sodium 100 mg PO BID 7. Lisinopril 20 mg PO DAILY 8. Loratadine 10 mg PO DAILY:PRN allergic rhinitis 9. Metoprolol Tartrate 50 mg PO BID 10. Multivitamins 1 TAB PO DAILY 11. Omeprazole 20 mg PO DAILY 12. OxyCODONE SR (OxyconTIN) 10 mg PO Q12H 13. Vitamin D 1000 UNIT PO DAILY 14. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN sob, wheeze 15. Aspirin 81 mg PO DAILY 16. Ferrous Sulfate 325 mg PO DAILY 17. Nicotine Patch 21 mg TD DAILY 18. Torsemide 60 mg PO DAILY 19. Zolpidem Tartrate 10 mg PO HS:PRN insomnia Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: diastolic CHF exacerbation Secondary: peripheral edema, macrocytic anemia, alcohol abuse Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for worsening leg and abdominal swelling, worsening shortness of breath, and low blood counts. We gave you medications to help you urinate out extra fluid. We were able to get fluid out of your lungs and you no longer requried oxygen to breathe. The fluid in your legs improved. You received blood to elevated your blood count to help your breathing and fatigue. Your blood counts remained stable. Please weigh yourself daily.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO DAILY 2. Enoxaparin Sodium 120 mg SC QDAY Start: ___, First Dose: Next Routine Administration Time 3. Levothyroxine Sodium 100 mcg PO DAILY 4. Loratadine 10 mg PO DAILY:PRN allergies 5. OLANZapine 2.5 mg PO QAM 6. OLANZapine 2.5 mg PO QPM 7. Senna 8.6 mg PO DAILY 8. Acetaminophen 500 mg PO Q6H:PRN headache 9. Dexamethasone 4 mg PO Q12H 10. Pantoprazole 40 mg PO Q24H 11. Polyethylene Glycol 17 g PO DAILY:PRN constipation 12. Omeprazole 40 mg PO QAM Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Brain metastases Cerebral edema History of lung cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms ___ it was a pleasure caring for you during your stay at ___. You were admitted with headache and difficulty with balance. You were found to have multiple brain tumors as well as swelling in the brain. You were started on radiation treatment which you have been tolerating well. We did not find any other areas where the cancer spread. Your steroid dose will be determined by the radiation oncologists. You also have a repeat brain MRI scheduled about one month after you complete radiation. You are discharged to ___ in ___ to continue rehabilitation. You will return to complete radiation this week. ___ at 10:30am. No treatment is scheduled on ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Glargine 40 Units Breakfast Glargine 40 Units Dinner Insulin SC Sliding Scale using HUM Insulin 3. Psyllium Powder 1 PKT PO DAILY 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 80 mg PO QPM 6. Calcium Carbonate 1500 mg PO DAILY 7. Clopidogrel 75 mg PO DAILY 8. Cyanocobalamin 1000 mcg PO DAILY 9. econazole 1 % topical DAILY 10. Estrogens Conjugated 1 gm VG 1X/WEEK (FR) 11. FLUoxetine 40 mg PO DAILY 12. Isosorbide Mononitrate (Extended Release) 150 mg PO QAM 13. Isosorbide Mononitrate (Extended Release) 30 mg PO QPM 14. Loratadine 10 mg PO DAILY 15. Lovaza (omega-3 acid ethyl esters) 1 gram oral BID 16. MetFORMIN (Glucophage) 500 mg PO QHS 17. Metoprolol Succinate XL 75 mg PO DAILY 18. Multivitamins 1 TAB PO DAILY 19. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 20. Omeprazole 40 mg PO BID Discharge Disposition: Home Discharge Diagnosis: PRIMARY: -Unstable Angina, s/p catheterization -Coronary Artery Disease s/p CABG Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the ___ Cardiology Team ___ after you had worsening chest pain. What was done? =============== -You had a cardiac catheterization which showed some narrowing and blockages, but none were suitable to have new stent placement. -We increased your lisinopril dose from 5 mg to 10 mg which may help with your pain. What to do next? ================== -Please follow up with your primary care ___ at 12P) and cardiologist ___ at 2P) for further medication titration as needed. These appointments have been scheduled for you. -We recommend no strict exercise limitations, walking is helpful for your heart, but avoid excessive stress. -Avoid fast food and fried foods as well as red meat. Eat food high in fiber such as fruits and vegetables. We wish you the best! - Your ___ cardiology team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Moderate RX *acetaminophen 500 mg 2 tablet(s) by mouth every eight (8) hours Disp #*20 Tablet Refills:*0 2. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet by mouth twice a day Disp #*8 Tablet Refills:*0 3. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID Duration: 1 Week RX *chlorhexidine gluconate 20 % 15mL twice a day Refills:*0 4. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Benztropine Mesylate 2 mg PO QHS 6. BuPROPion (Sustained Release) 300 mg PO QAM 7. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -400 unit oral DAILY 8. Docusate Sodium 100 mg PO BID 9. Fluticasone Propionate 110mcg 2 PUFF IH BID 10. Fluticasone Propionate NASAL 1 SPRY NU DAILY 11. Gabapentin 300 mg PO QHS 12. Gabapentin 600 mg PO TID 13. Loratadine 10 mg PO DAILY 14. MetFORMIN (Glucophage) 500 mg PO BID 15. Mylanta 30 mL ORAL TID:PRN nausea/heartburn 16. OLANZapine 35 mg PO QHS 17. Omeprazole 20 mg PO BID 18. Polyethylene Glycol 17 g PO DAILY 19. Senna 17.2 mg PO DAILY 20. Sertraline 100 mg PO DAILY 21. Simvastatin 40 mg PO QPM 22. TraZODone 100 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY: Periapical Abscess Multiple Dental Carries Urinary Retention SECONDARY: Schizophrenia Obstructive Sleep Apnea Hypertension Diabetes Gastroesphageal reflux Chronic Obstructive Pulmonary Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you Why you were here: -You were in the hospital because you were complaining of jaw pain and swelling from an infection around you tooth -You were not urinating well What we did for you: -You were given antibiotics for the treatment of your infection -The oral surgeons drained a pocket of infection around your tooth -A foley catheter was placed to drain the urine in the bladder What you should do after leaving the hospital: -Call the oral surgery clinic (___ Building at ___ - ___ at EXACTLY 7:00am any day ___ through ___ so you can have a same day clinic appointment to get your teeth removed. -Please continue taking your antibiotic (augmentin) twice a day to be completed for a 7 day course (last dose on ___ -please use the chlorhexadine to rinse your mouth twice a day -Please continue taking all your medicine and follow up with your primary care doctor and dentist We wish you the best, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Carbidopa-Levodopa (___) 2 TAB PO TID 3. Fluticasone Propionate NASAL 2 SPRY NU DAILY 4. Losartan Potassium 25 mg PO BID 5. Metoprolol Succinate XL 100 mg PO DAILY 6. Omeprazole 20 mg PO DAILY 7. Acetaminophen 1000 mg PO Q8H:PRN headache/fever 8. Levothyroxine Sodium 12.5 mcg PO DAILY 9. Meclizine 12.5 mg PO TID standing through ___ - then PRN 10. Furosemide 20 mg PO DAILY:PRN swelling 11. Zenpep (lipase-protease-amylase) 25,000-85,000- 136,000 unit oral 1 capsule by mouth three times daily To be restarted after meclizine stopped. if needed 12. Oxybutynin 2.5 mg PO TID 13. Venlafaxine XR 37.5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: peripheral vertigo vascular parkinsonism Gait instability Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to the neurology service because of you worsening gait. We restarted your home medications and this improved greatly. You were evaluated by ___ and will be going to acute rehab to work on your gait.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Baclofen 5 mg PO TID:PRN hiccups RX *baclofen 5 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 2. Lidocaine Viscous (lidocaine HCl) 2 % mucous membrane TID:PRN RX *lidocaine HCl [Lidocaine Viscous] 2 % 10mL three times a day Refills:*2 3. Maalox/Diphenhydramine/Lidocaine 5 mL PO QID mouth/throat pain RX *alum-mag hydroxide-simeth [Maalox Advanced] 200 mg-200 mg-20 mg/5 mL 5 ml by mouth four times a day Refills:*1 5. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 6. Acetaminophen 1000 mg PO Q8H 7. Lidocaine 5% Patch 1 PTCH TD QPM R lateral chest wall 8. melatonin 3 mg oral QHS:PRN 9. Morphine SR (MS ___ 15 mg PO Q12H 10. Ondansetron 8 mg PO Q8H:PRN Nausea/Vomiting - First Line 11. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN BREAKTHROUGH PAIN RX *oxycodone 5 mg/5 mL 5 ml by mouth every four (4) hours Refills:*0 12. Polyethylene Glycol 17 g PO DAILY 13. Prochlorperazine 10 mg PO Q6H:PRN Nausea/Vomiting - Second Line 14. Rivaroxaban 20 mg PO DAILY 15. Senna 8.6 mg PO BID:PRN Constipation - First Line Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: # Dysphagia (solids > liquids) ___ tumoral compression # Odynophagia ___ mucositis # Metastatic high-grade neuroendocrine carcinoma of the mediastinum # Cancer associated chest pain # Leukopenia, neutropenia # Acute on chronic anemia # Malignant hemoptysis and tracheal compression s/p stenting ___ s/p stent removal Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr ___ It was a pleasure taking care of you. As you know you were admitted due to difficulty swallowing which we found was due to irritated tissue. You were given a short course of steroids and medications to control the symptoms. Since you are now eating normally you don't need steroids but can continue the other meds to ensure pain relief. Please be sure to followup with Dr ___ and continue your remaining radiation treatments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Citalopram 10 mg PO DAILY RX *citalopram 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 2. Furosemide 20 mg PO DAILY RX *furosemide 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 3. 70/30 16 Units Breakfast 70/30 10 Units Dinner Insulin SC Sliding Scale using HUM Insulin RX *insulin NPH and regular human [Humulin 70/30] 100 unit/mL (70-30) 16 Units before BKFT ; 10 Units before DINR daily Disp #*3 Vial Refills:*1 4. Lactulose 45 mL PO QID RX *lactulose 10 gram/15 mL (15 mL) 45 ml by mouth four times a day Disp #*5400 Milliliter Refills:*1 5. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth daily Disp #*30 Capsule Refills:*1 6. Rifaximin 550 mg PO BID RX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*3 7. Spironolactone 50 mg PO DAILY RX *spironolactone 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 8. Nadolol 20 mg PO DAILY RX *nadolol 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 9. alpha lipoic acid ___ unit oral qam 10. Caltrate 600 (calcium carbonate) 600 mg (1,500 mg) oral BID RX *calcium carbonate 600 mg (1,500 mg) 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 11. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*1 12. Ferrous Sulfate 325 mg PO DAILY RX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 13. Magnesium Oxide 280 mg PO DAILY RX *magnesium oxide 250 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 14. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet,delayed release (___) by mouth twice a day Disp #*60 Tablet Refills:*1 15. Ciprofloxacin HCl 500 mg PO Q12H Duration: 3 Days RX *ciprofloxacin 500 mg 1 tablet(s) by mouth twice a day Disp #*6 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: gastric antral vascular ectasias decompensated cirrhosis acute toxic/metabolic encephalopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (___) Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to the hospital with bleeding and confusion. Your confusion cleared quickly with lactulose. You underwent endoscopy that showed non-bleeding esophageal varices, and areas of bleeding in your stomach related to your cirrhosis. You underwent a procedure called APC during your endoscopy to stop the bleeding, and your blood counts stabilized. During your admission, you started the evaluation for liver transplant with laboratory testing and social work consultation. You should follow up with the transplant hepatologist on ___, as previously scheduled, for further evaluation. You also underwent an echocardiogram on admission that showed your aortic stenosis has worsened. You were evaluated by cardiology. You should follow up with your outpatient cardiologist for further management of your aortic stenosis. You may need a special echo called a "trans-esophageal echo" in the future, if you are to be further evaluated for liver transplantion.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain or fever RX *acetaminophen 325 mg 2 tablet(s) by mouth every six (6) hours Disp #*45 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain Please do not operate heavy machinery, drink alcohol, or drive RX *oxycodone [Oxecta] 5 mg ___ tablet, oral only(s) by mouth every four (4) hours Disp #*75 Tablet Refills:*0 4. Amlodipine 10 mg PO DAILY 5. Sulfameth/Trimethoprim SS 1 TAB PO BID Duration: 3 Days RX *sulfamethoxazole-trimethoprim 400 mg-80 mg 1 tablet(s) by mouth twice a day Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: 1. Cervical disk herniation C4-5. 2. Cervical right upper extremity radicular symptoms with weakness. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>ACDF: You have undergone the following operation: Anterior Cervical Decompression and Fusion Immediately after the operation: • Activity: You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit in a car or chair for more than ~45 minutes without getting up and walking around. • Rehabilitation/ Physical Therapy: ___ ___ times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. ___ Isometric Extension Exercise in the collar: 2x/day x ___xercises as instructed. • Swallowing: Difficulty swallowing is not uncommon after this type of surgery. This should resolve over time. Please take small bites and eat slowly. Removing the collar while eating can be helpful – however, please limit your movement of your neck if you remove your collar while eating. • Cervical Collar / Neck Brace: You have been given a soft collar for comfort. You may remove the collar to take a shower or eat. Limit your motion of your neck while the collar is off. You should wear the collar when walking, especially in public • Wound Care: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually ___ days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Call the office at that time. If you have an incision on your hip please follow the same instructions in terms of wound care. • You should resume taking your normal home medications. • You have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so plan ahead. You can either have them mailed to your home or pick them up at the clinic located on ___ 2. We are not allowed to call in narcotic (oxycontin, oxycodone, percocet) prescriptions to the pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. • Follow up: ___ Please Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. ___ At the 2-week visit we will check your incision, take baseline x rays and answer any questions. ___ We will then see you at 6 weeks from the day of the operation. At that time we will most likely obtain Flexion/Extension X-rays and often able to place you in a soft collar which you will wean out of over 1 week. Please call the office if you have a fever>101.5 degrees Fahrenheit, drainage from your wound, or have any questions.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ascorbic Acid ___ mg PO DAILY 2. Atorvastatin 10 mg PO DAILY 3. Digoxin 0.25 mg PO DAILY 4. Finasteride 5 mg PO DAILY 5. Losartan Potassium 80 mg PO DAILY 6. Polyethylene Glycol 17 g PO DAILY:PRN constipation 7. Zolpidem Tartrate 10 mg PO HS:PRN insomnia 8. Acetaminophen 650 mg PO Q6H:PRN pain 9. Triamterene 32.5 mg PO DAILY ___ edema 10. Tricor *NF* (fenofibrate nanocrystallized) 48 mg ORAL DAILY Discharge Disposition: Home Discharge Diagnosis: Ecchymosis Supratherapeutic INR Mild hemarthrosis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you while you were admitted to ___. You were admitted because of pain at your elbow and redness/bruising on your right arm. We checked your bloodwork and found you to have an elevated INR (Coumadin level) which has lead to ecchymosis or bleeding within the superficial skin layers. We evaluated your arm with ultrasound and the preliminary read confirmed that there was no hematoma or blood collection that would require further intervention. Also, we repeated your INR which was trending down. After serial examinations of your arm, we feel that the current area of redness is not expanding further. When you return home, it is important that you do not take Coumadin today. Tomorrow, you have an appointment with your PCP, ___, at 3pm for a check-up of your arm and repeat INR level. Dr. ___ will instruct you on further Coumadin dosing. Additionally, please call your cardiologist to arrange an appointment in the next ___ days.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen-Caff-Butalbital ___ TAB PO Q4H:PRN Headache Do not exceed 6 tablets/day RX *butalbital-acetaminophen-caff 50 mg-325 mg-40 mg ___ tablet(s) by mouth every 4 hours Disp #*20 Tablet Refills:*0 2. Meclizine 12.5 mg PO Q8H:PRN dizziness RX *meclizine 12.5 mg 1 tablet(s) by mouth every 8 hours Disp #*60 Tablet Refills:*0 3. NIFEdipine (Extended Release) 60 mg PO DAILY RX *nifedipine 60 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Third Line RX *polyethylene glycol 3350 17 gram 1 powder(s) by mouth daily Disp #*30 Packet Refills:*0 5. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 by mouth two times per day Disp #*60 Tablet Refills:*0 6. Dexamethasone 4 mg PO BID 7. Ibuprofen 800 mg PO Q8H:PRN Pain - Mild 8. Omeprazole 40 mg PO DAILY 9. Ondansetron 4 mg PO Q8H:PRN Nausea/Vomiting - First Line 10.Outpatient Speech/Swallowing Therapy Clinical swallow evaluation and therapy for dysphagia ICD-10: R13.10 11.Outpatient Lab Work Please draw CBC on ___ Results should be faxed to Dr. ___ at ___. ICD-10: ___.___ Discharge Disposition: Home Discharge Diagnosis: Primary: Thalamic glioblastoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. Why was I admitted to the hospital? - You were dizzy and had difficulty speaking What was done while I was in the hospital? - You had an MRI that showed your cancer was stable - You had a swallow study that showed you are at risk for aspirating What should I do when I get home from the hospital? - Be sure to continue to take your medications as prescribed - Please go to all of your follow-up appointments, including with oncology and the speech and swallow team - If you have headache, nausea, vomiting, new weakness, numbness, tingling, problems speaking, worsening dizziness, or generally feel unwell, please call your doctor or go to the emergency room Sincerely, Your ___ Treatment Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Please shower daily -wash incisions gently with mild soap, no baths or swimming, look at your incisions daily Please - NO lotion, cream, powder or ointment to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics Clearance to drive will be discussed at follow up appointment with surgeon No lifting more than 10 pounds for 10 weeks **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours** **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Multivitamins 1 TAB PO DAILY 3. Omeprazole 20 mg PO BID 4. Pravastatin 40 mg PO DAILY 5. Amlodipine 10 mg PO DAILY 6. Docusate Sodium 100 mg PO BID discontinue if more that 7 loose stools per day 7. Senna 8.6 mg PO BID:PRN constipation discontinue use if more than 7 loose stools a day 8. FoLIC Acid 1 mg PO DAILY 9. Furosemide 20 mg PO DAILY 10. Hydrochlorothiazide 50 mg PO DAILY 11. Losartan Potassium 50 mg PO DAILY 12. Metoprolol Succinate XL 100 mg PO DAILY 13. Thiamine 100 mg PO DAILY 14. Acetaminophen 650 mg PO Q6H pain do not exceed more than 4gms a day Discharge Disposition: Home Discharge Diagnosis: Rib fractures secondary to Mechanical fall Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Thank you for choosing ___ for your care. You were seen in the emergency room by the Acute Care/Trauma Surgery team for a fall that happened a few days before you came in. You were admitted for pain control and was monitored for alcohol withdrawal since you had an elevated blood alcohol level. After evaluation from the Trauma service and Psychiatric service, you are now able to return home for further recovery. Rib Fractures: * Your injury caused 9 - 10th rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. * You should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. If the pain medication is too sedating take half the dose and notify your physician. * Pneumonia is a complication of rib fractures. In order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. This will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. * You will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. * Symptomatic relief with ice packs or heating pads for short periods may ease the pain. * Narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. * Do NOT smoke * If your doctor allows, non-steroidal ___ drugs are very effective in controlling pain ( ie, Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. * Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs (crepitus).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Protonix Wellbutrin Discharge Disposition: Home Discharge Diagnosis: Enteritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with abdominal pain. A CT abdomen at an outside hospital raised the possibility of a partial small bowel obstruction and you were transferred here for further workup. We repeated the CT abdomen, this time with oral contrast which can provide more information, and there was no evidence of a small bowel obstruction. There was no evidence of an acute abdominal process to explain your abdominal pain. You have been tolerating a stage III bariatric diet and you are safe to be discharged. Please return to the ___ if you have any recurrent abdominal pain or have any difficulty taking food down. Please also stop taking any NSAIDs, including aleve aspirin or advil. We also drew nutrition las, and you are iron deficient. Please be sure to have close follow up with nutrition labs either by your PCP or ___ nutritionist. We called your PCP to ensure they also know this information. Please also continue to take any medications you were on prior to your arrival EXCEPT for any NSAIDs including aleve or advil; these should be stopped.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ramelteon 8 mg PO QHS:PRN insomnia 2. amLODIPine 10 mg PO DAILY 3. Lisinopril 40 mg PO DAILY 4. Escitalopram Oxalate 20 mg PO DAILY 5. Levothyroxine Sodium 75 mcg PO DAILY 6. meloxicam 15 mg oral DAILY 7. Pantoprazole 40 mg PO Q24H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Fall, altered mental status Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Mental Status: Confused - sometimes. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after a fall and presumed loss of consciousness. We evaluated you for causes of your frequent falls, including arrhythmias, heart attacks, deconditioning, and low blood pressure. Ultimately we were not able to find a single unifying reason for your falls, however a condition called orthostatic hypotension may be contributing, as well as being on multiple sedating medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*5 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*1 3. Senna 1 TAB PO BID:PRN constipation 4. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 5. Megestrol Acetate 400 mg PO DAILY RX *megestrol 400 mg/10 mL (40 mg/mL) 1 Suspension(s) by mouth once a day Disp #*30 Packet Refills:*0 6. Metoclopramide 10 mg PO QIDACHS RX *metoclopramide HCl 10 mg 1 by mouth QIDACHS Disp #*56 Tablet Refills:*0 7. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*120 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1. Metastatic well differentiated adenocarcinoma. 2. Chronic cholecystitis and cholelithiasis. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the surgery service at ___ for surgical evaluation of your biliary obstruction. You have done well in the post operative period and are now safe to return home to complete your recovery with the following instructions: Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery. Please call your doctor or nurse practitioner if you experience the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain is not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BuPROPion (Sustained Release) 450 mg PO HS 2. Clonazepam 2 mg PO BID 3. Divalproex (DELayed Release) 500 mg PO QAM 4. Divalproex (DELayed Release) 750 mg PO HS 5. Doxepin HCl 100 mg PO HS 6. Ferrous Sulfate 325 mg PO DAILY 7. Furosemide 40 mg PO DAILY 8. Paroxetine 30 mg PO DAILY 9. Quetiapine extended-release 500 mg PO DAILY 10. TraMADOL (Ultram) 25 mg PO BID 11. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 12. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO QID:PRN GI upset 13. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN shortness of breath or wheezing 14. Bisacodyl 10 mg PR HS:PRN constipation not responsive to milk of magensia 15. Fleet Enema ___AILY:PRN constipation not responsive to suppository 16. Guaifenesin 10 mL PO Q6H:PRN cough 17. Milk of Magnesia 30 mL PO QHS:PRN constipation 18. Prochlorperazine 10 mg PO Q6H:PRN nausea or vomiting 19. TraMADOL (Ultram) 25 mg PO BID for back pain 20. Acetaminophen 650 mg PO Q6H:PRN pain or fever 21. Miconazole Powder 2% 1 Appl TP BID:PRN rash 22. Polyethylene Glycol 17 g PO EVERY OTHER DAY hold for diarrhea 23. ___ MD to order daily dose PO DAYS (___) Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Mechanical Fall Erosive gastritis Secondary: Bipolar disorder Gastroesophageal reflux disorder History of deep venous thrombosis Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Mental Status: Confused - sometimes. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted after you had a fall, and were vomiting blood. While you were hospitalized, you underwent two head CT scans, both of which did not demonstrate evidence of acute bleed after your falls. Given your history of vomiting blood, you were initially admitted to the ICU. Here you were started on a new medication, called pantoprazole, to treat your GI bleed. You were monitored for evidence of bleeding, which you did not have. You improved, and you were transferred to the normal medicine floor. You undewent an EGD, where the GI doctors used ___ to look into your esophagus, stomach, and first part of your small intestine. During this procedure, it was discoverd that you have erosive gastritis, which is likley the cause of the blood in your vomit. Additionally, you were found to have a large amount of food in your stomach. The GI doctors who did this procedure recommend that you have a repeat EGD in 8 weeks to evaluate for healing, as well as an outpatient gastric emptyng study to evaluate the cause of the food retention in your stomach. Please note that the following changes were made to your medications: 1. Please start taking pantoprazole 40 mg by mouth twice a day Please discuss your medications with your PCP and psychiatrist. It is possible your medications are contributing to your unsteadiness, and you may benefit from having your medications adjusted.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q12H 2. Aspirin 81 mg PO DAILY 3. Atovaquone Suspension 1500 mg PO DAILY 4. CycloSPORINE (Neoral) MODIFIED 50 mg PO Q12H 5. Diltiazem Extended-Release 180 mg PO DAILY 6. FoLIC Acid 1 mg PO DAILY 7. Metoprolol Succinate XL 100 mg PO QPM 8. Metoprolol Succinate XL 200 mg PO QAM 9. PredniSONE 7.5 mg PO DAILY 10. Cyanocobalamin 1000 mcg PO DAILY 11. Magnesium (oxide/AA chelate) (magnesium oxide-Mg AA chelate) 133 mg oral BID 12. Potassium Chloride 10 mEq PO TID 13. Furosemide 40 mg PO EVERY OTHER DAY 14. Furosemide 80 mg PO EVERY OTHER DAY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: - Acute on Chronic Kidney Injury Secondary Diagnoses: - Acute on Chronic Diastolic Heart Failure - Atrial fibrillation - Coronary artery disease - Chronic Lymphocytic Leukemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of ___ during your recent admission to ___ came to use because your creatinine was increased. We gave ___ fluids and your creatinine improved. We also adjusted your diuretic regimen. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. We wish ___ a fast recovery. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Benzonatate 200 mg PO TID Cough RX *benzonatate 100 mg 1 capsule(s) by mouth three times a day Disp #*30 Capsule Refills:*1 2. GuaiFENesin ER 1200 mg PO Q12H RX *guaifenesin [Mucus-ER MAX] 1,200 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*1 3. LevoFLOXacin 750 mg PO DAILY RX *levofloxacin 750 mg 1 tablet(s) by mouth once a day Disp #*8 Tablet Refills:*0 4. MetroNIDAZOLE 500 mg PO/NG Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*24 Tablet Refills:*0 5. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals 1 tablet(s) by mouth once a day Disp #*90 Tablet Refills:*3 6. Aspirin 81 mg PO DAILY 7. Atenolol 25 mg PO DAILY 8. Atorvastatin 20 mg PO QPM 9. colestipol 5 gram oral DAILY 10. Cyanocobalamin 1000 mcg PO DAILY 11. Dexamethasone 20 mg PO 1X/WEEK (___) 12. Fish Oil (Omega 3) 1000 mg PO DAILY 13. FoLIC Acid 1 mg PO DAILY 14. Glargine 22 Units Bedtime 15. Lisinopril 10 mg PO DAILY 16. magnesium chloride 64 mg oral BID 17. MetFORMIN XR (Glucophage XR) 1000 mg PO BID 18. Nateglinide 120 mg PO TIDAC 19. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN Chest pain 20. Omeprazole 20 mg PO DAILY 21. HELD- fluorouracil 5 % topical DAILY This medication was held. Do not restart fluorouracil until your oncologist tells you to 22. HELD- pomalidomide 2 mg oral DAILY This medication was held. Do not restart pomalidomide until your oncologist tells you to Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Febrile illness Acute metabolic encephalopathy Multiple myeloma Anemia and thrombocytopenia CAD s/p CABG Demand ischemia Diabetes mellitus Weakness Fall Conjunctivitis Essential hypertension Hyperlipidemia Gout Actinic keratosis: Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to ___ with an infection. We treated you for a respiratory infection, and your symptoms improved. We would like you to complete a 14-day course of antibiotics to help clear this up. Your oncologist would like to see you in clinic on ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO QAM 2. Senna 8.6 mg PO BID:PRN constipation 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 10 mg PO QPM 5. Docusate Sodium 100 mg PO BID 6. Gabapentin 300 mg PO NOON 7. NIFEdipine CR 30 mg PO QAM 8. Ranitidine 150 mg PO BID 9. Acetaminophen 1000 mg PO QPM 10. Acetaminophen 500 mg PO NOON 11. Gabapentin 600 mg PO QHS 12. Gabapentin 600 mg PO QAM 13. Simethicone 40-80 mg PO PRN gas 14. Vitamin D 1000 UNIT PO DAILY 15. Diltiazem 30 mg PO Q6H 16. Warfarin 1 mg PO DAILY16 17. Enoxaparin Sodium 80 mg SC Q12H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Pneumonia Atrial fibrillation - new dx Mild diastolic dysfunction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ because you had pneumonia. During your hospitalization you were transferred to the ICU because you were not breathing well, but this improved with positive airway pressure. You were also treated with antibiotics and responded well. You will be going to a rehab facility after discharge to continue your recovery. In the ICU you were also found to have a new diagnosis of atrial fibrillation, an irregular hearbeat. We started you on 2 medications to prevent clots and stroke. You will also get a call from the cardiology office to schedule an appointment for further management. Please also schedule an appointment with your PCP after you leave rehab. It was a pleasure taking care of you, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 250 mg PO Q12H Last day: ___. Glargine 22 Units Bedtime Humalog 6 Units Breakfast Humalog 6 Units Lunch Humalog 6 Units Dinner Insulin SC Sliding Scale using HUM Insulin 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. Levothyroxine Sodium 50 mcg PO DAILY 6. Lisinopril 10 mg PO DAILY 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Sertraline 50 mg PO DAILY 10. Tamsulosin 0.8 mg PO QHS 11. Vitamin D 1000 UNIT PO DAILY 12. HELD- Haloperidol 2 mg PO QHS This medication was held. Do not restart Haloperidol until you see your PCP 13. HELD- Haloperidol 0.5 mg PO Q4PM This medication was held. Do not restart Haloperidol until you see your PCP 14. HELD- TraZODone 12.5 mg PO Q5PM This medication was held. Do not restart TraZODone until you see your PCP ___: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: Urinary Tract Infection Dementia Altered Mental Status NSTEMI, type II Acute kidney injury SECONDARY DIAGNOSES: Hypertension Diabetes Mellitus Hypothyroidism Depression Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure to take care of you at ___. WHY WAS I HERE? - You were admitted to the hospital because you were found to be lethargic. WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL - You were found to have a urinary tract infection and were treated with antibiotics. - You were found to have low blood pressure which improved after receiving fluids through your IV. - Your mental status improved after starting antibiotics and giving fluids. - Your blood WHAT SHOULD I DO WHEN I GET HOME? - Follow up with your primary care physician - ___ taking antibiotics until ___ We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q12H 2. Glargine 11 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 3. LaMIVudine 100 mg PO DAILY 4. Levothyroxine Sodium 100 mcg PO DAILY 5. Nadolol 10 mg PO DAILY 6. Omeprazole 40 mg PO DAILY 7. Allopurinol ___ mg PO DAILY 8. CefePIME 2 g IV Q12H Please take through ___ to complete a ___. Gabapentin 100 mg PO Q8H 10. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain 11. Lactulose 30 mL PO Q4H 12. Lidocaine 5% Patch 1 PTCH TD QPM 13. Lorazepam 0.5 mg PO Q4H:PRN pain/agitation 14. Rifaximin 550 mg PO BID 15. Methadone 30 mg PO TID 16. Furosemide 40 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Diffuse Large B cell lymphoma Left patellar fracture HCAP pneumonia ___ ulcer/cellulitis Secondary: Chronic pain Diabetes Mellitus I Hyponatremia Thrombocytopenia Anemia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital after you suffered a fall. You were found to have a patellar fracture of the left knee. Incidentally, you were also found to have progression of your lymphoma. During your hospital stay you underwent radiation and chemotherapy to alleviate the symptoms you were experiencing from the lymphoma. We treated you for a pneumonia seen on your chest X-ray with antibiotics, which you will continue through ___. We monitored your blood sugars closely and you will be discharged with insulin. You may bear weight as tolerated on your injured leg while wearing the brace provided. Please follow up with the appointments listed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Captopril 6.25 mg PO TID 2. Glargine 30 Units Bedtime Humalog 6 Units Breakfast Humalog 6 Units Lunch Humalog 6 Units Dinner Insulin SC Sliding Scale using HUM Insulin 3. Citracal Regular (calcium citrate-vitamin D3) 250 mg calcium- 200 unit oral DAILY 4. Colestid (colestipol) 1 gram oral QID 5. Lactulose 30 mL PO TID 6. Magnesium Oxide 400 mg PO BID 7. Multivitamins 1 TAB PO DAILY 8. Pantoprazole 40 mg PO Q24H 9. rifAXIMin 550 mg PO BID 10. Spironolactone 25 mg PO DAILY 11. HELD- Fish Oil (Omega 3) Dose is Unknown PO Frequency is Unknown This medication was held. Do not restart Fish Oil (Omega 3) until you return home Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: intraparenchymal hemorrhage Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear ___, You were hospitalized due to symptoms of altered mental status resulting from an INTRAPARENCHYMAL HEMORRHAGE, a condition where there is bleeding found in the brain tissue. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain can result in a variety of symptoms. Brain bleed can have many different causes, including stroke, trauma, medical conditions. We assessed you for medical conditions that might raise your risk of bleeding and stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: 1) Alcoholic cirrhosis (liver disease from alcoholism) with portal hypertension (elevated blood pressure) 2) Diabetes 3) smoking We are NOT changing your medications. Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Atorvastatin 80 mg daily Aspirin 81 mg daily Discharge Disposition: Home Discharge Diagnosis: Transient ischemic attacks Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, During this admission you were determined to have a transient ischemic attack and because you are at a high risk of stroke we have started you on aspirin 81 mg daily and atorvastatin 80 mg daily. We are uncertain exactly why you had this event, but to complete our workup we will discharge you with a monitor to look for abnormal rhythms. We will have you follow up in stroke follow up clinic with Dr. ___. Thank you for allowing us to care for you ___ Neurology</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bumetanide 3 mg PO DAILY 2. Nystatin Ointment 1 Appl TP TID:PRN pruritis 3. Propranolol 10 mg PO BID 4. Rivaroxaban 15 mg PO DINNER 5. Amiodarone 200 mg PO DAILY 6. Atorvastatin 10 mg PO QPM 7. Losartan Potassium 100 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY ======= Atrial fibrillation s/p DVVC Acute on chronic heart failure exacerbation SECONDARY ========= HTN Mild Cognitive Impairment Conjunctivitis Urinary retention Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, You were admitted to the ___ after you had worsening shortness of breath. We had to give you IV diuretic medications to help remove the extra fluid from your body and lungs. We found that you were still in an irregular heart rhythm, "atrial fibrillation," and after talking with your Cardiologist Dr ___ decided to perform an electrical cardioversion, which flipped your heart back into a normal sinus rhythm. - Your dry weight is 62.7 kg. - Our hope is that your heart stays in a normal heart rhythm. If you start to feel palpitations you may have atrial fibrillation again, so notify your MD. - You have urine retention. We discussed this with a urologist while you were here, and this is typically followed as an outpatient. You should have follow up with a urologist to figure out why this is happening. It is probably a chronic problem, and there is nothing urgent to do about it. - Please take your medications as below. - Weigh yourself every day, and if you gain or lose more than 3 lbs please notify your doctor. - If you aren't feeling well and have a little bit of fluid buildup again, it is important to call Dr ___ potentially have yourself scheduled for an appointment to be seen. It was a pleasure taking care of you! Zei Gezunt, Refuah Shlaimah, ve'hatzlachah rabah ad me'ah ve'esrim!! Your ___ Cardiology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Famotidine 20 mg PO DAILY 2. GuaiFENesin ___ mL PO TID 3. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 4. Heparin 5000 UNIT SC TID 5. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 6. LORazepam 0.5 mg NG Q8H:PRN anxiety Cruch and give via PEG tube, flush w/ 10 mls water 7. Metoprolol Tartrate 37.5 mg NG Q6H Use suspension and give via PEG tube, flush w/ 10 mls water 8. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 9. Acetylcysteine 20% ___ mL NEB Q6H:PRN dyspnea 10. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB 11. Atorvastatin 10 mg PO QPM crush and give via PEG tube, flush w/ 10 mls water 12. Bisacodyl ___AILY:PRN Constipation - Second Line 13. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID 14. Diltiazem 60 mg NG Q6H Cruch and give via PEG tube, flush w/ 10 mls water 15. Gabapentin 600 mg NG TID crush and give via PEg tube. flush w/ 10 mls water 16. Multivitamins W/minerals 1 TAB PO DAILY use elixir and give via PEG tube, flush with 10 mls water 17. OxyCODONE Liquid 5 mg NG Q4H:PRN Pain - Moderate Give via PEG tube and flush with 10 mls water 18. QUEtiapine Fumarate 25 mg NG QHS Crush and give via PEG tube, flush w/ 10 mls water 19. Ramelteon 8 mg NG QPM Cruch and give via PEG tube, flush w/ 10 mls water Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Respiratory failure Trapped right lung Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>* You were admitted to the hospital for evaluation of your right pneumothorax and failure to wean from the respirator following your surgery. * You have done well in weaning from the ventilator and breathing on your own and are now ready to return to rehab for more therapy. * You will continue to require tube feedings via your PEG tube and the Speech and Swallow therapist will evaluate you when you are ready to safely swallow food. * Continue to work hard with Physical Therapy to get strong and improve your endurance. * You will need to follow up with Dr. ___ in ___ weeks and the rehab will arrange transportation for you to return to the Thoracic Clinic. * Call ___ with any questions about this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN pain 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*50 Tablet Refills:*0 3. Enoxaparin Sodium 40 mg SC DAILY Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 40 mg SC daily Disp #*14 Syringe Refills:*0 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*80 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right tibial plateau fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet ACTIVITY AND WEIGHT BEARING: - Nonweightbearing in the right leg - Range of motion at the right knee as tolerated, in an unlocked ___ brace Physical Therapy: NWB RLE ROMAT in unlocked ___ Treatments Frequency: Dressings may be changed as needed for drainage. No dressings needed if wound is clean and dry. Staples will be removed in ___ weeks at follow up appointment in Ortho trauma clinic.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Ranexa *NF* (ranolazine) 1,000 mg Oral BID 3. Vitamin D 1000 UNIT PO DAILY 4. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 5. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Simvastatin 5 mg PO DAILY 7. Outpatient Lab Work Please draw a ___ on ___ and fax results to Name: ___. Location: ___ MEDICINE Fax: ___ 8. Warfarin 5 mg PO 1X/WEEK (SA) 9. Warfarin 2.5 mg PO 6X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: acute systolic heart failure, coronary artery disease Secondary: aortic valve replacement Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were transferred to ___ because of dyspnea. You had an ECHO of your heart that showed decreased function. A second ECHO was done to better evaluate your valve and there was no evidence of infection or clot. A cardiac cath was done and one of your stents was opened up. Medication changes: START lisinopril 10 mg by mouth daily for your heart and blood pressure START metoprolol XL 25 mg by mouth daily for your heart and blood pressure STOP hydrochlorothiazide as you will be on metoprolol XL and lisinopril for your blood pressure Please have INR drawn on ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. carvedilol 12.5 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 2. diazepam 5 mg Tablet Sig: One (1) Tablet PO QHS PRN () as needed for insomnia. 3. gabapentin 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). 4. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. rosuvastatin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 7. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. ropinirole 1 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 10. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. Disp:*180 neb* Refills:*0* 11. fluticasone 220 mcg/actuation Aerosol Sig: Two (2) puffs Inhalation twice a day. 12. warfarin 1 mg Tablet Sig: Three (3) Tablet PO Once Daily at 4 ___. 13. fluticasone 50 mcg/actuation Spray, Suspension Sig: One (1) Spray Nasal HS (at bedtime). 14. nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). Disp:*30 Patch 24 hr(s)* Refills:*0* 15. cholecalciferol (vitamin D3) 1,000 unit Tablet Sig: One (1) Tablet PO once a day. 16. Supplemental Oxygen Sig: Two (2) liters per minute continuous: via nasal cannula. Disp:*1 1* Refills:*0* 17. nebulizer accessories Misc Sig: One (1) nebulizer machine Miscellaneous use as directed. Disp:*1 unit* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Pneumonia COPD exacerbation Hypoxemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with difficulty breathing and were diagnosed with pneumonia and a COPD exacerbation. You were treated with antibiotics, steroids, and nebulizers with improvement in your breathing. You are being sent home with continuous oxygen, which you should use at all times. MEDICATION CHANGES: - you were started on Albuterol nebulizers and given a prescription for a nebulizer machine - you were started on home oxygen - you should use the Nicotine patch daily - do NOT smoke cigarettes while using oxygen</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheeze RX *albuterol sulfate [ProAir HFA] 90 mcg 2 puff q4h prn Disp #*1 Inhaler Refills:*3 2. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 12 Days RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*19 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*1 4. Enoxaparin Sodium 90 mg SC Q12H Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 100 mg/mL 90 mg SC every twelve (12) hours Disp #*60 Syringe Refills:*0 5. GuaiFENesin ER 600 mg PO Q12H Duration: 3 Days RX *guaifenesin 600 mg 1 tablet(s) by mouth q12h prn Disp #*20 Tablet Refills:*0 6. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron HCl 4 mg 1 tablet(s) by mouth q8h prn Disp #*60 Tablet Refills:*0 7. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Mild RX *oxycodone 5 mg 1 tablet(s) by mouth q3h prn Disp #*56 Tablet Refills:*0 8. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth BID prn Disp #*60 Tablet Refills:*0 9. Space Chamber Plus (inhalational spacing device) 1 oral Q6H:PRN wheezing Use with albuterol inhaler RX *inhalational spacing device [ProChamber] as dir Disp #*1 Package Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Malignant pleural effusion HCAP Adenocarcinoma of the lung Pulmonary embolism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for shortness of breath and new blood clots in your lungs. You were also found to have a pneumonia (lung infection) and a pleural effusion (fluid accumulation in your chest). We treated you with blood thinners to prevent further clots. We also treated you with antibiotics and a procedure, called a thoracentesis, to drain the extra fluid. You were seen by our oncologists, who recommended that you ___ soon for further imaging and staging of your cancer. We are very sorry about this diagnosis. Please do the following once you leave the hospital: - Continue taking the prescribed antibiotics: Augmentin 875 mg every 12 hours, ending on ___, which will treat your pneumonia - Start taking oxycodone 5 mg every 3 hours as you need it for pain control. We have given you enough pills to last one week, before which you will see your primary care physician for ___ - Please also start taking the following medications: 1) Albuterol inhaler with spacer, and guaifenesin as needed for cough, 2) Colace and Senna as needed for constipation - Please continue doing the Lovenox injections (90 mg every 12 hours) to help prevent further blood clots It was a pleasure to participate in your care. We wish you all the best. Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 2. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 3. Chlorthalidone 25 mg PO DAILY 4. Cyanocobalamin ___ mcg PO DAILY 5. Lisinopril 20 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: acute ischemic right occipital stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized after your MRI revealed an ACUTE ISCHEMIC STROKE, a condition in which a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. Damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: - high cholesterol - high blood pressure We are changing your medications as follows: - starting plavix - stopping aspirin - increasing your atorvastatin dose Because we did not find the cause of your stroke, you will have a cardiac monitor outpatient (called ___ of Hearts). Please call ___ to set this up. Please take your other medications as prescribed. Please followup with Neurology and your primary care physician. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - sudden partial or complete loss of vision - sudden loss of the ability to speak words from your mouth - sudden loss of the ability to understand others speaking to you - sudden weakness of one side of the body - sudden drooping of one side of the face - sudden loss of sensation of one side of the body - sudden difficulty pronouncing words (slurring of speech) - sudden blurring or doubling of vision - sudden onset of vertigo (sensation of your environment spinning around you) - sudden clumsiness of the arm and leg on one side or sudden tendency to fall to one side (left or right) - sudden severe headache accompanied by the inability to stay awake It was a pleasure providing you with care during this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levemir 32 Units Breakfast Levemir 10 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 2. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 20 mg PO QPM 5. Docusate Sodium 100 mg PO BID 6. dulaglutide 0.75 mg/0.5 mL subcutaneous 1X/WEEK 7. MetFORMIN (Glucophage) 1000 mg PO BID 8. Senna 17.2 mg PO HS 9. HELD- Metoprolol Succinate XL 25 mg PO DAILY This medication was held. Do not restart Metoprolol Succinate XL until okay with PCP or cardiologist 10. HELD- ___ 0.4 mg PO DAILY Duration: 1 Dose This medication was held. Do not restart ___ until you speak to your PCP as it may be making you dizzy. Discharge Disposition: Home Discharge Diagnosis: Primary: -------------- Pulmonary Hypertension lower extremity edema, bilateral weakness lymphadenopathy bilateral pleural effusions thickened bronchial walls Secondary: -------------- insulin dependent diabetes mellitus coronary artery disease with stent placed in past obesity sleep apnea Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - Your primary care doctor referred you to the ED for low blood pressures. - You told us you had been experiencing occasional dizziness, weakness in your legs, and leg swelling for quite some time. WHAT HAPPENED TO ME IN THE HOSPITAL? - You had lab work that showed your red blood cells and platelets were lower than normal levels. - You had an ultrasound of your heart (echocardiogram) that showed no change in heart function from prior studies, but did show pulmonary hypertension (increased pressures in your lungs). - You had CT-imaging done of your chest to help determine why you have pulmonary hypertension. - You had CT-imaging of your stomach and pelvis to help figure out why your legs have been swelling over the past year or so. This showed lymph nodes deep in your abdomen that are larger than normal, and will need to be biopsied to get a clear answer as to why. - We monitored your blood pressures, and they were never low. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? -Please continue to take all of your medications and follow-up with your appointments as listed below. -You will need an Interventional Radiologist (___) guided biopsy of a lymph node. We have asked your PCP to help you arrange this biopsy. -You will need to see a pulmonologist for your new diagnosis of pulmonary hypertension. See below for your appointment scheduling instructions with a pulmonary hypertension specialist. - We held your ___, as well as metoprolol since it may be contributing to your low blood pressures and light-headedness. Speak with your Primary physician about restarting ___ if you are still having difficulty with urinary symptoms. Speak with your cardiologist before restarting metoprolol. - Your cardiology office should call you with a follow-up appointment. Please contact them if you don't hear in the next few days. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. GuaiFENesin ER 600 mg PO Q12H 2. MetroNIDAZOLE 500 mg PO TID please take for 14 days RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth three times a day Disp #*42 Tablet Refills:*0 3. amLODIPine 5 mg PO DAILY 4. Breo Ellipta (fluticasone-vilanterol) 100-25 mcg/dose inhalation DAILY 5. Citalopram 40 mg PO DAILY 6. Enoxaparin Sodium 40 mg SC Q24H Duration: 9 Days please take until ___, 9 more days, prevents blood clots after surgery RX *enoxaparin 40 mg/0.4 mL 40 mg subcutaneous once a day Disp #*9 Syringe Refills:*0 7. Levothyroxine Sodium 88 mcg PO DAILY 8. Losartan Potassium 50 mg PO DAILY 9. Melatin (melatonin) 3 mg oral QHS 10. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q4H:PRN 11. QUEtiapine Fumarate 150 mg PO QHS 12. Simvastatin 10 mg PO QPM 13. Tamsulosin 0.4 mg PO QHS 14. TraZODone 50 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital for a small bowel obstruction. You were given bowel rest and intravenous fluids and a nasogastric tube was placed in your stomach to decompress your bowels. Your obstruction has subsequently resolved after conservative management. You have tolerated a regular diet, are passing gas and your pain is controlled with pain medications by mouth. You may return home to finish your recovery. You had some evidence of inflammation of the bowel on your cat scan and your symptoms improved with antibiotics. You will continue to take flagyl for 3 weeks. If you have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or extended constipation. You have a midline incision from your prior surgery. We opened a portion of this wound and it will need to be packed with gauze. The rest of the incision is closed with steristrips. Please monitor for worsening signs of infection: increasing redness of the incision lines, white/green/yellow/malodorous drainage, increased pain at the incision, increased warmth of the skin at the incision, or swelling of the area. You may shower; pat the incisions dry with a towel, do not rub. The small incisions may be left open to the air. If closed with steri-strips (little white adhesive strips), these will fall off over time, please do not remove them. Please no baths or swimming until cleared by the surgical team. If you have pain you may take Tylenol as needed. Do not drink alcohol while taking Tylenol. Please do not take more than 3000mg of Tylenol in 24 hours. Thank you for allowing us to participate in your care! Our hope is that you will have a quick return to your life and usual activities.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain do not exceed 3000mg/day 2. Albuterol Inhaler 1 PUFF IH Q6H:PRN sob 3. Aspirin 325 mg PO DAILY 4. Bisacodyl 10 mg PO DAILY:PRN CONSTIPATION 5. Docusate Sodium 100 mg PO BID HOLD FOR DIARRHEA 6. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 7. Insulin SC Sliding Scale Insulin SC Sliding Scale using HUM Insulin 8. Isosorbide Mononitrate 30 mg PO DAILY hold for BP<100 9. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN pain hold for sedation, RR<12 10. Senna 1 TAB PO BID 11. Valsartan 80 mg PO DAILY 12. Metoprolol Succinate XL 200 mg PO DAILY 13. Nitrofurantoin (Macrodantin) 100 mg PO BID RX *nitrofurantoin macrocrystal [Macrodantin] 100 mg 1 capsule(s) by mouth twice a day Disp #*14 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Pyelonephritis Secondary ? Gastroenteritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital because you had nausea, vomiting and abdominal pain. This was thought to be related to a urinary tract infection. You were started on antibiotics and you improved and will continue to take antibiotics for another 6 days. You had imaging of your shoulder snd your torso which was unremarkable. Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CefTRIAXone 1 gm IV Q24H RX *ceftriaxone in dextrose,iso-os 1 gram/50 mL 1 gm IV q24 hrs Disp #*7 Intravenous Bag Refills:*0 2. Acetaminophen 650 mg PO Q6H:PRN pain 3. Allopurinol ___ mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. Benzonatate 200 mg PO TID:PRN cough 6. Furosemide 40 mg PO BID 7. Levothyroxine Sodium 125 mcg PO DAILY 8. Lisinopril 10 mg PO DAILY 9. Metoprolol Succinate XL 50 mg PO BID 10. Omeprazole 40 mg PO DAILY 11. PARoxetine 20 mg PO DAILY 12. Prochlorperazine 10 mg PO Q6H:PRN nausea 13. Simvastatin 10 mg PO QPM 14. ValACYclovir 1000 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: MDS pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted due to shortness of breath and cough, you were found to have pneumonia and will continue treatment with your IV antibiotic at home. Your symptoms greatly improved with your antibiotics. You will follow up in clinic as stated below. It was a pleasure taking care of you. Please call with any questions or concerns.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth Every six hours as needed Disp #*20 Tablet Refills:*0 2. amLODIPine 5 mg PO DAILY 3. Calcitriol 0.25 mcg PO EVERY OTHER DAY 4. Losartan Potassium 100 mg PO 4X/WK 5. Multivitamins 1 TAB PO DAILY 6. Selsun Blue (pyrithione zinc) (pyrithione zinc) 1 % Other DAILY 7. HELD- TraMADol 50 mg PO Q6H:PRN Pain - Moderate This medication was held. Do not restart TraMADol until cleared by your primary care doctor Discharge Disposition: Home Discharge Diagnosis: PRIMARY: -Ruptured renal cyst SECONDARY: -CKD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking part in your care here at ___! Why was I admitted to the hospital? - You were admitted for abdominal pain and blood in your urine What was done for me while I was in the hospital? - You had some imaging done of your abdomen. It looked like one of the cysts on your kidney had ruptured. - You were given pain medication and closely monitored. What should I do when I leave the hospital? - Continue to take all of your medications as prescribed. - Please obtain bloodwork at ___ prior to your appointment on ___. The order for your labwork has already been placed. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cinacalcet 60 mg PO DAILY 2. Clobetasol Propionate 0.05% Cream 1 Appl TP BID 3. Digoxin 0.0625 mg PO 3X/WEEK (___) 4. Docusate Sodium 100 mg PO BID 5. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 6. Gabapentin 300 mg PO 3X/WEEK (___) 7. Ipratropium Bromide MDI 2 PUFF IH Q6H:PRN wheezing 8. Levothyroxine Sodium 75 mcg PO DAILY 9. Lidocaine 5% Patch 1 PTCH TD QAM 10. Lorazepam 1 mg PO BID:PRN anxiety 11. Metoprolol Succinate XL 25 mg PO 4X/WEEK (___) 12. Midodrine 10 mg PO MWF 13. Montelukast Sodium 10 mg PO DAILY 14. Nephrocaps 1 CAP PO DAILY 15. Omeprazole 20 mg PO BID 16. sevelamer HYDROCHLORIDE 2400 mg OTHER TID 17. Warfarin 1 mg PO DAILY16 18. Cetirizine 10 mg oral daily prn allergy symptoms Discharge Disposition: Home Discharge Diagnosis: Elevated temperatures Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr ___, You were admitted to the ___ after feeling weak and falling at home. You were evaluated by our neurology team, who also did CT and MRI scans of your head, which did not show a stroke. Because you were retaining urine, you were discharged with a foley in place. You have a follow up appointment with Dr. ___ on ___. During hospitalization you had imaging performed which revealed a 1 cm thyroid nodule. Please discuss with Dr. ___ an ultrasound of your thyroid to better characterize the nodule. Please take note of the following: - Please stop taking your Coumadin for 2 days. Your primary care physician, ___, has asked that you restart your Coumadin on ___ at 1 tablet of 5mg and check your INR. Contact Dr ___ with your INR results. - Please follow up with urology to have your foley removed on ___ - Please follow up with your PCP Dr ___ on ___ at 2:30 ___ - Continue all your other home medications as normal It was a pleasure taking care of you at ___. We wish you all the best! - Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever please limit to 4000mg in 24 hour period. 2. Hyoscyamine SO4 (Time Release) 0.375 mg PO DAILY 3. Ascorbic Acid ___ mg PO DAILY 4. Levothyroxine Sodium 150 mcg PO DAILY 5. Multivitamins 1 TAB PO DAILY 6. Pantoprazole 40 mg PO Q24H 7. Vitamin D ___ UNIT PO BID Discharge Disposition: Home Discharge Diagnosis: Incarcerated right inguinal hernia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for evaluation of abdominal pain and you were found to have an incarcerated right inguinal hernia. You were therefore evaluated by the acute care surgery team and offered surgical repair, however you declined surgery during this hospital admission. Risks of delaying surgery were discussed at length, however you have elected to follow up as an outpatient with Dr. ___. You are therefore now ready for discharge. Please follow the instructions below to continue your recovery: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Loestrin ___ Fe *NF* (norethindrone-e.estradiol-iron) ___ (24)-75(4) mg-mcg-mg Oral DAILY 2. Sertraline 200 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis Hematochezia Diarrhea Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___. You presented with bloody diarrhea, which has since stopped. We are still unsure what caused it, but we think it either resulted from an infection in your colon, low blood flow to the colon while you exercised, or inflammation in the colon from another cause. You were given IV fluids and monitored closely. Your blood counts were stable, you are feeling better, are no longer having bloody diarrhea like you were yesterday, and are eating solid food, so we feel that you are ready for discharge. Additionally, the use of ibuprofen can exacerbate (or cause) gastrointestinal bleeding (typically from the stomach). Please use this sparingly and alternate with acetaminophen. Please keep yourself well-hydrated with drinks like gatorade while you continue to have diarrhea and only eat food that you can tolerate. Please review your medications below closely and take them as prescribed. Please keep your follow-up appointment below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. senna 8.6 mg Tablet Sig: ___ Tablets PO DAILY (Daily): while taking oxycodone to prevent constipation, do not take if having loose stools. 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day): while taking oxycodone to prevent constipation, do not take if having loose stools. 3. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for Constipation: while taking oxycodone, do not take if having loose stools. 4. multivitamin Tablet Sig: One (1) Cap PO DAILY (Daily). 5. enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) Injection Subcutaneous Q24H (every 24 hours). 6. anastrozole 1 mg Tablet Sig: One (1) Tablet PO daily (). 7. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. loperamide 2 mg Capsule Sig: One (1) Capsule PO once a day as needed for loose stool. 9. oxycodone 5 mg Tablet Sig: ___ Tablet PO every six (6) hours as needed for pain for 2 weeks: ___ cause drowsiness, do not drive while taking medication. Disp:*56 Tablet(s)* Refills:*0* 10. lithium carbonate 300 mg Capsule Sig: One (1) Capsule PO twice a day. 11. cholecalciferol (vitamin D3) 1,000 unit Capsule Sig: One (1) Capsule PO once a day. 12. acetaminophen 325 mg Tablet Sig: ___ Tablets PO every six (6) hours as needed for pain. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left subcapital femur fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, ___ were admitted to ___ because ___ had a fall at home resulting in a hip fracture. ___ had surgery on ___ without complications. ___ were then transferred to the medicine service because ___ were confused and drowsy. Your labwork showed a high sodium, likely due to your lithium therapy. ___ were given IV fluids and your sodium returned to normal. ___ should continue to drink plenty of water at home to prevent your sodium level from getting too high. ___ also were noted to have high calcium levels, likely due to the effects of lithium on a gland called the parathyroid gland. ___ should follow up with an endocrinologist and general surgeon to discuss management of your calcium levels, which may require surgery. We made the following changes to your medications: -START lovenox injections 30 units once daily (continue until your follow up appointment with orthopedics) -START tylenol ___ every six hours as needed for pain -START oxycodone 2.5-5mg every six hours as needed for pain not relieved by tylenol -START senna, docusate, and bisacodyl to prevent constipation while taking oxycodone We made no other changes to your medications while ___ were in the hospital. Please continue taking your medications as prescribed by your outpatient providers. Please see below for your currently scheduled appointments. If ___ are unable to make an appointment please call and reschedule. It has been a pleasure taking care of ___ at ___ and we wish ___ a speedy recovery. Wound Care: - Keep Incision clean and dry. - ___ can get the wound wet or take a shower starting from 7 days after surgery, but no baths or swimming for at least 4 weeks. - Dry sterile dresssing may be changed daily. No dressing is needed if wound continues to be non-draining. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. Activity: - Continue to be full weight bearing on your left leg - ___ should not lift anything greater than 5 pounds. - Elevate left leg to reduce swelling and pain. Other Instructions - Resume your regular diet. - Avoid nicotine products to optimize healing. - Resume your home medications. Take all medications as instructed. - Continue taking the Lovenox to prevent blood clots. - ___ have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so plan ahead. ___ can either have them mailed to your home or pick them up at the clinic located on ___. We are not allowed to call in narcotic (oxycontin, oxycodone, percocet) prescriptions to the pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - Narcotic pain medication may cause drowsiness. Do not drink alcohol while taking narcotic medications. Do not operate any motor vehicle or machinery while taking narcotic pain medications. Taking more than recommended may cause serious breathing problems. - If ___ have questions, concerns or experience any of the below danger signs then please call your doctor at ___ or go to your local emergency room.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PO DAILY:PRN Constipation - Second Line 2. Lansoprazole Oral Disintegrating Tab 30 mg PO BID 3. Magnesium Citrate 300 mL PO DAILY 4. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 5. Cyanocobalamin 1000 mcg PO DAILY 6. Felbamate 1400 mg PO BID 7. LevETIRAcetam 750 mg PO BID 8. Phenytoin (Suspension) 150 mg PO BID 9. Psyllium Powder 1 PKT PO DAILY 10. Rivaroxaban 20 mg PO DAILY 11. Selsun Blue (selenium sulfide) 1 % topical 3x/week prn 12. Senna 8.6 mg PO BID 13. starch (thickening) ___ spoonfuls oral TID W/MEALS 14. Sucralfate 1 gm PO QID 15. Tamsulosin 0.4 mg PO QHS 16. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: PRIMARY DIAGNOSIS ====================== - Upper GI bleed SECONDARY DIAGNOSIS ====================== - ___ syndrome Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, WHY WERE YOU ADMITTED TO THE HOSPITAL? - You had bloody vomit WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL? - You had a procedure performed, called an endoscopy, that tried to find a source of the blood. It did not find any single area of concern. - You were monitored closely and did not re-bleed. - You had a seizure in setting of acute illness WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Take all of your medications as prescribed (listed below) - Follow up with your doctors as listed below Please see below for more information on your hospitalization. It was a pleasure taking part in your care here at ___. We wish you all the best, - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear ___, It was a pleasure taking care of you at ___ ___. Why was I in the hospital? - You were having fevers at home What was done while I was in the hospital? - We found that one of your drains was not draining properly - We had the interventional doctors ___ the ___ - You were put back on antibiotics that helped with your fevers What should I do when I get home from the hospital? - Be sure to take all of your medications as prescribed, especially your antibiotics (last day ___ and your immunosuppression drugs - Please go to your follow-up appointments with your primary care doctor, your liver doctor, and the infectious disease doctor - If you have fevers, chills, abdominal pain, yellowing of the skin, or generally feel unwell, please call your doctor or go to the emergency room Sincerely, Your ___ Treatment Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It has been a pleasure caring for you at ___. You presented to ___ on ___ with 4 days of cough with blood, abdominal pain, nausea, and fever. Your symptoms were likely due to a viral illness, and this resolved without antibiotics. However, the levels of tacrolimus in your blood were undetectable and your liver tests continued to increase throughout your hospitalization, raising concern for transplant rejection. Therefore, we increased your dose of tacrolimus. We also performed a biopsy of your liver which showed rejection of your liver by your immune system. We gave you additional medicines including steroids to suppress your immune system, however your liver tests remained elevated. You received a second liver biopsy which showed ongoing rejection of your liver. We then added another medicine called ATG (anti-thymocyte globlulin) to further suppress your immune system. After 7 days of therapy with ATG, your liver tests improved. You will need to return to ___ next week for another liver biopsy to make sure that your immune system has stopped rejecting your liver. You will be following up with pulmonology as you have coughed up small amounts of blood and were found to have a nodule in the lung as well as high pressures in the blood vessels of the lung. You will also need an ultrasound of the heart (echocardiogram) to further evaluate this. Your blood sugars have been high so please follow up with your ___ endocrinologist. It has been a pleasure taking care of you, Best wishes, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 10 mg PO QPM 2. Atovaquone Suspension 1500 mg PO DAILY 3. CycloSPORINE (Sandimmune) 100 mg PO Q12H 4. Fluticasone Propionate NASAL 2 SPRY NU DAILY 5. Lisinopril 15 mg PO DAILY 6. PredniSONE 10 mg PO DAILY 7. Vitamin D 50,000 UNIT PO 1X/WEEK (___) Discharge Disposition: Home Discharge Diagnosis: vasovagal and orthostatic syncope hyponatremia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, It was a pleasure participating in your care while you were at ___. You had an episode of unresponsiveness while in your nephrologist's office, which we think was from a vagal response in response to nausea as well as reflective of decreased volume in your vessels. You were monitored on telemetry and we gave you IV fluids. Please schedule ___ in the near future with Dr. ___ your primary care doctor. We wish you the best! Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild/Fever RX *acetaminophen 500 mg ___ tablet(s) by mouth every 6 hours as needed Disp #*100 Tablet Refills:*0 2. Amoxicillin-Clavulanic Acid ___ mg PO/NG Q12H complicated pleural effusion RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tab-cap by mouth every twelve (12) hours Disp #*60 Tablet Refills:*0 3. Bisacodyl 10 mg PO/PR DAILY RX *bisacodyl 5 mg 2 tablet(s) by mouth once a day Disp #*60 Tablet Refills:*0 RX *bisacodyl 10 mg ___aily PRN Disp #*30 Suppository Refills:*0 4. LORazepam 0.5 mg PO Q4H:PRN anxiety, insomnia RX *lorazepam 0.5 mg 1 tablet(s) by mouth every 4 hours as needed Disp #*42 Tablet Refills:*0 5. Morphine SR (MS ___ 15 mg PO Q12H RX *morphine 15 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 6. Morphine Sulfate (Oral Solution) 2 mg/mL 4 mg PO Q2H:PRN Dyspnea RX *morphine 20 mg/5 mL (4 mg/mL) 4 mg by mouth every 2 hours as needed Refills:*0 7. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 8. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram 1 packet(s) by mouth once a day Disp #*30 Packet Refills:*0 9. Senna 17.2 mg PO BID RX *sennosides [senna] 8.6 mg 2 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 10. TraZODone 25 mg PO QHS:PRN insomnia RX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth QHS PRN Disp #*30 Tablet Refills:*0 11. GuaiFENesin-CODEINE Phosphate ___ mL PO Q2H:PRN cough 12. budesonide-formoterol 160-4.5 mcg/actuation inhalation BID RX *budesonide-formoterol [Symbicort] 160 mcg-4.5 mcg/actuation 1 puff IH twice a day Disp #*1 Inhaler Refills:*0 13. Fluticasone Propionate NASAL 1 SPRY NU DAILY RX *fluticasone propionate 50 mcg/actuation 1 spray NU once a day Disp #*30 Spray Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis ================= Loculated pleural effusion Stage IV non-small cell lung cancer Secondary Diagnosis ==================== Hyponatremia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? -You were admitted to the hospital because you were having shortness of breath. WHAT HAPPENED TO ME IN THE HOSPITAL? - You were seen by our lung experts who tried to drain the fluid around your lung. They were unable to drain the fluid unfortunately. We discussed possible surgery to treat this. You decided not to do surgery. We gave you antibiotics to control your lung infection and morphine to help with your shortness of breath. We arranged hospice services so help you spend quality time outside the hospital with family. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Take your medicines as prescribed. Take morphine 30 minutes before you exert yourself for best effect. - You have a follow-up appointment with your oncologist to check on you and make sure your symptoms are under control. If it is too difficult to make it to the office, your oncologist is happy to speak by phone instead. See below for details and phone number. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q8H RX *acyclovir 400 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID:PRN consitpation RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. Lorazepam 0.5-1 mg IV Q4H:PRN nausea RX *lorazepam [Ativan] 1 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 4. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 5. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 6. Ondansetron 4 mg PO Q8H:PRN nausea (may subsitute with non-dissolving tablets instead) RX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 7. Outpatient Lab Work please check blood work on ___ CEM10 CBC with diff fax to:Dr ___ ___ Office ___ dx: AML Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: primary: APML, perianal phlegmon secondary: neutropenia, anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came to the hospital because you felt fatigued. While you were here you were diagnosed with AML and we started on treatment with ATRA and arsenic. You tolerated the chemotherapy well and your blood cells went up at first and then went down. Also while here you were seen by the colorectal surgeons for a perianal phlegmon. They did not want to do any surgery on it and you were treated with antibiotics. You will continue with antibiotics till Dr. ___ you and tells you that you don't need to take them anymore. If you have a temp of 100.4 please come to the hospital</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 2. Acetaminophen 1000 mg PO BID 3. azelastine 137 mcg (0.1 %) nasal DAILY 4. Azithromycin 500 mg oral 1X:ASDIR 5. Breo Ellipta (fluticasone furoate-vilanterol) 200-25 mcg/dose inhalation DAILY 6. Clopidogrel 75 mg PO DAILY 7. Cyanocobalamin 2500 mcg PO DAILY 8. Diltiazem Extended-Release 240 mg PO DAILY 9. Docusate Sodium 100 mg PO BID 10. DULoxetine ___ 60 mg PO BID 11. Fexofenadine 180 mg PO DAILY 12. FoLIC Acid ___ mg PO DAILY 13. Gabapentin 300 mg PO BID 14. Invokana (canagliflozin) 100 mg oral DAILY 15. Levothyroxine Sodium 200 mcg PO DAILY 16. Magnesium Oxide 500 mg PO DAILY 17. Methylprednisolone 4 mg PO ASDIR taper for asthma attacks This is dose # of tapered doses 18. Montelukast 10 mg PO QPM 19. Pantoprazole 40 mg PO Q24H 20. Polyethylene Glycol 17 g PO DAILY 21. Potassium Chloride 10 mEq PO BID 22. Propafenone HCl 225 mg PO BID 23. Pulmicort Flexhaler (budesonide) 180 mcg/actuation inhalation BID 24. Pyridoxine 100 mg PO DAILY 25. Sodium Chloride Nasal 1 SPRY NU DAILY AND PRN nasal dryness 26. Tiotropium Bromide 1 CAP IH DAILY 27. TraMADol 50 mg PO BID 28. TraZODone 200 mg PO QHS 29. Vitamin D 1000 UNIT PO DAILY 30. Vitamin D ___ UNIT PO 1X/WEEK (SA) Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES ================= GERD Chest Pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You were having chest pain WHAT HAPPENED TO ME IN THE HOSPITAL? - You were given medications to treat a heart problem however the origin of the chest pain seemed less likely to be caused by the heart so those were stopped. You were given medications to treat you indigestion and nausea which did help. You were chest pain free on trial off the medications and were doing well with walking around. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? -Please continue to take all of your medications and follow-up with your appointments as listed below. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Metoprolol Tartrate 25 mg PO TID 2. Atorvastatin 40 mg PO DAILY 3. CeftriaXONE 1 gm IV Q24H Duration: 5 Doses 5 day course started ___. Dabigatran Etexilate 150 mg PO BID 5. Levothyroxine Sodium 50 mcg PO DAILY 6. Vitamin D 1000 UNIT PO DAILY 7. Vesicare (solifenacin) 10 mg oral daily 8. Escitalopram Oxalate 10 mg PO DAILY 9. Mirtazapine 7.5 mg PO HS 10. Duloxetine 60 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: - ACUTE ISCHEMIC STROKE with hemorrhagic conversion - atrial fibrillation - hypertention - hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear ___ were hospitalized due to symptoms of difficulty talking and right sided weakness resulting from an ACUTE ISCHEMIC STROKE, a condition in which a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed ___ for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: - afib - high blood pressure - high cholesterol We are changing your medications as follows: - START Dabigatran Etexilate 150 mg PO BID - STOP coumadin Please take your other medications as prescribed. Please followup with Neurology and your primary care physician as listed below. If ___ experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - sudden partial or complete loss of vision - sudden loss of the ability to speak words from your mouth - sudden loss of the ability to understand others speaking to ___ - sudden weakness of one side of the body - sudden drooping of one side of the face - sudden loss of sensation of one side of the body - sudden difficulty pronouncing words (slurring of speech) - sudden blurring or doubling of vision - sudden onset of vertigo (sensation of your environment spinning around ___ - sudden clumsiness of the arm and leg on one side or sudden tendency to fall to one side (left or right) - sudden severe headache accompanied by the inability to stay awake It was a pleasure providing ___ with care during this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Ciprofloxacin HCl 500 mg PO Q12H Duration: 9 Days RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*18 Tablet Refills:*0 3. MetroNIDAZOLE 500 mg PO Q8H Duration: 9 Days RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*27 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Acute Appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the Acute Care Surgery Service with abdominal pain and found to have inflammation in your appendix. You were counseled on different treatment options and elected for antibiotics. Your pain improved with antibiotics and you are now ready to be discharged home to complete a course of oral antibiotics. Please note the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. fluticasone Nasal 2. levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 3. lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for anxiety. Disp:*30 Tablet(s)* Refills:*0* 4. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for Pain: Please do not take if you are feeling tired or confused. Do not operate heavy machinery or drive while on this medication. Disp:*90 Tablet(s)* Refills:*0* 5. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for Pain. Disp:*30 Tablet(s)* Refills:*0* 6. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO every six (6) hours. Disp:*160 Tablet(s)* Refills:*0* 7. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 8. propranolol 20 mg Tablet Sig: One (1) Tablet PO three times a day. Disp:*90 Tablet(s)* Refills:*2* 9. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. Disp:*60 Tablet(s)* Refills:*0* 10. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 11. ondansetron 4 mg Tablet, Rapid Dissolve Sig: ___ Tablet, Rapid Dissolves PO every eight (8) hours as needed for nausea. Disp:*40 Tablet, Rapid Dissolve(s)* Refills:*0* 12. OxyContin 30 mg Tablet Extended Release 12 hr Sig: One (1) Tablet Extended Release 12 hr PO twice a day: Do not operate heavy machinery or drive while on this medication. Disp:*20 Tablet Extended Release 12 hr(s)* Refills:*0* 13. Miralax 17 gram Powder in Packet Sig: One (1) packet PO once a day as needed for constipation. Disp:*30 packets* Refills:*0* 14. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily): Apply patch to area of most significant pain (i.e. sternum). Leave leave patch on for 12 hours only. Remove patch, and reapply 12 hours later. Disp:*15 Adhesive Patch, Medicated(s)* Refills:*0* 15. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO BID (2 times a day) as needed for constipation. Disp:*1 bottle* Refills:*0* 16. Supplemental Oxygen ___ continuous pulse dose for portability Dx: metastatic nonsmall cell lung cancer RA sat 84% Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Metastatic lung cancer Secondary Diagonsis: Hypertension Low Back Pain Depression Hypothyroidism Eczema Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___ you for coming to the ___. You were in the hospital because of your pain and skin lesions that were concerning for cancer. We performed a biopsy which showed that you have metastatic lung cancer. You started radiation therapy to help with your pain. You will need to follow up with a lung cancer specialist to discuss further treatment options. We started you on oxycontin (long acting oxycodone), oxycodone, tylenol, and a lidocaine patch for pain. You should continue to take ativan and citalopram for anxiety. You were also noticed to need supplemental oxygen when walking around, which is being provided to you. You have been feeling weak throughout the admission, however physical therapy has evaluated you several times and feel that you are safe for discharge. It is important that you continue to drink water and eat food to keep your nutrition status up. . Medication Recommendations: Please START: -Supplemental oxygen at ___ -Oxycontin 30 mg twice daily -Oxycodone ___ tabs) every 4 hours as needed for pain. If you are feeling drowsy or confused, it is possible you are taking too much of this medication. Please avoid this medication until you are feeling back to normal. -Zofran (ondansetron) ___ mg three times per day as needed for nausea -Ibuprofen 600 mg every 8 hours as needed for pain -Acetaminophen 1000 mg every 6 hours for pain -Senna 8.6 mg twice daily as needed for constipation -Docusate 100 mg twice daily for constipation -Milk of magnesia as needed for constipation -Miralax 1 packet daily as needed for constipation -Citalopram 20 mg daily -Propanolol 20 mg every 8 hours It is important you continue to have regular bowel movements as the prescribed pain medications frequently cause constipation in patients. Please take colace daily and senna, miralax and milk of magnesia as needed so that you are having a bowel movement a day. . Please STOP lisinopril.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO 5X/DAY RX *acetaminophen [8HR Muscle Ache-Pain] 650 mg 1 tablet(s) by mouth every 6 hours Disp #*60 Tablet Refills:*0 2. Baclofen 10 mg PO TID RX *baclofen 10 mg 1 tablet(s) by mouth every 8 hours Disp #*21 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID use while taking narcotic pain medication. RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice daily Disp #*14 Capsule Refills:*0 4. Enoxaparin Sodium 40 mg SC QDAY RX *enoxaparin 40 mg/0.4 mL 1 injection subcutaneously daily Disp #*28 Syringe Refills:*0 5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain OK to request partial fill. Wean as tolerated. RX *oxycodone 10 mg ___ tablet(s) by mouth every 4 hours as needed Disp #*60 Tablet Refills:*0 6. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth daily as needed Disp #*30 Tablet Refills:*0 7. Senna 8.6 mg PO BID use when taking narcotic pain medication. RX *sennosides [Evac-U-Gen (sennosides)] 8.6 mg 2 tablets by mouth twice daily Disp #*28 Tablet Refills:*0 8. Tamsulosin 0.4 mg PO QHS RX *tamsulosin [Flomax] 0.4 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 9. Atenolol 50 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: right, closed acetabular fracture. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - touch down weight bearing on the right lower extremity. MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take enoxaparin daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Please remain in your dressing and do not change unless it is visibly soaked or falling off. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE <30 DAYS OF REHAB Physical Therapy: touch down weight bearing as tolerated on the right lower extremity. no hip precautions. Treatments Frequency: incision may be left open to air.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever 2. Furosemide 20 mg PO DAILY Duration: 5 Days RX *furosemide 20 mg 1 tablet(s) by mouth once a day Disp #*5 Tablet Refills:*0 3. Detemir 34 Units Breakfast Detemir 38 Units Bedtime Novolog 6 Units Breakfast Novolog 10 Units Lunch Novolog 16 Units Dinner 4. Metoprolol Tartrate 50 mg PO TID RX *metoprolol tartrate 50 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*1 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 80 mg PO QPM 7. Pantoprazole 40 mg PO Q24H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Coronary Artery Disease - IDDM - Hypertension - Dyslipidemia - Glaucoma - Prostatic CA s/p XRT - Basal cell carcinoma Past Surgical History: - s/p MOHs surgery (___) - left inguinal hernia repair (strangulated per pt but no bowel resected) Past Cardiac Procedures: - CAD s/p proximal LAD PCI (___) after positive stress test for angina symptoms - NSTEMI (___) with coronary angiogram showing 3 vessel CAD (90% RI, 90% distal LAD, 90% ___ RCA s/p POBA Discharge Condition: Alert and oriented x3 non-focal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage Edema- trace Followup Instructions: ___ [/INST] </s><s>Please shower daily -wash incisions gently with mild soap, no baths or swimming, look at your incisions daily Please - NO lotion, cream, powder or ointment to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics Clearance to drive will be discussed at follow up appointment with surgeon No lifting more than 10 pounds for 10 weeks Encourage full shoulder range of motion, unless otherwise specified **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 3. ClonazePAM 0.25 mg PO BID 4. Diltiazem Extended-Release 180 mg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. Losartan Potassium 100 mg PO DAILY 7. Metoprolol Tartrate 25 mg PO DAILY Hold for HR <60, Systolic blood pressure <100 8. Simvastatin 10 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Urinary Tract Infection Toxic Metabolic Encephalopathy Stage 1 Sacral decubitus Secondary Diagnosis Status Post C1-C3 laminectomy/fusion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. You were brought in for increasing confusion and weakness. We believe this was due to a urinary tract infection in addition to the pain medications you were taking. You were started on antibiotics which you will continue to take at hpme. Your pain medication regimen was also modified. You have decided to go home and not back to rehab. Your PCP ___ follow up with you at home this coming week.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Furosemide 20 mg PO DAILY 2. HYDROmorphone (Dilaudid) 12 mg PO Q4H:PRN Pain RX *hydromorphone 12 mg 1 tablet(s) by mouth Q4H PRN pain Disp #*42 Tablet Refills:*0 3. HydrOXYzine 25 mg PO BID:PRN anxiety 4. Lisinopril 20 mg PO DAILY 5. Lorazepam 1 mg PO DAILY:PRN anxiety 6. Metoprolol Tartrate 25 mg PO BID 7. Tizanidine 2 mg PO Q8H:PRN muscle spasm 8. Acetaminophen 650 mg PO Q6H:PRN pain 9. Atovaquone Suspension 750 mg PO BID 10. Cyclobenzaprine 10 mg PO TID:PRN leg tightness RX *cyclobenzaprine 10 mg 1 tablet(s) by mouth TID PRN pain/muscle spas, Disp #*90 Tablet Refills:*0 11. Fluticasone Propionate NASAL 2 SPRY NU BID 12. OxyCODONE SR (OxyconTIN) 60 mg PO Q8H RX *oxycodone [OxyContin] 60 mg 1 tablet(s) by mouth Q8 hours PRN pain Disp #*90 Tablet Refills:*0 13. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 14. Warfarin 2.5 mg PO DAILY16 HOLD THIS MEDICATION ON ___. Methylprednisolone ACETATE 32 mg IM DAILY 16. Outpatient Physical Therapy outpatient ___ for mangement of SIJ arthopathy Discharge Disposition: Home Discharge Diagnosis: Subacute L4 compression fracture with no canal compromise Pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>•Do not smoke. •No pulling up, lifting more than 10 lbs., or excessive bending or twisting. ___ must wear your brace when out of bed or when sitting. ___ may shower briefly without the collar or back brace; unless ___ have been instructed otherwise. •Take your pain medication as instructed; ___ may find it best if taken in the morning when ___ wake-up for morning stiffness, and before bed for sleeping discomfort. •Do not take any anti-inflammatory medications such as Motrin, Advil, Aspirin, and Ibuprofen etc. unless directed by your doctor. •Increase your intake of fluids and fiber, as pain ___ (narcotics) can cause constipation. We recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •Clearance to drive and return to work will be addressed at your post-operative office visit. ***** YOUR PAIN MANAGEMENT PLAN ***** ___ will ___ a 7 day supply of dilaudid 12mg every 4 hours, after this ___ should resume taking your home dose of dilaudid as prescribed by Dr. ___ will ___ a 30 day supply of oxycontin 60mg three times daily. After this ___ should refer to your pain Dr. ___ further pain medication. ___ should continue to take cyclobenzaprine. ___ should follow up with Dr. ___ call his office if ___ have questions about your pain managment.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN pain 2. Albuterol Inhaler 2 PUFF IH Q8H:PRN wheezing 3. Aspirin 81 mg PO DAILY 4. Clopidogrel 75 mg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. Fluticasone Propionate NASAL 2 SPRY NU DAILY 7. FoLIC Acid 1 mg PO DAILY 8. Hydroxychloroquine Sulfate 200 mg PO BID 9. Metoprolol Succinate XL 100 mg PO DAILY Hold for SBP <110 and hold for HR <60. 10. Nitroglycerin SL 0.3 mg SL PRN chest pain 11. Pantoprazole 40 mg PO Q24H 12. Psyllium 1 PKT PO TID:PRN constipation 13. Valsartan 160 mg PO DAILY 14. Vitamin D 1000 UNIT PO DAILY 15. Insulin SC Sliding Scale Fingerstick QACHS, HS Insulin SC Sliding Scale using HUM Insulin 16. Linezolid ___ mg PO Q12H 17. calcium carbonate-vitamin D3 *NF* 500mg (1,250mg) -600 unit Oral BID 18. Centrum Silver *NF* (multivitamin-minerals-lutein;<br>mv with min-lycopene-lutein;<br>mv-min-folic acid-lutein) 0.4-300-250 mg-mcg-mcg Oral daily 19. Ferrous Sulfate 325 mg PO DAILY 20. Lovastatin *NF* 40 mg ORAL DAILY 21. melatonin *NF* 3 mg Oral hs 22. Methotrexate 15 mg PO 1X/WEEK (___) Every ___ 23. Multivitamins 1 TAB PO DAILY 24. Polysaccharide Iron *NF* (polysaccharide iron complex) 150 mg iron Oral BID 25. Symbicort *NF* (budesonide-formoterol) 160-4.5 mcg/actuation Inhalation daily 26. Senna 1 TAB PO HS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Delirium Urinary Tract Infection Secondary Rheumatoid Arthritis -CAD s/p RCA stent ___, patent on ___ cath -mild dCHF (EF 60% in ___ -COPD (2L NC at night only) -CVA ___ (left sided weakness, speech affected) -PVD/PAD -DM type 2 -HTN -AAA (MRI ___- 3.4cm, ___ 3.5cm) -Right lacunar infarct (___) - on coumadin, then stopped ___ -erosive gastritis, angiodysplasia (Normal EGD ___ -diverticulosis, angioectasias on CSPY ___ -migraines manifest as left facial numbness -Lumbar stenosis and cervical spondylosis, C5-7 radiculopathy -OSA -Neurologic bladder on daily bactrim per urol -Depression/Anxiety -Recurrent UTIs -Anemia -Hyponatremia (baseline Na low 130s) -Right total knee replacement Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Mental Status: Confused - always. Followup Instructions: ___ [/INST] </s><s>You were admitted with delirium. You were found to have a urinary tract infection. You were started on linezolid. Given the interaction between linezolid and celexa, your celexa was held. Given your delirium zolpidem was also held. Given your delirum plans were made for you to go to a geriatric psychiatric unit.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Headache Reason for PRN duplicate override: Alternating agents for similar severity RX *acetaminophen 325 mg 2 capsule(s) by mouth every six (6) hours Disp #*240 Capsule Refills:*0 2. Amoxicillin 500 mg PO Q8H RX *amoxicillin 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*14 Tablet Refills:*0 3. Calcium Carbonate 1000 mg PO TID RX *calcium carbonate [Calcium 500] 500 mg calcium (1,250 mg) 2 tablet(s) by mouth three times daily Disp #*90 Tablet Refills:*0 4. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Sulfameth/Trimethoprim DS 2 TAB PO BID RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 2 tablet(s) by mouth twice a day Disp #*18 Tablet Refills:*0 6. Dronabinol 2.5 mg PO BID nausea or lack of appetite RX *dronabinol 2.5 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 7. Enoxaparin Sodium 60 mg SC Q12H RX *enoxaparin 60 mg/0.6 mL ___very twelve (12) hours Disp #*60 Syringe Refills:*0 8. Amiodarone 200 mg PO DAILY 9. Benzonatate 100 mg PO TID 10. Escitalopram Oxalate 20 mg PO DAILY 11. Fluticasone Propionate NASAL ___ SPRY NU DAILY 12. FoLIC Acid 1 mg PO DAILY 13. Guaifenesin-CODEINE Phosphate ___ mL PO Q8H:PRN wheezing/cough 14. Hydrocortisone (Rectal) 2.5% Cream ___ID:PRN rash 15. Ipratropium Bromide Neb 1 NEB IH Q6H 16. LORazepam 0.5 mg PO BID:PRN nausea 17. Multivitamins 1 TAB PO DAILY 18. Omeprazole 20 mg PO BID 19. Ondansetron 8 mg PO Q8H:PRN nausea RX *ondansetron 4 mg ___ tablet(s) by mouth up to three times daily as needed Disp #*90 Tablet Refills:*0 20. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Second Line 21. Prochlorperazine 10 mg PO Q8H:PRN nausea 22. Senna 8.6 mg PO BID:PRN Constipation Discharge Disposition: Home Discharge Diagnosis: Nausea and vomiting Pancytopenia due to chemotherapy Febrile neutropenia Preseptal cellulitis Hypocalcemia Hypophosphatemia Metastatic non small cell lung cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital because of nausea, vomiting, and poor appetite, which were most likely due to your chemotherapy. While in the hospital, you also had low blood counts due to your chemotherapy. Because you developed a fever and had evidence of a skin infection around your left eye, we needed to keep you on IV antibiotics for several days. When you leave the hospital you will need a few more days of oral antibiotics to complete the course. You also had low calcium and phosphorus levels, which were most likely due to the zometa you received recently. By the time of discharge, your calcium and phosphorus were stable with you receiving additional supplementation by mouth. While in the hospital you also had discussions with Dr. ___, Dr. ___ Dr. ___ about next steps in your cancer care. You have follow-up scheduled with each of their teams. We have reduced your metoprolol dose from 50 mg to 25 mg daily since your blood pressures were slightly low in the hospital. We also recommend taking your dronabinol twice daily instead of on an as-needed basis.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. multivitamin,tx-minerals Tablet Sig: One (1) Tablet PO once a day. 4. metoprolol succinate 100 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO twice a day. 5. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 9. calcium acetate 667 mg Capsule Sig: One (1) Capsule PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 10. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. prednisone 10 mg Tablet Sig: One (1) Tablet PO once a day. 12. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day. 13. insulin glargine 100 unit/mL Solution Sig: Fifteen (15) Units Subcutaneous at bedtime. 14. insulin lispro 100 unit/mL Solution Sig: Per sliding scale Subcutaneous qac. 15. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 ___. 16. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 17. camphor-menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical TID (3 times a day) as needed for pruritis. 18. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 19. hydrocortisone 2.5 % Cream Sig: One (1) Appl Rectal PRN (as needed) as needed for hemorrhoids. 20. mupirocin calcium 2 % Cream Sig: One (1) Appl Topical DAILY (Daily). 21. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO at bedtime. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Acute on chronic kidney disease, acute interstitial nephritis, Uremia, Vasculitic skin rash Secondary: Coronary artery disease, diabetes, hyperthyroidism Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, you presented to us with worsening rash on your legs and worsening mental status due to your kidneys' inability to clear toxins from your blood. We treated these problems by initially giving you a temporary hemodialysis line and performing hemodialysis to clear some toxins. We also had dermatology evaluate your rash and they felt that a biopsy was not indicated at this time. You were also evaluated by the ophthomology team and they stated that your eyes did not have evidence of cholesterol clots. You began to make urine and your creatinine decreased and we determined that you did not need more hemodialysis at the moment. We made the following changes to your medications: Please START Omeprazole 20mg daily while on steroids START Nephrocaps START Miconazole cream, Hyrdocortisone cream rectally, and Mupriocin cream STOP amitriptyline STOP gabapentin STOP levothyroxine CHANGE PhosLo to 1 tab daily CHANGE Prednisone to 10mg daily CONTINUE Warfarin 5mg daily adjust to INR</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Dabigatran Etexilate 150 mg PO BID 2. Multivitamins 1 TAB PO DAILY 3. Diltiazem Extended-Release 180 mg PO DAILY RX *diltiazem HCl 180 mg 1 capsule, extended release(s) by mouth daily Disp #*30 Capsule Refills:*0 4. Cialis (tadalafil) 0 tab ORAL UNK 5. Testim (testosterone) 0 gel TRANSDERMAL UNK 6. Simvastatin 10 mg PO DAILY RX *simvastatin 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Cephalexin 500 mg PO Q6H Duration: 2 Days RX *cephalexin 500 mg 1 tablet(s) by mouth every six (6) hours Disp #*8 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Pacemaker Tachy-brady syndrome atrial fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you at ___. You were admitted for a pacemaker for atrial fibrillation with tachycardia and bradycardia. Your procedure went smoothly. We started you on a low dose of calcium channel blocker. Please take as directed. Diltiazem 180mg daily. Please also decrease simvastatin to 10mg daily as this interacts with diltiazem.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO BID:PRN Pain - Mild 2. Amiodarone 200 mg PO DAILY 3. amLODIPine 10 mg PO DAILY 4. Ascorbic Acid ___ mg PO DAILY 5. Atorvastatin 10 mg PO QPM 6. Docusate Sodium 100 mg PO DAILY:PRN constipation 7. Ferrous Sulfate 325 mg PO DAILY 8. Furosemide 20 mg PO DAILY 9. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 10. Lidocaine 5% Patch 1 PTCH TD QAM 11. Lisinopril 2.5 mg PO DAILY 12. Multivitamins 1 TAB PO DAILY 13. Omeprazole 20 mg PO DAILY 14. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate 15. Vitamin D ___ UNIT PO DAILY 16. Warfarin 3.75 mg PO 2X/WEEK (MO,FR) 17. Warfarin 2.5 mg PO 5X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ ___: Primary diagnosis: Volume depletion likely due to diarrhea Secondary diagnoses: Atrial fibrillation HTN Chronic kidney disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure treating you at ___! Why was I admitted to the hospital? -You were admitted because you had had diarrhea, and because you were feeling dizzy. -When you were admitted, we also saw that your blood levels were low What was done while I was admitted? -We gave you some fluids to make sure you weren't dehydrated -We made sure your blood level was increasing and that your kidney was functioning well -We gave you diuretics to bring fluid off of your lungs and your legs -We made sure you were able to walk around without falling down What should I do when I go home? -Please continue to follow-up with the ___ clinic to dose your warfarin -Please continue to take iron supplementation for anemia -Please continue to follow a diet that is low in salt -Please weigh yourself every morning and call your doctor if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H RX *acetaminophen 500 mg 1 to 2 tablet(s) by mouth three times a day Disp #*60 Tablet Refills:*0 2. Aspirin 325 mg PO DAILY RX *aspirin 325 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. crutch miscellaneous as needed for ambulation RX *crutch Disp #*1 Each Refills:*0 4. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*50 Tablet Refills:*0 5. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*36 Tablet Refills:*0 6. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tab by mouth twice daily Disp #*50 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: left tibia fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - weight bearing as tolerated to the left lower extremity MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take aspirin 325mg daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Please remain in your dressing and do not change unless it is visibly soaked or falling off. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE <30 DAYS OF REHAB FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___. You will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for and any new medications/refills. Physical Therapy: weight bearing as tolerated to the left lower extremity Treatments Frequency: Any staples or superficial sutures you have are to remain in place for at least 2 weeks postoperatively. Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. You may shower and allow water to run over the wound, but please refrain from bathing for at least 4 weeks postoperatively. Please remain in the splint until follow-up appointment. Please keep your splint dry. If you have concerns regarding your splint, please call the clinic at the number provided.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acetaminophen 325 mg tablet Sig: ___ tablets PO Q6H (every 6 hours) as needed for pain or fever. 2. allopurinol ___ mg tablet Sig: One (1) tablet PO DAILY (Daily). 3. amlodipine 5 mg tablet Sig: One (1) tablet PO DAILY (Daily). 4. atorvastatin 20 mg tablet Sig: One (1) tablet PO DAILY (Daily). 5. carvedilol 12.5 mg tablet Sig: Two (2) tablet PO BID (2 times a day). 6. doxazosin 1 mg tablet Sig: Two (2) tablet PO HS (at bedtime). 7. gemfibrozil 600 mg tablet Sig: One (1) tablet PO BID (2 times a day). 8. glimepiride 1 mg tablet Sig: One (1) tablet PO daily (). 9. oxycodone 5 mg tablet Sig: ___ tablets PO Q4H (every 4 hours) as needed for pain. Disp:*25 tablet(s)* Refills:*0* 10. Colace 100 mg capsule Sig: One (1) capsule PO twice a day: take to prevent constipation. Disp:*60 capsule(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Nephrolithiasis, obstructing Acute renal failure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>-You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month; this may be related to the passage of stone fragments or the indwelling ureteral stent (if there is one). -The kidney stone may or may not have been removed AND/or there may fragments/others still in the process of passing. -You may experience some pain associated with spasm of your ureter.; This is normal. Take the narcotic pain medication as prescribed if additional pain relief is needed. -Ureteral stents MUST be removed or exchanged and therefore it is IMPERATIVE that you follow-up as directed. -Do not lift anything heavier than a phone book (10 pounds) -You may continue to periodically see small amounts of blood in your urine--this is normal and will gradually improve -Resume all of your pre-admission medications, except HOLD aspirin until you see your urologist in follow-up -You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month; this may be related to the passage of stone fragments or the indwelling ureteral stent. -The kidney stone may or may not have been removed AND/or there may fragments/others still in the process of passing. -You may experience some pain associated with spasm of your ureter.; This is normal. Take the narcotic pain medication as prescribed if additional pain relief is needed. -Ureteral stents MUST be removed or exchanged and therefore it is IMPERATIVE that you follow-up as directed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aripiprazole 10 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Duloxetine 60 mg PO DAILY 5. Gabapentin 100 mg PO TID 6. Lactulose 15 mL PO BID 7. Omeprazole 40 mg PO BID 8. QUEtiapine extended-release 200 mg PO QHS 9. Senna 8.6 mg PO BID 10. Vitamin D 1000 UNIT PO DAILY 11. Alendronate Sodium 70 mg PO 1X/WEEK (___) 12. Furosemide 40 mg PO DAILY Please do not start this medication until ___. 13. MetFORMIN (Glucophage) 500 mg PO BID 14. Metoprolol Succinate XL 12.5 mg PO DAILY 15. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation 2 puffs q6hr PRN SOB 16. Pravastatin 10 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnosis: Atypical chest pain, CVA Secondary diagnosis: ischemic cardiomyopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were hospitalized on ___ at ___ for your chest pain. During your hospitalization, we did not see any signs of heart attack by your blood work and EKG. While ___ were here, we were concerned about possible slurred speech so ___ got scans of your head and neck to look for a possible stroke. Neurology evaluated ___ had an MRI that showed ___ may have had a small stroke. We have made appointments with your PCP and cardiologist within the next week, so please keep these appointments. In addition, please keep your previously made doctor appointments. Please note that your other home medications have not been changed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Calcium Carbonate 400 mg PO DAILY 3. Fluticasone Propionate NASAL 1 SPRY NU DAILY 4. Multivitamins 1 TAB PO DAILY 5. Zonisamide 700 mg PO QPM 6. colloidal oatmeal 43 % topical PRN unknown 7. Lorazepam 0.5 mg PO X2 PRN seizure 8. melatonin 1 dose ORAL DAILY Discharge Disposition: Home Discharge Diagnosis: epilepsy autism Discharge Condition: Mental status: Nonverbal, alert, follows some commands, cooperates with exam. Ambulatory status: weight bearing as tolerated Followup Instructions: ___ [/INST] </s><s>___ was admitted to the hospital because she had two seizures. She underwent EEG in the hospital which did not show any ongoing seizures. She had no further clinical seizures and her mental status returned to baseline. We did not find any trigger for her breakthrough seizures - there was no sign of infection or electrolyte abnormalities. A discussion with her outpatient epileptologist was held and no changes were made to her anti-epileptic medications. We are waiting for the results of a blood test to monitor the level of her Zonegran to make sure her dose is at the therapeutic level.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 200 mg PO DAILY 2. Ascorbic Acid ___ mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Levothyroxine Sodium 100 mcg PO EVERY OTHER DAY 5. Levothyroxine Sodium 150 mcg PO EVERY OTHER DAY 6. Lisinopril 10 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: ================== Cocaine use SECONDARY DIAGNOSIS: ==================== History of intravenous drug use complicated by endocarditis status-post mitral valve replacement Recurrent prosthetic valve endocarditis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, Thank you for allowing us to take part in your care! WHY WERE YOU ADMITTED: - You were having chest pain and we wanted to figure out why. WHAT HAPPENED IN THE HOSPITAL: - We did bloodwork and a CAT scan, and everything was normal. - We think your chest pain was related to cocaine use. WHAT SHOULD YOU DO AFTER LEAVING: - Follow-up with your doctors as ___. - Take your medications as prescribed. - Please stop using IV drugs, as you have already had multiple heart infections related to drug use. - If you notice severe chest pain, shortness of breath, or headache, please return to the hospital. Thank you for allowing us to take part in your care! your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Carbidopa-Levodopa (___) 2 TAB PO Q3H *** THIS IS DOUBLE HOME DOSE WHILE PATIENT IS UNABLE TO TAKE TOLCAPONE*** 2. Carbidopa-Levodopa (___) 2 TAB PO HS *** THIS IS DOUBLE HOME DOSE WHILE PATIENT IS UNABLE TO TAKE TOLCAPONE*** 3. Fludrocortisone Acetate 0.2 mg PO DAILY 4. Levothyroxine Sodium 100 mcg PO DAILY 5. Selegiline HCl 5 mg PO BID 6. Ropinirole 12 mg PO TID 7. Aspirin 81 mg PO DAILY 8. Cyanocobalamin 50 mcg PO DAILY 9. Senna 1 TAB PO BID 10. Tasmar (tolcapone) 50 mg ORAL Q3H ***PATIENT IS CURRENTLY UNABLE TO TAKE THIS AS IT CANNOT BE CRUSHED-- SINEMET DOUBLED FOR NOW*** 11. trospium 20 mg oral bid 12. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: RETROPHARYNGEAL EDEMA ___ DISEASE RHABDOMYOLYSIS DEHYDRATION SECONDARY DIAGNOSES: HYPOTHYROIDISM Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege caring for you at ___. You were admitted because you were found on the ground in your apartment. You underwent imaging of your neck and head which did not reveal any fractures. You sustained an injury to your neck "whiplash" which caused swelling at the back of your throat, which made it difficult to swallow. You were kept in a soft collar neck brace for your comfort and should follow up with orthopedics (Dr. ___ in ___ weeks. While the swelling continues to improve, it will remain difficult to swallow. Your diet will be initially restricted to consistencies which decreases the risk that food and drink inappropriately pass down your windpipe instead of your esophagus. While you are having difficulty swallowing, your medications are given crushed in applesauce. Unfortunately your tolcapone cannot be crushed, so while you are unable to take this, we are doubling your dosage of sinemet to prevent worsening ___ symptoms. Once you are able to swallow better again your medications should be changed back to the previous doses. We wish you and your wife a speedy recovery. Best, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl ___AILY:PRN constipation 2. Docusate Sodium 100 mg PO BID 3. Mirtazapine 7.5 mg PO HS 4. Ondansetron 8 mg PO Q8H:PRN nausea 5. Polyethylene Glycol 17 g PO DAILY 6. Senna 2 TAB PO TID 7. Milk of Magnesia 30 mL PO Q6H:PRN constipation can be purchased over the counter 8. Acetaminophen 325-650 mg PO Q6H:PRN pain 9. Amlodipine 5 mg PO DAILY 10. atropine *NF* ___ drops SL Q4H secretions 11. Fleet Enema ___AILY:PRN constipation 12. Haloperidol 0.5-2 mg PO TID:PRN restlessness 13. Lorazepam 0.5-2 mg PO Q4H:PRN restlessness 14. Lidocaine 5% Patch 1 PTCH TD DAILY 15. Morphine Sulfate (Concentrated Oral Soln) ___ mg PO Q1H:PRN pain/dyspnea concentration=50mg/ml. dispense 60ml RX *morphine concentrate 100 mg/5 mL (20 mg/mL) ___ mg by mouth q1hr prn. Disp ___ Milliliter Refills:*0 16. Oxybutynin 5 mg PO TID RX *oxybutynin chloride 5 mg 1 tablet(s) by mouth three times a day Disp #*21 Tablet Refills:*0 17. Morphine Sulfate ___ ___ mg PO Q3H:PRN pain ___ q3hrs. PLease given 30mg ___ RX *morphine 15 mg ___ tablet(s) by mouth q3hrs Disp #*60 Tablet Refills:*0 18. Fentanyl Patch 25 mcg/h TD Q72H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Renal failure due to post obstructive uropathy Advanced prostate cancer Constipation Discharge Condition: Mental Status: Clear and coherent, occasionally confused with medication. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with pelvic pain and kidney failure. Your pain was better controlled by adjusting your pain medications and by addressing constipation. You were also found to have kidney failure which was due to obstruction from prostate cancer; this was managed with tubes placed in the back to drain each kidney. Your kidney function improved. . Please see below for your medications. . The urology doctors also ___ and replaced your suprapubic catheter. You were started on a medication for potential bladder spasms. . You will continue to be followed closely by Hospice of ___ ___ when you return home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin 500 mg PO Q8H 2. amLODIPine 5 mg PO DAILY 3. Artificial Tear Ointment 1 Appl LEFT EYE QHS 4. Artificial Tears 1 DROP BOTH EYES TID 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 80 mg PO DAILY 7. Baclofen 5 mg PO TID:PRN Pain - Moderate 8. Clopidogrel 75 mg PO DAILY 9. Famotidine 20 mg PO BID 10. Finasteride 5 mg PO DAILY 11. Lisinopril 20 mg PO DAILY 12. MetFORMIN (Glucophage) 1000 mg PO BID 13. Sertraline 25 mg PO DAILY 14. Tamsulosin 0.4 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Sequelae of Right MCA stroke with hemorrhagic transformation ___ edema Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to ___ due to headache, vomiting. On brain imaging, we found that the bleed in your known stroke from previous admission was stable, but the swelling around this brain bleed was increased. This swelling can increase up to 3 weeks after initial brain bleed, therefore we felt your symptoms were caused by the expected increase in the swelling around the known bleed. As your headache and vomiting improved soon after presentation, we did not have to give you medications to lower pressure in the brain. We also found that you had a Urinary tract infection, therefore we started you an antibiotic to treat this. [ ] Please take amoxicillin by mouth till ___ for urine infection. [ ] continue other medications as prescribed. You were seen by our physical therapist who recommendation continuation of rehabilitation. You were discharged to rehab on ___. It was a pleasure taking care of you, Sincerely ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q8H:PRN pain/HA 2. Docusate Sodium 100 mg PO BID 3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 4. Polyethylene Glycol 17 g PO DAILY 5. Raltegravir 400 mg PO BID 6. Senna 1 TAB PO BID 7. Oxycodone SR (OxyconTIN) 30 mg PO Q12H 8. Oxycodone SR (OxyconTIN) 45 mg PO QHS 9. Linezolid ___ mg PO Q12H day 1 = ___ RX *linezolid [Zyvox] 600 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 10. Methadone 30 mg PO DAILY 11. Triamcinolone Acetonide 0.1% Cream 1 Appl TP BID:PRN itch Discharge Disposition: Home Discharge Diagnosis: Tuberculosis rule out Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___. You came to ___ with concern that you had Tuberculosis. After we took 3 sputum samples, it was determined that you do NOT have Tuberculosis in your lungs. You will continue to need anti-biotics for your spine infection. You will be treated with oral antibiotics for your spine infection for another 30 days. You should follow-up with Dr. ___) for weekly blood work while taking this ___ antibiotics.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PO DAILY:PRN constipation 2. BuPROPion (Sustained Release) 150 mg PO QAM 3. BuPROPion (Sustained Release) 150 mg PO QPM 4. Ferrous Sulfate 325 mg PO DAILY 5. Gabapentin 800 mg PO BID 6. Thiamine 100 mg PO DAILY 7. Vitamin D 400 UNIT PO DAILY 8. Calcium Carbonate 1250 mg PO DAILY 9. Acetaminophen 1000 mg PO Q8H 10. Bismuth Subsalicylate 30 mL PO QID Duration: 14 Days 11. Docusate Sodium 100 mg PO BID 12. Doxycycline Hyclate 100 mg PO Q12H please do not take with calcium within 2 hours 13. Lorazepam 0.5 mg PO Q4H:PRN anxiety 14. MetRONIDAZOLE (FLagyl) 250 mg PO Q6H Duration: 14 Days 15. Multivitamins 1 CAP PO DAILY 16. Nicotine Patch 14 mg TD DAILY:PRN Tobacco withdrawal 17. Omeprazole 20 mg PO BID 18. Ondansetron 4 mg PO Q8H:PRN nausea 19. OxycoDONE (Immediate Release) 15 mg PO Q3H:PRN severe pain 20. Polyethylene Glycol 17 g PO DAILY:PRN constipation 21. Sucralfate 1 gm PO QID CRUSH AND ADD WATER TO MAKE LIQUID FORM 22. TraMADOL (Ultram) 50 mg PO Q6H:PRN moderate pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Marginal ulcer near the g-j anastomosis Gastro-gastric fistula Depression Anxiety SVT Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ for abdominal pain from ___ ___ in ___. You got an endoscopy which showed an ulcer and a fistula between two parts of your stomach. You were also found to have a bacteria called h. pylori in your blood. You will need to be on 4 medications for this for 14 days. Take your last dose of bismuth, metronidazole and doxycycline on ___. You continue the omeprazole after that date if it help with your symptoms. You should follow up with your PCP after your discharge from ___. . Medication changes see next page .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q6H:PRN Shortness of breath, wheezing RX *albuterol sulfate [ProAir HFA] 90 mcg ___ puffs inhaled Every 6 hours as needed Disp #*1 Inhaler Refills:*0 2. OSELTAMivir 30 mg PO Q12H Continue until ___ RX *oseltamivir 30 mg 1 capsule(s) by mouth Twice a day Disp #*5 Capsule Refills:*0 3. Tacrolimus 3.5 mg PO Q12H RX *tacrolimus 0.5 mg 7 capsule(s) by mouth Twice a day Disp #*60 Capsule Refills:*0 4. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild 5. Alendronate Sodium 70 mg PO QMON 6. Benzonatate 100 mg PO TID 7. bimatoprost 0.01 % ophthalmic QHS 8. Calcitriol 0.25 mcg PO 5X/WEEK (___) 9. Carvedilol 6.25 mg PO BID 10. ClonazePAM 0.5 mg PO QHS:PRN insomnia 11. Dapsone 100 mg PO DAILY 12. Fish Oil (Omega 3) 1000 mg PO BID 13. Furosemide 40 mg PO BID 14. Guaifenesin-Dextromethorphan 10 mL PO Q6H:PRN cough 15. HydrALAZINE 100 mg PO BID 16. Glargine 34 Units Bedtime 17. Mycophenolate Sodium ___ 360 mg PO QID 18. PredniSONE 5 mg PO DAILY 19. Pregabalin 50 mg PO DAILY 20. Simvastatin 20 mg PO QPM 21. Sodium Bicarbonate 650 mg PO BID 22. ValGANCIclovir 450 mg PO Q24H 23. Warfarin 2 mg PO DAILY16 Discharge Disposition: Home Discharge Diagnosis: Flu Acute on chronic diastolic heart failure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital for shortness of breath. You were found to have the flu that is causing your difficulty breathing. You also had mild heart failure from the flu. You should continue to take the oseltamivir (Tamiflu) for flu treatment until ___. Please follow-up with your transplant doctors next week as they will need to check your labs again. They also recommend you take 3.5 mg twice a day of your tacrolimus. Please continue to take your furosemide (Lasix) as previously prescribed. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Take care. Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever 2. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Second Line 3. Senna 8.6 mg PO BID:PRN Constipation - First Line 4. Sulfameth/Trimethoprim DS 2 TAB PO/NG BID 5. Glargine 75 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 6. Albuterol Inhaler 2 PUFF IH Q6H:PRN asthma 7. Aspirin 81 mg PO DAILY 8. Cetirizine 10 mg PO DAILY 9. Clopidogrel 75 mg PO DAILY 10. Flovent HFA (fluticasone) 220 mcg/actuation inhalation BID 11. Fluticasone Propionate NASAL 2 SPRY NU DAILY 12. Furosemide 20 mg PO DAILY 13. Gabapentin 300 mg PO BID 14. Gabapentin 900 mg PO QHS 15. Isosorbide Mononitrate (Extended Release) 90 mg PO DAILY 16. Metoprolol Succinate XL 100 mg PO DAILY 17. Niacin 500 mg PO BID 18. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 19. Nystatin-Triamcinolone Cream 1 Appl TP QID:PRN rash 20. Ranitidine 300 mg PO DAILY 21. Simvastatin 5 mg PO QPM 22. TraMADol 50 mg PO TID 23. Venlafaxine XR 150 mg PO DAILY 24. Vitamin D ___ UNIT PO EVERY 2 WEEKS (MO) 25. HELD- diclofenac sodium 1 % topical TID:PRN This medication was held. Do not restart diclofenac sodium until you follow-up with your PCP 26. HELD- HYDROcodone-Acetaminophen (5mg-325mg) 1 TAB PO Q6H:PRN Pain - Moderate This medication was held. Do not restart HYDROcodone-Acetaminophen (5mg-325mg) until you follow-up with your PCP 27. HELD- Lactulose 30 mL PO BID This medication was held. Do not restart Lactulose until you follow-up with your PCP 28. HELD- Potassium Chloride 20 mEq PO DAILY This medication was held. Do not restart Potassium Chloride until you follow up with your physician (risk of high potassium with bactrim use) 29. HELD- promethazine-codeine 6.25-10 mg/5 mL oral Q6H:PRN This medication was held. Do not restart promethazine-codeine until you follow-up with your PCP ___: Extended Care Facility: ___ Discharge Diagnosis: =================== PRIMARY DIAGNOSIS =================== Acute cholecystitis =================== SECONDARY DIAGNOSIS =================== Coronary artery disease Type 2 diabetes Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You were admitted to the hospital because you were having severe abdominal pain, nausea, and vomiting. WHAT HAPPENED TO ME IN THE HOSPITAL? - You had lab tests and imaging that showed that you had inflammation of the gallbladder (cholecystitis) that was causing your symptoms. - The Interventional Radiology team performed a percutaneous cholecystostomy (tube placement in the gallbladder to drain bile). - Tests showed that there was an infection with E. coli in the gallbladder. - You were treated with antibiotics and your pain and nausea and fevers improved. You received IV fluids for rehydration and then slowly restarted eating and drinking. - You were seen by the Cardiology and Surgery teams, who recommended that you get a cholecystectomy (gall bladder removal) in the future after your acute infection resolves. - You worked with Physical Therapy who recommended that you go to ___ rehab to regain your strength before returning home. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Please continue to take all of your medications and follow-up with your appointments as listed below. - You are going to need to continue your antibiotics until you have your gallbladder surgery. - You will need to keep the gallbladder drain in place until your follow-up appointment with the surgery team. You will have help draining this at rehab. - Please discuss with your cardiologist and their team about timing of stopping your Plavix prior to surgery. We wish you the best! Sincerely, Your ___ Team</s>