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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Carbamazepine (Extended-Release) 600 mg PO QAM 3. Carbamazepine (Extended-Release) 800 mg PO QPM 4. LaMOTrigine 250 mg PO BID 5. Phenytoin Sodium Extended 100 mg PO QAM 6. Phenytoin Sodium Extended 200 mg PO QPM 7. Sertraline 200 mg PO DAILY 8. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Lamotrigine toxicity Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neuro: no nystagmus, CN exam benign, full strength, Pt presents with mildly unsteady gait patterning as manifested by slowed, discontinuous cadence, slowed gait speed (although improved from initial evaluation), arms held out in extension especially with negotiation of turns, decreased heel strike at initial contact bilaterally, narrowed BOS throughout stance with occasional (___) L>R ___ crossing midline, variable stance time BLE, decreased trail limb posturing and push off in terminal stance bilaterally, decreased foot clearance throughout swing phase with variable step length observed. + LOB with turns secondary to LLE crossing midline. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for lamotrigine toxicity. We have put you on your correct dose of 250mg twice per day. You were also evaluated by physical therapy and found to be very unsteady on your feet. As a result, we got an MRI of your head, which was unremarkable. You were kept on continuous EEG while your phenytoin was weaned off. You are to continue lamotrigine 250mg twice per day and carbamazepine 600mg in the morning and 800mg in the evening. It was a pleasure taking care of you in the hospital, and 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. Amlodipine 10 mg PO DAILY 2. Losartan Potassium 100 mg PO DAILY 3. Pantoprazole 40 mg PO Q24H 4. Oxcarbazepine 300 mg PO BID 5. Docusate Sodium (Liquid) 100 mg PO BID 6. Polyethylene Glycol 17 g PO DAILY 7. Calcium 600 with Vitamin D3 (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral BID Discharge Disposition: Home Discharge Diagnosis: Small Bowel Obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>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. *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: [/INST] </s><s>You were admitted to the hospital because of increased sedation and concern that you were having difficulty managing your oral secretions. We stopped your Seroquel, a medication that was likely making you more sleepy. A workup for infections was all unremarkable. You were assessed by Physical Therapy and Occupational Therapy, who recommended a new motorized wheelchair and home suction equipment in order to have safer care at home. In the hospital, you developed a urinary tract infection. This was treated with IV antibiotics (Ceftriaxone), then changed to oral antibiotics (Cefpodoxine) on discharge. We made the following changes to your medications: 1. STOPPED Seroquel 2. STARTED Modafinil (Provigil) 2.5mg in AM 3. STARTED Cefpodoxine 200mg twice daily for 7 days to treat UTI (first day = ___, last day = ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PR QHS:PRN constipation RX *bisacodyl [Bisac-Evac] 10 mg 1 suppository(s) rectally once a day Disp #*12 Suppository Refills:*0 2. LORazepam 0.25 mg PO Q4H:PRN anxiety RX *lorazepam [Ativan] 0.5 mg 0.5 (One half) tablet(s) by mouth every four (4) hours Disp #*10 Tablet Refills:*0 3. Morphine Sulfate (Concentrated Oral Solution) 20 mg/mL ___ mg PO Q2H:PRN Pain - Moderate RX *morphine concentrate 20 mg/mL ___ mg by mouth every 2 hours as needed Disp #*50 Syringe Refills:*0 4. Scopolamine Patch 1 PTCH TD ONCE Duration: 72 Hours Apply behind ear RX *scopolamine base [Transderm-Scop] 1.5 mg (delivers 1 mg over 3 days) Apply behind ear Q72H Disp #*10 Patch Refills:*0 5. Acetaminophen 1000 mg PO Q8H 6. Aquaphor Ointment 1 Appl TP TID:PRN wound care 7. Ipratropium-Albuterol Neb 1 NEB NEB Q6H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis ================== Septic shock secondary to pneumonia Acute renal failure Severe malnutrition Secondary Diagnosis =================== Atrial fibrillation with rapid ventricular response Sacral decubitus ulcer Hypertension Constipation Hypothyroidism Discharge Condition: Activity Status: Bedbound. Level of Consciousness: Lethargic and not arousable. Mental Status: Confused - always. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ because you had severely infected skin wounds on your back, kidney failure, and a very fast heart rate. You were treated with antibiotics, but your condition continued to worsen. After an extensive conversation with your family, we switched you to comfort-based care. We started medications to control your symptoms. You were seen by our hospice team for control of your symptoms, but you family declined hospice care at this time. You will be followed by a palliative care visiting nurse after discharge. Your family was provided with instructions on administering pain and anxiety medications through your PEG tube. Your family should ask the visiting nurse if they have any questions regarding use of the PEG tube or inadequate control of your symptoms. It was a privilege taking care of you and 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. Calcium Carbonate 1500 mg PO BID 2. Fish Oil (Omega 3) 1000 mg PO BID 3. Levothyroxine Sodium 88 mcg PO DAILY 4. Warfarin 5 mg PO DAILY16 Please follow up with ___ clinic to monitor the dosing RX *warfarin 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. 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 6. Diltiazem Extended-Release 120 mg PO DAILY RX *diltiazem HCl 120 mg 1 capsule,extended release 24hr(s) by mouth daily Disp #*30 Capsule Refills:*0 7. Losartan Potassium 25 mg PO BID RX *losartan [Cozaar] 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 8. Alendronate Sodium 70 mg PO QSUN Discharge Disposition: Home Discharge Diagnosis: Syncope Atrial fibrillation with RVR Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Hello Ms. ___, It was a pleasure to take care of you. You came in after you fainted. We believe that it was due to an irregular heart rate called atrial fibrillation. You were put a medication called diltiazem that put your heart rhythm back to normal. Because of your age and other factors, you were also started on a blood thinner, coumadin in order to decrease the chances of having a stroke with this type of heart rhythm. You will resume your home medications but with the following changes: Your losartan will be 25 mg twice a day instead of 50 mg twice a day. You have been started on two new medicines. The first is diltiazem extended release 120 mg every day. This is to prevent you from going into the irregular rhythm that brought you to the hospital. The second is coumadin, also called warfarin, 5 mg to thin your blood and decrease your risk of having a stroke. Coumadin requires that you have follow up blood checks to decrease the risk of bleeding. Please follow up with your primary care doctor to setup these check ups. Since you have been started on coumadin, we will stop your aspirin, which is a blood thinning drug. Lastly you will no longer be taking the amolodipine unless directed by your primary doctor. We wish you the best.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. amLODIPine 5 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Transient global amnesia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___ came to the hospital because ___ had an episode of amnesia. We did a CT scan and an MRI of your brain, which did not show a stroke. We also did an EEG, which showed that your brain waves were slightly slower on one side compared to the other, and did not show any seizures. This slowing is probably from scar tissue in your brain that we are unable to see on MRI. We think that your memory loss is either from a condition called Transient Global Amnesia, or potentially from a seizure. We would like ___ to have a repeat EEG in 3 months and follow up in neurology clinic as an outpatient. If ___ have any more episodes of memory loss, please come back to the ED for evaluation. ___ have previously been diagnosed with atrial fibrillation, but were not on treatment because your risk of stroke was low. ___ were previously told to take Aspirin daily, but ___ hadn't been doing this regularly. We would recommend taking Aspirin 81mg daily for stroke prevention, and we started this medication while ___ were in the hospital. It was a pleasure taking care of ___ and we wish ___ the best!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain RX *hydromorphone 4 mg ___ tablet(s) by mouth every four (4) hours Disp #*90 Tablet Refills:*0 2. Diazepam 5 mg PO Q6H:PRN muscle spasms RX *diazepam 5 mg 5 mg by mouth every six (6) hours Disp #*20 Tablet Refills:*0 3. Enoxaparin Sodium 80 mg SC Q12H Duration: 5 Days Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 80 mg/0.8 mL 80 mg subcutaneous every twelve (12) hours Disp #*10 Syringe Refills:*0 4. Axillary Crutches x 2 Axillary crutches x 2 Diagnosis: Right patellar tendon injury Prognosis: good Duration: 13 months Discharge Disposition: Home Discharge Diagnosis: Right patellar tendon disruption 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 on the right leg - Please remain in full extension in the locked ___ brace at all times unless instructed otherwise 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 80 mg every 12 hours by subcutaneous injection AND Coumadin 5 mg every night by mouth until you follow-up with your PCP to get your INR re-checked. 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. - ___ brace must be left on until follow up appointment unless otherwise instructed - Do NOT get ___ 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 FOLLOW UP: Please follow up with your surgeon's team (Dr. ___, with ___, NP in the Orthopaedic Trauma Clinic ___ days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within 3 days for anticoagulation management, an INR check, and for and any new medications/refills.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate To treat pain from your rib fractures and recent chest tube placement. RX *oxycodone [Oxaydo] 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 2. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [Evac-U-Gen (sennosides)] 8.6 mg 1 tablet by mouth Daily Disp #*20 Tablet Refills:*0 3. Acyclovir Ointment 5% 1 application Other Q4H:PRN 4. albuterol sulfate 1.25 mg/3 mL inhalation Q4H:PRN 5. ClonazePAM 1 mg PO Q8H:PRN anxiety, insomnia 6. Cyanocobalamin 500 mcg PO DAILY 7. Docusate Sodium 100 mg PO BID 8. Doxycycline Hyclate 50 mg PO Q12H 9. Erythromycin 0.5% Ophth Oint 0.5 in BOTH EYES BID 10. famciclovir 500 mg PO BID:PRN 11. Fluticasone Propionate 110mcg 4 PUFF IH BID 12. Fluticasone Propionate NASAL 2 SPRY NU DAILY 13. Furosemide 20 mg PO DAILY:PRN edema 14. ketotifen fumarate 0.025 % (0.035 %) ophthalmic 1 gtt each eye daily 15. Levothyroxine Sodium 100 mcg PO DAILY 16. Lidocaine 2% 2 mL SC QHS:PRN intercourse 17. MetronidAZOLE Topical 1 % Gel 1 Appl TP BID 18. Mirtazapine 45 mg PO QHS 19. Mupirocin Ointment 2% 1 Appl NU DAILY 20. Nystatin Oral Suspension 10 mL PO QID:PRN thrush 21. Omeprazole 20 mg PO BID 22. OxyCODONE (Immediate Release) 10 mg PO Q4H:PRN Pain - Moderate 23. polyvinyl alcohol 1.4 % ophthalmic TID:PRN 24. Spironolactone 50 mg PO DAILY 25. Triamcinolone Acetonide 0.1% Cream 1 Appl TP 3X/WEEK (___) 26. vit A-vit C-vit E-zinc-copper ___ unit-mg-unit oral DAILY Discharge Disposition: Home Discharge Diagnosis: 1. right 10th rib fracture 2. right pneumothorax 3. subcutaneous emphysema 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 trauma surgery service with a right-sided rib fracture, right pneumothorax, and subcutaneous emphysema. You had a chest tube placed and your pain control was optimized. You are being discharged home in stable condition with the following directions: * Your injury caused a rib fracture, 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). 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. 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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PR HS:PRN constipation 2. Calcium Carbonate 600 mg PO BID 3. Citalopram 10 mg PO DAILY 4. Collagenase Ointment 1 Appl TP DAILY 5. Docusate Sodium 100 mg PO BID 6. Donepezil 10 mg PO HS 7. Lidocaine 5% Patch 1 PTCH TD DAILY 8. Memantine 10 mg PO BID 9. Methylprednisolone 2 mg PO QOD 10. Milk of Magnesia 30 mL PO DAILY:PRN constipation 11. Senna 2 TAB PO HS 12. TraZODone 100 mg PO HS 13. TraZODone 25 mg PO TID PRN anxiety 14. Vitamin D 1000 UNIT PO DAILY 15. Azo Cranberry Plus Vit C *NF* (cranberry extract-vit C) 250-60 mg Oral BID 16. ibandronate *NF* 150 mg Oral Qmonthly 17. Levothyroxine Sodium 125 mcg PO DAILY 18. Polyethylene Glycol 17 g PO DAILY:PRN constipation 19. Voltaren *NF* (diclofenac sodium) 1 % Topical TID PRN pain 20. Aspirin 81 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: transient ischemic attack 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>Dear ___, ___ was a pleasure caring for ___ while ___ were hospitalized at the ___. ___ were admitted for facial asymmetry that likely reflected a transient ischemic attack. We did not find anything on our work-up which would merit intervention, but did start ___ on aspirin to decrease your future risk of stroke. We made the following changes to your medication list: - We STARTED ___ on ASPIRIN 81mg once a day Please continue to take your other medications as previously prescribed. If ___ experience any of the below listed Danger Signs, please contact your doctor or go to the nearest Emergency Room. It was a pleasure taking care of ___ on this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Symbicort 160-4.5 mcg/Actuation HFA Aerosol Inhaler Sig: One (1) Inhalation 2 puffs BID (). 2. levetiracetam 250 mg Tablet Sig: Three (3) Tablet PO qam on ___. 3. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): at noon and bedtime (in addition to AM dose on non-dialysis days). 4. Renvela 800 mg Tablet Sig: Two (2) Tablet PO TID on ___. 5. meclizine 12.5 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 6. furosemide 80 mg Tablet Sig: Two (2) Tablet PO BID ON SAT/SUN/TUES/THURS (). 7. furosemide 80 mg Tablet Sig: Two (2) Tablet PO ONCE DAILY ___ (). 8. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. calcium acetate 667 mg Tablet Sig: Three (3) Tablet PO four times a day. 10. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 11. Calcium 600 + D(3) 600 mg(1,500mg) -400 unit Tablet Sig: One (1) Tablet PO once a day. 12. Benicar 20 mg Tablet Sig: Three (3) Tablet PO daily (). 13. ferrous sulfate 300 mg (60 mg iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 15. doxazosin 4 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 16. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 17. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain/fever. 18. bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal HS (at bedtime) as needed for constipation. 19. hydrocodone-acetaminophen ___ mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 20. Milk of Magnesia 400 mg/5 mL Suspension Sig: 400 mg PO every four (4) hours as needed for nausea. 21. insulin pump cartridge Cartridge Sig: use as directed by Diabetes Clinic Subcutaneous continuous. 22. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*90 Capsule(s)* Refills:*0* 23. senna 8.6 mg Tablet Sig: ___ Tablets PO BID (2 times a day) as needed for constipation. Disp:*90 Tablet(s)* Refills:*0* 24. dextromethorphan-guaifenesin ___ mg/5 mL Syrup Sig: Five (5) ML PO Q6H (every 6 hours) as needed for cough. Disp:*200 ML(s)* Refills:*0* 25. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 26. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) nebulization Inhalation every four (4) hours as needed for dyspnea, wheezing. Disp:*90 nebulizations* Refills:*0* 27. ipratropium bromide 0.02 % Solution Sig: One (1) nebulization Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. Disp:*90 nebulizations* Refills:*0* 28. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO BID (2 times a day). Disp:*90 packets* Refills:*2* 29. Glucagon Emergency 1 mg Kit Sig: One (1) Injection three times a day as needed for hypoglycemia. Disp:*30 kits* Refills:*0* 30. prednisone 20 mg Tablet Sig: Two (2) Tablet PO once a day for 1 doses. Disp:*2 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Diabetes Mellitus II End Stage Renal Disease Obstructive Sleep Apnea Obesity Asthma Chronic Obstructive Pulmonary 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. ___, You were admitted with fever of unknown origin. Your fever is likely due to the drug minoxidil or from the antibiotic vancomycin. You underwent workup with tagged white blood cell scan with was positive only for slightly increased uptake in the right upper extremity, however ultrasound of your graft does not indicate that it is infected. While here you also developed a COPD exacerbation, and were found to have some infiltrates on CT of your chest. A bronchoscopy was performed without signficant growth. A small amount of bacteria grew on culture which your outpatient doctors ___ follow up ___ final results regarding these bacteria are still pending. In light of your overall clinical status, a pneumonia appears unlikely. The following changes were made to your medications: Please START prednisone 40mg daily for 1 more day. START colace scheduled daily, senna as needed, and miralax daily for your constipation. START guaifenasin for your cough STOP minoxidil as this may have caused your fevers STOP vancomycin as this may have caused your fevers - Your Insulin doses on the insulin pump have been changed and will need to be changed further at your Endocrinology appointment tomorrow. ** Please be sure to make it to your Endocrinology appointment this week. ** - You will also be prescribed glucagon injectable to be used as needed for low blood sugars.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Donepezil 10 mg PO QHS 2. Rosuvastatin Calcium 5 mg PO QPM 3. biotin (biotin-calcium carbonate) 1,000 mcg oral DAILY 4. Centrum Silver (multivit-min-FA-lycopen-lutein;<br>mv-min-folic acid-lutein) 400-250 mcg oral DAILY 5. cranberry (cranberry conc-ascorbic acid;<br>cranberry extract) 450 mg oral Other 6. Allopurinol ___ mg PO DAILY Please take for 10 additional days after discharge. Last day will be on ___. RX *allopurinol ___ mg 1 tablet(s) by mouth daily Disp #*10 Tablet Refills:*0 7. Metoprolol Tartrate 37.5 mg PO TID RX *metoprolol tartrate 37.5 mg 37.5 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 8. Filgrastim 300 mcg SC Q24H Please start this on ___ and your last day will be ___. RX *filgrastim [Neupogen] 300 mcg/0.5 mL 1 daily Disp #*7 Syringe Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: High grade diffuse B-cell lymphoma Secondary: Acute kidney injury, atrial fibrillation 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 during your stay at ___. You came for further evaluation of a new mass in your abdomen. While here, a cystoscopy and TURBT procedure was performed and biopsies were taken. The mass was found to be lymphoma and you had a port placed to receive chemotherapy. You received one cycle of chemotherapy without any complications. Your kidney function worsened while you were admitted, which may have been related to obstruction from the mass. With chemotherapy, the mass grew smaller in size and your kidney function improved. You also were found to be have an atypical rhythm to your heartbeat. This resolved with medication. It was a pleasure caring for you, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice daily Disp #*15 Tablet Refills:*0 2. Escitalopram Oxalate 10 mg PO DAILY 3. Acetaminophen 650 mg PO Q6H:PRN pain 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every 4 hours Disp #*30 Tablet Refills:*0 5. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *polyethylene glycol 3350 17 gram/dose 1 packet by mouth daily Disp #*10 Packet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: ___ abscess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>___ abscess: Discharge Instructions You have undergone a surgical procedure for drainage of an abscess near your rectum. You did not have any fevers or a high white blood cell count (an indication of infection), so you did not receive antibiotics. Your wound was initially packed tightly with iodoform packing. It was replaced once yesterday, and came out on its own. You do not need to have this replaced. You may place some gauze near the anal opening if you continue to have any drainage or bleeding. Home care: *For the next several days, as healing takes place, take two or three warm baths daily ___ baths) * You should also keep a cotton or gauze dressing tucked against the opening of the abscess to absorb any drainage or bleeding - it is normal to have some drainage for up to 10 days * normal activities can be resumed as tolerated * If constipation has been a problem or if you are taking pain pills that make you constipated (any narcotic pain meds), take a stool softener such as Colace (docusate sodium) * Do not drive or operate heavy machinery while taking narcotic pain medication</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*22 Tablet Refills:*0 2. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q8H 3. Gabapentin 300 mg PO QHS 4. Glargine 24 Units Breakfast Novolog 14 Units Breakfast Novolog 14 Units Lunch Novolog 14 Units Dinner 5. Lumigan (bimatoprost) 0.01 % ophthalmic Q8H 6. MetFORMIN (Glucophage) 850 mg PO BID 7. Ranitidine 300 mg PO DAILY 8. Simvastatin 10 mg PO QPM 9. HELD- Lisinopril 10 mg PO DAILY This medication was held. Do not restart Lisinopril until you talk with Dr ___ PCP ___: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: E.coli bacteremia Pyelonephritis Acute Kidney Injury SECONDARY DIAGNOSIS: IDDM Neuropathy Hypertension 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 in the hospital because you had fevers and dizziness. We did blood work which showed you had a bacterial infection in your blood. We think this was caused by a urinary tract infection. You were given antibiotics to treat the infection and you felt better. Now that you are going home, it will be important for you to take all of your medicines as prescribed. You will need to take the antibiotic "ciprofloxacin" twice a day for 11 days until ___. Please call your doctor if you develop new joint stiffness or pain in your tendons while taking this medicine. Please call your doctor if you have any of the danger signs in this discharge paperwork. Please follow-up with your PCP ___ 2 weeks to ensure you are feeling better. We are working on scheduling this appointment for you. 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. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB 2. Gabapentin 300 mg PO TID RX *gabapentin 300 mg 1 capsule(s) by mouth three times a day Disp #*90 Capsule Refills:*0 3. Montelukast 10 mg PO DAILY 4. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation Daily Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Acute post-infectious demyelination at T6 Secondary diagnosis: Asthma 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 for numbness in your legs reaching up to your waist area. An MRI of your thoracic spine had previously shown a suspected demyelinating lesion at T6. This likely led to your symptoms. We also checked an MRI of your head which was normal. We believe that this lesion in your spinal cord is likely a 'post-infectious demyelinating lesion'. In other words, your body produced anti-bodies to fight a virus that likely also attacked myelin in that one area of your spinal cord. As you have no other lesions in your brain or in other areas of your spinal cord, you do not have MS at this time. Your symptoms should improve with time. You have also been started on gabapentin to help decrease the tingling sensation in your legs. We wish you all the best!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms. ___, You presented with GI bleeding, likely related to your diverticular disease. This bleeding ultimately stopped on its own, and your blood counts remained stable. You were seen by the GI service. You also had pain in your lower back. This was ultimately felt to be related to arthritis as there was no evidence of fracture or other disease on your CT scan or X-ray. You should continue to take Tylenol around the clock and follow up with your PCP to discuss ongoing physical therapy.</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 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation RX *bisacodyl 10 mg 1 suppository(s) rectally once a day Disp #*30 Suppository Refills:*0 3. Docusate Sodium 100 mg PO BID please hold for loose stool RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 4. Senna 8.6 mg PO BID:PRN Constipation Do not take if having diarrhea RX *sennosides [senna] 8.6 mg 1 capsule by mouth twice a day Disp #*40 Capsule Refills:*0 5. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Do not drive or use machinery when taking RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*40 Tablet Refills:*0 6. Lidocaine 5% Patch 1 PTCH TD DAILY:PRN pain Use as directed RX *lidocaine 5 % Apply as directed to site of chest pain daily Disp #*30 Patch Refills:*0 7. LeVETiracetam 1000 mg PO BID Use as directed to prevent seizures. Take as directed on label RX *levetiracetam 1,000 mg 1 tablet(s) by mouth twice a day Disp #*10 Tablet Refills:*0 8. Pravastatin 40 mg PO QPM 9. Lisinopril 10 mg PO DAILY 10. MetFORMIN XR (Glucophage XR) 1500 mg PO DAILY Do Not Crush; take with largest meal of the day Discharge Disposition: Home Discharge Diagnosis: -Subarachnoid hemorrhage -Right rib fractures ___ 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 presented to the ___ on ___ after suffering a snowmobile accident. You experienced loss of consciousness, an injury to your head and right-sided rib fractures. You were admitted to the Trauma/Acute Care Surgery team for further medical management. Given your injuries and your history of shoulder surgery, you will need to follow with your regular orthopedist and may require imaging of the shoulder. Please follow with your outpatient orthopedist to make sure that your shoulder implant is MRI compatible before any MRI imaging. You were evaluated by the Neurology and Neurosurgery teams for your head injury. The Neurology team recommends alcohol cessation to prevent further health issues, and possible outpatient counseling regarding alcohol if needed. The Neurosurgery team recommends you stay on the medication Keppra to prevent seizures. You are now medically cleared to be discharged home to continue your recovery. Please note the following discharge instructions: Return to the Emergency Department or see your own doctor right away if any problems develop, including the following: Rib Fractures: * Your injury caused right-sided 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). • Persistent nausea or vomiting. • Increasing confusion, drowsiness or any change in alertness. • Loss of memory. • Dizziness or fainting. • Trouble walking or staggering. • Worsening of headache or headache feels different. • Trouble speaking or slurred speech. • Convulsions or seizures. These are twitching or jerking movements of the eyes, arms, legs or body. • A change in the size of one pupil (black part of your eye) as compared to the other eye. • Weakness or numbness of an arm or leg. • Stiff neck or fever. • Blurry vision, double vision or other problems with your eyesight. • Bleeding or clear liquid drainage from your ears or nose. • Very sleepy (more than expected) or hard to wake up. • Unusual sounds in the ear. • Any new or increased symptoms</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 2. Polyethylene Glycol 17 g PO DAILY 3. Senna 8.6 mg PO BID 4. Gabapentin 300 mg PO BID 5. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Moderate 6. Aspirin 81 mg PO DAILY 7. Divalproex (DELayed Release) 500 mg PO QAM 8. Divalproex (DELayed Release) 1000 mg PO QHS 9. LevETIRAcetam ___ mg PO BID 10. Omeprazole 20 mg PO DAILY 11. HELD- amLODIPine 10 mg PO DAILY This medication was held. Do not restart amLODIPine until talking with your doctors at rehab 12. HELD- Hydrochlorothiazide 25 mg PO DAILY This medication was held. Do not restart Hydrochlorothiazide until talking with your doctors at rehab 13. HELD- Lisinopril 40 mg PO DAILY This medication was held. Do not restart Lisinopril until talking with your doctors at rehab ___ Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES ================== -E coli bacteremia -Sepsis secondary to intraabdominal source -Complicated diverticulitis SECONDARY DIAGNOSES ===================== -Vascular dementia -Prior CVA 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>Dear Ms. ___, It was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - You were admitted for pain in your stomach, confusion, and chills. WHAT HAPPENED TO ME IN THE HOSPITAL? - While you were in the hospital, you had a CT scan which showed inflammation in your intestines. - We found that you also had injury to your kidneys. - We treated you with antibiotics for the infection in your abdomen. - You were improved so we felt it was safe for you to go home WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. 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. Docusate Sodium 100 mg PO BID 2. FoLIC Acid 1 mg PO DAILY 3. Methadone 10 mg PO TID 4. Omeprazole 20 mg PO BID RX *omeprazole 20 mg 1 capsule,delayed ___ by mouth twice per day Disp #*60 Capsule Refills:*0 5. Polyethylene Glycol 17 g PO DAILY:PRN constipation 6. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation Inhalation q6h:prn shortness of breath, wheeze 7. Senna 1 TAB PO BID 8. Lidocaine 5% Ointment 1 Appl TP BID 9. ZOFRAN ODT *NF* (ondansetron) 4 mg ORAL EVERY 8 HOURS AS NEEDED nausea RX *ondansetron [ZOFRAN ODT] 4 mg ___ tablet,disintegrating(s) by mouth every 8 hours Disp #*10 Tablet Refills:*0 10. OxycoDONE (Immediate Release) 25 mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: primary diagnosis: shoulder pain secondary diagnosis: avascular necrosis of the shoulder sickle cell anemia 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 the ___ for pain in your shoulder. You were treated with pain medications. Your pain improved. We are discharging you with pain medications. We encourage you to follow up with hematology, orthopedic surgery and your primary care doctor. We wish you all the best.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 10 mg PO BID Duration: 3 Days Last day ___ RX *apixaban [Eliquis] 5 mg 2 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 2. Apixaban 5 mg PO BID Duration: 1 Month Please do not start reduced dose until ___ RX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Ferrous GLUCONATE 324 mg PO EVERY OTHER DAY RX *ferrous gluconate 324 mg (38 mg iron) 1 tablet(s) by mouth every other day Disp #*15 Tablet Refills:*0 4. Acetaminophen 1000 mg PO Q8H 5. Atenolol 25 mg PO QHS 6. Atorvastatin 40 mg PO QPM 7. Cilostazol 100 mg PO BID 8. Docusate Sodium 100 mg PO BID 9. Levothyroxine Sodium 75 mcg PO DAILY 10. MetFORMIN (Glucophage) 1000 mg PO QHS 11. Omeprazole 20 mg PO DAILY 12. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain 13. Senna 8.6 mg PO BID 14. Vitamin D ___ UNIT PO 1X/WEEK (MO) 15. HELD- amLODIPine 10 mg PO DAILY This medication was held. Do not restart amLODIPine until reassess if needed 16. HELD- Hydrochlorothiazide 12.5 mg PO DAILY This medication was held. Do not restart Hydrochlorothiazide until reassess if needed 17. HELD- Potassium Chloride 20 mEq PO DAILY This medication was held. Do not restart Potassium Chloride until decide if needed Discharge Disposition: Home With Service Facility: ___ services of ___ Discharge Diagnosis: Primary: Pulmonary embolism Osteoarthritis Iron deficiency anemia Secondary: HTN HLD PAD Hypothyrodism GERD 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 ___, It was a pleasure to care for you at the ___ ___. Why did I come to the hospital? - You were found to have a clot in your lungs, which is likely a complication of the orthopedic surgery What happened while I was in the hospital? - We did several lab and imaging tests to show that the clot was not impacting your heart function. We treated you with a medication to help prevent further clot formation in your lungs (blood thinner). You will need to take this medication when you leave the hospital for at least 3 months. Your primary care doctor ___ help determine when it's ok to stop the medications What should I do once I leave the hospital? - We started you on iron supplementation for your low iron levels. This sometimes can cause constipation so if you become constipated you should use more of your stool softeners or start taking miralax every day to keep you regular. If you become too constipated then talk to your doctor about receiving iron through the IV. - Be sure to take your blood thinner every day until your primary care doctor says you should stop. You will take 10 mg twice a day for 3 more days and then on ___ you should start 5mg twice a day. - Take your medications as prescribed and follow up with your doctor appointments as listed below. We wish you the best! ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 1250 mg PO QHS 2. Sodium Chloride 2 gm PO BID 3. Acetaminophen 1000 mg PO Q8H:PRN fever / pain 4. Atorvastatin 80 mg PO QPM 5. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol 6. Ethambutol HCl 800 mg PO DAILY 7. Famotidine 20 mg PO Q12H 8. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 9. Glucose Gel 15 g PO PRN hypoglycemia protocol 10. Insulin SC Sliding Scale Fingerstick Q6H Insulin SC Sliding Scale using HUM Insulin 11. Isoniazid ___ mg PO DAILY 12. LACOSamide 100 mg PO BID 13. LeVETiracetam ___ mg PO BID 14. Levofloxacin 750 mg PO Q24H 15. Levothyroxine Sodium 50 mcg PO DAILY 16. Miconazole Powder 2% 1 Appl TP QID:PRN groin rash 17. Midodrine 5 mg PO Q8H 18. PredniSONE 30 mg PO DAILY Duration: 7 Days 19. Pyrazinamide 1000 mg PO DAILY 20. Pyridoxine 50 mg PO DAILY 21. Rifampin 600 mg PO Q24H 22. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 23. Vancomycin Oral Liquid ___ mg PO Q6H 24. Vitamin D 1000 UNIT PO DAILY 25. Heparin 5000 UNIT SC BID 26. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: pachymenigitis of unclear etiology Secondary Diagnosis: Hyponatremia/SIADH S/p prolonged respiratory failure w/ trach and PEG Hypothyroidism vs Sick Euthyroid Syndrome C difficile H/o status epilepticus: continue lacosamide and keppra Hypotension Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic and not arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You came to the hospital after you felt very weak and could not get up off the ground. We discovered that you have something called pachymeningitis. We did many tests and two brain biopsies to try to find out what was causing your symptoms and the pachymeningitis but we were unable to discover the cause. We have worked with many consulting services and have decided that it would be bets to continue to finish the treatment for Tb meningitis. You will continue to be treated for c. difficille for 2 weeks after you finish the Tb treatment. Additionally, we will continue your prednisone and decrease it every week. We wish you and your family the very best and hope that you recover. It was a pleasure taking care of you, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LevETIRAcetam 500 mg PO BID 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 3. Aspirin 81 mg PO MWF 4. Fluticasone Propionate NASAL 1 SPRY NU DAILY stuffiness 5. Ibuprofen 400 mg PO Q8H:PRN Pain - Mild 6. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 7. Simvastatin 10 mg PO QPM 8. SITagliptin 50 mg oral DAILY 9. TraMADol 25 mg PO Q6H:PRN Pain - Moderate 10. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Generalized tonic clonic seizure 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>Dear Ms. ___, You were hospitalized due to symptoms of slurred speech and left facial droop resulting from a seizure. We were unable to find a source of your seizure while in the hospital, but you will need to take medications to prevent future seizures. We are changing your medications as follows: - Start taking LevETIRAcetam (Keppra) 500 mg twice daily Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician. -Please follow up with your primary care physician ___ 2 weeks of hospital discharge -Please follow up with neurology in 2 to 4 week after hospital discharge. If you do not hear from the clinic within a week, please call ___ Also, take the follow seizure precautions: - Take seizure medication as prescribed above - Avoid activities that require being alert such a operating equipment that could cause injury - Where an ID bracelet or necklace at all times - Do not stop your seizure medication without being instructed by your doctor ___ 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 It was a pleasure taking care of you! Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ClonazePAM 0.5 mg PO QHS:PRN anxiety 2. Lidocaine 5% Patch 1 PTCH TD QAM PRN pain 3. Ondansetron 8 mg PO Q8H:PRN nausea 4. Ranitidine 150 mg PO BID 5. Ropinirole 0.5 mg PO TID pain Discharge Disposition: Home Discharge Diagnosis: Possible Bell's palsy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane) due to left foot post-surgical pain. Neuro exam: subtle, equivocal left NLFF. Symmetric activation of facial musculature. Rest normal. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were hospitalized due to mild left face droop. You were admitted for evaluation for possible stroke. We obtained an MRI of your brain which did NOT show stroke. Since your face droop was noted by somebody one week ago and you also had some left eye irritation (potentially from dry eye due to weak lid closure), we think that you may have idiopathic Bell's palsy which is already improving at this time. As Lyme is sometime a cause for Bell's palsy, we sent blood test to check that. The result of the Lyme test is pending and can be followed up by your primary care doctor. As your facial weakness is very mild, you will not require any medication or eye drop. While you are here, we spoke to your podiatrist's office and discussed your warfarin. Since you are ambulating right now, we do not think you need anticoagulation. Please discontinue your warfarin. Please take your other medications as prescribed. Please follow-up with 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</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO FOR FEVER RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth Take for fever >100.5 and present to urgent care for evaluation Disp #*1 Tablet Refills:*0 2. Cefpodoxime Proxetil 400 mg PO Q12H pneumonia RX *cefpodoxime 200 mg 2 tablet(s) by mouth once in the evening of ___ Disp #*2 Tablet Refills:*0 3. Levothyroxine Sodium 125 mcg PO DAILY RX *levothyroxine 125 mcg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Sertraline 100 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: ================== PRIMARY DIAGNOSIS: ================== Pericardial effusion Cardiac Tamponade Multifocal pneumonia Hypoxemic respiratory failure Secondary Diagnosis ================== Asplenia Anemia Transaminitis Depression 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 to care for you at the ___ ___. Why did you come to the hospital? You came into the hospital because you were having chest pain, trouble breathing, and were fatigued. What did you receive in the hospital? While you were in the hospital, we found that you had fluid around your heart and you had a procedure to remove that fluid. You also had some fluid in your lungs, so we gave you a diuretic called Lasix to help remove it. We also found that you had pneumonia that might have been contributing to the fluid in your lungs, and gave you antibiotics to treat that. What should you do once you leave the hospital? -You should follow up with the appointments we have listed below. -Since you do not have a spleen you should always carry antibiotics with you. If you have a fever >100.4F you should take a dose of augmentin (we provided you with a prescription) and present to urgent care immediately as this may be the sign of a series illness. 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. HydrALAZINE 100 mg PO Q8H RX *hydralazine 100 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 2. Isosorbide Mononitrate (Extended Release) 120 mg PO DAILY RX *isosorbide mononitrate 120 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Torsemide 100 mg PO DAILY RX *torsemide 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 80 mg PO QPM 6. Calcitriol 0.25 mcg PO EVERY OTHER DAY 7. Calcitriol 0.5 mcg PO EVERY OTHER DAY 8. Carvedilol 6.25 mg PO BID 9. Gabapentin 600 mg PO QHS 10. Glargine 30 Units Bedtime 11. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 12. linaGLIPtin 5 mg oral DAILY 13. Losartan Potassium 100 mg PO DAILY 14. NIFEdipine (Extended Release) 90 mg PO DAILY 15. Vitamin D ___ UNIT PO 1X/WEEK (MO) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: Heart failure, preserved EF, exacerbation Hypertensive emergency Chronic kidney disease Secondary diagnoses: Type II Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, What brought you to the hospital? - You came to the hospital with fatigue, worsening breathing and leg swelling What happened while you were in the hospital? - You were given IV diuretics (medications to help get rid of extra fluid in your body) - We also changed your blood pressure medications since we believe your high blood pressure is the cause of your difficulty breathing and fluid build up What should you do when you leave the hospital? - Continue to take your medications as prescribed. See below for a complete list of your new medications. - Please make sure that you follow up with your primary care doctor, cardiologist and nephrologist - Please weigh yourself every morning and call your cardiologist if you gain more than 3 lbs. It was a pleasure taking care of you. -Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID 2. Albuterol 0.083% Neb Soln 1 NEB IH Q4H wheeze 3. Amitriptyline 25 mg PO HS 4. Citalopram 10 mg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. Ipratropium Bromide Neb 1 NEB IH Q4H wheeze 7. Levothyroxine Sodium 112 mcg PO DAILY 8. Senna 8.6 mg PO BID 9. Simvastatin 40 mg PO DAILY 10. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain 11. Heparin 5000 UNIT SC TID 12. Aspirin 81 mg PO DAILY 13. Lorazepam 1 mg PO BID:PRN anxiety 14. Morphine Sulfate ___ mg IV Q4H:PRN pain RX *morphine 2 mg/mL ___ mg IV every 4 hours Disp #*7 Cartridge Refills:*0 15. Metoprolol Tartrate 25 mg PO TID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Mechanical fall resulting in: -Right 11th rib fracture -Sacral fractures -Right transverse process L2 and L5 fractures -Small right tentorial subdural hematoma 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>Mrs. ___, ___ was a pleasure taking care of you here at ___ ___. You were admitted to our hospital after sustaining a fall that resulted in multiple bone fractures, as well as a small intracranial hemorrhage. Luckily, none of these injuries required a surgical intervention. We now feel that you are ready to be discharged to a rehabilitation facility, where you should continue with your ongoing recovery. Please follow these recommendations in order to ensure a speedy and uneventful recovery. Discharge instructions: -Your injury caused a rib fracture 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 antiinflammatory 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). Please call your doctor or return to the emergency room if you have any of the following: -You experience new chest pain, pressure, squeezing or tightness. -New or worsening cough or wheezing. -If you are vomiting and cannot keep in 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 have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. -Any serious change in your symptoms, or any new symptoms that concern you. -Please resume all regular home medications and take any new meds as ordered.</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. Calcitriol 0.25 mcg PO DAILY 3. Calcium Carbonate 1000 mg PO TID 4. Levothyroxine Sodium 125 mcg PO DAILY RX *levothyroxine [Levothroid] 125 mcg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth every 12 hours Disp #*60 Capsule Refills:*0 6. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule,delayed ___ by mouth daily Disp #*30 Capsule Refills:*0 7. Ondansetron 8 mg PO BID RX *ondansetron 8 mg 1 tablet,disintegrating(s) by mouth every 12 hours Disp #*60 Tablet Refills:*0 8. Senna 1 TAB PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth every 12 hours Disp #*60 Tablet Refills:*0 9. Lorazepam 0.5 mg PO Q6H:PRN nausea, anxiety Do not drive, drink alcohol, or perform activities that require concentration RX *lorazepam 0.5 mg 1 tablet by mouth every six (6) hours Disp #*15 Tablet Refills:*0 10. Metoclopramide 2.5 mg PO BID can increase to QID as needed RX *metoclopramide HCl 5 mg 2.5 mg by mouth twice a day Disp #*120 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: dehydration; protein-calorie malnutrition, severe Secondary: T4b anaplastic thyroid cancer 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 during your most recent admission. You were admitted for poor oral intake. While you were here you had a PEG tube inserted and were started on tube feeds. Please continue tube feeds on disharge.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your stay at ___ ___. You were admitted for lightheadedness and low pressure. This was likely due to your new blood pressure medications and the water pills. Some of these symptoms are also related to the longstanding diabetes that causes nerve damage that prevents you blood vessels from maintaining a stable blood pressure. You were give intravenous fluid and your blood pressure improved. We have stopped your nifedipine and decreased the dose of the carvedilol you were on. We restarted you on a small dose of the water pills to keep you from accumulating fluid. You should follow-up with your primary care physician ___ 2 days of discharge. This appointment has been scheduled for you. We wish you all the best! Your ___ 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 fever or dropping water temp 2. Amiodarone 400 mg PO BID ___ PO BID until ___ then reduce dose to 400mg PO daily X 2 weeks then 200mg PO daily 3. Atorvastatin 20 mg PO QPM 4. Furosemide 40 mg PO DAILY 5. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush This can be discontinued when midline IV is discontinued. 6. Metoprolol Tartrate 50 mg PO QHS 7. Metoprolol Tartrate 75 mg PO BID AT ___ AND 1600 8. Ramelteon 8 mg PO DAILY at 1800 9. Rivaroxaban 20 mg PO DINNER 10. Vancomycin 1000 mg IV Q 12H post ICD Duration: 3 Doses Only 1 more dose due tonight ___ at 11pm then can discontinue. 11. Aspirin 81 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: s/p vfib arrest non obstructive CAD s/p placement of AICD infectious colitis PNA 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 transferred to ___ after cardiac arrest. You were also being treated for pneumonia and recent colitis. You were given IV antibiotics for your colitis and pneumonia which finished on ___. You underwent a heart catheterization on ___ which did not show any significant coronary artery disease that required intervention. You underwent an echocardiogram on ___ which showed your ejection fraction to be 60%. On ___ you underwent an internal defibrillator placement in case you should have any further lethal heart arrhythmias. You were seen by neurology and they recommended a brain MRI which showed.....</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Clopidogrel 75 mg PO DAILY 3. Glargine 16 Units Bedtime Humalog 5 Units Lunch Humalog 9 Units Dinner 4. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 5. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth qday Disp #*15 Tablet Refills:*0 6. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 7. Rosuvastatin Calcium 40 mg PO QPM 8. Metoprolol Succinate XL 100 mg PO DAILY RX *metoprolol succinate 100 mg 1 tablet(s) by mouth qday Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: - NSTEMI - Acute on chronic anemia Secondary Diagnoses: - Delirium - Non-infectious antibiotic-associated diarrhea Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ on ___ for chest pain. You underwent a procedure called 'cardiac catheterization' with placement of a stent in one of the vessels that supplies blood to your heart. This procedure resulted in resolution of your chest pain. Your hospital course was complicated by fluid in the lungs that necessitated placing a breathing tube temporarily and transferring you to the intensive care unit. You recovered well from this complication and are now safe to go home with close follow up with both your cardiologist and primary care doctor. Please weigh yourself every morning and call your doctor if your weight increases by more than 3 lbs. It was a pleasure to take care of you during your hospital stay. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 500 mg PO QID:PRN reflux 2. Ciprofloxacin HCl 500 mg PO Q12H Duration: 3 Days RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*6 Tablet Refills:*0 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 4. Docusate Sodium 100 mg PO BID hold for diarrhea RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 5. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 by mouth twice a day Disp #*30 Tablet Refills:*0 6. Acetaminophen 650 mg PO Q6H:PRN pain Discharge Disposition: Home Discharge Diagnosis: 1. Chronic cholecystitis. 2. Choledocholithiasis. 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 the Acute Care Surgery team on ___ with abdominal pain. You had an ultrasound of your abdomen that showed inflammation in your glallbladder and your liver enzymes were elevated. You were taken to the endoscopy suite to have an ERCP, sphincterotomy, and placement of a stent. Your liver enzymes were monitored and decreased. Therefore, you were taken to the operating room on ___ and had your gallbladder removed laparoscopically. You tolerated the procedure well and are now ready to be discharged home to continue your recovery. You will need to follow up with Dr. ___ in his outpatient clinic to have the stent removed in approximately 4 weeks. Please note the following discharge instructions: Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 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. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o 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: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o 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. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. 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. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o 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. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o 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 following, 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. Azithromycin 250 mg PO Q24H Duration: 4 Doses 2. Dextromethorphan-Guaifenesin (Sugar Free) 10 mL PO Q6H:PRN COUGH 3. Docusate Sodium 100 mg PO BID 4. GuaiFENesin 10 mL PO Q6H 5. HydrALAZINE 10 mg PO Q8H RX *hydralazine 10 mg 1 tablet(s) by mouth three times per day Disp #*90 Tablet Refills:*0 6. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram/dose 17 g by mouth once to twice daily Refills:*0 7. Ramelteon 8 mg PO QHS:PRN insomnia RX *ramelteon [Rozerem] 8 mg 1 tablet(s) by mouth before bed Disp #*30 Tablet Refills:*0 8. Bisacodyl 10 mg PR QHS 9. ___ 30 Units Breakfast 10. Senna 17.2 mg PO BID 11. Acetaminophen ___ mg PO QHS:PRN Pain - Mild 12. amLODIPine 10 mg PO DAILY 13. Aspirin 81 mg PO DAILY 14. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q8H 15. Dorzolamide 2% Ophth. Soln. 1 DROP BOTH EYES TID 16. Lactulose 15 mL PO BID:PRN constipation 17. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 18. Lidocaine 5% Patch 1 PTCH TD QAM:PRN pain 19. Pilocarpine 4% 1 DROP BOTH EYES Q8H 20. Simvastatin 10 mg PO QPM 21. Vitamin D3 (cholecalciferol (vitamin D3)) 1,000 unit oral DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnoses: viral URI, lethargy, constipation Secondary diagnoses: chronic renal failure, anemia, chronic diastolic heart failure, glaucoma, cataracts 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 Ms. ___, You were admitted to the hospital with coughing. Your chest x-ray did not show any obvious pneumonia, but we gave you some antibioitcs (azithromycin, "Z-pack") to treat you, because you had fever. You were evaluated and felt to benefit from rehabilitation, so you were discharged to rehab. It was a pleasure caring for you! We wish you the very best, Your care team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___. You were admitted due to abdominal distension and constipation. After giving you medications for your bowels, you were able to have a normal bowel movement and your symptoms improved. Medication Changes: STOP Tesselon Perles -We recommend discussing with your PCP stopping your lisinopril and using a different medication such as losartan, as the lisinopril may be causing your chronic cough. Incidentally we found a small cyst in your left kidney on your CT Scan, you should discuss further workup with this with your primary care provider. We have setup and appointment with your primary care provider, please see below. Please discuss the possible medication changes.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth q4hr prn Disp #*7 Tablet Refills:*0 2. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Third Line Please hold for diarrhea or loose stool. 3. Senna 8.6 mg PO BID:PRN Constipation - First Line Please hold for diarrhea or loose stool. 4. BuPROPion XL (Once Daily) 150 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: symptomatic cholelithiasis 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 privilege to care for you at the ___ ___. You were admitted with abdominal pain due to gallstones. You underwent surgical removal of your gallbladder to prevent recurrent episodes of pain. Please take all medications as prescribed and follow up with all appointments as detailed below. 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 ___ lbs for 4 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. -You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: -You may feel weak or "washed out" for a couple of 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: -Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you may have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). If your incisions are closed with dermabond (surgical glue), this will fall off on it's own in ___ days. -Your incisions may be slightly red. This is normal. -You may gently wash away dried material around your incision. -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. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: -Constipation is a common side effect of narcotic pain medications. 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. 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 for pain medicine to take by mouth. It is important to take this medicine as directed. o 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 following, 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. 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: Expired Discharge Disposition: Expired Discharge Diagnosis: Expired s/p cardiac arrest. Discharge Condition: Expired Followup Instructions: ___ [/INST] </s><s>Admitted s/p arrest. Found to have cerebral edema and herniation. INitally on max support, but following prognosis discussion with the family made CMO and passed away with the family at his side.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Baclofen 10 mg PO TID:PRN leg spasm 2. Calcium Carbonate 500 mg PO DAILY 3. ClonazePAM 0.5 mg PO BID:PRN anxiety 4. Fludrocortisone Acetate 0.1-0.2 mg PO DAILY 5. FoLIC Acid 1 mg PO DAILY 6. Levothyroxine Sodium 100 mcg PO DAILY 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q4H:PRN pain 9. PredniSONE 20 mg PO DAILY 20 mg on ___ and ___ 10 mg on ___ 5 mg on ___ and afterwards as advised by endocrinologist Tapered dose - DOWN RX *prednisone 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 10. Methotrexate 25 mg PO 1X/WEEK (___) 11. Estring (estradiol) 2 mg vaginal q 12 weeks 12. Acyclovir 400 mg PO BID:PRN symptoms of HSV 13. Alendronate Sodium 70 mg PO 1X/WEEK (___) 14. Clobetasol Propionate 0.05% Cream 1 Appl TP BID 15. Esomeprazole Magnesium 40 mg ORAL BID 16. Diazepam 5 mg PO Q6H:PRN back pain 17. Vitamin D 400 UNIT PO DAILY 18. Estradiol (estradiol) 0.01 % (0.1 mg/gram) VAGINAL AS DIRECTED Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Hyperkalemia Addison's Disease Secondary diagnoses: Rheumatoid arthritis Hypothyroidism Hypertension 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 ___. You were admitted because you had fatigue, palpitations, muscle discomfort after having a recent UTI treated with Bactrim, being found to have a high potassium level, and concern for crisis of your Addisons disease. Fortunately, you did very well with IV steroids and your blood pressure was never low. We recommend that you take 20 mg of prednisone on ___ and ___ 10 mg on ___, and then resume your normal dose of 5 mg prednisone. Please continue to take your fludracortisone as prescribed by your endocrinologist (0.1-0.2 mg per day). Please have labs drawn on ___ and follow up with your endocrinologist. In the future, if you have a UTI, please do not take Bactrim, as it can cause high potassium levels. You can be treated with other antibiotics such as Macrobid. Best wishes, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*3 2. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth Every evening Disp #*30 Tablet Refills:*3 3. Cyanocobalamin 100 mcg PO DAILY RX *cyanocobalamin (vitamin B-12) 100 mcg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*3 4.Outpatient Physical Therapy Home ___. ICD: I63.9. 5.Cane Straight cane. ICD I63.9. Prognosis: Good. Length of need: 13 months. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Acute ischemic stroke 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 due to symptoms of trouble speaking resulting from an ACUTE ISCHEMIC STROKE, a condition where 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: - High cholesterol We are changing your medications as follows: - Started aspirin 81 mg daily - Started atorvastatin 40 mg daily - Started vitamin B12 100 mcg daily Please take your other medications as prescribed. Please follow up 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 Sincerely, Your ___ Neurology Team</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 RX *acetaminophen 160 mg/5 mL 20 mls by mouth every six (6) hours Refills:*0 2. Amoxicillin-Clavulanate Susp. 500 mg PO/NG Q8H RX *amoxicillin-pot clavulanate 250 mg-62.5 mg/5 mL 10 mls by mouth every eight (8) hours Refills:*1 3. Lansoprazole Oral Disintegrating Tab 30 mg PO BID RX *lansoprazole 30 mg 1 tablet(s) twice a day Disp #*28 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Pneumomediastinum 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 to rule out esophageal perforation following your endoscopy. Your barium swallow was normal, without evidence of perforation. You may have had a "micro" perforation which sealed off quickly. You have remained afebrile and your white blood cell count is normal. * You will remain on clear liquids for today and can have full liquids tomorrow. Remain on full liquids until you see Dr. ___ ___ week. All medication should be in liquid form or a tablet that dissolves under your tongue. * Call Dr. ___ you have any fevers > 101, chills 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. Azithromycin 250 mg PO DAILY Duration: 1 Dose 2. Cefpodoxime Proxetil 400 mg PO DAILY Duration: 10 Doses 3. Ferrous Sulfate 325 mg PO DAILY 4. Multivitamins W/minerals 1 TAB PO DAILY 5. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line Reason for PRN duplicate override: Alternating agents for similar severity 6. Acetaminophen 500 mg PO Q8H:PRN Pain - Mild/Fever 7. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing 8. Allopurinol ___ mg PO DAILY 9. amLODIPine 5 mg PO DAILY 10. Fluticasone Propionate NASAL 1 SPRY NU DAILY:PRN postnasal drip 11. melatonin 3 mg oral QHS:PRN insomnia 12. Senna 8.6 mg PO DAILY:PRN Constipation - First Line 13. Sodium Bicarbonate 650 mg PO BID:PRN belching 14. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Community Acquired Pneumonia ================== Bronchiectasis SECONDARY DIAGNOSIS: Iron deficiency anemia ==================== Acute Kidney Injury 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 privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You had cough for several weeks and shortness of breath WHAT HAPPENED TO ME IN THE HOSPITAL? - You were found to have a low blood level (hemoglobin) and were given a blood transfusion - You were found to have a pneumonia, and were treated with antibiotics, to be continued after you leave the hospital - Your shortness of breath got better with the above medications as well as breathing treatments 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. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. citalopram 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). 3. famotidine 20 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 4. simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for abdominal discomfort. 5. morphine 15 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain: hold for sedation, hr<50, rr<12. 6. trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for insomnia. 7. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for anxiety, nausea. 8. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 9. acetaminophen 325 mg Tablet Sig: ___ Tablets PO every six (6) hours as needed for fever or pain. 10. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) PO once a day. 11. senna 8.6 mg Capsule Sig: One (1) Capsule PO once a day. 12. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Abdominal pain Subacute Left Occipital Infarct Secondary: Stage IIIB non-small cell lung cancer Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you at the ___ ___. You were admitted with abdominal pain and imaging concerning for lesions in your brain and spine. We did additional imaging which showed that you had a small stroke, causing you to lose vision in part of your right eye. We did further imaging of the blood vessels in your ___ and neck, as well as an echocardiogram of your heart, which did not reveal any abnormalities. Review of your spine imaging also did not reveal any lesions that may be contributing to your pain. Please followup with Dr. ___ repeat imaging of your brain in 2 months time. we started you on aspirin to help reduce your chance of having another stroke. Imaging of your abdomen did show enlarged lymph nodes in your abdomen as well as thicking of your bowel wall. We controlled your abdominal pain with morphine. We discussed your case with Dr. ___ eventually performed a colonoscopy with a biopsy of the thickened region of your bowel wall. At the time of discharge, the biopsy results were pending. Please followup with Dr. ___ further management of your abdominal findings. We made the following changes to your medications: STOPPED: -Amlodipine-valsartan -Atenolol -Loperamide -Maalox:benadryl:2%lidocaine -Nystatin -Famciclovir STARTED: -Trazodone -Metoprolol succinate -Simethicone -Acetaminophen -Aspirin Please continue taking your other medications as usual. Please followup with your doctors, see below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 10 mg PO DAILY 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation - First Line 3. Docusate Sodium 100 mg PO BID 4. Glargine 18 Units Bedtime Insulin SC Sliding Scale using REG Insulin 5. Labetalol 400 mg PO Q8H 6. Lansoprazole Oral Disintegrating Tab 30 mg NG DAILY 7. Senna 8.6 mg PO BID 8. Hydrochlorothiazide 25 mg PO DAILY 9. Desmopressin Acetate 0.2 mg PO QHS 10. Fluvoxamine Maleate 100 mg PO BID 11. L-Methylfolate (levomefolate calcium) 15 mg oral DAILY 12. Lisinopril 40 mg PO DAILY 13. MetFORMIN (Glucophage) 1000 mg PO BID 14. Sertraline 75 mg PO DAILY 15. HELD- RisperiDONE 1 mg PO QHS This medication was held. Do not restart RisperiDONE until meet with your doctor Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left IPH Pial AVM Hypertension Acute hypoxemic respiratory failure Type 2 Diabetes Mellitus 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. ___, You were admitted to ___ because you had a large stroke. At ___, you were given medications to control your blood pressure along with a medication to reverse your blood thinner. You were then transferred to ___ for neurosurgery evaluation. We believe the reason for the hemorrhage was a atrial-venous malformation. Neurology evaluated you and felt there was no need for intervention. You were not a candidate for surgery given the location of the lesion. Neurology will see patient for repeat angiogram in 1 month with plan for definitive therapy at that point. You developed fevers, high blood pressure, and high blood sugars during that prompted transfer to the medicine service. You were also seen by cardiology for a mild heart attack, but they did not recommend any treatment and your heart recovered. We used diuretic medications to eliminate additional fluid, started you on medications to control your blood pressure, You were unable to swallow and so we placed a tube in your stomach for you to receive nutrition. You should follow up with neurosurgery in 1 month for a repeat CT scan of your head along with consideration of treatment for your AVM. It was a privilege taking care of you and 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. Acetaminophen 1000 mg PO Q8H 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 40 mg SC QHS Take for 4 weeks RX *enoxaparin 40 mg/0.4 mL 40 mg subcutaneous once a day Disp #*28 Syringe Refills:*0 5. Milk of Magnesia 30 ml PO BID:PRN Constipation - Second Line 6. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity Partial fill ok. Wean. No driving/heavy machinery. RX *oxycodone 5 mg ___ tablet(s) by mouth Every 4 hours as needed for pain Disp #*30 Tablet Refills:*0 7. Senna 8.6 mg PO DAILY 8. Alendronate Sodium 70 mg PO QSUN 9. amLODIPine 5 mg PO DAILY 10. Aspirin 81 mg PO DAILY 11. Atorvastatin 20 mg PO QPM 12. dextran 70-hypromellose (PF) 0.1-0.3 % ophthalmic (eye) BID 13. Diazepam 2.5-5 mg PO QHS:PRN anxiety/insomnia 14. diclofenac sodium 1 % topical BID 15. Hydrochlorothiazide 12.5 mg PO DAILY 16. HydrOXYzine 10 mg PO BID 17. linaCLOtide 145 mcg oral DAILY 18. Losartan Potassium 25 mg PO DAILY 19. Ranitidine 150 mg PO BID 20. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left 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>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: -Weightbearing as tolerated left lower extremity MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take Lovenox 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. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - 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 greater than 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 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 any new medications/refills. THIS PATIENT IS EXPECTED TO REQUIRE ___ DAYS OF REHAB Physical Therapy: Weightbearing as tolerated left lower extremity Functional mobility No range of motion restrictions Treatments Frequency: Your incision is closed with staples that will be taken out at your 2-week postoperative visit. If the dressing falls off on its own three days after surgery, no need to replace the dressing unless actively draining.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ascorbic Acid ___ mg PO DAILY 2. Aspirin 81 mg PO 3X/WEEK (___) 3. Atenolol 50 mg PO DAILY 4. Atorvastatin 10 mg PO QPM 5. BusPIRone 5 mg PO BID 6. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 7. Moexipril 15 mg PO QAM 8. Tiotropium Bromide 1 CAP IH DAILY 9. Docusate Sodium 100 mg PO BID 10. Psyllium Powder 1 PKT PO TID:PRN constipation 11. Calcium 600 with Vitamin D3 (calcium carbonate-vitamin D3) 600 mg(1,500mg) -500 unit oral DAILY 12. glimepiride 4 mg ORAL DAILY 13. MetFORMIN (Glucophage) 500 mg PO BID 14. Levofloxacin 500 mg PO Q48H 15. Polyethylene Glycol 17 g PO DAILY:PRN constipation Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: DIAGNOSES ========= #mechanical fall #urinary tract infection #hyponatremia #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 hospital after you experienced a fall at your home. Because you hit your head, you underwent CT scans of your head and neck which did not show any fractures or bleeds. You were diagnosed with a urinary tract infection likely because of your chronic urinary catheter, and were treated with antibiotics. You were also given IV fluids because you were dehydrated. We found a good rehab for you to go to in order to build up your strength before returning home. It is very important that you are careful when you walk, and always use a walker or cane (preferably a walker) to help prevent falls. 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. Aspirin 325 mg PO DAILY 2. Carvedilol 25 mg PO BID 3. Gabapentin 100 mg PO DAILY 4. Mycophenolate Mofetil 500 mg PO TID 5. Nystatin Oral Suspension 5 mL PO QID 6. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 7. Ciprofloxacin HCl 500 mg PO Q12H Duration: 7 Days RX *ciprofloxacin 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*14 Tablet Refills:*0 8. Docusate Sodium 100 mg PO BID 9. Senna 1 TAB PO BID 10. ValGANCIclovir 450 mg PO EVERY OTHER DAY 11. Hecoria *NF* (tacrolimus) 7 mg Oral q12H Duration: 2 Doses Reason for Ordering: Wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. 12. GlipiZIDE 2.5 mg PO DAILY do not take if hypoglycemic, check BS daily Discharge Disposition: Home Discharge Diagnosis: constipation, gastroparesis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please call the Transplant Clinic ___ if you have any of the following: temperature of 101 or greater, chills, nausea, vomiting, inability to take any of your medications, worsening abdominal pain, decreased urine output or pain/burning/urgency with urination, incision redness/bleeding/drainage, constipation, diarrhea or concerns. ** Please record your urine output. No driving while taking pain medication. No heavy lifting/straining (nothing heavier than 10 pounds)to prevent an incision hernia from developing. You may shower with soap and water, rinse/pat dry. Do not apply powder/lotion/ointment to incision. No tub baths or swimming yet. Keep incision out of sun to avoid scarring. Refer to transplant binder. 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. Tamsulosin 0.4 mg PO HS 2. Metoclopramide 10 mg PO QID 3. Omeprazole 20 mg PO DAILY we recommend that you take this medication twice daily. 4. Oxygen Home oxygen @ 2 LPM continuous via nasal cannula, conserving device for portability. 5. Hospital bed Please provide with hospital bed to allow for head of bed elevation to 40-degrees given chronic aspiration concerns. ICD-9 code: ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: - Chronic aspiration - Gastric outlet obstruction - Metastatic esophageal adenocarcinoma 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 the hospital for complaints of persistent nightly cough productive of sputum and food material that was keeping you from sleeping. You were found to have low oxygen levels on presentation to the emergency department with oxygen saturations in the 80's on room air. Imaging revealed compression of your lungs by a dilated conduit concerning for persistent outlet obstruction. Our advanced GI endoscopy team performed an upper endoscopy and noted twisting of your intrathoracic stomach. Unfortunately, there is no surgical correction for this. Continue the PPI therapy and keep your head of bed elevated. We would encourage you to avoid eating by mouth going forward and only take liquids for comofort - utilizing your J-tube for tube feeding as your dominant form of nutrition. It was pleasure taking care you. Sincerely, 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 RX *acetaminophen 500 mg ___ tablet(s) by mouth every 6 hours Disp #*50 Tablet Refills:*1 2. Ciprofloxacin HCl 750 mg PO/NG Q12H RX *ciprofloxacin HCl 750 mg 1 tablet(s) by mouth every 12 hours Disp #*20 Tablet Refills:*0 3. Ibuprofen 600 mg PO Q6H:PRN pain RX *ibuprofen 600 mg 1 tablet(s) by mouth every 6 hours Disp #*40 Tablet Refills:*1 4. Lorazepam ___ mg PO QHS:PRN insomnia Do not drive while using this medication. RX *lorazepam 1 mg 1 tablet by mouth at bedtime Disp #*5 Tablet Refills:*0 5. MetRONIDAZOLE (FLagyl) 500 mg PO TID RX *metronidazole 500 mg 1 tablet(s) by mouth every 8 hours Disp #*30 Tablet Refills:*0 6. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain do not drive or drink alcohol, causes sedation RX *oxycodone 5 mg 1 tablet(s) by mouth every 4 hours Disp #*20 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: bilateral tubo-ovarian abscesses left tubo-ovarian abscess with colonic fistula 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 gynecologic oncology service with bilateral adnexal masses, pain, and fever. You were found to have bilateral tubo-ovarian abscesses, one of which connected with your colon. Interventional radiology placed tubes into the abscesses to drain and these were later replaced with larger drains. You were given antibiotics which you will continue when you go home. You have recovered well after this procedure, and the team feels that you are safe to be discharged home close outpatient followup. Please follow these instructions: . * Take your medications as prescribed. * Do not drive while taking narcotics. * Do not combine narcotic and sedative medications or alcohol. * Do not take more than 4000mg acetaminophen in 24 hrs. * No strenuous activity until cleared by your physician. * You may eat a regular diet. * It is safe to walk up stairs. . Incision care: * You may shower and allow soapy water to run over incision; no scrubbing of incision. No bath tubs for 6 weeks. . To reach medical records to get the records from this hospitalization sent to your doctor at home, call ___. .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. bumetanide 0.5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)) as needed for insomnia. 4. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation BID (2 times a day). 6. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr Sig: 0.5 Tablet Extended Release 24 hr PO DAILY (Daily). 7. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. pantoprazole 20 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 9. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. tenofovir disoproxil fumarate 300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for fever or pain. 12. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 13. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 14. insulin regular hum U-500 conc 500 unit/mL Solution Sig: sliding scale units Injection three times a day: New sliding scale: Sugar-breakfast-lunch-dinner ___ 81 to 180 - ___ 181 to 280 - ___ 281 to 380 - ___ 381 to 480 - ___ >480 - ___. 15. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 16. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Inhalation 17. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Hypoglycemia Type 2 diabetes Secondary diagnoses: Chronic systolic heart failure CAD s/p CABGx4 HTN Asthma Chronic kidney 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 during your admission to ___ for low blood sugar. You were unresponsive at home and found to have a blood sugar of 11 by the EMTs. This was likely due to not eating as much as you usual do last night. You were seen by the ___ team and your home sliding scale insulin was changed, as below. Please continue to check your blood sugar at home. You will also follow-up with your PCP and Dr. ___ at the ___ after discharge. You had some pain in your left shoulder, your EKG was unchanged and your cardiac enzymes, which help tell us if your pain is from heart damage, were normal. Please remember to space apart your simvastatin and amlodipine by at least a few hours. The following changes have been made to your medications: CHANGE Insulin U-500 sliding scale three times daily as below: Sugar Breakfast Lunch Dinner ----- -------- ----- ------ <80 10 10 ___ 15 15 12 181-280 17 17 14 ___ 19 19 16 >480 20 20 16</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 2. acetaminophen-codeine 300-15 mg Tablet Sig: One (1) Tablet PO three times a day as needed for pain. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: T12 chance fracture Renal Lesions 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. •Take your pain medication, including Tylenol, as instructed; you may find it best if taken in the morning when you 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. • You must wear your TLSO brace for support for 8 weeks, until follow-up. Please wear your TLSO at all times when OOB or ambulating CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING: •Pain that is continually increasing or not relieved by pain medicine. •Any weakness, numbness, tingling in your extremities. •Any signs of infection at the wound site: redness, swelling, tenderness, and drainage. •Fever greater than or equal to 101° F. •Any change in your bowel or bladder habits (such as loss of bowl or urine control).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>ACTIVITY AND WEIGHT BEARING (left upper extremity): - Non weight bearing in your left upper extremity with a sling. - Out of the sling at least three times daily for elbow range of motion exercises. •Have a friend/family member check your incision daily for signs of infection. •Take your pain medicine as prescribed. •Exercise should be limited to walking; no lifting, straining, or excessive bending. •Your wound was closed with sutures. You may wash your hair only after sutures have been removed. •You may shower before this time using a shower cap to cover your head. •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, and Ibuprofen etc. •You have been prescribed Dilantin (Phenytoin) for anti-seizure medicine, take it as prescribed and follow up with laboratory blood drawing in one week. This can be drawn at your PCP’s office, but please have the results faxed to ___. •You have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. •Clearance to drive and return to work will be addressed at your post-operative office visit. You have had a seizure and will not be able to drive for 6 months. •Make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. •***You are being sent to rehab while being treated for a low potassium. Please take your second dose of 40mEq of potassium in the evening of ___. Please have your potassium levels checked on ___. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING •New onset of tremors or seizures. •Any confusion 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. •Any signs of infection at the wound site: redness, swelling, tenderness, or drainage. •Fever greater than or equal to 101.5° F.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Carbidopa-Levodopa (___) 1 TAB PO 6X/DAY 3. Tamsulosin 0.4 mg PO HS 4. Acetaminophen 650 mg PO Q6H 5. Docusate Sodium 100 mg PO BID 6. Lidocaine 5% Patch 2 PTCH TD DAILY 7. Senna 1 TAB PO BID:PRN constipation 8. TraMADOL (Ultram) 50 mg PO Q6H:PRN breakthrough pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY: mechanical fall SECONDARY: atrial fibrillation sick sinus syndrome with pacemaker chronic diastolic heart failure ___ disease with autonomic 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 Mr. ___, It was a pleasure participating in your care at ___. You were admitted for pain control after you sustained multiple rib fractures after a fall last week. You will be going to a rehabilitation center to recover and get stronger. Please 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. Docusate Sodium 100 mg PO BID:PRN constipation RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*2 2. Senna 8.6 mg PO BID:PRN constipation only take if >2 days without a bowel movement RX *sennosides [senna] 8.6 mg 1 tablet by mouth ___ times per day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: abdominal pain 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 gynecologic oncology service for abdominal pain and diarrhea. You had imaging performed of your abdomen that did not show any signs of bowel injury or infection. You had 24 hours of bowel rest and your symptoms have resolved. We recommend that you continue a bowel regimen with Colace and senna to help with constipation but you can stop either of these medications if you have diarrhea or loose stools. Laparoscopic instructions: * Take your medications as prescribed. We recommend you take non-narcotics (i.e. Tylenol, ibuprofen) regularly for the first few days post-operatively, and use the narcotic as needed. As you start to feel better and need less medication, you should decrease/stop the narcotic first. * Do not drive while taking narcotics. * Do not combine narcotic and sedative medications or alcohol. * Do not take more than 4000mg acetaminophen (tylenol) in 24 hrs. * No strenuous activity until your post-op appointment. * No heavy lifting of objects >10 lbs for 4 weeks. * You may eat a regular diet. * It is safe to walk up stairs. . Incision care: * You may shower and allow soapy water to run over incision; no scrubbing of incision. . To reach medical records to get the records from this hospitalization sent to your doctor at home, call ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LeVETiracetam 750 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Osteolytic bone lesions, notably in the right hip and L2 spinous process 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 with newfound bone lesions of unclear cause. You underwent numerous imaging studies as well as a biopsy of one of your spinous vertebrae to figure out the diagnosis. While this important test result is pending, you do not have to stay in the hospital in the mean time. Because the lesion in your right hip is possibly destabilizing, we ask that you continue to use "toe touch weightbearing" only on the right lower extremity. The orthopedics and oncology teams will be able to advise you on whether you can return to normal activity as soon as the biopsy result comes back. We have made no changes to your medications I wish you the best of luck, ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms ___, You were admitted to the hospital with back pain and diverticulitis. Your diverticulitis was treated with antibiotics and bowel rest. You will need to continue to have only clear liquids today, and you will continue to take antibiotics for a few days. Tommorrow, advance to full liquids, including soups. The next day, if your stomach can tolerate, advance to a regular diet. In the future, you should eat a high-fiber diet to help prevent diverticulitis from occuring again. This involves plenty of fruits and vegetables and whole grains. You may consider a fiber supplement. Hydration is also very important, so drink plenty of fluids. You also had back pain from your prior back compression fracture. This was treated with pain medications. These can make you constipated, so you have a prescription for a stool softener to use sa needed. You were evaluated by our physical therapists, who thought you would benefit from home physical therapy. We also will refer you to the Spine Clinic for further care. The following changes were made to your medications: ** START flagyl (antibiotic) ** START augmentin (antibiotic) ** START oxycodone (pain medication). It is important you do not take more than 1 pill every 6 hours. ** START miralax as needed for constipation (this is a powerful stool softener) ** START compazine as needed for nausea</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every six (6) hours as needed for pain. 2. magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) ML PO Q6H (every 6 hours) as needed for constipation. 3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day): hold for loose stool. 4. tramadol 50 mg Tablet Sig: One (1) Tablet PO four times a day. Disp:*25 Tablet(s)* Refills:*0* 5. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 6. Multiple Vitamins Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>___ were admitted to the hospital with right upper quadrant pain. ___ underwent an ultrasound of your abdomen and ___ were found to have gallstones. ___ were taken to the operating room and ___ had your gallbladder removed. ___ are recovering from your surgery. Your vital signs are stable and ___ are preparing for discharge home with the following instructions: Please call your doctor or return to the emergency room if ___ have any of the following: * ___ experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If ___ are vomiting and cannot keep in fluids or your medications. * ___ 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. * ___ see blood or dark/black material when ___ vomit or have a bowel movement. * ___ have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern ___. * Please resume all regular home medications and take any new meds as ordered. Activity: No heavy lifting of items ___ pounds for 6 weeks. ___ may resume moderate exercise at your discretion, no abdominal exercises. Wound Care: ___ may shower, no tub baths or swimming. If there is clear drainage from your incisions, cover with clean, dry gauze. Your steri-strips will fall off on their own. Please remove any remaining strips ___ days after surgery. Please call the doctor if ___ have increased pain, swelling, redness, or drainage from the incision sites.</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 - Moderate 2. Bisacodyl 10 mg PR QHS:PRN Constipation 3. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID RX *chlorhexidine gluconate 0.12 % Rise mouth twice a day Refills:*0 4. Docusate Sodium 100 mg PO BID:PRN Constipation 5. FoLIC Acid 1 mg PO DAILY 6. Ipratropium-Albuterol Neb 1 NEB NEB Q6H RX *ipratropium-albuterol 0.5 mg-3 mg (2.5 mg base)/3 mL 1 neb nebulizer every six (6) hours Disp #*10 Ampule Refills:*0 7. Multivitamins 1 TAB PO DAILY 8. OxycoDONE Liquid ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg/5 mL ___ mL by mouth every four (4) hours Refills:*0 9. Pantoprazole 40 mg PO Q24H RX *pantoprazole [Protonix] 40 mg 1 granules(s) by mouth Q24H Disp #*30 Packet Refills:*0 10. Senna 8.6 mg PO BID:PRN constipation 11. Tamsulosin 0.4 mg PO QHS 12. Thiamine 100 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: ___ ___ fracture, R orbital fracture, mandibular fracture, thyroid cartilage fracture, significant R neck subcutaneous emphysema 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 for a fracture of your jaw bones, your right orbital bones and thyroid cartilage. The Ear Nose and Throat team had scoped your airway and did not see exposed cartilage or mucosal injury, and a patent airway. You have recovered and are now ready to be discharged to home before you return for your surgery with oral & maxillofacial surgery team to have your fractures fixed. Someone will give you a call to let you know more about the surgery schedule. 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. - 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 the endoscopy. YOUR DIET: As per oral & maxillary surgery team's recommendations, your jaw bone has not healed and so chewing is not advised. Please stay on your full liquid diet until you have undergone surgery and have recovered from it. Please make sure that the night before your surgery, you should refrain from drinking or eating after midnight. Please also use your chlorhexidine mouth wash twice a day to ensure your mouth to be clean 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: - Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. 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 650 mg PO TID maximum 4000mg/day please 2. Amiodarone 400 mg PO BID postop atrial fibrillation 400mg BID x 6 days, then 200mg BID x 7 days, then 200mg daily continuous RX *amiodarone 400 mg 1 tablet(s) by mouth as directed Disp #*60 Tablet Refills:*1 3. Docusate Sodium 100 mg PO BID hold for loose stools RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Metoprolol Succinate XL 200 mg PO BID RX *metoprolol succinate [Toprol XL] 200 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 5. Senna 17.2 mg PO DAILY 6. Warfarin ___ mg PO ASDIR atrial fibrillation take 1 to 4 tablets daily as directed by ___ goal INR ___ RX *warfarin [Coumadin] 1 mg ___ tablet(s) by mouth as directed Disp #*60 Tablet Refills:*1 7. Warfarin 1 mg PO ONCE Duration: 1 Dose will be given prior to d/c home ___ 8. amLODIPine 5 mg PO DAILY RX *amlodipine 5 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 9. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 10. TraMADol ___ mg PO Q6H:PRN pain RX *tramadol 50 mg ___ tablet(s) by mouth every six (6) hours Disp #*20 Tablet Refills:*0 11. alfuzosin 10 mg oral DAILY 12. Aspirin 81 mg PO DAILY 13. Atorvastatin 40 mg PO QPM 14. Omeprazole 20 mg PO DAILY 15. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Rapid Atrial Fibrillation Syncope Secondary: Bicuspid Aortic Valve s/p tiss AVR ___ Coronary Artery Disease s/p CABG ___ Basal Cell Carcinoma BPH Chronic Kidney Disease, baseline 1.6 Degenerative Disc Disease Hyperlipidemia Hypertension Osteoarthritis Rosacea Squamous Cell Carcinoma 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 RLE EVH Incision - trace amount erythema, no warmth or drainage Edema- trace RLE, none LLE 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. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*3 2. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 3. Aspirin 81 mg PO DAILY RX *aspirin [Aspir-81] 81 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*11 4. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule by mouth Daily Disp #*30 Capsule Refills:*3 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Stroke 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 the neurology stroke service at ___ ___ because you had a stroke in your brainstem which caused you to develop left hand weakness as well as some unsteadiness of your gait and abnormal speech. You were started on a medication called Plavix (also known as clopidogrel) to help keep your platelets from being too sticky and causing another stroke. This medication can increase your risk for bleeding if you cut yourself or fall. You were also started on a cholesterol medication called atorvastatin to help lower your cholesterol and prevent strokes. You are being discharged to an acute rehab facility. It is important to follow-up with your neurologist as well as your primary care doctor. You will also need to have an echocardiogram done as an outpatient.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. FLUoxetine 20 mg PO DAILY 3. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 4. Atorvastatin 20 mg PO QPM hyperlipidemia 5. Clopidogrel 75 mg PO DAILY 6. Fish Oil (Omega 3) 1000 mg PO DAILY 7. Gemfibrozil 600 mg PO BID 8. QUEtiapine Fumarate 12.5 mg PO QHS:PRN sleep Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right Pontine Stroke 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 pleasure taking care of you. You were hospitalized due to symptoms of dysarthria and increasing weakness in your left arm resulting from an ACUTE ISCHEMIC STROKE, a condition where your vessels aren't carrying enough blood to provide oxygen and nutrients to parts of the brain. 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 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: radiation therapy. We are changing your medications as follows: -Please take Aspirin 81mg and Plavix together daily. -Fluoxetine 20 mg daily for mood, also shown to help improve return of strength in patient's who have had a stroke Please take your other medications as prescribed. Please follow up with Neurology on ___ at 3:45 ___. Please schedule an appointment with your primary care physician ___ ___ weeks of hospital discharge. ******************* 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: 1. Cinacalcet 90 mg PO 2X/WEEK (___) 2. Citalopram 10 mg PO DAILY 3. ClonazePAM 0.5 mg PO 3X/WEEK (___) 4. FoLIC Acid 2 mg PO DAILY 5. Furosemide 40 mg PO DAILY 6. Labetalol 800 mg PO TID 7. LACOSamide 100 mg PO 3X/WEEK (MO,TH,SA) 8. Losartan Potassium 100 mg PO DAILY 9. NIFEdipine CR 60 mg PO BID 10. Phenytoin Sodium Extended 430 mg PO QHS 11. Rosuvastatin Calcium 5 mg PO QPM 12. sevelamer CARBONATE 800 mg PO TID W/MEALS 13. Zonisamide 200 mg PO QHS 14. Acetaminophen 650 mg PO Q6H:PRN pain 15. Aspirin 81 mg PO DAILY 16. B complex with C#20-folic acid 1 mg oral DAILY 17. Epoetin Alfa 4000 UNIT SC QMOWEFR 18. Ondansetron 8 mg PO Q8H:PRN nausea Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hypoglycemia secondary to Glipizide ESRD Hypertension Epilepsy Hyperlipidemia 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 ___ on ___ for low blood sugars (hypoglycemia), likely due to a mixup in the medications you were taking. Your blood sugars remained stable after we gave you some sugar. Please be careful in taking your medications and ask the visiting nurse for any help. Thank You, It was a pleasure taking care of you Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LeVETiracetam 500 mg PO BID Duration: 7 Days RX *levetiracetam 500 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Mechanical fall Small 6, Right sided frontal subdural hematoma Minimally displaced Sacral fracture Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to Acute Care Surgery Service after sustaining a fall. You are recovering well and are ready to be discharged. Please call us or come to the nearest emergency deparmtment if you experience any of the following: Dizziness or lightheadedness Numbness or tingling Change in vision Confusion Headache Weakness in arm, leg, or face Difficulty walking Difficulty talking Loss of balance Incontinence of urine or stool</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 2. Allopurinol ___ mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. Carvedilol 12.5 mg PO BID 6. Cyanocobalamin 50 mcg PO DAILY 7. Losartan Potassium 50 mg PO DAILY 8. macitentan 10 mg oral daily 9. Sildenafil 20 mg PO TID 10. albuterol sulfate 90 mcg/actuation INHALATION Q6H: PRN wheezing 11. GlipiZIDE XL 10 mg PO DAILY 12. Klor-Con M20 (potassium chloride) 20 mEq oral DAILY 13. Metolazone 5 mg PO 2X/WEEK (___) 14. NexIUM (esomeprazole magnesium) 20 mg oral DAILY 15. Torsemide 140 mg PO DAILY RX *torsemide [Demadex] 20 mg 7 tablet(s) by mouth daily Disp #*210 Tablet Refills:*0 16. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis Acute on chronic diastolic heart failure exacerbation Pulmonary hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to the hospital for increased weight and hypoxia concerning for heart failure. We started you on an IV Lasix drip and got off some fluid. We discharged you on your home dose of torsemide as well as your other home medications. You also had a CT scan which showed that the nodules in your lung that were identified over a year ago are still present and are stable. Because of your tendency to accumulate fluid, we recommend that you weigh yourself every morning, and call MD if weight goes up more than 3 lbs. It is very important that you continue to take your medications. All of your medications are detailed in your discharge medication list. You should review this carefully and take it with you to any follow up appointments. The details of your follow up appointments are given below. It was a pleasure taking care of you. Sincerely, Your ___ Cardiology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CloniDINE 0.1 mg PO BID 2. Docusate Sodium 100 mg PO BID 3. Gabapentin 600 mg PO TID 4. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain 5. Senna 1 TAB PO BID 6. Acetaminophen 1000 mg PO Q8H Discharge Disposition: Home Discharge Diagnosis: Trauma: Cyclist hit by car Left fibular fracture T12/L1 unstable fracture pneumomediastinum, bilat pneumothorax Left ___ posterior rib 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>You were admitted to the hospital after you were struck by a car while riding your bike. You reported back pain when you were admitted and found to have fractures of your lower back. Because of your injuries, you were seen by Neurosurgery and they recommended a special brace for back stabilization. You were also found to have a fracture of your left lower leg and had a brace for immobilization. You were evaluated by physical therapy and recommendations made for discharge home with the following instructions: Because you sustained rib fractures, please follow these instructions: * Your injury caused left 12 th rib fracture 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 antiinflammatory 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 ). You also sustained a fracture to your back: Please wear the TLSO brace when ambulating *report increased numbness/tingling lower extremities * weakness in legs * bowel or bladder changes You also sustained a fracture to your left leg: *Report increased pain left foot *increased swelling, numbness of toes left foot *pain in calf of left leg *air cast left foot when ambulating You also hit your head and may note increased headache, dizziness, and memory changes. We recommend follow-up with cognitive neurology for further evaluation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Multivitamins W/minerals 1 TAB PO DAILY 2. Apixaban 5 mg PO BID 3. Atorvastatin 80 mg PO QPM 4. Furosemide 40 mg PO DAILY 5. Levothyroxine Sodium 150 mcg PO DAILY 6. Metoprolol Succinate XL 25 mg PO DAILY 7. Sacubitril-Valsartan (24mg-26mg) 1 TAB PO BID 8. Sertraline 150 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Ischemic stroke Atrial fibrillation Heart failure with reduced ejection fraction 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 ___, You were hospitalized due to symptoms of left facial droop, left-sided weakness, and difficulty speaking resulting from an ACUTE ISCHEMIC STROKE, a condition where 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 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: - Atrial fibrillation - Hypertension We are changing your medications as follows: - Stop taking aspirin Please take your other medications as prescribed. Please follow up with neurology and your primary care physician as listed below. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. 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: 1. Levothyroxine Sodium 88 mcg PO DAILY 2. Lorazepam 0.5 mg PO DAILY:PRN anxiety 3. Nephrocaps 1 CAP PO DAILY 4. Omeprazole 40 mg PO DAILY 5. OxycoDONE (Immediate Release) 10 mg PO QHS 6. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 7. QUEtiapine Fumarate 25 mg PO 3X/WEEK (___) 8. Sertraline 100 mg PO DAILY 9. sevelamer CARBONATE 1600 mg PO TID W/MEALS 10. Lidocaine-Prilocaine 1 Appl TP ASDIR 11. Polyethylene Glycol 17 g PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Supratherapeutic INR Right knee hemarthrosis Secondary: Systolic and diastolic congestive heart failure (resolved) Left ventricular thrombus (resolved) 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>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. You were admitted to the hospital because your right knee has been swollen and painful. X-rays of your right knee showed that you did not any fractures. We believe that your right knee was swollen because your INR was very high and that you may have injured your knee, resulting in an accumulation of blood in that joint. You were evaluated by Orthopedic Surgery, and received medication, ice packs, and compression wraps to treat your knee pain. Because your INR was very high, we initially stopped your Coumadin. You had an ECHO of your heart to check the size and function of your heart chambers and to see if the clot in your heart had decreased in size. The ECHO showed that your heart chambers are now normal and that the clot is gone. Therefore, we did not restart your Coumadin since you do not need it anymore. Besides stopping your Coumadin, we did not make any other changes to your medications. Thank you for allowing us to participate in your care. All best wishes for your recovery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Apixaban 10 mg PO BID Duration: 7 Days Last day ___ RX *apixaban [Eliquis] 5 mg 2 tablet(s) by mouth twice daily Disp #*13 Tablet Refills:*0 3. Apixaban 5 mg PO BID 4. Bisacodyl 10 mg PO/PR DAILY 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. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity RX *oxycodone 5 mg 1 tablet(s) by mouth every 4 hours as needed Disp #*15 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 8. Senna 8.6 mg PO BID 9. Multivitamins 1 TAB PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: #Left intertrochanteric femur fracture #Acute pulmonary embolism with right ventricular strain #Acute deep venous thrombosis of left lower extremity #Paroxysmal atrial fibrillation #Acute hypoxemic respiratory failure #Acute blood loss anemia #Reactive leukocytosis #Consumptive thrombocytopenia SECONDARY DIAGNOSES: #Pulmonary nodule 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 because you fell and broke your hip. WHILE YOU WERE HERE: - You had surgery to repair your hip. - We found out that you have a large blood clot in your lungs (a "pulmonary embolism", or "PE"). We gave you blood thinners to treat this. - The clot caused your heart to go into an abnormal rhythm ("atrial fibrillation", or "A-fib"). We gave you medicines for this and you get better. WHEN YOU LEAVE THE HOSPITAL: - Work with the physical therapists to rebuild your strength. - Take all of your new medicines exactly as prescribed. See below for detailed list. - Let your nurses and doctors know immediately if you have any chest pain, shortness of breath, palpitations, dizziness, or any other symptoms that worry you. - See below for more instructions from your surgeons. We wish you all the best! Sincerely, Your ___ Care Team ============================================== 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. You can bear weight on your left leg as long as it is not too painful. ACTIVITY AND WEIGHT BEARING: - weight bearing as tolerated left lower extremity MEDICATIONS: 1) Take Tylenol ___ every 8 hours around the clock. 2) Add oxycodone as needed for increased pain. Aim to get off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 3 hours as needed x 1 day, then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take apixiban every day, every 12 hours. You need this to treat the blood clot in your lungs and to prevent strokes from your abnormal heart rhythm (atrial fibrillation). 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. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. 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 symptoms that worry you THIS PATIENT IS EXPECTED TO REQUIRE <30 DAYS OF REHAB</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 10 mg PO DAILY 2. Albuterol Inhaler ___ PUFF IH Q6H:PRN SOB 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. CARVedilol 25 mg PO BID 6. Clopidogrel 75 mg PO DAILY 7. Cyanocobalamin 1000 mcg PO DAILY 8. GlyBURIDE 1.25 mg PO DAILY 9. Losartan Potassium 100 mg PO DAILY 10. MetFORMIN (Glucophage) 1000 mg PO BID 11. Multivitamins 1 TAB PO DAILY 12. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN angina 13. Torsemide 80 mg PO DAILY 14. Triamcinolone Acetonide 0.025% Cream 1 Appl TP DAILY:PRN affected areas 15. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Heart failure with preserved ejection fraction Secondary Diagnoses: Depression Diabetes Mellitus Type II, not on insulin Hyperlipidemia Hypertension Severe Obesity Obstructive sleep apnea; not compliant with her CPAP at home Coronary Artery 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. ___, WHY WAS I IN THE HOSPITAL? You were in the hospital because you were having a heart failure exacerbation. WHAT WAS DONE WHILE I WAS HERE? We gave you medication through your IV, furosemide, to help you urinate. WHAT SHOULD I DO WHEN I GO HOME? -You should take your medications as instructed. You should go to your doctors ___ as below. -Weigh yourself every morning, call your doctor if your weight goes up more than 3 lbs in two days or more than 5 lbs in one week. -Try to limit your salt intake We wish you the ___! -Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO BID RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*9 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Common bile duct obstruction Pancreatic mass 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 to ___ with a blockage of your common bile duct. The pictures we took (ultrasound, MRCP) and the ERCP showed that the pancreatic mass caused this blockage. During the ERCP we placed a stent to open up the blockage and also took new biopsies. The gastroenterologists, surgeons, and oncologists will review these with the pathologist (the doctor who looks at the biopsies under the microscope) and call you with the results as well as set up a clinic appointment. Please take the antibiotic ciprofloxacin 500 mg twice daily through ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Nafcillin 2 g IV Q4H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: 1. tricuspid endocarditis 2. MSSA bactremia 3. chest pain SECONDARY DIAGNOSES: 1. IV drug abuse 2. Chronic Hepatitis C infection 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 here at the ___ ___. You presented with chest pain and history of a positive blood culture for staph aureus. You were found to have septicemia and tricuspid endocarditis with septic emboli in the lungs. We treated your septicemia and endocarditis with antibiotics, including vancomycin initially and nafcillin later on. We managed your pain with non-steroid anti-inflammatory medications and acetaminophen. A PICC line was placed for administration of longterm antibiotics. Based on infectious disease recommendation, you are to receive 4-week course of nafcillin. We started nafcillin on ___ here and thus, end date would be ___. An arrangement was made with Shattuc and you will be receiving the remainder course of your antibiotics at their facility until ___. You have chronic Hepatitis C and infectious disease recommended that you follow up with infectious disease clinic in the future to establish care. Their phone number is ___. Please take your medication and follow up with your outpatient appointments as instructed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*5 2. Indomethacin 50 mg PO DAILY:PRN gout flare Discharge Disposition: Home Discharge Diagnosis: viral illness, colchicine toxicity 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 due to numbness and tingling in your hands as well as lab values concerning for liver injury. You had a significant work-up including MRI of the cervical spine that was normal. Your abnormal liver tests were slightly improving by the time of discharge and you should have close follow-up with your PCP to follow these labs (scheduled for ___ you should have repeat CBC, chemistry, LFTs, LDH, reticulocyte count). Your symptoms were thought to be due to excess colchicine use as well as a likely viral illness. Your symptoms should slowly resolve over time. We started you on folic acid (dietary supplement) to help your body recover faster. Please seek care if you have worsening or new symptoms. Best, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID 2. Albuterol Inhaler 1 PUFF IH Q6H:PRN SOB, wheeze 3. Carvedilol 25 mg PO BID 4. Clarinex (desloratadine) 5 mg oral QAM 5. Cyanocobalamin 1000 mcg PO DAILY 6. Enablex (darifenacin) 15 mg oral QPM 7. Escitalopram Oxalate 10 mg PO DAILY 8. Januvia (sitaGLIPtin) 50 mg oral QAM 9. Montelukast 10 mg PO QPM 10. Omeprazole 20 mg PO DAILY 11. Pravastatin 10 mg PO DAILY 12. Tamoxifen Citrate 20 mg PO QAM 13. Tiotropium Bromide 1 CAP IH DAILY 14. Torsemide 5 mg PO DAILY 15. Docusate Sodium 100 mg PO BID 16. Lidocaine 5% Patch 1 PTCH TD DAILY 17. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN pain Hold for sedation or respiratory rate < 12 per minute. RX *oxycodone 5 mg half to 1 tablet(s) by mouth Up to every 4 hours Disp #*14 Tablet Refills:*0 18. Polyethylene Glycol 17 g PO DAILY 19. Senna 17.2 mg PO HS 20. Simethicone 40-80 mg PO QID:PRN bloating, stomach upset 21. Alendronate Sodium 70 mg PO DAILY 22. Caltrate 600+D Plus Minerals (Ca-D3-mag ___ 600 mg-400 unit tablet oral BID 23. Centrum Silver ( m u l t i v i t - m i n - F A - lycopen-lutein;<br>multivitamin-minerals-lutein;<br>mv-min-folic acid-lutein) 0.4-300-250 mg-mcg-mcg oral daily 24. MetFORMIN (Glucophage) 850 mg PO BID 25. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation INHALATION 2 PUFFS IH BID 26. Cefpodoxime Proxetil 200 mg PO Q12H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: - Right ___ and 10th rib fractures - Dyspnea secondary to splinting - Right pleural effusion - Small right apical pneumothorax - s/p fall SECONDARY DIAGNOSES: - Kyphoscoliosis - Reactive airways - Left rotator cuff injury, likely chronic - Incidental pancreatic head lesion on CT - Incidental left adrenal mass on CT - Pyuria 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 hospital because you fell on broke some ribs on the right side. This caused difficulty breathing. At first, you required oxygen. We think this is from pain, lack of deep breaths, and from some fluid in the right lung. Over your hospital stay, your breathing improved and you no longer required oxygen. Your pain was better controlled and the fluid on the right side of your lung also looked improved on chest xray. You are being discharged to rehab so that you can get stronger and they can help prevent falls in the future. The imaging studies during this hospitalization showed that you also may have an old rotator cuff injury in your left shoulder. This does not require any immediate intervention. However, you should follow up with your PCP ___ this issue. Imaging also showed that you have a mass inside your pancreas and inside your left adrenal gland. We are not sure about the significance of these findings, since according to your medical record, these have been noted before. Please discuss these findings with your PCP ___ whether or not you need further imaging. It was a pleasure to take care of you during this hospitalization. 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 81 mg PO DAILY 2. Bisacodyl ___AILY:PRN Constipation - Second Line 3. Chlorthalidone 12.5 mg PO DAILY 4. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using HUM Insulin 5. Polyethylene Glycol 17 g PO DAILY 6. Senna 8.6 mg PO BID 7. amLODIPine 10 mg PO DAILY 8. CARVedilol 12.5 mg PO BID 9. Donepezil 10 mg PO QHS 10. Levothyroxine Sodium 50 mcg PO DAILY 11. MetFORMIN XR (Glucophage XR) 750 mg PO BID 12. Pravastatin 20 mg PO QPM 13. PredniSONE 3 mg PO DAILY 14. Sertraline 100 mg PO DAILY 15. Vitamin D 1000 UNIT PO DAILY 16. Vitamin E 400 UNIT PO QID 17.Equipment Rx: ___ Lift Dx: Immobility M62.3, Dementia F03.90 Duration: 12 months Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Moderate to severe dementia Type 2 diabetes mellitus HTN Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you during your admission to ___. You were admitted with confusion. This may have been due to recent medication changes. You had an MRI of your brain that did not show an acute change. You are now stable for discharge. You will need to work with ___ to build up strength before you can return home</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: None. Hospice will manage home symptom management meds. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hematochezia Anemia Advanced dementia Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___ & family, It was a pleasure caring for you at ___ ___ You were admitted to the hospital because you were having blood from your rectum and your mental status was different than usual. You were not found to have any infections or any abnormalities. Your goals of care were discussed with her family and it was decided that doing invasive and aggressive procedures is not within the goals for your care right now. We monitored your blood levels and they remained stable. He will be discharged with home hospice, which will help focus on your comfort and symptoms. Sincerely, Your ___ Medicine Team</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 RX *acetaminophen 650 mg 1 tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 (One) capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Do not drink alcohol, drive, or operate heavy machinery while taking this medication RX *oxycodone 5 mg 1 (One) capsule(s) by mouth every four (4) hours Disp #*20 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>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. 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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Colchicine 0.6 mg PO DAILY This medication should be taken for six months. 2. Ferrous Sulfate 325 mg PO DAILY 3. FoLIC Acid 1 mg PO DAILY 4. Vitamin B Complex 1 CAP PO DAILY 5. Warfarin 1 mg PO DAILY16 Goal INR ___. 6. Lisinopril 5 mg PO DAILY 7. Senna 17.2 mg PO HS 8. Allopurinol ___ mg PO DAILY 9. Amiodarone 100 mg PO DAILY 10. Aspirin 81 mg PO DAILY 11. Atorvastatin 80 mg PO QPM 12. Carvedilol 12.5 mg PO BID 13. Digoxin 0.0625 mg PO DAILY 14. Docusate Sodium 100 mg PO BID 15. Omeprazole 20 mg PO DAILY BEFORE BREAKFAST 16. Polyethylene Glycol 17 g PO DAILY 17. TraMADol 25 mg PO Q6H:PRN Pain - Moderate RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth every six (6) hours Disp #*20 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: PRIMARY: Hemolytic anemia, mechanical Acute gout flare Pericardial effusion SECONDARY: History of heart failure with reduced ejection fraction History of atrial fibrillation 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 pleasure to care for you at the ___ ___. You were seen at our hospital because you had joint pain and high levels of your blood thinner, as well as some signs of low blood counts ("anemia"). Your joint pain was likely due to another gout flare; we added a new medicine ("colchicine") which helped your gout. Your low blood counts were related to your recent heart valve repair; we gave you a small amount of blood, and you did not have any active blood loss before you went home. We held your blood thinner ("warfarin") for a few days given some concern for blood loss, but restarted it before you left. You also had some fluid around your heart ("pericardial effusion") that we saw on a picture of your heart. This fluid was not making your heart worse, and not related to bleeding. This can happen after heart surgery, and the heart surgeons believe that it will likely resolve on its own. Initially we thought you had a urinary tract infection, based on a test of your urine. Repeat testing did not show an infection. We briefly gave you antibiotics, but stopped them as you did not appear to have an infection. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. 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. Acetaminophen 650 mg PO Q6H:PRN neck pain Do not exceed more than 4 grams of tylenol in 24hrs. 2. Cyclobenzaprine 10 mg PO TID spasm RX *cyclobenzaprine 10 mg 1 tablet(s) by mouth three times a day Disp #*60 Tablet Refills:*0 3. Docusate Sodium 100 mg PO DAILY:PRN constipation 4. TraZODone 25 mg PO QHS:PRN insomnia Follow up with your PCP for further prescriptions. RX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth Q HS Disp #*4 Tablet Refills:*0 5. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain/headcahe Please do not drive or operate mechanical machinery while taking pain meds. RX *oxycodone 5 mg ___ tablet(s) by mouth Q 4 hrs Disp #*90 Tablet Refills:*0 6. Ondansetron 4 mg PO Q8H:PRN nausea Duration: 3 Days RX *ondansetron 4 mg 1 tablet(s) by mouth Q 8hrs Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: C2 odontoid 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 Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •No contact sports until cleared by your neurosurgeon. ** PLease continue to wear your brace at all times, Sponge baths only, do not remove your brace. Medications •Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. •It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: •New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amitriptyline 25 mg PO HS 2. Bisacodyl 10 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Escitalopram Oxalate 10 mg PO DAILY 5. Heparin 5000 UNIT SC TID 6. Glargine 10 Units Breakfast Glargine 50 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 7. MetFORMIN (Glucophage) 1500 mg PO BID 8. Morphine SR (MS ___ 15 mg PO Q12H 9. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain Please do not drive or operate mechanical machinery while taking this medication/ narcotics. RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth Q4hrs Disp #*60 Tablet Refills:*0 10. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush 11. Nystatin Ointment 1 Appl TP QID:PRN the fungus 12. Polyethylene Glycol 17 g PO DAILY:PRN constipation 13. Nafcillin 2 g IV Q4H Antibiotic Stop date: ___ 14. Senna 8.6 mg PO BID 15. Simvastatin 40 mg PO DAILY 16. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line flush 17. Tizanidine 6 mg PO TID 18. Tricor (fenofibrate nanocrystallized) 48 mg ORAL HS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Staphlococcus aureus coagulase positive wound infection 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>Spine Surgery-Wound Revision Dr. ___ •Do not smoke. •Keep your wound(s) clean and dry / No tub baths or pool swimming for two weeks from your date of surgery. * You have sutures and staples, please keep them dry until they are removed. •No pulling up, lifting more than 10 lbs., or excessive bending or twisting. •Limit your use of stairs to ___ times per day. •Have a friend or family member check your incision daily for signs of infection. •Take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. •Do not take any medications such as Aspirin unless directed by your doctor. •Unless you had a fusion, you should take Advil/Ibuprofen 400mg three times daily •Increase your intake of fluids and fiber, as pain medicine (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. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING: •Pain that is continually increasing or not relieved by pain medicine. •Any weakness, numbness, tingling in your extremities. •Any signs of infection at the wound site: redness, swelling, tenderness, and drainage. •Fever greater than or equal to 101° F. •Any change in your bowel or bladder habits (such as loss of bowl or urine control). Follow Up Instructions/Appointments</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY 2. Divalproex (DELayed Release) 875 mg PO QHS 3. Divalproex (DELayed Release) 500 mg PO QAM 4. Ferrous Sulfate 325 mg PO DAILY 5. FoLIC Acid 1 mg PO DAILY 6. Lorazepam 0.5 mg PO BID:PRN anxiety, agitation Hold for oversedation, confusion or RR < 12 7. Risperidone 0.5 mg PO BID 8. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB, wheezing 9. Docusate Sodium 100 mg PO BID 10. cranberry extract *NF* 425 mg Oral BID 11. Hydrocortisone Cream 1% 1 Appl TP BID apply to buttocks 12. Ketoconazole 2% 1 Appl TP BID to face 13. Vagifem *NF* (estradiol) 10 mcg Vaginal 2 times weekly at bedtime 14. zinc oxide *NF* 20 % Topical BID apply to buttocks every shift 15. Vancomycin 1250 mg IV Q 24H day 1: ___. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush Temporary Central Access-ICU: Flush with 10mL Normal Saline daily and PRN. 17. Simvastatin 20 mg PO DAILY 18. Senna 2 TAB PO DAILY 19. Meropenem 500 mg IV Q6H 20. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 21. Heparin Flush (10 units/ml) 2 mL IV PRN line flush PICC, heparin dependent: Flush with 10mL Normal Saline followed by Heparin as above daily and PRN per lumen. 22. Ipratropium Bromide Neb 1 NEB IH Q4H:PRN SOB 23. Heparin 5000 UNIT SC TID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Healthcare Associated Pneumonia, Urinary Tract Infection Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Ms. ___, you were admitted to ___ ___ due to low blood pressure in the setting of pneumonia and urinary tract infection.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cetirizine 10 mg PO BID:PRN Allergies 2. DiphenhydrAMINE 50 mg PO QHS:PRN Insomnia 3. Docusate Sodium 100 mg PO BID:PRN Constipation - First Line 4. Magnesium Oxide 400 mg PO BID 5. Mycophenolate Mofetil 1500 mg PO BID 6. Omeprazole 20 mg PO BID 7. Pramipexole 0.125 mg PO QHS 8. PredniSONE 7.5 mg PO DAILY 9. Senna 8.6 mg PO BID:PRN Constipation - Second Line 10. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 11. Tacrolimus 2.5 mg PO Q12H 12. ValGANCIclovir 900 mg PO Q24H 13. Vitamin D ___ UNIT PO 1X/WEEK (___) 14.Outpatient Lab Work CMV viral load CHEM10, CBC, AST, ALT, tBili, AlkPhos B25.9 Please fax to ___ ___, MD Discharge Disposition: Home Discharge Diagnosis: Fever Diarrhea CMV viremia Cholangitis secondary to biliary sludge Cryptogenic cirrhosis status post DDLT (___) Pancytopenia Transaminitis Acute kidney injury Restless leg syndrome Vitamin D deficiency 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 privilege taking care of you at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? =================================== -You had fevers and body aches. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? ========================================== -We treated you with broad-spectrum antibiotics -You had a procedure called an ERCP to remove sludge from your gallbladder. You got better after this. -We found that you have a virus in your blood called CMV, which sometimes happens after transplant. -You had a biopsy of your liver which did NOT show any rejection. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? ============================================ - Please continue to take all your medications and follow up with your doctors at your ___ appointments. - Please get your labs drawn in one week. We wish you all the best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. ClonazePAM 0.5 mg PO QAM 3. ClonazePAM 1 mg PO QHS 4. Docusate Sodium 100 mg PO BID 5. Enoxaparin Sodium 40 mg SC Q24H Duration: 14 Doses Start: Today - ___, First Dose: Next Routine Administration Time 6. Gabapentin 1200 mg PO TID 7. LeVETiracetam 1000 mg PO BID 8. Multivitamins W/minerals 1 TAB PO DAILY 9. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain 10. Senna 8.6 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right hip intertrochanteric 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>Instructions After Orthopedic 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. Medicines - Resume taking your home medications unless specifically instructed to stop by your surgeon. Please talk to your primary care doctor within the next ___ weeks regarding this hospitalization and any changes to your home medications that may be necessary. - Do not drink alcohol, drive, or operate machinery while you are taking narcotic pain relievers (oxycodone/dilaudid). - As your pain lessens, decrease the amount of narcotic pain relievers you are taking. Instead, take acetaminophen (also called tylenol). Follow all instructions on the medication bottle and never take more than 4,000mg of tylenol in a single day. - If you need medication refills, call your surgeon's office 3-to-4 days before you need the refill. Your prescriptions will be mailed to your home. - Please take lovenox injections for 2 weeks to help prevent the formation of blood clots. Constipation - Both surgery and narcotic pain relievers can cause constipation. Please follow the advice below to help prevent constipation. - Drink 8 glasses of water and/or other fluids like juice, tea, and broth to stay well hydrated. - Eat foods that are high in fiber like fruits and vegetables. - Please take a stool softener like docusate (also called colace) to help prevent constipation while you are taking narcotic pain relievers. - You may also take a laxative such as senna (also called Senokot) to help promote regular bowel movements. - You can buy senna or colace over the counter. Stop taking them if your bowel movements become loose. If your bowel movements continue to stay loose after stopping these medications, please call your doctor. Incision - Please return to the emergency department or notify your surgeon if you experience severe pain, increased swelling, decreased sensation, difficulty with movement, redness or drainage at the incision site. - You can get the wound wet/take a shower starting 3 days after surgery. Let water run over the incision and do not vigorously scrub the surgical site. Pat the area dry after showering. - No baths or swimming for at least 4 weeks after surgery. - Your staples/sutures will be taken out at your 2-week follow up appointment. No dressing is needed if your wound is non-draining. - You may put an ice pack on your surgical site, but do not put the ice pack directly on your skin (place a towel between your skin and the ice pack), and do not leave it in place for more than 20 minutes at a time. Activity - Your weight-bearing restrictions are: weight bearing as tolerated in the right lower extremity. Physical Therapy: WBAT RLE. ROMAT Treatments Frequency: right hip daily dressing changes with dry sterile dressing until no drainage. R hip staples to be removed upon follow up in ___ clinic in 2 weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Famotidine 20 mg PO DAILY 2. Glargine 10 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 3. PredniSONE 5 mg PO DAILY 4. QUEtiapine Fumarate 12.5 mg PO QHS 5. QUEtiapine Fumarate 12.5 mg PO DAILY 6. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 7. Levothyroxine Sodium 100 mcg PO DAILY 8. Tamsulosin 0.4 mg PO QHS 9. Vitamin D ___ UNIT PO DAILY 10. HELD- GlipiZIDE 5 mg PO DAILY This medication was held. Do not restart GlipiZIDE until discharged with outpatient follow-up Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: - craniopharyngioma - panhypopituitarism s/p craniopharyngioma resection - adrenal insufficiency - hypothyroidism - delirium/agitation/ dementia - emesis/transaminitis SECONDARY DIAGNOSIS: - diabetes mellitus type II - hypernatremia - GERD - BPH - insomnia 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. ___, You were admitted for confusion. We treated you by replacing the steroids and thyroid hormone in your body and you improved. You will be transferred to ___ for a second opinion regarding surgery. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 2.5 mg PO DAILY RX *amlodipine 2.5 mg 1 tablet(s) by mouth Daily Disp #*10 Tablet Refills:*0 2. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth Daily Disp #*7 Tablet Refills:*0 3. coenzyme Q10 200 mg oral DAILY 4. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN Anginal pain RX *nitroglycerin 0.3 mg 1 tablet(s) sublingually Q5 minutes PRN Disp #*100 Tablet Refills:*0 5. Ondansetron ODT 4 mg PO Q8H:PRN Nausea RX *ondansetron [Zofran ODT] 4 mg 3 tablet(s) by mouth Q8H: PRN Disp #*3 Tablet Refills:*0 6. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth Daily Disp #*10 Tablet Refills:*0 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Calcipotriene 0.005% Cream 1 Appl TP BID 9. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral daily 10. Halobetasol Propionate 0.05 % topical BID 11. Multivitamins 1 TAB PO DAILY 12. TiCAGRELOR 90 mg PO BID 13. Vitamin D ___ UNIT PO 4X/WEEK (___) 14. Vitamin D 4000 UNIT PO 3X/WEEK (___) 15. HELD- Hydrochlorothiazide 12.5 mg PO 3X/WEEK (MO,WE,SA) This medication was held. Do not restart Hydrochlorothiazide until evaluated by your PCP and cardiologist ___ Disposition: Home Discharge Diagnosis: Primary Diagnosis: ==================== Type I NSTEMI Secondary Diagnosis: ==================== Coronary artery disease Hypertension Hyperparathyroidism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, Thank you for choosing ___ as your site of care! Why was I admitted to the hospital? -You were admitted to the hospital because you were experiencing chest discomfort and trouble breathing at home. What was done for me while I was in the hospital? -A tracing of you heart was taken, this did not show obvious changes. -Your heart markers were slightly elevated. -Because of your history, and your chest pain you had a heart catheterization. -This study showed the blood vessel that you had stented previously was blocked again. -We spoke to our cardiac surgeons and your previous doctor, ___. ___. -A second procedure was completed ___ and a new ___ was placed in your heart. -After the procedure you went to the ICU briefly to help manage your blood pressure. -You were initially placed on medication to thin your blood. -You continued your home medications, including your Aspirin, Brillinta and Metoprolol. -Once your chest pain resolved, you were felt safe to be discharged home. What should I do when I leave the hospital? -Please continue taking your aspirin and Brillinta daily. This medication is important to keep your ___ open. -Please also continue to take amlodipine 2.5 daily and metoprolol XL 25mg daily. You may stop your HCTZ (hydrochlorothiazide). -Your atorvastatin dose was increased to 80 mg daily. While on this higher dose, you should take coenzyme Q10, 200 mg daily. You can get this over the counter at the pharmacy. -You are also being discharged with nitroglycerin sublingual which you can take if you develop chest pain (and call your doctor). -If you notice you are having chest pain or trouble breathing, please return to the hospital. -Please follow up with your outpatient providers. You should call Dr. ___ office to schedule follow up at ___, please follow up within 2 weeks. -Please all call Dr. ___ at ___ to schedule PCP follow up within one week of discharge. We wish you the best, Your ___ treatment team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 10 mg PO DAILY 2. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 3. Lisinopril 30 mg PO DAILY 4. Zinc Sulfate 220 mg PO DAILY Duration: 14 Days 5. Glargine 5 Units Breakfast Insulin SC Sliding Scale using REG Insulin 6. Methadone (Oral Solution) 2 mg/1 mL 5 mg PO Q6H RX *methadone 5 mg/5 mL 5 mL by mouth q6hours Refills:*0 7. OxyCODONE (Immediate Release) 5 mg PO Q8H:PRN Pain - Moderate RX *oxycodone 5 mg 1 capsule(s) by mouth every eight (8) hours Disp #*21 Capsule Refills:*0 8. Polyethylene Glycol 17 g NG BID constipation 9. Acetaminophen 650 mg NG Q6H:PRN Pain - Mild 10. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN shortness of breath 11. Aspirin 81 mg PO DAILY 12. Atorvastatin 40 mg PO QPM 13. Bisacodyl 10 mg PO DAILY:PRN constipation 14. Calcium Carbonate 500 mg PO QID 15. Gabapentin 400 mg NG TID 16. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 17. Lidocaine 5% Patch 1 PTCH TD QAM 18. Metoprolol Tartrate 6.25 mg PO Q6H 19. Multivitamins W/minerals 1 TAB PO DAILY 20. Ramelteon 8 mg PO QHS:PRN sleep Should be given 30 minutes before bedtime 21. Senna 17.2 mg NG BID Constipation 22. Sertraline 50 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS Aspiration pneumonia Toxic metabolic encephalopathy Sepsis Pleural effusion Hypoxemia Constipation Hemoperitoneum Stercoral colitis SECONDARY DIAGNOSIS CAD Fibromyalgia DM Type II Depression GERD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. Why did you come to the hospital? - You initially came to the hospital because of confusion and fever, and you were found to have a pneumonia What happened during your hospitalization? - You were given antibiotics in order to treat your pneumonia - You had a second pneumonia during the hospital and you were treated with another course of antibiotics - You also had a chest tube placed in order to help drain fluid from around your lungs - You had your J tube exchanged because it was frequently clogging - You were given blood because you had some bleeding in your abdomen - You had severe constipation and we gave you enemas and laxatives - We decreased your methadone dosing to prevent further constipation What you should do when you leave the hospital? - Continue to take all of your medications as prescribed - Please keep all of your scheduled healthcare appointments listed below Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gabapentin 100 mg PO DAILY Dose decreased due to kidney injury RX *gabapentin 100 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*0 2. RisperiDONE 1 mg PO QHS Dose decreased due to kidney injury RX *risperidone 1 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 3. Apixaban 2.5 mg PO BID 4. Bumetanide 4 mg PO TID 5. Docusate Sodium 100 mg PO BID constipation 6. DULoxetine 60 mg PO DAILY 7. Ferrous GLUCONATE 324 mg PO DAILY 8. glimepiride 2 mg oral 2X/WEEK 9. Isosorbide Mononitrate (Extended Release) 15 mg PO DAILY 10. linaclotide 145 mcg oral Q24H Do not take more than instructed 11. Lubiprostone 24 mcg PO DAILY:PRN constipation Do not take more than instructed 12. Metolazone 2.5 mg PO PRN fluid overload 13. Metoprolol Succinate XL 25 mg PO BID 14. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN CP 15. Omeprazole 20 mg PO DAILY 16. Senna 8.6 mg PO PRN constipation 17. Simvastatin 40 mg PO QPM 18. Spironolactone 25 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS Anemia SECONDARY DIAGNOSIS Congestive heart failure 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>Ms. ___, You were admitted for your severe lethargy and diarrhea and were found to have an anemia (low blood count). We transfused you with blood while you were admitted at ___. Your blood counts improved. We continued you on your heart medications for your congestive heart failure. Dr. ___ cardiologist, and your son are aware of this plan. Two of your medications, gabapentin and risperidone have been decreased because of kidney injury. You will follow up with Dr. ___ shortly to discuss the possibility of further changing the medications. Finally, we believe these symptoms were due to taking too many laxatives. Please do not take more laxatives than instructed and let your doctor know if you are constipated and uncomfortable. If you have worsening symptoms of diarrhea, weakness, or dizziness please return for further evaluation. It was a pleasure taking care of you at ___! Sincerely, Your ___ Team</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 fever or pain Please do not exceed more than 4 grams in 24hrs. 2. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 4. Docusate Sodium 100 mg PO BID 5. Heparin 5000 UNIT SC BID 6. LevETIRAcetam 500 mg PO BID 7. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain Please do not drive or operate mechanical machinery while taking narcotics. 8. Phenytoin Sodium Extended 200 mg PO BID 9. Tamsulosin 0.4 mg PO QHS 10. Thiamine 100 mg PO DAILY 11. amLODIPine 5 mg PO DAILY 12. Atorvastatin 20 mg PO QPM 13. FoLIC Acid 1 mg PO DAILY 14. Multivitamins 1 TAB PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: subdural hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Hemorrhage with Surgery Surgery · You underwent a surgery called a craniotomy to have blood removed from your brain. · Please keep your staples along your incision dry until they are removed. · It is best to keep your incision open to air but it is ok to cover it when outside. · Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity · We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. · You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. · No driving while taking any narcotic or sedating medication. · If you experienced a seizure while admitted, you are NOT allowed to drive by law. · No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications · Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. · *You have been discharged on Keppra (Levetiracetam) and Dilantin (Phenytoin). These medications helps to prevent seizures. Please continue this medicatiosn as indicated on your discharge instruction. It is important that you take the medications consistently and on time and follow up with laboratory blood drawing in one week. This can be drawn at your PCP’s office, but please have the results faxed to ___. · You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: · You may have difficulty paying attention, concentrating, and remembering new information. · Emotional and/or behavioral difficulties are common. · Feeling more tired, restlessness, irritability, and mood swings are also common. · You may also experience some post-operative swelling around your face and eyes. This is normal after surgery and most noticeable on the second and third day of surgery. You apply ice or a cool or warm washcloth to your eyes to help with the swelling. The swelling will be its worse in the morning after laying flat from sleeping but decrease when up. · You may experience soreness with chewing. This is normal from the surgery and will improve with time. Softer foods may be easier during this time. · Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Headaches: · Headache is one of the most common symptoms after a brain bleed. · Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. · Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. · There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: · Severe pain, swelling, redness or drainage from the incision site. · Fever greater than 101.5 degrees Fahrenheit · Nausea and/or vomiting · Extreme sleepiness and not being able to stay awake · Severe headaches not relieved by pain relievers · Seizures · Any new problems with your vision or ability to speak · Weakness or changes in sensation in your face, arms, or leg 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: [/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: -Nonweightbearing in the right lower extremity MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 3 hours as needed x 1 day, then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take aspirin 325 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. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - 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 ___ DAYS OF REHAB Physical Therapy: Clinical Impression/Prognosis: Pt is a ___ y/o F with a history of chronic back pain who presents to physical therapy during hospitalization for RLE trimalleolar fx requiring ORIF. Pt is functioning well below baseline limited by impairments in body structure and function including decreased balance, and endurance consistent with RLE fx s/p surgery requiring NWB. Pt also presents with activity limitations in mobility and self care contributing to difficulty in fulfilling societal role of caregiver for father. Pt is currently functionally appropriate for home d/c when medically stable. Pt does not require additional inpatient ___ prior to D/C but will f/u to progress endurance/higher level balance if pt remains at ___ for medical reasons. pt will require AC's and home ___ following discharge. Goals: Time Frame: 1 Week - Pt will amb 200' with AC and I while maintaining NWB status - Pt will be I with a FOS while maintaining NWB status Recommended Discharge: ( )rehab (X)home with home ___, following 0 ___ visits Treatment Plan: Progress functional mobility including bed mobility, transfers, gait and stairs as tolerated. Balance training Pt/caregiver education RE: fall risk D/C planning Frequency/Duration: ___ for 1 week Recommendations for Nursing: Amb with AC's and S 3x/day. OOB for all meals and at least 3 hours a day, no more than 1 hour at a time to prevent skin breakdown. 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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 40 mg PO BID RX *omeprazole 40 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 2. Sucralfate 1 gm PO QID RX *sucralfate 1 gram/10 mL 10 mL by mouth four times a day Disp #*1 Bottle Refills:*3 3. ClonazePAM 0.5 mg PO DAILY:PRN anxiety 4. DULoxetine 20 mg PO DAILY 5. Estradiol 0.5 mg PO DAILY 6. Furosemide 20 mg PO DAILY 7. Gabapentin 600 mg PO TID pain 8. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN SOB 9. Lactulose 15 mL PO DAILY BM 10. Magnesium Oxide 400 mg oral Frequency is Unknown 11. melatonin 3 mg oral QHS 12. Metoclopramide 5 mg PO BID:PRN nausea 13. Midodrine 10 mg PO BID 14. Nicotine Patch 21 mg/day TD DAILY 15. Ondansetron ODT 8 mg PO BID:PRN Nausea/Vomiting - First Line 16. OxyCODONE (Immediate Release) 15 mg PO Q8H:PRN Pain - Moderate 17. Potassium Chloride 40 mEq PO DAILY Hold for K > 18. Rifaximin 550 mg PO BID 19. Simethicone 80 mg PO Q6H:PRN abdominal pain 20. Spironolactone 25 mg PO DAILY 21. Vitamin D ___ UNIT PO 1X/WEEK (___) 22. HELD- Alendronate Sodium 70 mg PO QMON This medication was held. Do not restart Alendronate Sodium until discussion with primary care Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: -Severe esophagitis -Cirrhosis with portal hypertension and small volume ascites -Roux-en-Y hepaticojejunostomy after bile duct injury from CCY Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, =================================== WHY DID YOU COME TO THE HOSPITAL? =================================== - You vomited blood =================================== WHAT HAPPENED AT THE HOSPITAL? =================================== - We monitored your blood counts for several days after a blood transfusion. - You had a procedure called an "EGD" which looked at the lining of your stomach and esophagus. This study showed severe irritation to the esophagus called "esophagitis" which probably explained the bleeding. - We started medication to help with healing your esophagus. ================================================== WHAT NEEDS TO HAPPEN WHEN YOU LEAVE THE HOSPITAL? ================================================== - Please take all of your medications as prescribed. - Please stop taking the potassium and alendronate for now. - Follow up with your medical team (see below). We wish you the best! - Your Care Team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Hydrochlorothiazide 25 mg PO DAILY 2. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 3. Levothyroxine Sodium 75 mcg PO DAILY 4. Rosuvastatin Calcium 10 mg PO DAILY 5. Metoprolol Succinate XL 75 mg PO DAILY 6. Lisinopril 20 mg PO DAILY 7. Warfarin 5 mg PO DAILY16 8. Heparin IV No Initial Bolus Initial Infusion Rate: 750 units/hr Start: Today - ___, First Dose: 1200 Goal PTT 50-70, check PTT every 6 hours. Heparin can be stopped once INR therapeutic at ___. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left midbrain, left medial temporal lobe, left occipital acute infarcts Valvular atrial fibrillation Myxomatous mitral valve Discharge Condition: Mental Status: Confused - sometimes. 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 hospitalized due to symptoms of confusion and a fall 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 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: Valvular atrial fibrillation due to myxomatous mitral valve Hypertension Hyperlipidemia We are changing your medications as follows: Coumadin - dose to be determined by doctor based on blood levels Metoprolol ER 75mg by mouth once a day Lisinopril 20mg by mouth once a day Please stop your Verapamil Please take your other medications as prescribed. Please followup with Neurology, Cardiology, 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 - 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: [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___. You were admitted because you felt dizzy and short of breath. We had the neurology doctors ___, and they felt that your neurologic symptoms were due to your old stoke, and we confirmed that there were no new signs of stroke with an MRI of your brain. Your shortness of breath was due to fluid back up in your lungs, so we gave you a medicine through your veins to help you urinate more to remove the excess fluid from your body. This helped you to breath easier. Unfortunately, we were unable to get you off the oxygen completely and may still require the oxygen once at home, especially when ambulating. Please make the following changes to your medications: INCREASE Lasix to 140mg daily INCREASE coumadin to 3 mg daily STOP clobetasol STOP metoprolol 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. Aspirin 81 mg PO DAILY 2. Entecavir 0.5 mg PO DAILY 3. Hydrochlorothiazide 25 mg PO DAILY 4. Glargine 80 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 5. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY hold for BP <100, HR<60 6. Lisinopril 40 mg PO DAILY hold for BP<100, HR<60 7. Lorazepam 0.5 mg PO BID:PRN anxiety hold for sedation, RR<12 8. NIFEdipine CR 60 mg PO DAILY HOLD FOR bp<100, hr<60 9. Omeprazole 20 mg PO BID 10. MetFORMIN XR (Glucophage XR) 1000 mg PO DAILY Do Not Crush 11. Metoprolol Succinate XL 100 mg PO BID 12. Vytorin ___ *NF* (ezetimibe-simvastatin) ___ mg Oral daily 13. Vitamin D 50,000 UNIT PO EVERY OTHER ___ Discharge Disposition: Home Discharge Diagnosis: GI illness Chest pain NOS Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking care of you while you were here at ___. You were admitted for chest pain that was concerning for possible heart attack. Your EKGs and blood tests were negative for this and you were no longer having chest pain as we watched you. You had a very thorough lung scan as well, which was able to rule out many other potentially dangerous causes of chest pain. Your chest pain was likely due to irritation related to vomiting recently. In addition, a component of chest pain was reproduced when pressure was applied to your chest, suggesting some component of musculoskeletal pain. None of your medications have changed.</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 Reason for PRN duplicate override: Patient is NPO or unable to tolerate PO Do not exceed 4000 mg daily. 2. Docusate Sodium 100 mg PO BID Hold for loose or frequent stool. 3. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Mild Do not drink alcohol or drive while taking this medication. RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 4. Senna 8.6 mg PO BID:PRN constipation 5. Dolutegravir 50 mg PO DAILY 6. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 7. Fluticasone Propionate 110mcg 2 PUFF IH BID:PRN allergy 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 Mr. ___, You were admitted to ___ with acute appendicitis. You underwent a laparoscopic converted to open appendectomy. Post-operatively, you had a tube inserted into your nose for treatment of an ileus. You have recovered well and are now ready for discharge. Please follow the instructions below to ensure a speedy recovery: Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 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. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o 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: You have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o 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. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. 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. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o 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. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o 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 following, 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. Thank you for allowing us to participate in your care. Sincerely, Your ___ Surgery Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ALPRAZolam 1.5 mg PO TID:PRN anxiety 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 40 mg PO QPM 4. BusPIRone 30 mg PO BID 5. Erythromycin 250 mg PO Q12H 6. FLUoxetine 60 mg PO DAILY 7. FoLIC Acid 1 mg PO DAILY 8. Gabapentin 400 mg PO TID 9. Genvoya ___ ALAFEN) ___ mg oral DAILY 10. GlipiZIDE XL 5 mg PO DAILY 11. HYDROmorphone (Dilaudid) 2 mg PO BID:PRN Pain - Severe 12. LevETIRAcetam 1000 mg PO BID 13. Loratadine 10 mg PO DAILY 14. MetFORMIN (Glucophage) 1000 mg PO BID 15. Methotrexate 5 mg PO 1X/WEEK (SA) 16. Methotrexate 7.5 mg PO BID Q ___ 17. Metoclopramide 10 mg PO TID 18. NIFEdipine (Extended Release) 30 mg PO DAILY 19. Ondansetron 8 mg PO Q8H:PRN nausea 20. Prazosin 5 mg PO DAILY 21. ProAir HFA (albuterol sulfate) 90 mg inhalation Q6H:PRN shortness of breath 22. Propranolol 40 mg PO BID 23. Ranitidine 150 mg PO BID:PRN Dyspepsia Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Toxic Metabolic Encephalopathy in the setting of Substance use disorder 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 at ___. Why was I here? - You were confused and had some bruising and pain What was done for me while I was here? - You had a small fracture of your right ankle, and were given a walking boot. The Orthopedic doctors saw ___, and recommend you ___ with them in the next two weeks, but you do not need surgery. - You were monitored for withdrawal and given medications to avoid withdrawal. - You had a CT scan of your head which did not show any acute bleeding or acute processes What should I do when I go home? - You should take all of your medications as prescribed. - You should attend all of your ___ appointments. - Work with your PCP on weaning down the Xanax and Dilaudid, over time - Do not take the Lorazepam (Ativan) We wish you the best in the future. - ___ teams</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear ___: You were admitted for fever and rash. We thought this was zoster (also called shingles). You will be treated with one week of a medication called Valtrex. We did many tests for other types of infections that did not show anything else. Please continue taking Valtrex (last day ___. 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. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 10 days: Day 1 of ___. Disp:*20 Tablet(s)* Refills:*0* (holding amlodipine as patient normotensive in house) Discharge Disposition: Home Discharge Diagnosis: Uncomplicated Pyelonephritis (sterile cultures). 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 ___. You were admitted for an infection of your urinary tract and kidneys. You were treated with antibiotics. The following changes were made to your medications: STARTED Ciprofloxacin to treat your infection (14 days total) STOPPED Amlodipine since your blood pressures have been fine here</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY 2. Atorvastatin 40 mg PO QPM 3. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 4. Sodium Bicarbonate 650 mg PO TID 5. Timolol Maleate 0.5% 1 DROP BOTH EYES QAM 6. Vitamin D ___ UNIT PO DAILY 7. Omeprazole 20 mg PO DAILY 8. Torsemide 5 mg PO BID 9. Allopurinol ___ mg PO DAILY 10. GlipiZIDE 10 mg PO BID Glipizide ER 11. Metoprolol Succinate XL 25 mg PO DAILY 12. Potassium Chloride 20 mEq PO DAILY 13. Amoxicillin 500 mg PO Q24H Take one pill (500mg) every day for 8 days. Start on ___ (tomorrow). Stop on ___. 14. Calcium Carbonate 500 mg PO TID with meals Take one pill with each meal. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Vertigo Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Needs home ___ safety evaluation Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure working with you at the ___. You were seen because you had vertigo (dizziness that feels like the room is spinning). This was from two problems: an infection in your right ear, and ear wax in your right ear. We gave an antibiotic called amoxicillin the infection. You should start using ear drops to reduce the amount of ear wax in your right ear. You can use Debrox Earwax Removal Aid Drops; you can buy this at ___. You also had low mineral levels (like magnesium) in your blood. We fixed this problem. While you were in the hospital, you had brain imaging that told us you did not have a stroke. We fixed your low mineral levels and started treating your ear infection with an antibiotic. When you go home, you should make these changes to your daily medicines: For your dizziness: -Continue taking Amoxicillin 500mg by mouth every day for 8 more days, until ___. This is for your ear infection. -Start using daily ear drops on your right ear to soften the wax. You can buy Debrox Earwax Removal Aid Drops at ___ for this. Generic is fine too. Use this until your dizziness goes away, or until your doctor tells you to stop. For your kidney disease: -Continue taking your other home medications, but with these changes: -Take sodium bicarbonate 650mg by mouth three times each day -Take calcium carbonate 500mg by mouth with meals For your diarrhea: -Continue to buy lactose-free dairy, like Lactaid milk. -Start taking Lactaid pills with meals when you drink non-Lactaid milk, or eat non-Lactaid icecream. One option is Lactaid Fast Act Lactase Enzyme Supplement, Chewable Tablet, from ___. Generic is fine. You also need a physical therapy home safety evaluation. They will come to your home and make sure that you can walk safely even with your dizzy spells.</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 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. Ibuprofen 800 mg PO Q8H:PRN Pain - Moderate please take with foood 4. OxyCODONE (Immediate Release) ___ mg PO Q3H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every 3 hours Disp #*40 Tablet Refills:*0 5. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: right distal clavicle fracture 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 after you were struck by a car while driving your car. You sustained a right clavicle fracture. You did not require any operative intervention. Since the accident, you have reported left wrist pain. Imaging was done and did not indicate a fracture. Your pain has been controlled with oral analgesia. You are preparing for discharge with the following instructions: Please call the Acute care clinic if the following occur: ___ *fever *chills *nausea, vomiting, abdominal pain *chest pain *increased pain right shoulder, decreased movement fingers right hand, numbness fingers right hand, inability to move fingers right hand *sling for comfort *ROM exercises as reviewed with occupational therapy *please take food with the ibuprofen *do not drive while on the narcotic medication</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Loperamide 2 mg PO QID RX *loperamide [Anti-Diarrhea] 2 mg 1 tab by mouth four times daily Disp #*60 Tablet Refills:*2 Discharge Disposition: Home Discharge Diagnosis: Small Bowel Obstruction Acute Renal insufficieny due tovolume depletion 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 West 3 surgery for treatment of small bowel obstruction. You were treated conservatively and made NPO, IVF, and an NG tube was inserted. Your small bowel obstruction improved and at time of discharge you were passing flatus, tolerating a regular diet, and ambulating. You are now ready to continue your recover at home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 3. LORazepam 1 mg PO Q12H:PRN anxiety or nausea 4. Methadone 153 mg PO DAILY Consider prescribing naloxone at discharge 5. Multivitamins W/minerals 1 TAB PO DAILY Discharge Disposition: Home Facility: ___ Discharge Diagnosis: Primary: acute severe hepatitis, likely viral fever abdominal pain generalized weakness severe malnutrition Secondary: major depressive disorder anxiety opioid use disorder 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 came to the hospital because you were not feeling well overall. While you were here, we found that your liver tests are not normal, probably because of a virus. You have 2 viruses that are active in your blood, called ___ (EBV) and Hepatitis C. You received IV medicine to help your liver heal. You worked with physical therapy and nutrition staff to get stronger. When you leave the hospital, please: - use a cane to walk - take your medicines as prescribed - see the infectious disease doctor and your primary care doctor as below - make an appointment to see your psychiatrist - keep taking supplements and make sure you eat enough to help regain your strength It was a pleasure caring for you and 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. Ascorbic Acid ___ mg PO DAILY 2. Ferrous GLUCONATE 324 mg PO DAILY 3. Fluticasone Propionate NASAL 2 SPRY NU DAILY 4. FoLIC Acid 5 mg PO DAILY 5. Nortriptyline 25 mg PO QHS 6. Omeprazole 40 mg PO BID 7. OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN pain RX *oxycodone 5 mg 2 tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 8. Ranitidine 300 mg PO QHS 9. Sodium Chloride Nasal ___ SPRY NU QID:PRN dryness 10. Vitamin D 1000 UNIT PO DAILY 11. Polyethylene Glycol 17 g PO DAILY:PRN constipation 12. Albuterol Inhaler 2 PUFF IH Q6H:PRN cough 13. Symbicort (budesonide-formoterol) 80-4.5 mcg/actuation INHALATION QD 14. Magnesium Citrate 300 mL PO ONCE MR1 constipation Duration: 1 Dose 15. Bisacodyl 10 mg PR QHS:PRN constipation 16. Metamucil (psyllium;<br>psyllium husk;<br>psyllium husk (with sugar);<br>psyllium seed (sugar)) 3.4 gram/12 gram oral daily 17. Outpatient Lab Work CBC with diff, retic, T bili, LDH, haptoglobin send report to Dr. ___: ___ OF HEMATOLOGY/ONCOLOGY Address: ___, ___ Phone: ___ Fax: ___ Discharge Disposition: Home Discharge Diagnosis: sickle cell disease pain crisis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>you were treated for sickle cell pain crisis take pain meds as directed speak with your hematologist to schedule your next visit drink plenty of water seek medical care if you have shortness of breath, chest pain, focal neurological problems, worse pain, fatigue, fever do not stay immobile in bed, make sure to walk in regular intervals</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You were admitted to the hospital with chest pressure after having had a cardiac catheterization the previous day. The possible serious causes of your symptoms were ruled out. You also received hemodialysis. Please take your medications as presribed, and follow up at the medical appointments listed below. 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. Acetaminophen ___ mg PO TID:PRN Pain - Mild 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN Wheezing 3. amLODIPine 10 mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 20 mg PO QPM 6. EpiPen (EPINEPHrine) 0.3 mg/0.3 mL injection AS NEEDED 7. Fluticasone Propionate NASAL 1 SPRY NU DAILY 8. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 9. HydrALAZINE 10 mg PO BID 10. Losartan Potassium 100 mg PO DAILY 11. Polyethylene Glycol 17 g PO EVERY OTHER DAY 12. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation QID 13. TraMADol 50 mg PO Q6H:PRN Pain - Moderate Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Urinary tract infection Secondary: CVA 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. ___, You were admitted to the hospital after a fall and found to be somewhat confused, possibly due to a urinary tract infection. We treated you for the infection and you improved. Fortunately you had no injuries from the fall. It was a pleasure taking care of you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Metoprolol Succinate XL 50 mg PO DAILY 2. Multivitamins W/minerals 1 TAB PO DAILY 3. OxyCODONE (Immediate Release) 2.5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg 0.5 (One half) tablet(s) by mouth every 4 hours Disp #*30 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY 5. Diltiazem Extended-Release 180 mg PO BID 6. Omeprazole 20 mg PO DAILY 7. Torsemide 10 mg PO EVERY OTHER DAY 8. Acetaminophen 650 mg PO Q6H:PRN Pain - Moderate 9. Apixaban 2.5 mg PO BID 10. diclofenac sodium 1 appl topical Q12H:PRN pain 11. Docusate Sodium 100 mg PO DAILY:PRN constipation 12. Hydrocortisone (Rectal) 2.5% Cream ___ID 13. Levothyroxine Sodium 100 mcg PO DAILY 14. melatonin 2 mg oral QHS 15. Psyllium Powder 1 PKT PO DAILY:PRN constipation 16. rOPINIRole 0.5 mg PO QAM 17. rOPINIRole 0.5 mg PO QPM:PRN Pain 18. Senna 8.6 mg PO DAILY:PRN Constipation - First Line 19. Sertraline 100 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary ======= Displaced Left Femoral Neck Fracture Acute on Chronic Diastolic Heart Failure Secondary ========= Atrial Fibrillation Urinary Tract Infection Depression Hypothyroidism Restless Leg Syndrome Gastroesophageal Reflux 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>====================== DISCHARGE INSTRUCTIONS ====================== Dear Ms. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You fell and broke you hip. You had surgery to fix it with the orthopedic team - Your heart rate was found to be fast and you had fluid overload - You were found to have a urinary tract infection WHAT HAPPENED TO ME IN THE HOSPITAL? - You had a partial hip replacement by orthopedic surgery. - Your home diltiazem dose was increased and a new medication called metoprolol was added to control your heart rate and you were treated with IV direutics to remove excess fluid from your body. - Your pain was controlled with oxycodone and Tylenol and worked with ___, who recommended that you go to rehab on discharge to continue to regain your strength. As you surgery heals and your pain decreases you should be able to wean off of the oxycodone. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Weigh yourself every morning, and call your doctor if your weight goes up more than 3 lbs in a day or 5 pounds in a week. - Continue to take all your medicines and keep your appointments. We wish you the best! Sincerely, Your ___ Team</s>