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<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 the ___ ___! Why was I admitted to the hospital? -You were admitted because you had high blood pressure and chest pain. What happened while I was in the hospital? - Because you had chest pain, we did blood tests and an EKG to look at your heart. Both of these tests looked normal which is reassuring. You should follow up with your outpatient cardiologist, Dr. ___ 3 weeks after leaving the hospital. *** Please call ___ to schedule an appointment. *** - You were also found to have high blood pressure, so we started you on your home blood pressure medication (carvedilol). We also started another medication called Losartan. Your blood pressure is now back to normal. - You were also found to have low sodium in your blood. We gave you fluid through your veins to correct this, and your sodium level returned to normal. We also stopped your home medication (Hyzaar) because this can cause low sodium in your blood. Please stop taking this medication at home. What should I do after leaving the hospital? - Please take your medications as listed in discharge summary and follow up at the listed appointments. Thank you for allowing us to be involved in your care, we wish you all the best! Sincerely, Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CloniDINE 0.1 mg PO DAILY 2. Acetaminophen 650 mg PO Q6H 3. Calcium Carbonate 500 mg PO TID 4. Docusate Sodium 100 mg PO BID 5. Enoxaparin Sodium 40 mg SC DAILY Duration: 10 Days Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 40 mg sub-q Daily for 10 days following d/c to rehab Disp #*10 Syringe Refills:*0 6. Milk of Magnesia 30 ml PO BID:PRN Constipation 7. Multivitamins 1 CAP PO DAILY 8. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth Every 4 hours as needed for pain control Disp #*70 Tablet Refills:*0 9. Senna 2 TAB PO HS 10. Vitamin D 400 UNIT PO DAILY 11. desvenlafaxine succinate 100 mg Oral QD Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left tib/fib fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. -Splint must be left on until follow up appointment unless otherwise instructed ACTIVITY AND WEIGHT BEARING: - Weight bearing as tolerated left lower extremity Physical Therapy: Weight bearing as tolerated in left lower extremity Treatments Frequency: Dressing changes as needed for comfort only. Dressings are not needed as long as wound continues to be non draining. Staples will be removed at follow up appointment.</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/fever 2. Docusate Sodium 100 mg PO BID 3. Famotidine 20 mg PO BID 4. Phenytoin Sodium Extended 100 mg PO TID 5. Senna 1 TAB PO HS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Subdural hemorrhage Cerebral edema Altered mental status Dysphagia Aphasia Metabolic Acidosis 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>Craniotomy for Hemorrhage •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. •You may shower. •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. •If you were on a medication such as Coumadin (Warfarin), or Plavix (clopidogrel), or Aspirin, prior to your injury, you may safely resume taking this only after clearance from your neurosurgeon. • 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 ___. •Clearance to drive and return to work will be addressed at your post-operative office visit. •Make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. 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: [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you at the ___ ___. Please find detailed discharge instructions below: WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted because you appeared to have elevated potassium levels in your blood, and you had some premature heart beats, noted at your outpatient urology appointment. WHAT HAPPENED TO YOU IN THE HOSPITAL? - Your blood potassium levels were rechecked and found to be within the normal range. The first potassium level at your outpatient appointment was falsely elevated because the blood had deteriorated in the collection tube. - You had occasional premature heart beats, as seen on the heart monitor, but you did not have any symptoms from it. Occasional premature heart beats are very common and not dangerous. - Your urine was examined in the lab and sent for a culture. Your urine looks like it may have an infection, but it is difficult to tell because of your complicated kidney history with the PCN tube (percutaneous nephrostomy tube) and ureter stent. You also did not seem to have obvious symptoms of a urine infection. However, because of your complicated medical history, we felt it was best to be safe and treat you with antibiotics for a possible urinary tract infection. - You received IV antibiotics while you were in the hospital for a urinary tract infection. - You were transitioned to oral antibiotics to take as an outpatient. - CT scan of your chest and abdomen showed that you had a prostate mass, with lesions in the bone that were concerning for metastatic cancer. WHAT SHOULD YOU DO WHEN YOU LEAVE THE HOSPITAL? - Please follow up with your urologist and oncologist outpatient to discuss further cancer testing and options. - Please follow up with your PCP. - Please take all your medications as prescribed. - In particular, please complete a total 7-day course of antibiotics. You last day of antibiotics will be on ___. 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. Omeprazole 20 mg PO BID 2. Simvastatin 20 mg PO DAILY 3. Clobetasol Propionate 0.05% Ointment 1 Appl TP DAILY apply to affected area once daily Discharge Disposition: Home Discharge Diagnosis: Colitis 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 transferred to ___ for evaluation of your abdominal pain. A CT scan of your abdomen done at ___ ___ showed inflammation of your colon. The doctors at ___ were concerned that you may have had ischemic colitis, which is a condition in which the colon does not get enough blood supply and is damaged. This can occur because of very low blood pressure or because of a clot in the vessels that supply the colon. The doctors at ___ were concerned that you may have needed surgery, so you were sent to ___. The surgeons here did not believe that you needed surgery because you were feeling better. We got another CT scan of your abdomen, which showed that your colon had not suffered more damage; it was unchanged from your CT scan in ___. It also did not show any clots or blockages in the blood vessels that supply your colon. It is also possible that the inflammation in your colon is due to infection (infectious colitis), so we gave you antibiotics while you were in the hospital. We also tested your stool for bacteria. The results of your stool tests have not yet returned. We will contact you with these results when they are available. You no longer need to take antibiotics. When the inflammation in your colon has resolved, we recommend that you get a colonoscopy. Please discuss the timing of this procedure with your primary care doctor and with the surgeon at your follow-up appointment. While you were in the hospital, your blood pressure was lower than it normally is, so we stopped your blood pressure medication (lisinopril). You should not restart this medication until talking with your primary care doctor. You should also drink lots of fluids to help keep your blood pressure up. We made the following changes to your medications: 1. lisinopril - we stopped this medication. We have scheduled follow-up appointments for you with your primary care physician and with acute care surgery. If you cannot keep your appointments, please call to reschedule. It was a pleasure taking part in your care. We wish you a quick recovery and good health.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H 2. Cyclobenzaprine 5 mg PO TID:PRN back pain/muscle spasm RX *cyclobenzaprine 5 mg 1 tablet(s) by mouth three times a day Disp #*30 Tablet Refills:*0 3. Ibuprofen 600 mg PO Q8H:PRN back pain Duration: 10 Days RX *ibuprofen 600 mg 1 tablet(s) by mouth every eight (8) hours Disp #*30 Tablet Refills:*0 4. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth once a day Disp #*10 Capsule Refills:*0 5. Gabapentin 300 mg PO TID RX *gabapentin 300 mg 1 capsule(s) by mouth three times a day Disp #*30 Capsule Refills:*0 6. TraMADOL (Ultram) 50 mg PO Q6H:PRN severe pain Duration: 3 Days RX *tramadol 50 mg 1 tablet(s) by mouth every six (6) hours Disp #*12 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Radiculopathy/Muscle Spasm Nausea Headache Secondary: C6/7 disc herniation and syrinx s/p C6/7 anterior cerivcal discectomy/fusion on ___. Secondary: 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 being involved in your care. You were admitted to the hospital for worsening neck pain and nausea. Your neck was evaluated by the neurosurgery service who felt that there were no complications from your surgery. You developed lower back pain likely from a muscle spasm while here. We started you on medications to help with the pain and recommended continued physical therapy. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear ___- ___ were admitted to the Acute Care Surgery Unit at ___ and ___ were treated for an acute episode of diverticulitis. Please continue your antibiotics for a total of two weeks. Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: ___ experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If ___ are vomiting and cannot keep down 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. ___ experience burning when ___ 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. ___ 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 ___. 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 driving or operating heavy machinery while taking pain medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PO DAILY:PRN constipation 2. Morphine Sulfate ___ 15 mg PO Q6H:PRN pain 3. Polyethylene Glycol 17 g PO DAILY:PRN constipation 4. Ranitidine 150 mg PO DAILY 5. Senna 1 TAB PO BID:PRN constipation 6. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation 2 puffs bid 7. Tiotropium Bromide 1 CAP IH DAILY 8. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*3 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: ___ Secondary: pulmonary embolism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ with worsened shorntess of breath and coughing up blood. While you were here you were evaluated by Radiation Oncology and it was not thought that you tumor could be treated by radiation. Due to the risk of bleeding with blood thinners and your goals of focusing more on quality of life and symptom management, you were not started on a blood thinner. You did have an IVC filter placed. While you were in the hospital we treated your symptoms with medications and after a conversation with your family and palliative care, we decided that we could provide you with the best care by adding hospice services to your team.</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 [Dilaudid] 2 mg ___ tablet(s) by mouth q4hours Disp #*60 Tablet Refills:*0 2. OxyCODONE SR (OxyconTIN) 80 mg PO Q8H RX *oxycodone [OxyContin] 80 mg 1 tablet extended release 12 hr(s) by mouth q8hours Disp #*60 Tablet Refills:*0 3. Acetaminophen 650 mg PO Q6H:PRN headache 4. Docusate Sodium 100 mg PO BID 5. Gabapentin 900 mg PO TID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Postoperative fever Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>• Activity: You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit or stand more than ~45 minutes without getting up and walking around. • Rehabilitation/ Physical Therapy: ___ ___ times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. ___ Limit any kind of lifting. • Diet: Eat a normal healthy diet. You may have some constipation after surgery. You have been given medication to help with this issue. • You should resume taking your normal home medications. • You have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. You can either have them mailed to your home or pick them up at the clinic located on ___ 2. We are not allowed to call in or fax narcotic prescriptions (oxycontin, oxycodone, percocet) to your pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. • Follow up: ___ Please Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. Please call the office if you have a fever>101.5 degrees Fahrenheit and/or drainage from your wound. Physical Therapy: Gait training, lower extremity strengthening, balance Treatments Frequency: Wound assessments</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Losartan Potassium 50 mg PO DAILY 3. Acetaminophen 650 mg PR Q6H:PRN pain, fever 4. Atorvastatin 80 mg PO DAILY 5. Bisacodyl 10 mg PR HS:PRN constipation 6. Clopidogrel 75 mg PO DAILY 7. Docusate Sodium 100 mg PO BID 8. Fluconazole 200 mg PO Q24H 9. Metoprolol Tartrate 50 mg PO BID Hold for HR < 60 or SBP < 110 10. Piperacillin-Tazobactam 4.5 g IV Q8H 11. Senna 8.6 mg PO BID 12. Vancomycin 1000 mg IV Q 12H 13. Amlodipine 10 mg PO DAILY 14. Omeprazole 40 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right MCA infarct resulting from Right Carotid Stenosis 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>Dear ___, ___ were hospitalized due to symptoms of headache, lightheadedness, intermittent dysarthria, left lower face weakness, and difficulty using the left side 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 Blood Pressure - High Cholesterol We are changing your medications as follows: - We are STARTING ___ on ATORVASTATIN 80mg daily - We are STARTING ___ on TYLENOL ___ every 6 hours as need for pain or fever - We are INCREASING your ASPIRIN to 325mg daily - We are STARTING ___ on AMLODIPINE 10mg dailhy - We are STARTING ___ on BISACODYL 10mg as needed for constipation - We are STARTING ___ on CLOPIDOGREL 75mg daily - We are STARTING ___ on DOCUSATE 100mg two times daily - We are STARTING ___ on FLUCONAZOLE 200mg daily - We are STARTING ___ on METOPROLOL 50mg BID - We are STARTING ___ on PIPERACILLIN-TAZOBACTAM 4.5g IV every eight hours - We are STARTING ___ on SENNA 8.6mg two times daily - We are STARTING ___ on VANCOMYCIN 1000mg IV two times daily - We are INCREASING your OMEPRAZOLE to 40mg once a day. - We are STOPPING ATENOLOL 50mg daily - We are STOPPING ALPRAZOLAM 0.25mg BID as needed Please take your other medications as prescribed. Please followup with Neurology and your primary care physician as listed below. It was a pleasure providing ___ with care during this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lorazepam 0.5-1 mg PO Q6H:PRN agitation RX *lorazepam 0.5 mg ___ tablet(s) by mouth every six (6) hours Disp #*56 Tablet Refills:*0 2. B-12 DOTS *NF* (cyanocobalamin (vitamin B-12)) 200 MCG Oral 1 daily anemia 3. Warfarin 1 mg PO DAILY16 4. Ranitidine (Liquid) 150 mg PO BID acid reducer 5. Pravastatin 20 mg PO DAILY 6. Polyethylene Glycol 17 g PO DAILY constipation 7. Multivitamins 1 TAB PO DAILY 8. Mirtazapine 7.5 mg PO HS 9. HYDROmorphone (Dilaudid) 4 mg PO Q3H:PRN pain 10. Gabapentin 300 mg PO TID pain 11. Docusate Sodium (Liquid) 100 mg PO BID 12. Clopidogrel 75 mg PO DAILY 13. Acetaminophen (Liquid) 650 mg PO Q8H:PRN pain 14. Ampicillin 500 mg PO Q6H RX *ampicillin 500 mg 1 capsule(s) by mouth every six (6) hours Disp #*36 Capsule Refills:*0 15. Normal saline Please administer 1L NS via IV three times a week (MWF) 16. Saline Flush 10cc saline flushes after each access from midline. Discharge Disposition: Home With Service Facility: ___ ___: Seizure of unknown origin Urinary tract infection, complicated Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear ___ was our pleasure caring for you at the ___. You were admitted to the hospital for concerns of a possible seizure you endured the night before admission which caused you to have confusion and agitation thereafter. We did a CT and MRI scan of your head and worked with the neurology team to investigate the cause of your confusion. The images of your brain showed old lesions which indicate past strokes. We could not find any brain infection which could have also been the cause of your seizure. We are treating you with an antibiotic for a urinary tract infection which you are to complete at home (total of 10 day course). You expressed your wish to return home and have comfort-focused care. You will have visiting nurses and physical therapy to care for you at home. The palliative care team will also continue to see you and further discuss your goals of care. Since you are possibly at risk for future seizures, we also recommend you follow-up with a neurologist (their office will call you).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. ClonazePAM 1 mg PO BID 3. ClonazePAM 0.5 mg PO QAFTERNOON 4. Cyanocobalamin 1000 mcg PO DAILY 5. Desmopressin Acetate 0.2 mg PO QHS 6. DiCYCLOmine 10 mg PO TID 7. Diphenoxylate-Atropine 2 TAB PO BID 8. Fluocinolone Acetonide 0.025% Ointment 1 Appl TP DAILY 9. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 10. Hyoscyamine SO4 (Time Release) 0.375 mg PO BID 11. Levalbuterol Neb 0.63 mg NEB TID 12. Pantoprazole 40 mg PO Q12H 13. Ranitidine 150 mg PO QHS 14. Valsartan 160 mg PO DAILY 15. Vitamin D ___ UNIT PO DAILY 16. dornase alfa 2.5 mg inhalation BID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS ================= Weakness Cystic Fibrosis Depression Acute Kidney Injury SECONDARY DIAGNOSIS =================== Gastroesophageal Reflux Disease Temporal lobe epilepsy Primary nocturnal enuresis 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 ___ because of some falls you have been having at home. Your medical work up for the cause of your falls was negative. You were also seen by physical therapy and psychiatry. Please make sure you follow up with your primary care physician, ___, Dr. ___ your neurologist at your earliest convenience. It was a pleasure taking part in your care Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 2. Ipratropium-Albuterol Neb 1 NEB NEB Q4H 3. Thiamine 500 mg IV Q24H Duration: 5 Days 4. Amitriptyline 50 mg PO QHS 5. ClonazePAM 1 mg PO TID 6. Glargine 35 Units Bedtime 7. QUEtiapine Fumarate 75 mg PO TID 8. Aspirin 81 mg PO DAILY 9. HYDROmorphone (Dilaudid) 2 mg PO Q4-6HR pain 10. Nicotine Patch 21 mg TD DAILY 11. Omeprazole 40 mg PO DAILY 12. Rosuvastatin Calcium 40 mg PO QPM Discharge Disposition: Extended Care Discharge Diagnosis: COPD Exacerbation Toxic metabolic encephalopathy 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>Mrs. ___, ___ were hospitalized with shortness of breath. ___ have a severe COPD exacerbation that is likely related to the amount of sedating medications ___ take at home. Per ___ family request, ___ are being transferred to ___ for further care. It was a pleasure taking care of ___! Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Pyridoxine 50 mg PO DAILY 3. Omeprazole 40 mg PO BID 4. Cyanocobalamin 500 mcg PO DAILY 5. Mycophenolate Mofetil 1000 mg PO BID 6. Nitroglycerin SL 0.3 mg SL QID:PRN chest pain 7. PredniSONE 10 mg PO QAM 8. Sulfameth/Trimethoprim DS 1 TAB 3x/week. 9. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Chest 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. ___ ___ were admitted to ___ because ___ had severe and sudden chest pain. As such, we were concerned about your heart. We did an EKG to look at your heart and it was found to be unchanged. We checked enzymes, which inform us if ___ have heart damage, and they were found to be normal. Given that ___ were complaining of chest pain, ___ underwent a stress test, which did not reveal abnormalities in your heart. ___ were started on atorvastatin to help control your cholesterol. ___ were seen by your pulmonologist, who recommended changes to your medication regimen. He discussed decreasing your ___ to 3 times a week, changing Omeprazole 40 mg twice a day, and recommended Vitamin B6 for your muscle cramps. He recommended continuing your current CellCept dosing. Your pulmonary appointment was also moved to ___. ___ were scheduled for a cardiology appointment on ___. ___ are also scheduled to see your primary care physician on ___ ___. It was a pleasure to take care of ___. We wish ___ the best with your health! Your ___ Cardiac Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Benztropine Mesylate 0.5 mg PO DAILY 2. Calcium Carbonate 600 mg PO DAILY 3. ChlorproMAZINE 50 mg PO QHS 4. ChlorproMAZINE 25 mg PO DAILY:PRN agitation 5. Divalproex (DELayed Release) 1250 mg PO QHS 6. Ferrous GLUCONATE 324 mg PO DAILY 7. Fish Oil (Omega 3) ___ mg PO DAILY 8. Levothyroxine Sodium 75 mcg PO DAILY 9. Paroxetine 20 mg PO DAILY 10. RISperidone 6 mg PO HS 11. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet,delayed release (___) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis 1. left eye monocular vision changes 2. hypoplastic left sigmoid and transverse venous sinuses, possible partially occlusive thrombus Secondary diagnosis 1. Schizoaffective disorder/Bipolar disorder 2. Right retinal microaneursym Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neurologic: no deficits Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You were admitted for some transient vision changes in your left eye. You had an MRI of your brain which showed no evidence of a stroke. An MR venogram showed that the veins draining the left side of your brain are smaller than the right. This is likely something you were born with and is unlikely to be related to your visual complaints. You should have a repeat MRV in ___ months to re-evaluate this. You also had an echocardiogram to rule out the possibility of a blood clot in your heart, and this showed no blood clot on prelim report. You were evaluated by opthalmology who did not find any abnormality inside your eye to explain your symptoms. You will need to follow up in their clinic for a repeat evaluation as well as formal visual field testing. You will also need to follow up with your primary care doctor as well as Dr. ___ in neurology clinic (see details below). We started you on a baby aspirin to reduce your risk of future strokes. We did not make any changes in the rest of your medications. It is important that you take all medications as prescribed, and keep all follow up appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Lisinopril, Celexa, Keppra 500mg BID Discharge Disposition: Home Discharge Diagnosis: Right parietal 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 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). This medication helps to prevent seizures. Please continue this medication until your follow up appointment with Dr. ___. It is important that you take this medication consistently and on time. •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. •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 symptom 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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day for 7 days. Disp:*7 Tablet(s)* Refills:*0* 2. metronidazole 500 mg Tablet Sig: One (1) Tablet PO every eight (8) hours for 7 days: do not consume alcohol while on this medication. Disp:*21 Tablet(s)* Refills:*0* 3. Percocet ___ mg Tablet Sig: ___ Tablets PO every six (6) hours as needed for pain. Disp:*10 Tablet(s)* Refills:*0* 4. ZOFRAN ODT 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO every eight (8) hours as needed for nausea. Disp:*20 Tablet, Rapid Dissolve(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: bilateral pyosalpinx Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You left the hospital against medical advice. We strongly recommend that you continue to stay here and receive IV antibiotics for at least the next day but you decided to leave. YOU MUST RETURN TO THE EMERGENCY ROOM IF YOU HAVE A FEVER OR ABDOMINAL PAIN THAT IS WORSE. These things could be a sign of an under-treated infection. You could die if you have an infection that is not properly treated. General instructions: * Take your medications as prescribed. Continue to take both oral antibiotics and complete a ___o not consume alcohol while on these antibiotics, as this will cause severe nausea/discomfort. * Do not drive while taking narcotics. * Do not combine narcotic and sedative medications or alcohol * Do not take more than 4000mg acetaminophen (APAP) in 24 hrs * You may eat a regular diet 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. Metoprolol Tartrate 100 mg PO BID 2. Simvastatin 40 mg PO DAILY 3. Rivaroxaban 15 mg PO BID RX *rivaroxaban [Xarelto] 15 mg 1 tablet(s) by mouth twice a day Disp #*42 Tablet Refills:*0 4. TraZODone 100 mg PO HS:PRN insomnia RX *trazodone 50 mg 1 tablet(s) by mouth at night Disp #*30 Tablet Refills:*0 5. Hydrochlorothiazide 12.5 mg PO DAILY 6. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Unprovoked, pulmonary embolism. Duodenitis, hematuria SECONDARY DIAGNOSIS: Sickle Cell. Hypertension, Diabetes, Systolic Heart Failure, Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your hospitalization. You were admitted when you developed an acute onset of shortness of breath. We were worried that this could have been due to your heart not functioning as well or from a problem with your lungs. We obtained a scan of your lungs that showed that you had blood clots in your lungs. We kept you on a blood thinner and started you on a medication called Rivaroxaban that you should continue taking for at least six months. You also reported poor appetite so we performed a endoscopy and colonoscopy to make sure that there were no anatomical problems with your gastrointestinal system. This showed mild irritation for which you should take a medication called pantoprazole twice a day. We also gave a you a medication for your sleep. We have followup with Dr. ___ you next ___. 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. Amiodarone 400 mg PO BID RX *amiodarone 400 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Apixaban 5 mg PO BID 3. Furosemide 20 mg PO DAILY 4. Lisinopril 20 mg PO DAILY 5. Sildenafil 100 mg PO ONCE:PRN Erectile Dysfunction 6. TraZODone 50 mg PO QHS:PRN Insomnia Discharge Disposition: Home Discharge Diagnosis: PRIMARY: ======== Atrial fibrillation Hypertension CHF exacerbation Subacute/Chronic CVAs SECONDARY: ========== Hyperlipidemia Transaminitis 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 at ___. WHY WERE YOU IN THE HOSPITAL? - You were recently in the hospital because of heart failure and atrial fibrillation. You came back to the hospital because of fatigue and garbled speech. - Because of these symptoms, you were concerned that you were back in atrial fibrillation. WHAT HAPPENED IN THE HOSPITAL? - Because of the garbled speech, you had imaging of the brain. This showed old strokes but nothing new. - Your amiodarone dose was increased. - You went for another cardioversion procedure. This was successful and you went back in to a normal rhythm. WHAT SHOULD YOU DO AFTER LEAVING THE HOSPITAL? - You should take all of your medications as prescribed, including the increased dose of amiodarone. You should take the 400 mg twice a day for 1 week, then 400 mg per day thereafter. - You should take it easy at work. - You should follow up with your cardiologist on ___. - You should follow up with your primary care doctor on ___, ___. 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. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth at bedtime Disp #*7 Tablet Refills:*0 2. Fluconazole 100 mg PO Q24H Duration: 14 Days RX *fluconazole 40 mg/mL 2.5 mL(s) by mouth daily Refills:*0 3. ClonazePAM 0.25 mg PO BID RX *clonazepam 0.25 mg 1 tablet(s) by mouth twice daily at 8AM and noon Disp #*14 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line RX *polyethylene glycol 3350 17 gram 1 packet by mouth daily Disp #*14 Packet Refills:*0 5. QUEtiapine Fumarate 50 mg PO QHS RX *quetiapine 50 mg 1 tablet(s) by mouth at bedtime Disp #*7 Tablet Refills:*0 6. QUEtiapine Fumarate 25 mg PO BID:PRN agitation RX *quetiapine 25 mg 1 tablet(s) by mouth twice daily Disp #*14 Tablet Refills:*0 7. ClonazePAM 0.5 mg PO QHS RX *clonazepam 0.5 mg 1 tablet(s) by mouth at bedtime Disp #*7 Tablet Refills:*0 8. Dipyridamole-Aspirin 1 CAP PO BID RX *aspirin-dipyridamole 25 mg-200 mg 1 capsule(s) by mouth twice daily Disp #*14 Capsule Refills:*0 9. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY RX *lansoprazole 30 mg 1 tablet(s) by mouth daily Disp #*7 Tablet Refills:*0 10. Levothyroxine Sodium 50 mcg PO DAILY RX *levothyroxine 50 mcg 1 tablet(s) by mouth daily Disp #*7 Tablet Refills:*0 11. Lithium Carbonate 150 mg PO QHS RX *lithium carbonate 150 mg 1 capsule(s) by mouth at bedtime Disp #*7 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: ================== Subacute encephalopathy in the setting of dementia Cerebral vascular accident Failure to thrive Severe malnutrition SECONDARY: ================== Tardive dyskinesia Schizophrenia vs bipolar disorder Hypernatremia Recurrent urinary tract infection, ___ Oropharyngeal dysphagia GERD Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to ___ because you were confused. While you were here, you had a cat scan of your head which showed that you had a stroke. We gave you medicines to help make you feel better. Your family and your doctors decided that ___ be happiest at home with home ___. These doctors and ___ help manage any symptoms that you have. It was a pleasure taking part in your care. We wish you all the best. Sincerely, The 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. You were admitted to the ___ because you had severe diarrhea with dehydration and weight loss from a bacteria in your large intestine known as Clostridium difficile. In the hospital, we continued your antibiotics and gave you intravenous fluids to rehydrate you. Your diarrhea has decreased in frequency, but you will need to continue your antibiotic for another 10 days after you leave the hospital (total of 14 days - last day ___. You should follow-up with your primary care physician ___ ___ days of discharge and your GI specialist after you finish your antibiotic course. In some cases, the infection may recur. If your diarrhea increases in frequency or recurs after it has completely resolved, please see your GI specialist. We wish you a speedy recovery, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl ___AILY:PRN constipation 2. Clopidogrel 75 mg PO DAILY 3. Docusate Sodium 100 mg PO BID:PRN constipation 4. Furosemide 40 mg PO DAILY Duration: 10 Days 5. Metoprolol Tartrate 25 mg PO BID 6. Pantoprazole 40 mg PO Q24H Duration: 30 Days 7. Polyethylene Glycol 17 g PO DAILY:PRN constipation 8. Potassium Chloride 20 mEq PO DAILY Duration: 10 Days 9. Tamsulosin 0.4 mg PO QHS 10. TraMADol 50 mg PO Q6H:PRN Pain - Moderate 11. Aspirin EC 81 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Myocardial infarction, coronary artery disease s/p Coronary artery bypass graft x 1, drug-eluting stent placement x 2 Past medical history: Hypertension LBBB Osteoporosis Hyperlipidemia Basal cell carcinoma of skin b/l total knee replacement Cataract extraction Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Incisions: Sternal - healing well, no erythema or drainage 1+ Edema Followup Instructions: ___ [/INST] </s><s>Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments 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, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns ___ Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Glargine 18 Units Dinner Insulin SC Sliding Scale using HUM Insulin 3. Metoprolol Succinate XL 100 mg PO DAILY 4. Apixaban 5 mg PO BID 5. Atorvastatin 80 mg PO QPM Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Primary diagnosis - C3 fractures Secondary diagnoses - Atrial fibrillation - Type II diabetes Discharge Condition: Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital after falling at home. You likely fell because your blood sugar was so low. When you fell you broke a bone in your neck. This should heal without surgery, but you will need to wear a collar for quite a while. You will see the spine surgeons in clinic. We decreased your insulin dose to prevent your blood sugar from going so low. It was a privilege to care for you in the hospital, and we wish you all the best. Sincerely, Your ___ Health Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. insulin lispro 100 unit/mL Solution Sig: Sliding scale unit Subcutaneous ASDIR (AS DIRECTED). 3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 4. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain: take 1 for chest pain, wait 5 min, take another, if call ambulance. Disp:*30 Tablet, Sublingual(s)* Refills:*0* 5. warfarin 2 mg Tablet Sig: as directed Tablet PO once a day: please discuss with Dr. ___ prior to taking dose. 6. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for pain: do not drink alcohol while taking. 7. lamotrigine 200 mg Tablet Sig: Two (2) Tablet PO once a day. 8. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 9. ranolazine 1,000 mg Tablet Extended Release 12 hr Sig: One (1) Tablet Extended Release 12 hr PO twice a day. Disp:*60 Tablet Extended Release 12 hr(s)* Refills:*2* 10. aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 11. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr Sig: Three (3) Tablet Extended Release 24 hr PO DAILY (Daily). 12. simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for gas, bloating. Disp:*30 Tablet, Chewable(s)* Refills:*0* 13. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 14. metoprolol tartrate 100 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 15. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 16. Flomax 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO once a day. 17. Seroquel 25 mg Tablet Sig: One (1) Tablet PO at bedtime. Disp:*60 Tablet(s)* Refills:*0* 18. Seroquel 25 mg Tablet Sig: One (1) Tablet PO at bedtime as needed for agitation. 19. lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis- # CHF exacerbation # Right PDA stenting with bare metal stent # Acute delerium 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>It was a pleasure taking care of you during your recent admission. You were admitted because of worsening shortness of breath. You were given lasix to help get excess fluid off of your lungs, and you improved. You had no ongoing shortness of breath. You had a cardiac catheterization and a stent was placed. You had no ongoing chest pain for the remainder of admission. You were very delerious throughout the admission, requiring lots of medication to help you calm down. For help sleeping at night, please take seroquel, and do not take trazodone or alprazolam. If you are more confused or agitated after taking 1 dose of seroquel, you may take a second tab. You also had difficulty urinating on your own, and need to have a catheter placed in your bladder. You were started on a medication to help you urinate, but for now should keep the catheter in place until you see a urologist. The following changes were made to your medication regimen: - START plavix daily - INCREASE aspirin to 325mg daily - INCREASE metoprolol to 100mg twice a day - STOP spironolactone - STOP donepezil - STOP alprazolam as this will cause confusion - STOP trazodone as this will cause confusion - START seroquel at night to help with sleep and decrease confusion. For increasing agitation, may give an extra dose of seroquel. - START tamsulosin once daily at night for help with urinary retention Please continue the remainder of medications as prescribed prior to admission</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ascorbic Acid ___ mg PO DAILY 2. ClonazePAM 0.5 mg PO QAM 3. ClonazePAM 1 mg PO QHS 4. Docusate Sodium 100 mg PO BID 5. LaMOTrigine 50 mg PO DAILY 6. Levothyroxine Sodium 150 mcg PO DAILY 7. Multivitamins 1 TAB PO DAILY 8. Nystatin Oral Suspension 5 mL PO QID thrush 9. Omeprazole 20 mg PO DAILY 10. Pravastatin 10 mg PO DAILY 11. Cyclobenzaprine 5 mg PO BID:PRN spasm 12. Enoxaparin Sodium 40 mg SC DAILY Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 40 mg SC Daily Disp #*14 Syringe Refills:*0 13. Milk of Magnesia 30 mL PO Q6H:PRN constipation 14. Senna 8.6 mg PO BID 15. TraZODone 25 mg PO HS:PRN insomnia 16. Vitamin D 400 UNIT PO DAILY 17. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Tibial plateau fracture and compartment syndrome Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - 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. - Keep your donor graft site open to air. The area will form a scab and can be left dry. - Daily dressing changes with xeroform and gauze over skin graft site for 5 days. ACTIVITY AND WEIGHT BEARING: - touch down weight bearing left lower extremity in unlocked ___. ROM as tolerated. Physical Therapy: Touch down weight bearing in unlocked ___. Treatments Frequency: WOUND CARE: - 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. - Keep your donor graft site open to air. The area will form a scab and can be left dry. - Daily dressing changes with xeroform and gauze over skin graft site for 5 days.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY 2. isometh-dichloral-acetaminophn 65-100-325 mg oral PRN headache 3. Levothyroxine Sodium 25 mcg PO DAILY 4. Lorazepam 0.5 mg PO QHS 5. Lorazepam 0.25 mg PO QAM 6. Lovastatin 40 mg oral QHS 7. Mirtazapine 15 mg PO QHS 8. Omeprazole 20 mg PO DAILY 9. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*3 10. Aspirin 81 mg PO DAILY 11. Vitamin D 1000 UNIT PO DAILY 12. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *polyethylene glycol 3350 [ClearLax] 17 gram/dose 17 powder(s) by mouth once a day Disp #*510 Gram Gram Refills:*3 Discharge Disposition: Home Discharge Diagnosis: Primary: Gastrointestinal bleeding Colitis Hiatal Hernia Secondary: Anxiety Skin cancer s/p Mohs Cataracts Constipation GERD Migraine headaches GERD Hypercholesterolemia Hypertension Hypothyroidism Neck pain Osteopenia Recurrent urinary tract infections Pedal Edema Hemorrhoids 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 being involved in your care. You were admitted to the hospital because you had bright red blood in your stool. We were concerned that you were having bleeding from your gastrointestinal tract. You had a sigmoidoscopy that looked at the lower part of your gastrointestinal tract that showed showed inflammation or colitis. This was thought to most likely be due to constipation. We started you on a medication called colace and miralax that you should take daily to help with constipation. It is also important for you to drink fluids daily to help prevent constipation. You also had a scope of your upper gastrointestinal tract that showed your hiatal hernia. It was recommended that you continue to take prilosec. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY 2. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*5 3. Atorvastatin 80 mg PO DAILY RX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*5 4. Lisinopril 20 mg PO DAILY 5. Outpatient Occupational Therapy Dx: Stroke To Evaluate and Treat Discharge Disposition: Home Discharge Diagnosis: Left MCA Stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, You were hospitalized due to symptoms of right hand weakness 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: Hypertension High Cholesterol We are changing your medications as follows: Aspirin 81 daily Atorvastatin 80 daily Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - sudden partial or complete loss of vision - sudden loss of the ability to speak words from your mouth - sudden loss of the ability to understand others speaking to you - sudden weakness of one side of the body - sudden drooping of one side of the face - sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology 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. Docusate Sodium 100 mg PO BID 3. Ferrous Sulfate 325 mg PO BID 4. Lisinopril 20 mg PO HS 5. Meclizine 12.5 mg PO TID:PRN dizziness 6. Metoprolol Tartrate 12.5 mg PO BID 7. Mirtazapine 15 mg PO HS 8. Paroxetine 40 mg PO DAILY 9. Senna 1 TAB PO BID 10. Acetaminophen 1000 mg PO Q8H RX *acetaminophen 500 mg 2 tablet(s) by mouth every 8 hours (three times a day) Disp #*30 Tablet Refills:*0 11. Calcium Carbonate 500 mg PO BID RX *calcium carbonate [Calcium 500] 500 mg calcium (1,250 mg) 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 12. Naproxen 250 mg PO Q12H RX *naproxen 250 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 13. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours as needed Disp #*30 Tablet Refills:*0 14. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 [Gavilax] 17 gram/dose 1 dose by mouth daily Disp #*20 Packet Refills:*0 15. Vitamin D 1000 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 16. ALPRAZolam 0.5 mg PO BID:PRN anxiety 17. Cyanocobalamin 0 mcg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis 1. comminuted displaced left distal radius fx with ulnar styloid fx 2. altered mental status from narcosis Secondary Diagnosis 1. osteopenia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You were admitted with a left wrist fracture after a fall. You were seen by hand surgery, who partially externally fixed the fracture. You will need to follow up in hand clinic on ___ for likely surgery later in the week. It is important that you avoid driving or operating heavy machinery while taking oxycodone for pain. Please take all medications as prescribed, and keep all follow up appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ferrous Sulfate 325 mg PO BID RX *ferrous sulfate 325 mg (65 mg ___ 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 2. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule,delayed ___ by mouth daily Disp #*60 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: ___ deficiency 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. ___, It was a pleasure to take part in your care during your stay at the ___. As you know, you were admitted to the hospital to receive a blood transfusion and investigate the cause of your anemia (low blood counts). You received a Esophagogastroduodenoscopy or EGD in which a camera took pictures of your esophagus, stomach and the upper part of your small intestine. There was no site of bleeding identified during the EGD. You also received a CT scan to look for changes in your intestine that might be bleeding and could also result in a low blood count. The results of this test were pending at the time of discharge. We have made you an appointment with your primary doctor who you should ___ with so that he can help get you scheduled for an outpatient colonoscopy. You may also need a capsule study (which looks at your small intestine), but only if the other tests are negative. We wish you good health in the future.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: *** 1. Acetaminophen 1000 mg PO Q8H 2. BusPIRone 15 mg PO TID 3. Labetalol 200 mg PO Q8H 4. LACOSamide 200 mg PO BID 5. LamoTRIgine 150 mg PO BID 6. LevETIRAcetam Oral Solution 1000 mg PO BID Duration: 7 Days 7. LevETIRAcetam Oral Solution 500 mg PO BID 8. QUEtiapine Fumarate 12.5 mg PO DAILY 9. QUEtiapine Fumarate 25 mg PO QHS 10. Ramelteon 8 mg PO QHS 11. TraZODone 37.5 mg PO QHS Discharge Disposition: Extended Care Facility: ___ - Discharge Diagnosis: Traumatic brain injury Epidural hematom Subdural hematoma Traumatic subarachnoid hemorrhage Intraparenchymal hemorrhage Brain compression/Mass effect Nondisplaced fractures of left zygomatic, left sphenoid, left temporal bones Multiple rib fractures Seizures Pneumonia Dysphagia Hypertension Tachycardia Oral thrush 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>Surgery: • You underwent a surgery called a craniectomy. A portion of your skull was removed to allow your brain to swell. You then underwent a cranioplasty and the skull was replaced. • You had a thin catheter in your brain that helped the neurosurgeon monitor the pressure and oxygen level in your brain. This was removed on ___. • 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. • You make shower. • 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). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. • 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. • 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 traumatic brain injury. Headaches can be long-lasting. • 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. More Information about Brain Injuries: • You were given information about headaches after TBI and the impact that TBI can have on your family. • If you would like to read more about other topics such as: sleeping, driving, cognitive problems, emotional problems, fatigue, seizures, return to school, depression, balance, or/and sexuality after TBI, please ask our staff for this information or visit ___ 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: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *Augmentin 500 mg-125 mg twice a day Disp #*9 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *Colace 100 mg twice a day Disp #*30 Capsule Refills:*1 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg q4-6 hours Disp #*30 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *Miralax 17 gram daily Disp #*30 Packet Refills:*1 5. Senna 1 TAB PO BID RX *senna 8.6 mg twice a day Disp #*30 Tablet Refills:*1 6. ketorolac *NF* 10 mg Oral q6 Duration: 3 Days RX *ketorolac 10 mg q6 Disp #*12 Tablet Refills:*0 7. Albuterol Inhaler ___ PUFF IH Q4H:PRN wheezing Discharge Disposition: Home Discharge Diagnosis: Bile duct stricture in the setting of chronic pancreatitis 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 for evaluation and treatment of your biliary stricture. You underwent ERCP with stent placement, as well as cholecystectomy and a biliary bypass. You tolerated these well and are ready to continue your recovery at home. Please resume all regular home medications , unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. You will complete a course of oral antibiotics as prescribed. You should continue stool softeners and a bowel regimen. Please take toradol for pain control and try to slowly decrease the amount of oxycodone that you are needing for pain control. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gabapentin 100 mg PO HS 2. Gabapentin 300 mg PO DAILY 3. Glargine 15 Units Bedtime 4. Simvastatin 40 mg PO DAILY 5. Ticlopidine HCl 250 mg PO BID 6. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 Capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 7. Nitrofurantoin (Macrodantin) 50 mg PO Q6H RX *nitrofurantoin macrocrystal 50 mg 1 Capsule(s) by mouth every 6 hours Disp #*36 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Chronic atypical chest pain Urinary retension 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>Dear Ms. ___, Thank you for choosing us for your care. You were admitted for chest pain in conjunction with feelings of lightheadedness. There are many reasons for chest pain. You previously had a filter placed in one of your body's large veins to prevent pulmonary embolism. This time, we have done testing to rule out dangerous conditions such as heart attack and aortic dissection. When you arrived in the ER, one of your blood tests showed that your kidneys were not working optimally. We placed a catheter in your bladder to help measure your urine output. When placed, it drained a large amount of urine, suggesting that your bladder is not emptying properly. We ruled out a physical obstruction by kidney stone using ultrasound. Since we've been draining your urine with a foley, your kidney function has returned to normal. Please see your urologist to follow up this issue of urinary retention on an outpatient basis. When we looked at your urine, we found that it contained bacteria. This can happen if urine is retained for a long time. However, without a fever and without a rise in your immune response, this was more likely to be a benign bacterial colonization of your bladder than an invasive infection. We have started the following medication: Omeprazole 20mg by mouth daily - for treatment of your heartburn</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to ___ (___) due to your nausea, jaundice, and pruritus. Your labs showed that you had an acute hepatitis. We did an extensive laboratory workup to understand the cause of your hepatitis. Additionally, we performed a biopsy for which we will call your doctor with the results. While inpatient, we continued to monitor your progress and saw that you had a low neutrophil count (immune cells that help to fight infections). You had no signs of infection while in the hospital, but please follow-up with your primary care doctor about this issue. Please follow up with your outpatient providers and all your scheduled appointments. Thank you for allowing us to be involved in your care. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levofloxacin 500 mg PO Q48H 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 3. Aspirin 81 mg PO DAILY 4. Calcitriol 1 mcg PO 3X/WEEK (___) 5. Docusate Sodium 300 mg PO BID 6. HYDROmorphone (Dilaudid) 4 mg PO Q4H:PRN Pain - Severe 7. LamoTRIgine 200 mg PO BID 8. macitentan 10 mg oral DAILY 9. Meclizine 12.5 mg PO Q12H:PRN dizziness 10. Mupirocin Ointment 2% 1 Appl TP QID:PRN rash 11. Ondansetron 8 mg PO BID nausea 12. Ranitidine 300 mg PO QHS 13. RESTASIS 1 drop ophthalmic BID 14. Senna 17.2 mg PO BID:PRN constipation 15. sevelamer CARBONATE 2400 mg PO TID W/MEALS 16. sevelamer CARBONATE 1600 mg PO ONCE DAILY W/ SNACK 17. Sildenafil 20 mg PO TID 18. Sucralfate 1 gm PO QID 19. TraZODone 200 mg PO 3X/WEEK (___) 20. TraZODone 100 mg PO 4X/WEEK (___) 21. Warfarin 3 mg PO DAILY16 22.Outpatient Physical Therapy Discharge Disposition: Home Discharge Diagnosis: Diplopia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital for symptoms of dizziness, gait instability, and double vision that were concerning for stroke. Your brain CT was normal. Your symptoms improved to baseline after you received dialysis. The likely cause of your problems was electrolyte abnormalities or drug clearance problems due to your renal disease, not stroke. You were cleared by ___ to go home. We made a follow-up appointment with Dr. ___ ___ neurology) for you. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Continue taking your home medications. Best, Your ___ Neurology Team</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): hold for loose bowel movements. 2. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for pain: may cause increased drowsiness, avoid driving while on this medication. Disp:*20 Tablet(s)* Refills:*0* 3. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain. 4. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 6. metformin 500 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). Discharge Disposition: Home Discharge Diagnosis: Acute cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with abdominal pain related to acute cholecystitis. You subsequently underwent a laparascopic cholecystectomy and recovered in the hospital. You are now preparing for discharge to home with the following instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications , unless specifically advised not to take a particular medication. 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. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 2. MetroNIDAZOLE 500 mg PO Q8H 3. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 [ClearLax] 17 gram/dose 1 powder(s) by mouth daily Disp #*1 Package Refills:*0 4. Senna 8.6 mg PO BID:PRN Constipation - First Line 5. Daptomycin 300 mg IV Q24H RX *daptomycin 500 mg 0.6 bag IV daily Disp #*14 Vial Refills:*0 6. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four hours Disp #*30 Tablet Refills:*0 7. Ascorbic Acid ___ mg PO DAILY 8. Aspirin 81 mg PO DAILY 9. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral DAILY 10. Cholestyramine 4 gm PO BID 11. Ciprofloxacin HCl 500 mg PO Q12H 12. Cyanocobalamin 1000 mcg PO DAILY 13. Enoxaparin Sodium 80 mg SC DAILY 14. Levothyroxine Sodium 100 mcg PO 5X/WEEK (___) 15. Levothyroxine Sodium 200 mcg PO 2X/WEEK (___) 16. Magnesium Oxide 400 mg PO BID 17. Morphine SR (MS ___ 30 mg PO Q12H 18. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 19. Omeprazole 20 mg PO DAILY 20. Ondansetron ODT 8 mg PO Q8H:PRN nausea/vomiting 21. Potassium Chloride 20 mEq PO DAILY 22. Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting 23. Rosuvastatin Calcium 40 mg PO QPM 24. Tamsulosin 0.4 mg PO DAILY 25. Vitamin E 400 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Small bowel obstruction Secondary Metastatic colorectal cancer DVT rectal wall dehiscence Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___. WHY DID YOU COME TO THE HOSPITAL? -You were having nausea and vomiting. WHAT HAPPENED WHILE YOU WERE HERE? - You were diagnosed with a small bowel obstruction - You had a tube placed into your stomach and you did not eat for 24 hours to give your bowel rest. - Your nausea improved and you were able to tolerate eating, and your ostomy output improved. - It is possible that some of your symptoms may be due to opiates, which slow down the gut's movement. WHAT SHOULD YOU DO WHEN YOU LEAVE THE HOSPITAL? - Please continue to take all of your medications as directed, and follow up with all of your doctors. Again, it was a pleasure taking care of you! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Warfarin 5 mg PO DAILY16 RX *warfarin 5 mg 1 tablet(s) by mouth qday Disp #*30 Tablet Refills:*0 2. Enoxaparin Sodium 70 mg SC Q12H pulmonary embolus You will stop these injections once your INR reaches goal. RX *enoxaparin 80 mg/0.8 mL 70 mg IM every 12 hours Disp #*30 Syringe Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: - acute Pulmonary embolus SECONDARY DIAGNOSIS: - acute lower extremity Deep venous thrombosis 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 in the hospital. You were admitted with chest pain due to a pulmonary embolus which originated from a vein in your leg. You were started on a heparin drip with the plan to transition to warfarin as an outpatient. Because it will not be therapeutic for a few days, you will need to take lovenox for a short period of time as a bridge. During your admission, you did not have shortness of breath, fever or evidence of heart damage. This is your second pulmonary embolus occurring in the post-operative period, which may indicate that you need a longer course of warfarin. Please follow up with a hematologist to discuss further.</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 to participate in your care. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you were having fevers at home. Your family also noticed that you seemed more weak than usual, and you had a hard time getting up after you fell at home. WHAT HAPPENED WHILE I WAS HERE? - You were started on antibiotics to treat for a possible pneumonia. We did a CT scan of your chest which did not show any signs of pneumonia so the antibiotics were stopped. -You received IV fluids because we felt that you were dehydrated. WHAT SHOULD I DO WHEN I LEAVE THE HOSPITAL? - Please follow up with your PCP - ___ take all of your medications as prescribed We wish you 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. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush 3. Senna 1 TAB PO BID Please hold for loose stools. 4. Sodium Chloride 0.9% Flush 3 mL IV Q8H:PRN line flush 5. Oxycodone SR (OxyconTIN) 40 mg PO Q8H pain RX *oxycodone [OxyContin] 40 mg 1 tablet(s) by mouth every eight (8) hours Disp #*42 Tablet Refills:*0 6. Ondansetron 4 mg IV Q8H:PRN nausea 7. Nicotine Patch 21 mg TD DAILY 8. Nafcillin 2 g IV Q4H 9. Methocarbamol 750 mg PO QID RX *methocarbamol 750 mg 1 tablet(s) by mouth four times a day Disp #*56 Tablet Refills:*0 10. Ibuprofen 400 mg PO Q8H 11. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth Q3H Disp #*224 Tablet Refills:*0 12. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 13. Gabapentin 300 mg PO TID 14. Heparin 5000 UNIT SC TID 15. Docusate Sodium 100 mg PO BID 16. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN shortness of breath, wheezing, or coughing 17. Bisacodyl 10 mg PO/PR DAILY 18. Cepacol (Menthol) 1 LOZ PO PRN throat irritation Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: T7-8 paraspinous abscesses pleural effusions Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Patient must wear his TLSO brace when at or above 30 degrees in bed. Followup Instructions: ___ [/INST] </s><s>•If you have staples, keep your wound clean and dry until they are removed. • No tub baths or pool swimming for two weeks from your date of surgery. •Do not smoke. •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. Pain medication should be used as needed when you have pain. You do not need to take it if you do not have pain. •Do not take any anti-inflammatory medications such as Motrin, Advil, Aspirin, and Ibuprofen etc. for two weeks. •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. •Loss of control of bowel or bladder functioning •You have to wear you TLSO brace at all times when you are at 30 degrees or more in bed. 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 101.5° F. •Loss of control of bowel or bladder functioning</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Docusate Sodium 100 mg PO BID 3. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID 4. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 5. Metoprolol Succinate XL 25 mg PO DAILY 6. Mirtazapine 15 mg PO QHS 7. Torsemide 40 mg PO DAILY 8. Duloxetine 20 mg PO DAILY 9. Acetaminophen 650 mg PO Q6H:PRN pain Discharge Disposition: Extended Care Facility: ___ ___ Discharge Diagnosis: Primary: Acute respiratory failure Secondary: ___ exacerbation Opioid overdose COPD exacerbation UTI Type II NSTEMI 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 admitted to the hospital for severe difficulty with breathing. We feel this was due to taking too much tramadol, along with your COPD and congestive heart failure. We treated with a drug to reverse the tramadol, and antibiotics and ___ improved. The physical therapists saw ___ and recommended ___ go to an acute rehab facility to help with your care and improve your strength. Please continue to take your medications as directed. Also please weigh yourself every morning, and call MD if weight goes up more than 3 lbs. Finally, please stop taking your tramadol. We have replaced it with a medication called duloxetine which will not have the same side effects. It was a pleasure taking care of ___. Best of luck, Your ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Losartan Potassium 100 mg PO DAILY 2. Simvastatin 40 mg PO QPM 3. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 7 Days Day 1 = ___. Should be continued for 10 day course for complicated UTI. 4. Docusate Sodium 100 mg PO BID:PRN constipation 5. Polyethylene Glycol 17 g PO DAILY:PRN constipation 6. Senna 8.6 mg PO BID:PRN constipation 7. Glargine 50 Units Bedtime NPH 15 Units Breakfast Insulin SC Sliding Scale using HUM Insulin Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Enterococcus UTI, hyperglycemia due to poorly controlled T2DM, ___ and hypernatremia caused by hyperglycemia. Code status: Full Discharge follow-up with Dr. ___ (PCP) (___) Discharge Condition: Ambulating comfortably off O2 and taking a full diet without difficulty. Mentating at baseline. Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized at ___ after a fall at home. We think that fall was due to high blood sugars and a urine infection. Unfortunately, because you were on the ground for such a long time, you developed high sodium (blood salt levels) and a mild injury to your kidney from dehydration. Your blood sugars, urine infection, sodium level, and kidney injury are all getting better. If you fall again and cannot get up, please promptly call Emergency Medical Services for assistance. Please see appointments and medications below. Sincerely, Your ___ Internal Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for stomach upset. 2. cyanocobalamin (vitamin B-12) 500 mcg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 3. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day. 4. morphine 30 mg Tablet Extended Release Sig: Two (2) Tablet Extended Release PO Q12H (every 12 hours). Disp:*30 Tablet Extended Release(s)* Refills:*0* 5. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 6. amitriptyline 50 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). Disp:*60 Tablet(s)* Refills:*2* 7. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for SOB/wheezing. 8. trazodone 50 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). Disp:*60 Tablet(s)* Refills:*2* 9. lorazepam 1 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for anxiety. Disp:*30 Tablet(s)* Refills:*0* 10. fluticasone 50 mcg/actuation Spray, Suspension Sig: One (1) Spray Nasal DAILY (Daily). 11. carisoprodol 350 mg Tablet Sig: One (1) Tablet PO q8 (). 12. gabapentin 300 mg Capsule Sig: Instructions Capsule PO BID (2 times a day): Take 600 mg in AM and afternoon. Take 900 mg at bedtime. Disp:*200 Capsule(s)* Refills:*0* 13. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for sob/wheezing. 14. morphine 15 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*21 Tablet(s)* Refills:*0* 15. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) PO once a day. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1. Compression polyneuropathy, 2. Fibromyalgia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Neuro Exam: AOx3, full strength in upper extremities. Largely full strength in lower extremities with some giveway strength, likely related to pain at the left ankle. Followup Instructions: ___ [/INST] </s><s>Ms. ___ you were admitted for further evaluation of your pain and weakness. Your weakness improved dramatically with time, nutrtional supplementation and B12. Your pain medications were adjusted a bit as whenever these medications were increased to your home regiment you became unarousable and your oxygen level would drop down. This is an indication of over medication and is dangerous. Therefore we will provide you prescriptions of the medication doses that you were on here, as detailed in the discharge medications. Please contact your regular neurologist.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Ertapenem Sodium 1 g IV DAILY RX *ertapenem [Invanz] 1 gram 1 g IV Daily Disp #*30 Vial Refills:*0 3.Outpatient Lab Work ICD-9: 513.0 Lung Abscess LABS:WEEKLY CBC with differential, BUN, Cr, AST, ALT, Total Bili, ALK PHOS FAX TO: ATTN: ___ CLINIC FAX: ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Left upper lobe mass, presumed abscess Pneumomediastinum Reduced ejection fraction 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 Mr. ___, You were admitted to the hospital because you were having chest pain and the CAT scan of your chest showed a mass. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? - You were treated with antibiotics, because the mass in your lung is most likely an infection/abscess. - You were evaluated by the infectious disease team, who recommended a long course of antibiotics. - You were evaluated by the thoracic surgeons and interventional pulmonologists (lung specialists). They did not recommend biopsy or other procedures at this time because they felt the antibiotics alone should treat the infection. - You had an echo (an ultrasound of your heart) and an ultrasound of the veins in your neck. There was no evidence that the infection in your lungs had spread to those areas. - You had a PICC line placed so that you could get IV antibiotics at home. - Your blood tests showed some kidney injury. This may be from one of the antibiotics you got in the hospital. You will be taking a different antibiotic at home. Your primary care doctor ___ continue to monitor this to ensure it improves. WHAT SHOULD I DO WHEN I GO HOME? - You will need to complete at least 4 weeks of IV antibiotics. The infectious disease doctors ___ be in touch with you regarding the exact duration. - ***You will need to get blood tests each week while on antibiotics, starting on ___. *** This is to monitor for side effects. - Please keep all your follow up appointments as listed below. - You will see the infectious disease, interventional pulmonology, and thoracic surgery doctors as ___ outpatient. - You will get a repeat CAT scan of your chest in ___ as listed below to make sure the mass in your lungs improved with antibiotics. If the mass is still there, you will likely need additional testing and treatment. - It is very important not to drink alcohol or use any other recreational drugs while you are on antibiotics. WHEN SHOULD I COME BACK TO THE HOSPITAL? - If you have fevers/chills, chest pain, difficulty breathing, nausea/vomiting. - If you have pain, redness, swelling around your PICC line. It was a pleasure caring for you, and we wish you all the best. Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 2. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for SOB. 3. ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed for SOB. 4. sevelamer carbonate 800 mg Tablet Sig: Three (3) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 5. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 7. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) Powder in Packet PO DAILY (Daily). 8. miconazole nitrate 2 % Powder Sig: One (1) application Topical four times a day as needed for intertrigo. 9. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain. 10. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 11. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 12. warfarin 2.5 mg Tablet Sig: One (1) Tablet PO once a day. 13. heparin (porcine) 5,000 unit/mL Cartridge Sig: One (1) Injection three times a day: Until therapeutic on coumadin. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. Medication side effect 2. End stage renal disease 3. 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 Ms. ___, You were admitted to the hospital because you had an episode of unresponsiveness at your extended care facility. We did several studies including an EEG, a CT of your head, and blood work and did not see any concerning cause of this episode. We believe it may have been caused by a medication recently started called olanzapine (Zyprexa). We stopped this medication and you had no more episodes. We did have one blood culture grow some bacteria, and we started you on antibiotics. However, after further review, it appears the baceteria was contamination from your skin and you do not need to be on antiobiotics. Please note the following changes to your medications: INCREASE Coumadin (Warfarin) to 2.5 mg daily or as otherwise directed CONTINUE Heparin 5000 units SC until INR>2.0 STOP Olanzapine (Zyprexa) STOP Artificial tears No other changes were made to your medications. Please weigh yourself every morning, and call your MD if weight goes up more than 3 lbs. It has been a pleasure taking care of you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID 2. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth Dao;y Disp #*30 Tablet Refills:*2 3. 70/30 50 Units Breakfast 70/30 40 Units Dinner 4. Praluent Pen (alirocumab) 150 mg/mL SC EVERY 2 WEEKS 5. Valsartan 160 mg PO DAILY 6. Aspirin 81 mg PO DAILY 7. glimepiride 4 mg oral BID 8. Isosorbide Mononitrate (Extended Release) 120 mg PO DAILY 9. MetFORMIN (Glucophage) 1000 mg PO DAILY 10. Pantoprazole 40 mg PO BID 11. Tamsulosin 0.4 mg PO DAILY 12.Outpatient Physical Therapy ___ Acute Ischemic stroke Physical therapy at least 3x weekly Discharge Disposition: Home Discharge Diagnosis: Acute ischemic stroke Non-ST elevation myocardial infarction 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 due to symptoms of trouble speaking, word 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: Diabetes Hypertension Heart disease You were also noted to have had a minor heart attack this admission or NSTEMI. You were on a blood thinner for this and were seen by the cardiologists and cardiothoracic surgeons. You will see ___ as an outpatient and will follow-up with We are changing your medications as follows: - Starting Apixiban 5mg twice daily (this is a blood thinner, please take it every day) - Start Metoprolol - Increased Valsartan (blood pressure medication) - Stop atenolol Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Azathioprine 100 mg PO DAILY RX *azathioprine 50 mg 2 tablet(s) by mouth Daily Disp #*60 Tablet Refills:*0 2. Acetaminophen 650 mg PO Q6H:PRN pain, fever 3. Amlodipine 10 mg PO HS 4. Calcitriol 0.25 mcg PO 6X/WEEK (___) 5. Labetalol 300 mg PO BID 6. Vitamin D 50,000 UNIT PO 1X/WEEK (WE) 7. Outpatient Lab Work Needs CBC, chem-10, INR, tacrolimus checked on ___, send results to Dr. ___, ___ Phone: ___ Fax: ___ ICD-9: V42.0 8. PredniSONE 10 mg PO DAILY 9. Sodium Bicarbonate 1300 mg PO BID 10. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 11. Tacrolimus 2 mg PO Q12H 12. Warfarin 4 mg PO DAILY16 RX *warfarin [Coumadin] 1 mg 4 tablet(s) by mouth Daily Disp #*120 Tablet Refills:*0 13. LOPERamide 2 mg PO QID:PRN diarrhea RX *loperamide [Anti-Diarrheal (loperamide)] 2 mg 1 capsule by mouth four times a day Disp #*30 Capsule Refills:*0 14. Magnesium Oxide 250 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: ___ Infectious gastroenteritis Secondary diagnoses: S/p renal transplant Hypertension Hypercoaguability 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 with renal injury that improved with IVF. We have adjusted doses of several of your medications. Please keep all of your followup appointments. Eating a lactose free diet should help with your loose stool as your GI tract recovers from the infection. Please have labs checked on ___. These will be sent to the ___. Your INR should be checked at that time as well. Sincerely, 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. Atorvastatin 80 mg PO DAILY 3. Carvedilol 25 mg PO BID 4. Ferrous Sulfate 325 mg PO DAILY 5. Torsemide 20 mg PO BID 6. Potassium Chloride (Powder) 10 mEq PO DAILY Hold for K >4.8 7. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID apply to gluteal fold RX *clobetasol 0.05 % 1 application twice a day Disp #*1 Tube Refills:*0 8. Glargine 50 Units Bedtime Humalog 20 Units Breakfast Humalog 20 Units Lunch Humalog 20 Units Dinner Insulin SC Sliding Scale using HUM Insulin 9. 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. RX *heparin lock flush 10 unit/mL 2mL Line flush Disp #*100 Unit Refills:*0 10. NovoLOG *NF* (insulin aspart) ___ UNITS SUBCUTANEOUS DAILY according to sliding scale as above 11. Lantus *NF* (insulin glargine) 50 units SUBCUTANEOUS QHS 12. Nafcillin 2 g IV Q4H Duration: 6 Weeks RX *nafcillin in D2.4W 2 gram/100 mL 2 grams every 4 hours Disp #*504 Gram Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Osteomyelitis Secondary: Diabetes mellitus, Congestive heart failure, hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance with crutches Followup Instructions: ___ [/INST] </s><s>It was a pleasure to participate in your care at ___. You were admitted to the hospital because of your left foot ulcer. You were treated with antibiotics. A biopsy of your bone was performed by the podiatry service and a portion of infected bone was removed. Cultures were obtained from the deep tissues during surgery. Your wound continued to improve and was closed with sutures. A PICC line was placed so that you can receive IV antibiotics outside of the hospital. You remained stable and were discharged home. You will be treated with the IV antibiotic nafcillin through your PICC line for 6 weeks. A visiting nurse ___ show you how to set up the infusion. You will follow up with the Infectious Disease department as well as Podiatry for care of the ulcer.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clopidogrel 75 mg PO DAILY 2. Escitalopram Oxalate 10 mg PO DAILY 3. Lisinopril 2.5 mg PO DAILY 4. Pravastatin 40 mg PO DAILY 5. Acetaminophen 1000 mg PO Q8H RX *acetaminophen 500 mg 2 tablet(s) by mouth 8 hours Disp #*30 Tablet Refills:*0 6. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth 4 hours Disp #*20 Tablet Refills:*0 8. Metoprolol Tartrate 50 mg PO TID RX *metoprolol tartrate 50 mg 1 tablet(s) by mouth three times daily Disp #*90 Tablet Refills:*1 9. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice daily Disp #*30 Capsule Refills:*0 10. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 by mouth twice a day Disp #*30 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: ruptured abdominal aortic aneursym 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 following surgery to repair the leak in your aorta. You have done amazingly well and are now ready for discharge. Please allow us to give you some general instructions regarding your discharge as well as a few specific to you. 1) we have started a new medication metoprolol to help control your blood pressure. You should continue to take this and follow up with your PCP ___ ___ weeks to have your blood pressure checked. 2) Because your aorta had an aneursym it is possible that other blood vessels in your body may be predisposed to aneursym. Accordingly we have scheduled you to have an ultrasound of the arteries in your knees next week. WHAT TO EXPECT: 1. It is normal to feel weak and tired, this will last for ___ weeks • You should get up out of bed every day and gradually increase your activity each day • You may walk and you may go up and down stairs • Increase your activities as you can tolerate- do not do too much right away! 2. It is normal to have incisional and leg swelling: • Wear loose fitting pants/clothing (this will be less irritating to incision) • Elevate your legs above the level of your heart with ___ pillows every ___ hours throughout the day and at night • Avoid prolonged periods of standing or sitting without your legs elevated 3. It is normal to have a decreased appetite, your appetite will return with time • You will probably lose your taste for food and lose some weight • Eat small frequent meals • It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing • To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication • • Take all the medications you were taking before surgery, unless otherwise directed • Take one aspirin daily. Continue to take your plavix. ACTIVITIES: • No driving until post-op visit and you are no longer taking pain medications • You should get up every day, get dressed and walk, gradually increasing your activity • You may up and down stairs, go outside and/or ride in a car • Increase your activities as you can tolerate- do not do too much right away! • No heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit • You may shower (let the soapy water run over incision, rinse and pat dry) • Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area CALL THE OFFICE FOR : ___ • Redness that extends away from your incision • A sudden increase in pain that is not controlled with pain medication • A sudden change in the ability to move or use your leg or the ability to feel your leg • Temperature greater than 101.5F for 24 hours • Bleeding from incision • New or increased drainage from incision or white, yellow or green drainage from incisions</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 400 mg PO Q24H Duration: 9 Doses RX *cefpodoxime 200 mg 2 tablet(s) by mouth once per day Disp #*18 Tablet Refills:*0 2. OxyCODONE (Immediate Release) 5 mg PO BID:PRN Pain - Moderate Duration: 6 Days RX *oxycodone [Oxaydo] 5 mg 1 tablet(s) by mouth twice per day as needed Disp #*12 Tablet Refills:*0 3. sevelamer CARBONATE 800 mg PO TID W/MEALS RX *sevelamer carbonate [Renvela] 800 mg 1 tablet(s) by mouth three times per day Disp #*90 Tablet Refills:*0 4. Tacrolimus 1 mg PO QPM RX *tacrolimus 1 mg 1 capsule(s) by mouth QPM Disp #*28 Capsule Refills:*0 5. Tacrolimus 1.5 mg PO QAM RX *tacrolimus 0.5 mg 3 capsule(s) by mouth QAM Disp #*84 Capsule Refills:*0 6. Acetaminophen 500 mg PO Q8H:PRN pain 7. Amlodipine 10 mg PO DAILY 8. Aspirin 81 mg PO DAILY 9. Atorvastatin 80 mg PO QPM 10. Carvedilol 6.25 mg PO BID 11. darbepoetin alfa in polysorbat 40 mcg/0.4 mL injection EVERY 2 WEEKS 12. Lisinopril 2.5 mg PO DAILY 13. PredniSONE 4 mg PO DAILY 14. Ranitidine 150 mg PO BID 15. TiCAGRELOR 90 mg PO BID 16.Outpatient Lab Work Chem 10, CBC, tacro level End stage renal disease N18.6 ___ FAX: ___ Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES ================= SEPTIC ARTHRITIS HYPONATREMIA LOWER EXTREMITY EDEMA GROUND GLASS OPACITIES, RADIOGRAPHICALLY CONSISTENT WITH PNEUMONIA ATRIAL FIBRILLATION WITH RAPID VENTRICULAR RESPONSE HYPERKALEMIA ANEMIA SECONDARY DIAGNOSES =================== END STAGE RENAL DISEASE STATUS-POST KIDNEY TRANSPLANT CORONARY ARTERY DISEASE STATUS-POST DRUG ELUTING STENT ___ 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 came to ___ with a swollen and painful right shoulder. While you were here, we noticed you had low sodium and high potassium, and you were admitted to the intensive care unit for monitoring. Your electrolytes improved. Infection of the shoulder joint is the most likely explanation of your shoulder pain, so please continue your antibiotic until ___, for a total of 2.5 weeks. We also did a chest catscan to see why your right arm was swollen. We saw evidence of a lung infection. However, you did not have symptoms. The most likely lung infections are also treated with the antibiotic (cefpodoxime) that you are taking. We recommend your PCP get ___ imaging in ___ weeks to see if the lung findings have improved. Your legs started swelling, so we treated you with medicine to help remove fluid from your body. We also restarted your lisinopril, which should help. You will follow up with your nephrologist as scheduled below. Please get labs drawn in one week (___). Please also weigh yourself every day. If your weights start to rise, or if you notice worsening swelling in your legs, call the renal transplant clinic at ___. It was a pleasure taking care of you! We wish you the ___. - Your Care Team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 20 mg PO BID 2. Acetaminophen 650 mg PO Q6H:PRN pain 3. DiphenhydrAMINE 25 mg PO Q6H:PRN pruritis RX *diphenhydramine HCl 25 mg 1 capsule(s) by mouth every six (6) hours Disp #*8 Capsule Refills:*0 4. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 5. Sarna Lotion 1 Appl TP TID:PRN pruritis RX *camphor-menthol [Anti-Itch (menthol/camphor)] 0.5 %-0.5 % 1 application three times a day Refills:*0 6. albuterol sulfate 90 mcg/actuation inhalation Q6H:PRN wheezing 7. Amlodipine 10 mg PO DAILY 8. Aspirin 325 mg PO DAILY 9. Atorvastatin 80 mg PO QPM 10. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 11. Hydrochlorothiazide 25 mg PO DAILY 12. Metoprolol Succinate XL 25 mg PO DAILY 13. Potassium Chloride 20 mEq PO DAILY 14. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*2 15. Milk of Magnesia 30 mL PO Q12H:PRN constipation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right spontaneous pneumothorax Left lower lobe lung nodule Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>* You were admitted to ___ for treatment of a pneumothorax. A chest tube was placed at ___ and you were transferred to ___ for further management. There is a persistent air leak from your lung which will need time to heal and seal over. Your chest xray shows full expansion of the lung which is good. You are ready to go home, but still need your chest tube. A small device, called an Atrium Pneumostat, has been placed on the end of your chest tube to help you get better. The ___ will help you manage this device. * Your oxygen has been reordered for you and you should wear it at ___ LPM as you were doing at home. * If you have any increased shortness of breath, fevers > 101 or any new concerns call Dr. ___ at ___. About The Atrium Pneumostat: The Atrium Pneumostat is made to allow air and a little fluid to escape from your chest until your lung heals. The device will hold 30ml of fluid. Empty the device as often as needed (see directions below) and keep track of how much you empty each day. Items Needed for Home Use: • Atrium Pneumostat Chest Drain Valve (provided by hospital) • ___ syringes to empty drainage, if needed (provided by hospital or ___ Nurse) • Wound dressings (provided by hospital or ___ Nurse) Securing the Pneumostat: Utilize the pre-attached garment clip to secure the Pneumostat to your clothes. It is small and light enough that you won't even feel it hanging at your side. Make sure to keep the Pneumostat in an upright position as much as possible. Before lying down to sleep or rest, empty the Pneumostat so there will be no fluid to potentially leak out. Wound Dressing: You have a dressing around your chest tube. This should be changed at least every other day or as prescribed by your doctor. Showering/Bathing: Showering with a chest tube is all right as long as you don't submerge the tube or device in water. Place the pneumostat in a zip lock bag for showering then remove. No baths, swimming, or hot tubs. Note: This device is very important and the tubing must stay attached to the end of your chest tube. • If it falls off, reconnect it immediately and tape it securely. • If it falls off and you can't get it back together, go to the closest hospital emergency room. Warnings: 1. Do not obstruct the air leak well. 2. Do not clamp the patient tube during use. 3. Do not use or puncture the needleless ___ port with a needle. 4. Do not leave a syringe attached to the needleless ___ port. 5. Do not connect any ___ connector to the needleless ___ port located on the bottom of the chest drain valve. 6. If at any time you have concerns or questions, contact your nurse or physician. Emptying the Pneumostat • Keep the Pneumostat in an upright position and make sure the tubing stays firmly attached to the end of your chest tube. Make sure the Pneumostat stays clean and dry. Do not allow the Pneumostat to completely fill with fluid or it may start to leak out. If fluid does leak out, clean off the Pneumostat and use a Q-tip to dry out the valve. • If the Pneumostat becomes full with fluid, empty it using a ___ syringe. Firmly screw the ___ onto the port located on the bottom of the Pneumostat. • Pull the plunger back on the syringe to empty the fluid. When the syringe is full, unscrew the syringe and empty the fluid into the nearest suitable receptacle. Repeat as necessary. If it becomes difficult to empty the fluid using a syringe, squirt water through the port to flush out the blockage or consult your nurse or physician. The Pneumostat may need to be changed out.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 6. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for pain. 7. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain. 8. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical QID (4 times a day). Disp:*1 bottle* Refills:*2* 9. Ostomy supplies ConvaTec Surfit Moldable Large Convex it ___: # ___ 10. Ostomy supplies ConvaTec Drainable Pouch ___: ___ ___ 11. Ostomy supplies Ostomy Belt: manf # ___ 12. Dressing/Wound supplies Aquacel AG rope Sig: Commercial wound cleanser, pat dry. Aquacel AG rope, dry gauze, change daily. Disp: 1 tube Refills: 4 Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Leaking ostomy appliance Candidiasis skin infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with non adherent ostomy due to leaking. As a result you developed a fungal skin rash that is beingtreated with an anti-fungal powder. A new ostomy appliance has been used - you will be given prescriptions for the new supplies. DO NOT use the old ostomy appliance that you have at home. You may resume your home medications as prescribed. Return to the Emergency room if your ostomy appliance leaks again.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q6H:PRN pain/temp 2. Aspirin EC 81 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Levothyroxine Sodium 75 mcg PO DAILY 5. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 6. Furosemide 40 mg PO BID RX *furosemide 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 7. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY: ---------------- # GI BLEED # Acute anemia # Acute on chronic systolic congestive heart failure SECONDARY: ---------------- # Polycythemia ___ ___ 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 to get your care at ___! You were admitted with anemia ("low blood counts") and dark stools, which were concerning for GI bleeding. The GI specialists were consulted and perfermed endoscopic studies including an EGD and a colonoscopy. Your EGD was unrevealing, and the colonoscopy showed some possible sources of bleeding but no active bleeds. A capsule study was performed but was incomplete because the capsule never left your stomach. This test can be performed again outside the hospital. You have a scheduled ___ appointment with the GI doctors to discuss this further. During your hospitalization, you were found to be having some problems with the amount of water in your body because of your Congestive Heart Failure (CHF). This had caused some problems with your breathing as is typical for this condition. You were treated with diuretics to remove the extra water. As we did this, your breathing was better and your kidney function improved. You will be discharged on a new dose of the diuretic furosemide. You should follow up with your cardiologist as an outpatient to make sure this is the right dose for you. In the meantime, you should weigh yourself every morning and call your doctor if weight goes up more than 3 lbs. Also let your doctor know if you are having difficulty breathing, especially when you are lying down or in the middle of the night. You were not treated for your polycythemia ___ during this hospitalization because your blood counts were low and Dr. ___ ___ already been holding your hydroxyurea. You have a follow up appointment with your hematologists scheduled, at which point you can discuss this further. We wish you the best of future health! Sincerely, Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Artificial Tears 1 DROP BOTH EYES QID 2. Bisacodyl 10 mg PO DAILY:PRN constipation 3. Calcium Carbonate 600 mg PO BID 4. ClonazePAM 0.5 mg PO BID 5. Divalproex Sod. Sprinkles 250 mg PO TID 6. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 7. Guaifenesin ER 600 mg PO Q12H 8. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN wheeze/sob 9. Lidocaine 5% Patch 1 PTCH TD QAM 10. OLANZapine 10 mg PO QHS 11. Sertraline 150 mg PO DAILY 12. Tiotropium Bromide 1 CAP IH DAILY 13. Acetaminophen 650 mg PO TID 14. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO QID:PRN heartburn 15. Bacitracin Ointment 1 Appl TP BID:PRN cuts/scrapes 16. Fluticasone Propionate NASAL 1 SPRY NU BID 17. Milk of Magnesia 30 mL PO Q24H:PRN constipation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnoses: - Methicillin resistant Staph aureus pneumonia - Urinary tract infection - Aspiration - COPD exacerbation 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 during your recent hospital stay at the ___. You were admitted for back pain with low oxygen levels and a new productive cough consistent with a lung infection called pneumonia. You also had your urine tested and you also had evidence of a urinary tract infection. You were treated with intravenous antibiotics, and your symptoms improved. Because you had some difficulty with breathing, you were also treated with steroids to treat a COPD exacerbation in the setting of your infections, and your breathing improved. While you were here, you were also noticed to have some difficulty with swallowing, so our speech and swallow specialists evaluated you, and recommended you have someone with you to help feed you your meals to prevent food going into your lungs, to help prevent future lung infections. Your medications and future medical appointments are listed below for you. We wish you the best with your health. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 200 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Warfarin 5 mg PO 4X/WEEK (___) 4. Warfarin 6 mg PO 3X/WEEK (___) 5. Metoprolol Succinate XL 50 mg PO DAILY 6. Torsemide 20 mg PO DAILY RX *torsemide [Demadex] 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Potassium Chloride 20 mEq PO DAILY Duration: 24 Hours RX *potassium chloride [Klor-Con M20] 20 mEq 20 mEq by mouth daily Disp #*30 Packet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Partial Dehiscence of Mitral valve replacement RV dilation w/RV failure CHF exacerbation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, you were admitted to the ___ after gaining weight despite your water pills at home. You were given strong medications through an IV to get water out of your body. It was also noted that there was a leak around your mitral valve and unfortunately, this valve needs to be replaced. The plan is for you to go home for several days to take care of your mother and then come back to the Hospital on ___ to have the special catheter placed to measure the pressures in your heart prior to going to surgery for a valve replacement. In preparation for your procedure, your last dose of coumadin (warfarin) should be on ___. You will be contacted with a time to come back to the Hospital on ___ with the plan to stay and have your valve replaced. 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 500 mg PO Q6H:PRN Pain - Mild 2. Amiodarone 200 mg PO DAILY 3. Apixaban 5 mg PO BID 4. Bumetanide 3 mg PO BID 5. HydrOXYzine 25 mg PO QHS 6. Metolazone 5 mg PO 1X/WEEK (MO) 7. Tamsulosin 0.4 mg PO QHS 8. HELD- Metoprolol Succinate XL 200 mg PO QHS This medication was held. Do not restart Metoprolol Succinate XL until you discuss with your cardiologist. Discharge Disposition: Home Discharge Diagnosis: Severe anemia secondary to chronic blood loss Acute on Chronic diastolic CHF CKD stage III 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>Hi Mr. ___, It was a pleasure to take care of you at ___. WHY WAS I HERE? You were admitted to the hospital because you had very low blood counts (anemia) and had a lot of fluid on your body due to your heart failure. WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL - You received multiple blood transfusions to help with your anemia - You had a colonoscopy and upper endoscopy to look for a cause of your anemia and showed no source of bleeding - You received diuretics to help remove the extra fluid from your body. WHAT SHOULD I DO WHEN I GET HOME? You are leaving the hospital against medical advice. Please be sure to follow up with your doctors as below. 1) Follow up with your Primary Care Doctor. 2) Follow up with a Hematologist, Cardiologist, and Primary Care Physician 3) Take all your medications as prescribed by your doctors. 4) Return to the emergency room if you see black tarry or blood in your stool or if you develop new shortness of breath or dizziness. Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 20 mg PO QPM 2. DiCYCLOmine 20 mg PO QID 3. Fenofibrate 160 mg PO DAILY 4. Gabapentin 300 mg PO BID 5. Ibuprofen 600 mg PO Q8H:PRN pain 6. Levothyroxine Sodium 100 mcg PO DAILY 7. GlyBURIDE 5 mg PO DAILY 8. MetFORMIN (Glucophage) 500 mg PO BID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: 1. Abdominal Pain SECONDARY DIAGNOSES: 2. Bipolar Disorder 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 during your hospital stay at ___. You were admitted to the hospital with abdominal pain, and underwent a workup including a CT scan, and an ultrasound which did not show any cause of this abdominal pain. Unfortunately we were unable to find a specific cause for your pain, and after treating you conservatively you started to improve. Please follow up with your primary care physician this week, and continue to take all of your medications as prescribed. Before you left, you met with our social work team here to help provide you transportation home. Take Care, 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/PR Q6H:PRN Pain - Mild RX *acetaminophen 325 mg ___ tablet(s) by mouth every 6h Disp #*20 Tablet Refills:*0 2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation RX *bisacodyl 10 mg 1 suppository(s) rectally daily Disp #*3 Suppository Refills:*0 3. Gabapentin 100 mg PO DAILY RX *gabapentin 100 mg 1 capsule(s) by mouth daily Disp #*3 Capsule Refills:*0 4. Haloperidol 0.5 mg PO Q6H:PRN agitation RX *haloperidol 0.5 mg 1 tablet(s) by mouth every 6h Disp #*12 Tablet Refills:*0 5. Ondansetron ODT 4 mg PO Q8H:PRN nausea RX *ondansetron 4 mg 1 tablet(s) by mouth every 8h as needed Disp #*9 Tablet Refills:*0 6. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN BREAKTHROUGH PAIN RX *oxycodone 5 mg ___ tablet(s) by mouth every 4h Disp #*22 Tablet Refills:*0 7. Rivaroxaban 20 mg PO ONCE Duration: 1 Dose RX *rivaroxaban [___] 20 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 8. Senna 8.6 mg PO BID:PRN Constipation - First Line RX *sennosides 8.6 mg 1 tab by mouth twice daily Disp #*6 Tablet Refills:*0 9. Colchicine 0.6 mg PO DAILY RX *colchicine [Colcrys] 0.6 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 10. Allopurinol 50 mg PO DAILY RX *allopurinol ___ mg 0.5 (One half) tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Metastatic neuroendocrine tumor to the ___ Lung lesion Fever, resolved Altered mental status Aseptic meningitis Toxic-metabolic encephalopathy Bilateral lower extremity DVT 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>Activity • We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise. • 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. Medications • Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) other than what is being prescribed for you at discharge. • 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. • 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: • 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: 1. Acetaminophen 650 mg PO Q6H:PRN pain, ___ 2. Aspirin EC 81 mg PO DAILY 3. Atorvastatin 40 mg PO DAILY 4. Bisacodyl ___AILY:PRN constipation 5. Docusate Sodium 100 mg PO BID:PRN constipation 6. Furosemide 20 mg PO DAILY 7. Levothyroxine Sodium 75 mcg PO DAILY 8. Polyethylene Glycol 17 g PO DAILY:PRN constipation 9. Ranitidine 150 mg PO DAILY 10. Warfarin 3 mg PO DAILY16 11. amLODIPine 10 mg PO DAILY 12. Baclofen 10 mg PO QHS:PRN restless leg 13. mometasone 50 mcg/actuation nasal DAILY 14. Nystatin-Triamcinolone Cream 1 Appl TP BID:PRN rash 15. Potassium Chloride 10 mEq PO DAILY 16. Vitamin D ___ UNIT PO 1X/WEEK (___) 17. Calcium Carbonate 1250 mg PO BID 18. Calcitriol 0.25 mcg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Toxic-Metabolic Encephalopathy Hypercalcemia Sick Sinus Syndrome Hypoparathyroidism Hypothyroidism Afib ___ 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 admitted to ___ for repeated falls and a change in your mental status. WHAT WAS DONE ============== -You were found to have high calcium levels that made you confused and damaged your kidneys. This was treated with fluids and other medications -You had a pacemaker placed for a slow heart rate that was thought to be the cause of your falls -You did not have a bleed in your brain, which was a concern at an outside hospital WHAT TO DO NEXT =============== -Take your medications as prescribed -Follow up with your doctors, including device clinic in ___ for your pacemaker. You should also follow up with an endocrinologist -Call your doctors ___ develop chest pain, fevers, chills, or worsening confusion Wishing you the best of health moving forward, 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 mild pain 2. LevETIRAcetam 500 mg PO BID RX *levetiracetam [Keppra] 500 mg 1 tablet(s) by mouth twice a day Disp #*10 Tablet Refills:*0 3. Loratadine 10 mg PO DAILY 4. Metoprolol Succinate XL 25 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Simvastatin 10 mg PO QPM 7. Timolol Maleate 0.25% 1 DROP BOTH EYES BID 8. TraZODone 25 mg PO QHS:PRN sleep Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Bilateral subdural hematomas Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Surgery - You underwent a surgery called burr holes 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). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. - 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: 1. BuPROPion 150 mg PO BID 2. Citalopram 20 mg PO DAILY 3. Clonazepam 0.5 mg PO QID:PRN anxiety 4. Colchicine 0.6 mg PO DAILY 5. Doxepin HCl 150 mg PO DAILY 6. Furosemide 20 mg PO BID 7. HydrOXYzine 50 mg PO Q6H:PRN pruritis 8. Meclizine 50 mg PO Q6H:PRN vertigo 9. Nicotine Patch 21 mg TD DAILY 10. Omeprazole 20 mg PO DAILY 11. Propranolol 60 mg PO BID 12. OxycoDONE (Immediate Release) 10 mg PO Q6H:PRN pain hold for sedation, RR < 10 RX *oxycodone 10 mg 1 Tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 13. Warfarin 5 mg PO DAILY16 14. Outpatient Lab Work - Please draw INR on ___ for warfarin monitoring. ICD-9 289.81 - Fax result or notify primary care doctor: Name: ___ ___ Address: ___, ___ Phone: ___ Fax: ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: acute encephalopathy secondary to medication side effect, chronic back pain, transaminitis, atypical chest pain 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>It was a pleasure taking care of you at ___ ___. You came in with difficulty moving your limbs and falling. Your MRI and CT imaging did not show any concerning pathology. This was likely due to medications you were taking (oxycodone with gabapentin). We have changed your medications and discontinued gabapentin. You also complained of chest pain and there was no evidence of damage to your heart. You had normal imaging of your heart. You also had elevated liver tests. The pictures of your liver were normal except for some fatty changes. The numbers decreased and you will need to follow up with your primary care doctor and avoid any medications toxic to the liver such as tylenol. You came in with back pain and had an MRI of you ___ done that showed only mild degenerative changes seen with age. You also complained of hip pain and an x-ray of your hip did not show any breaks or fractures.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You were evaluated in the Emergency Room following a fall down a flight of stairs. You were found to have a small bleed in your brain, facial fractures (maxillary and zygomatic fractures), Left hand fractures for which you were evaluated by Neurosurgery, Plastic Surgery, and Hand Surgery. FACIAL FRACTURES INFORMATION You were diagnosed with a facial fracture. Some facial fractures require an operation, others do not and heal on their own. Until you can be further evaluated, you do need to take some precautions: - Sleep with the head of your bed elevated about 45 degrees (prop yourself up with some pillows) - Do not do anything to increase pressure in your face: Do not use straws to drink, do not blow your nose, if you have to sneeze do so with an open mouth, and do not strain with bowel movements. - Avoid contact sports or strenuous physical activity - Take an over-the-counter stool softener, such as Colace, for the next 2 weeks to prevent straining with bowel movements. This is especially important if you have been prescribed narcotic pain medications, because all narcotics are constipating. - If an antibiotic was prescribed, please take it as directed. Call your doctor or return to the emergency room for: - Fevers or chills - Worsening headaches - Purulent or foul smelling drainage from one or both nostrils - Worsening tenderness in your face - Pain with ___ movement or difficulty moving eyes - Blurry vision - Nausea or vomiting - Any other concerns HAND/WRIST FRACTURES Many hand and wrist injuries are simple sprains or strains that will resolve over ___ weeks. Some types of ligament tears can take longer or require surgery. Fractures will require follow-up care for casting. The severity of some injuries can be difficult to determine at the time of an emergency visit. Certain types of injuries are always treated with a plaster splint since some fractures can take more than a week to show up on X-Rays. If X-Rays were taken: they were reviewed by physicians in the Emergency Department today, and will also be reviewed by a radiologist within 24 hours. We will call you if there are any questions, or if more x-rays are needed. <B>Treatment:</B> * Rest the affected area. If a splint was applied, be sure to wear it and use a sling. As much as possible, you should keep your arm elevated above the level of your heart. * For the first 2 days, apply ice packs for 15 minutes at a time. You can do this as frequently as possible, up to once every hour if there is a lot of swelling. Be sure to always place a towel between the ice pack and your skin. * After 2 days you can switch to heat if it is more comfortable, or continue using the ice. * Unless told otherwise by your doctor, you can use over the counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). If you were given a prescription for strong pain medications you should not drive, operate machinery or drink alcohol while taking them. * Be sure to follow up with your doctor or the specialist as instructed. <B>Warning Signs:</B> Call your doctor or return to the Emergency Department right away if any of the following problems develop: * Your pain or swelling gets much worse * Your arm or hand is cold or numb HEAD INJURY You have been diagnosed as having sustained an injury to your head. Most head injuries are not serious and get better over a few days. However in rare cases, further problems develop, so it is important that you, and a friend or relative monitor your condition and seek immediate help if you notice any of the warning signs below. If X-Rays were taken: they were reviewed by physicians in the Emergency Department today, and will also be reviewed by a radiologist within 24 hours. We will call you if there are any questions, or if more x-rays are needed. <B>Treatment:</B> * It is important that you stay with a friend or relative for at least 24 hours so they can help you watch for the warning signs below. * You should rest, and avoid exertion or heavy lifting for ___ days or until you feel completely well again. Do not drive, operate machinery or perform other tasks that require strict concentration until you are well. * Avoid alcohol, sedatives and any other substances that will make you sleepy. * Mild nausea is normal for a few hours after an injury. If you have severe nausea or if you are vomiting, seek medical attention. * A mild to moderate headache is to be expected. For the first 24 hours take only Tylenol (acetaminophen) for headache. <B>Warning Signs:</B> Call your doctor or return to the Emergency Department right away if any of the following problems develop: * Prolonged nausea * Vomiting * Confusion, drowsiness, change in normal behavior * Trouble walking, or speaking (slurred speech) * Numbness or weakness of an arm or leg. * Severe headache * Convulsions or seizures Dizziness, changes in sleep, forgetfulness and difficulty concentrating are not uncommon after a head injury. These symptoms will usually clear over a few days, but if they persist or become worrisome, you may benefit from following up with a Neurologist specializing in head injuries. Please call ___ to schedule an appointment at the Concussion Clinic. Indicate that you were recently seen in the ___ Emergency Room and you will generally be seen within 1 to 2 weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. DICYCLOMine 20 mg PO TID RX *dicyclomine 20 mg 1 tablet(s) by mouth three times a day as needed Disp #*21 Tablet Refills:*0 2. LOPERamide ___ mg PO QID:PRN loose stools RX *loperamide 2 mg ___ tablet(s) by mouth every six hours as needed Disp #*28 Tablet Refills:*0 3. Naloxone Nasal Spray 4 mg IH ONCE MR1 Duration: 1 Dose RX *naloxone [Narcan] 4 mg/actuation ___ spray intranasally as needed for opiate overdose Disp #*2 Spray Refills:*0 4. Simethicone 40-80 mg PO TID RX *simethicone 80 mg 1 tablet(s) by mouth three times a day as needed for stomach cramps Disp #*21 Tablet Refills:*0 5. Zonisamide 400 mg PO QHS RX *zonisamide 100 mg 4 capsule(s) by mouth at bedtime Disp #*120 Capsule Refills:*3 6. BusPIRone 15 mg PO QID 7. Cetirizine 10 mg PO DAILY 8. CloNIDine 0.1 mg PO TID 9. linaCLOtide 145 mcg oral DAILY 10. Methadone 150 mg PO DAILY Consider prescribing naloxone at discharge 11. Mirtazapine 30 mg PO QHS 12. Prazosin 2 mg PO QHS 13. Pregabalin 150 mg PO BID 14. QUEtiapine Fumarate 200 mg PO QAM 15. QUEtiapine Fumarate 400 mg PO QHS 16. QUEtiapine Fumarate 100 mg PO BID 17. Ranitidine 150 mg PO BID:PRN GERD 18. Sertraline 200 mg PO BID 19. TraZODone 100 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: epilepsy history of traumatic brain injury homelessness ___ abuse bipolar disorder chronic hepatitis C 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 presented to ___ hospital because of concern that you had a seizure. While in the hospital, you were monitored on EEG. You also received antibiotics for a possible skin infection. You were seen by our addiction psychiatry team. After leaving the hospital, make sure you take your medications as prescribed. 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. Apixaban 5 mg PO BID 2. Levofloxacin 500 mg PO Q24H Duration: 1 Day last dose: ___ on ___, to complete a ___. Pantoprazole 40 mg PO BID prior to meals 4. Sucralfate 1 gm PO QID 5. PredniSONE 10 mg PO DAILY 6. Citalopram 10 mg PO DAILY 7. Donepezil 5 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: =========================== Primary: =========================== Syncope secondary to massive pulmonary embolism Catheter-associated urinary tract infection ============================= Secondary: ============================= Anemia Esophagitis Peptic ulcer disease Bullous pemphigoid Alzheimer's dementia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were admitted to the hospital with a pulmonary embolism, which is a large blood clot in your lungs. ============================================= What happened while ___ were in the hospital? ============================================= - ___ received heparin, a blood thinning medicine, through your IV. The day before ___ were discharged, this was switched to a tablet called apixaban. - Because of the large blood clot in your lungs, the interventional radiologists put a filter to prevent other clots in your legs from traveling to your lungs. - ___ had low blood pressures and signs of an infection. This made ___ somewhat confused. We think the infection may have been from your urinary catheter, but we cannot say for sure. ___ were given antibiotics and fluids through the IV, which led to improvement. - ___ also had low blood counts and required a few blood transfusions. =============================================== What should ___ do when ___ leave the hospital? =============================================== - Make sure to work hard at rehab to rebuild strength and follow up with the gastroenterology team. - ___ should continue taking the new blood thinner medicine, apixaban (Eliquis), 5mg twice a day, for at least 3 months to treat the blood clot. It was a pleasure taking care of ___! Congratulations on your 90th birthday! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H:PRN mild to severe 2. FoLIC Acid 1 mg PO DAILY 3. Lidocaine 5% Patch 1 PTCH TD QPM 4. Multivitamins 1 TAB PO DAILY 5. Pantoprazole 40 mg PO Q24H 6. Propranolol 20 mg PO TID 7. Thiamine 100 mg PO DAILY Discharge Disposition: Extended Care Discharge Diagnosis: # Alcohol Withdrawal # Alcohol Use Disorder # Clostridium difficile infection # Bipolar Disorder with depressive symptoms Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege to care for you at the ___ ___. You were admitted for alcohol detox. You were also noted to have poorly controlled Bipolar Disorder with depressive symptoms requiring inpatient psychiatric therapy. While you were here, you were diagnosed with an infection called C. Difficile which causes diarrhea. You were treated with antibiotics for this with improvement in your symptoms. You were also started on propranolol for your tremor. Now that you have completed treatment for your infection, you are ready for transfer to ___ at ___ for ongoing ECT treatments and management of your depression. We wish you the best in your recovery. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CARVedilol 12.5 mg PO BID RX *carvedilol 12.5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Losartan Potassium 50 mg PO DAILY RX *losartan 50 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. HydrALAZINE 50 mg PO TID RX *hydralazine 50 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 4. NPH 28 Units Breakfast NPH 5 Units Bedtime 5. Albuterol Inhaler 2 PUFF IH Q4H:PRN cough, chest tightness 6. amLODIPine 10 mg PO DAILY 7. Aspirin 81 mg PO DAILY 8. Atorvastatin 80 mg PO QPM 9. BuPROPion 75 mg PO BID 10. Fluticasone Propionate NASAL 2 SPRY NU DAILY 11. Gabapentin 300 mg PO DAILY 12. Gabapentin 900 mg PO QHS 13. Gabapentin 600 mg PO QPM 14. Isosorbide Mononitrate (Extended Release) 120 mg PO DAILY 15. Lidocaine 5% Patch 1 PTCH TD QAM back pain 16. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 17. OxyCODONE--Acetaminophen (5mg-325mg) 1 TAB PO TID:PRN Pain - Moderate 18. Rivaroxaban 2.5 mg PO BID 19. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Hypertensive Emergency Secondary: CAD, DM2, CKD, PVD 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 because you could not breath and had chest pain. These symptoms were due to an extremely high blood pressure, which we have treated by increasing your blood pressure medications. When you leave the hospital, please follow up with any doctor appointments listed below and make a note of any medication changes below. 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. CeFAZolin 2 g IV Q8H Duration: 23 Days last day ___ (4 weeks from first negative culture, ___ RX *cefazolin in dextrose (iso-os) 2 gram/50 mL 2 g IV every eight (8) hours Disp #*60 Intravenous Bag Refills:*0 2. Ciprofloxacin HCl 500 mg PO BID Duration: 8 Days RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth twice a day Disp #*17 Tablet Refills:*0 3. Lidocaine Jelly 2% 1 Appl TP ONCE Duration: 1 Dose apply to lower back for back pain RX *lidocaine 5 % apply thin film twice daily as needed Refills:*0 4. sodium chloride 0.9 % injection 6X/WEEK for orthostatic hypotension NS 1L IV with MVI-13 added, 6 days per week PRN RX *sodium chloride 0.9 % 1 Liter IV 6 days per week, PRN Disp #*24 Cartridge Refills:*0 5. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild/Fever 6. Diphenoxylate-Atropine 1 TAB PO Q6H 7. Dolutegravir 50 mg PO DAILY 8. dutasteride 0.5 mg oral QHS 9. Emtricitabine-Tenofovir alafen (200mg-25mg) *DESCOVY* 1 TAB PO DAILY 10. Escitalopram Oxalate 30 mg PO DAILY 11. Fludrocortisone Acetate 0.2 mg PO DAILY 12. FoLIC Acid 1 mg PO DAILY 13. LevETIRAcetam 1000 mg PO BID 14. LOPERamide 4 mg PO QID diarrhea 15. LORazepam 0.5 mg PO Q6H:PRN nausea 16. Midodrine 2.5 mg PO TID 17. Montelukast 10 mg PO DAILY 18. Multivitamins W/minerals 1 TAB PO DAILY 19. Niacin SR 1000 mg PO BID 20. Omeprazole 40 mg PO BID 21. Potassium Chloride 20 mEq PO DAILY 22. Prochlorperazine 5 mg IV Q8H:PRN Nausea/Vomiting - First Line Reason for PRN duplicate override: Not tolerating PO 23. Promethazine 25 mg PO Q6H:PRN nausea 24. Rivaroxaban 20 mg PO QPM 25. Simvastatin 20 mg PO QPM 26. Thiamine 100 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Staph aureus (methicillin-susceptible) bacteremia Acenitobacter bacteremia Acute right upper extremity Deep vein thrombosis associated with PICC line 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 for an infection of your bloodstream associated with your PICC line. This has been treated with antibiotics, which will continue for 4 weeks total. The last day of your IV antibiotics will be ___. You will also complete 2 weeks of an antibiotic, Ciprofloxacin, by mouth. The first dose will be tonight. I have included prescription for lidocaine cream to apply to your low back for pain, as needed. It was also found while in the hospital that you had a new rash reaction to your niacin. You may continue to use it at home as previously directed, though if there is a repeat of this reaction, you should stop and discuss future use with your outpatient doctor.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Glargine 34 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO DAILY RX *atorvastatin 80 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 5. Carvedilol 25 mg PO BID RX *carvedilol 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 6. Chlorthalidone 25 mg PO DAILY RX *chlorthalidone 25 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 7. Lisinopril 40 mg PO DAILY RX *lisinopril 40 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 8. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation q4-6h prn SOB, wheezing 9. Outpatient Lab Work Please have chemistry-10 panel drawn on ___ DX: Unspecified essential hypertension ICD-9 Code: ___. Please Fax Results To: ___. Fax ___ Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES ==================== # Type II Non-ST Elevation Myocardial Infarction # Hypertensive Emergency # Acute Kidney Injury CHRONIC ISSUES =============== # Insulin Dependent Diabetes Mellitus # Asthma # Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure meeting and caring for you during your hospitalization at ___. You were admitted with chest pain and arm pain. We found that you had a small heart attack. Your heart attack was probably not from a blockage in the heart artery (coronary artery) but because of very elevated blood pressures. We performed a stress test on your heart which returned normal which makes a blockage in a heart artery even less likely. We changed your blood pressure medication regimen which is expalined below. Please continue to take your blood pressure pills as they are prescribed at the same time each day. Also, please record your blood pressures in a journal. Bring the journal and your blood pressure cuff to your next primary care appointment. We wish you a speedy recovery. All the best, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Astelin *NF* (azelastine) 137 mcg NU QD 2. Calcium Carbonate 500 mg PO QID 3. Fluticasone Propionate NASAL 2 SPRY NU DAILY 4. Latanoprost 0.005% Ophth. Soln. 1 DROP RIGHT EYE HS 5. Venlafaxine XR 150 mg PO DAILY 6. Vitamin D 800 UNIT PO DAILY 7. Guaifenesin-CODEINE Phosphate ___ mL PO Q6H:PRN Cough RX *codeine-guaifenesin 100 mg-10 mg/5 mL ___ ml by mouth q6 Disp #*200 Milliliter Refills:*0 8. Levofloxacin 250 mg PO Q24H Duration: 5 Days RX *levofloxacin 250 mg 1 tablet(s) by mouth daily Disp #*5 Tablet Refills:*0 9. Alendronate Sodium 70 mg PO QMON 10. Estring *NF* (estradiol) 2mg Vaginal Every 3 months 11. Oseltamivir 75 mg PO Q12H RX *oseltamivir [Tamiflu] 75 mg 1 capsule(s) by mouth twice a day Disp #*6 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Community Acquired Pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for pneumonia. You were given Levofloxacin and your symptoms improved, and your white count went down. Please continue to take Levofloxacin for 5 more days. Return to the hospital or clinic if you develop fevers, worsening of your symptoms, trouble breathing, or diarrhea.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 50 mg PO DAILY Please hold for SBP <100 or HR <55. 2. Cyanocobalamin 1000 mcg PO DAILY 3. Glargine 14 Units Dinner 4. Lisinopril 20 mg PO DAILY Please hold for SBP <100. 5. MetFORMIN (Glucophage) 500 mg PO BID 6. Magnesium Oxide 0 PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Metastatic Pancreatic Neoplasm Stomach Mass 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>You were admitted to ___ with an obstruction in your bile ducts. You had an ultrasound that was concerning for a mass in your pancreas. You had a stent placed to keep your bile ducts open, and you had biopsies taken which were still pending at the time of discharge. Finally, you also had a CT scan, which showed a pancreatic malignancy, with concern for metastases to the liver. The CT scan also showed a mass in your stomach. You are being discharged to a rehab facility. You will need to follow-up with an oncologist to further discuss your results and treatment options. You will also need to discuss potential additional evaluation of the mass in your stomach. You should discuss this further with your primary care physician. You will need a repeat ERCP in approximately 6 weeks to have your stent replaced for a metal one. Our ERCP office will be in contact to schedule this. You can contact them at ___ if you have any questions. It was a pleasure taking part in your medical care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: NONE Discharge Disposition: Home Discharge Diagnosis: Transient headache, confusion, LT sided weakness, and chest tightness in the setting of severe anxiety after cocaine use. 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 with left arm and leg weakness and confusion. Initial concerns were for a stroke or a seizure. We obtained imaging of your brain with MRI, as well as vessels with CTA head and neck which did not show any evidence of stroke or vessel spasm. We sent a Lyme blood test which is still pending. We also monitored your cardiac enzymes as you had symptoms of chest tightness and these were stable. You complained of leg pain and swelling so we checked your veins for clots and this was also negative. Your gait and strength slowly improved back to baseline. At this point we recommend close follow up with your PCP and one follow up appointment with us here in Neurology. We think that this episode was likely a physical manifestation of the severe stress you have been undergoing as well as possible transient small vasospasm due to cocaine use. We strongly urge you to NOT use cocaine in the future. Please have an ultrasound of your heart done in the outpatient setting. It was a pleasure caring for you and we are glad that you are on your way to recovery. It was a pleasure taking care of you, Your ___ neurology team</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:*0 2. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Severe RX *oxycodone 5 mg 1 tablet(s) by mouth q6h PRN Disp #*28 Tablet Refills:*0 3. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Levothyroxine Sodium 25 mcg PO DAILY 5. LORazepam 1 mg PO Q8H:PRN Anxiety 6. Lovastatin 20 mg oral QHS 7. Magnesium Oxide 280 mg PO DAILY 8. Tamsulosin 0.4 mg PO QHS 9. Vitamin B Complex 1 CAP PO DAILY 10. Zolpidem Tartrate 10 mg PO QHS 11. HELD- Nadolol 20 mg PO DAILY This medication was held. Do not restart Nadolol until you follow up with your PCP 12.Outpatient Lab Work Lab: Na,K,Cl,HCO3,BUN,Cr,Glu Date: ___ Dx: Acute kidney failure (ICD9:___.9) ___: ___ (Dr. ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Leukocytoclastic Vasculitis 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 caring for you at ___ ___! WHY WERE YOU ADMITTED? -You were admitted for a rash and worsening kidney function. WHAT HAPPENED IN THE HOSPITAL? -Your rash and kidney function remained stable. You were evaluated by the rheumatologists, nephrologists and dermatologists who did not feel you needed immediate treatment. -You received a transfusion for anemia, which has likely been chronic. You were evaluated by hematology who did not find abnormalities on your blood smear. Please have your PCP continue to monitor your anemia. WHAT SHOULD YOU DO AT HOME? -You should take your medications as prescribed. -You should follow-up with your physicians based on the appointments listed below. Thank you for allowing us be involved in your care, 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. Advair HFA (fluticasone propion-salmeterol) 115-21 mcg/actuation inhalation BID 2 puffs twice a day RX *fluticasone propion-salmeterol [Advair HFA] 115 mcg-21 mcg/actuation 2 puffs IH twice a day Disp #*1 Inhaler Refills:*0 2. Albuterol Inhaler ___ PUFF IH Q6H cough, wheeze, shortness of breath RX *albuterol sulfate [ProAir HFA] 90 mcg ___ puffs IH every six (6) hours Disp #*1 Inhaler Refills:*0 3. Cephalexin 500 mg PO QID Duration: 7 Days RX *cephalexin 500 mg 1 tablet(s) by mouth four times a day Disp #*28 Tablet Refills:*0 4. Lidocaine 5% Patch 1 PTCH TD QAM 5. Spiriva Respimat (tiotropium bromide) 2.5 mcg/actuation inhalation DAILY 2 puffs daily RX *tiotropium bromide [Spiriva Respimat] 2.5 mcg/actuation 2 puffs IH once a day Disp #*1 Inhaler Refills:*0 6. TraMADol 25 mg PO Q6H:PRN BREAKTHROUGH PAIN Duration: 2 Days RX *tramadol [Ultram] 50 mg 0.5 (One half) tablet(s) by mouth every six (6) hours Disp #*6 Tablet Refills:*0 7. ValACYclovir 1000 mg PO TID Duration: 7 Days RX *valacyclovir 1,000 mg 1 tablet(s) by mouth three times a day Disp #*4 Tablet Refills:*0 8. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth nightly Disp #*30 Tablet Refills:*0 9. U-500 Conc 160 Units Breakfast U-500 Conc 160 Units Bedtime 10. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 11. Metoprolol Succinate XL 100 mg PO DAILY RX *metoprolol succinate 100 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 12. Aspirin 81 mg PO DAILY 13. ClonazePAM 2 mg PO QHS:PRN sleep 14. Spironolactone 25 mg PO DAILY 15. Venlafaxine XR 225 mg PO DAILY 16. Vitamin D ___ UNIT PO DAILY 17. Warfarin 13 mg PO DAILY16 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS ====================== COPD Cellulitis of Left Lower Extremity Varicella Zoster SECONDARY DIAGNOSIS ======================== ATRIAL FIBRILLATION HEART FAILURE WITH PRESERVED EJECTION FRACTION Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you were short of breath. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? - You had a lot of tests to determine the cause of your shortness of breath. - The pulmologists (lung doctors) saw you and think it was due to COPD so we treated you with nebulizers and prednisone. - You also developed shingles in the hospital and were given a medicine to treat this. - You had cellulitis (an infection of your skin) on your left leg and you were given antibiotics for this. You had an MRI to make sure the infection wasn't in the bone. WHAT SHOULD I DO WHEN I GO HOME? - You should continue to take your medications as prescribed. - You should attend the appointments listed below. - Weigh yourself every morning, call your doctor (___) at ___ if your weight goes up more than 3 lbs. - Seek medical attention if you have new or concerning symptoms or you develop swelling in your legs, abdominal distention, or shortness of breath at night. - Your discharge weight: 365 lbs. You should use this as your baseline after you leave the hospital. We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO TID 2. Escitalopram Oxalate 20 mg PO DAILY 3. Lorazepam 0.5-1 mg PO Q6H:PRN nausea 4. Ondansetron ___ mg PO Q8H:PRN nausea 5. Prochlorperazine ___ mg PO Q8H:PRN nausea 6. Ranitidine 150 mg PO DAILY 7. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 8. Zolpidem Tartrate 10 mg PO HS:PRN insomnia 9. Filgrastim 480 mcg SC Q24H 10. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*14 Tablet Refills:*0 11. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*21 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Fever Secondary: Hodgkin's Lymphoma 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 during your stay at ___. You were admitted for a fever. We did not think you had an obvious infection but are sending you home on antibiotics to cover for possible infection. We think that the fever is most likely likely due to Neupogen and/or chemotherapy. Please talk to your outpatient hem/onc doctor about how long to continue the antibiotics. Please keep the follow-up appointments made for you. ___ MDs</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 2. Aspirin 81 mg PO DAILY RX *aspirin [Adult Low Dose Aspirin] 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth QPM Disp #*30 Tablet Refills:*0 4. Bengay Cream 1 Appl TP TID:PRN pain RX *menthol [BenGay Vanishing Scent] 2.5 % apply three times a day Refills:*0 5. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 6. Gabapentin 300 mg PO TID RX *gabapentin 300 mg 1 capsule(s) by mouth three times a day Disp #*90 Capsule Refills:*0 7. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 8. Multivitamins 1 TAB PO DAILY RX *multivitamin [Daily Multi-Vitamin] 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 9. QUEtiapine Fumarate 200 mg PO QHS RX *quetiapine 200 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 10. QUEtiapine Fumarate 50 mg PO QAM RX *quetiapine 50 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 11. Thiamine 250 mg PO DAILY RX *thiamine HCl (vitamin B1) 250 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 12. Furosemide 100 mg PO BID RX *furosemide [Lasix] 80 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 RX *furosemide [Lasix] 20 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 RX *furosemide 20 mg 5 tablet(s) by mouth twice a day Disp #*300 Tablet Refills:*0 13. QUEtiapine Fumarate ___ mg PO Q6H:PRN anxiety, agitation, insomnia 14. Potassium Chloride (Powder) 40 mEq PO DAILY RX *potassium chloride 20 mEq 2 packet(s) by mouth daily Disp #*100 Packet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: acute on chronic systolic heart failure Urinary tract infection Secondary diagnoses: Leg ulcers Mood disorder 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 the hospital because you had gained a lot of weight because you were refusing your diuretic medicine at your rehab. This weight was all fluid. As well, we found that you had a urinary tract infection that we treated with antibiotics. The wound on your leg was treated with dressings but we did not think it was infected. At home you should check your weight every day and if you gain more than 3 pounds you should call your doctor right away. You decided to leave AGAINST MEDICAL ADVICE on ___. We strongly encourage you to seek care at a hospital after leaving because you still have a lot of extra fluid causing strain on your heart and you need ongoing treatment with IV medication to remove fluid. However, you understand the risks of leaving the hospital, including the risks of serious illness and death. Be well, your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to ___ with concern for worsening confusion. This is due to your liver disease. There was no evidence of infection. We increased your lactulose and your mental status improved. Please follow up with your appointments and continue to take your lactulose. Please increase your lactulose to every 2 hours if you notice worsening confusion. Best of luck, it was a pleasure taking care of you. Your ___ medical 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, HA, fever 2. Atenolol 50 mg PO DAILY 3. Codeine Sulfate ___ mg PO Q4H:PRN pain RX *codeine sulfate 15 mg ___ tablet(s) by mouth Q4hrs Disp #*60 Tablet Refills:*0 4. Fluoxetine 20 mg PO DAILY 5. Heparin 5000 UNIT SC TID may start at 2200 ___ 6. LeVETiracetam 1000 mg PO BID Duration: 6 Days Last dose on ___ 7. NIFEdipine CR 60 mg PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Simvastatin 20 mg PO DAILY 10. Xopenex Neb *NF* 1 NEB IH Q6H wheezing Reason for Ordering: Wheezing, albuterol may induce A. Fib 11. Docusate Sodium 100 mg PO BID 12. Senna 1 TAB PO BID constipation 13. Bisacodyl 10 mg PO/PR DAILY constipation 14. Nitroglycerin SL 0.4 mg SL PRN chest pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right Subdural Hematoma 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>Craniotomy for Hemorrhage •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 staples. You may wash your hair only after sutures and/or staples have been removed on ___ •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 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. •Make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ibuprofen 600 mg PO Q8H:PRN headache 2. Sumatriptan Succinate 50 mg PO DAILY:PRN headache 3. TraMADOL (Ultram) 50 mg PO Q6H:PRN headache Discharge Disposition: Home Discharge Diagnosis: Migraine Headaches Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neurological Exam: Non-focal Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted with a headache and back pain. We were concerned that the two symptoms together may have indicated meningitis so we performed a lumbar puncture, which returned as normal. Therefore, we feel that your symptoms were related to a migraine headache. We made no following changes to your medications. Please continue to take your other medications as previously prescribed. If you 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 you on this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H RX *acetaminophen 500 mg 2 tablet(s) by mouth Every 6 hours Disp #*90 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 4. Ibuprofen 600 mg PO Q8H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity Please take for the next ___ days then stop. RX *ibuprofen 600 mg 1 tablet(s) by mouth Every 8 hours Disp #*20 Tablet Refills:*0 5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Severe Duration: 5 Days Reason for PRN duplicate override: Alternating agents for similar severity Please taper off this medication over the next 5 days. RX *oxycodone 5 mg ___ tablet(s) by mouth Every 4 hours Disp #*25 Tablet Refills:*0 6. Senna 17.2 mg PO BID RX *sennosides [Senexon] 8.6 mg 2 Tablet by mouth twice a day Disp #*60 Tablet Refills:*0 7. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 8. Vitamin D 800 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 2 tablet(s) by mouth Daily Disp #*60 Tablet Refills:*0 9. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath 10. amLODIPine 10 mg PO DAILY 11. Aspirin 81 mg PO DAILY 12. Citalopram 20 mg PO DAILY 13. Cyclobenzaprine 5 mg PO TID 14. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 15. Furosemide 20 mg PO DAILY 16. HydrALAZINE 50 mg PO DAILY 17. Loratadine 10 mg PO DAILY 18. LORazepam 1 mg PO QHS:PRN extreem anxiety 19. Metoprolol Tartrate 50 mg PO BID 20. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 21. Omeprazole 20 mg PO DAILY 22. Tamsulosin 0.4 mg PO QHS 23. Tiotropium Bromide 1 CAP IH DAILY 24. TraMADol 50 mg PO TID:PRN Pain - Moderate Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Arthritis pain Likely recurrence of Thymic cancer 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 for control of your blood pressure, evaluation of your shoulder pain, and follow up of your recurrent thymic cancer. You were continued on your home medications and placed on pain control with improvement in your symptoms. You had a CT scan that showed likely recurrence of your thymic cancer. We discussed a biopsy of the site but your declined an inpatient and requested this be worked up as an outpatient instead. As we discussed arthritis pain is not well treated with narcotic pain medication and you will have a short course but the intention is to taper off of this over the upcoming week. Please follow up as noted below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 2. Docusate Sodium 100 mg PO BID hold for ___ stool 3. Metoprolol Succinate XL 50 mg PO DAILY 4. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Severe RX *oxycodone 5 mg 1 tablet(s) by mouth Q4H PRN Disp #*18 Tablet Refills:*0 5. Sulfameth/Trimethoprim DS 1 TAB PO BID RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 6. Glargine 45 Units Bedtime Humalog 10 Units Breakfast Humalog 10 Units Lunch Humalog 10 Units Dinner 7. Amitriptyline 25 mg PO QHS 8. amLODIPine 10 mg PO DAILY 9. Atorvastatin 10 mg PO QPM 10. CloNIDine 0.2 mg PO TID 11. Gabapentin 800 mg PO TID 12. Lisinopril 10 mg PO DAILY 13. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Rt Bellow Knee stump infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, It was a pleasure talking care of you at ___ ___. You were admitted to the vascular surgery service with an infection iof your Rt bellow knee amputation stump. You were admitted with febrile illness and a CT scan of your lower extremities showed a collection at the distal part of your stump. which later drained spont. You were treated conservatively with intravenous antibiotics. You tolerated the treatment well and got better. you were admitted with a Cr of 1.9 ( your lowest levels recently were 1.6) which during your stay went up as high as 2.8 and now trending down. On your day of discharge you are afebrile and feel well. What to expect: You should get stronger every day and the fever should nor return. Your stump should be getting better as well with no erythema or pain. If your fever returns and /or the stump starts to be painful red, warm or develop ulcer and/or a discharge you should be reffered to the ED or call your surgeon. ACTIVITY: - please do not use a prosthesis at least until your visit with Dr ___ a new prosthesis was contumed for you by this time please bring it with you to your visit. - Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. - You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. 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 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 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 fluids and see if it goes away. If it does not go away, or is severe and you feel ill, please call your surgeon. MEDICATIONS: - Take all the medicines you were on before the admission 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. CeFAZolin 2 g IV Q8H Duration: 6 Weeks RX *cefazolin ___ dextrose (iso-os) 2 gram/50 mL 2 Grams IV every eight (8) hours Disp #*126 Intravenous Bag Refills:*0 2. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*84 Tablet Refills:*0 3. MetroNIDAZOLE 500 mg PO TID RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*126 Tablet Refills:*0 4. Aspirin 81 mg PO DAILY 5. Diltiazem Extended-Release 240 mg PO DAILY 6. Lisinopril 20 mg PO DAILY 7. Sotalol 80 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right Foot Infection with osteomyelitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Non-weightbearing to right foot Followup Instructions: ___ [/INST] </s><s>Dear ___ ___ was a pleasure taking care of you at ___. You were admitted to the Podiatric Surgery service for your right foot infection which also required surgery. You were given IV antibiotics while here. You are being discharged home with the following instructions: ACTIVITY: There are restrictions on activity. Please remain non weight bearing to your R foot until your follow up appointment. You should keep this site elevated when ever possible (above the level of the heart!) No driving until cleared by your Surgeon. PLEASE CALL US IMMEDIATELY FOR ANY OF THE FOLLOWING PROBLEMS: Redness ___ or drainage from your leg wound(s). New pain, numbness or discoloration of your foot or toes. Watch for signs and symptoms of infection. These are: a fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site. If you experience any of these or bleeding at the incision site, CALL THE DOCTOR. Exercise: Limit strenuous activity for 6 weeks. No heavy lifting greater than 20 pounds for the next ___ days. Try to keep leg elevated when able. BATHING/SHOWERING: You may shower immediately upon coming home, but you must keep your dressing CLEAN, DRY and INTACT. You can use a shower bag taped around your ankle/leg or hang your foot/leg outside of the bathtub. Avoid taking a tub bath, swimming, or soaking ___ a hot tub for 4 weeks after surgery or until cleared by your physician. Your dressing should be changed daily with betadine soaked gauze and a gauze wrap. MEDICATIONS: Unless told otherwise you should resume taking all of the medications you were taking before surgery. Remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods ___ your diet. (Check with your physician if you have fluid restrictions.) If you feel that you are constipated, do not strain at the toilet. You may use over the counter Metamucil or Milk of Magnesia. Appetite suppression may occur; this will improve with time. Eat small balanced meals throughout the day. DIET: There are no special restrictions on your diet postoperatively. Poor appetite is not unusual for several weeks and small, frequent meals may be preferred. FOLLOW-UP APPOINTMENT: Be sure to keep your medical appointments. If a follow up appointment was not made prior to your discharge, please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit. This should be scheduled on the calendar for seven to fourteen days after discharge. Normal office hours are ___ through ___. PLEASE FEEL FREE TO CALL THE OFFICE WITH ANY OTHER CONCERNS OR QUESTIONS THAT MIGHT ARISE.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for Pain. 2. enoxaparin 30 mg/0.3 mL Syringe Sig: Thirty (30) mg Subcutaneous Q12H (every 12 hours) for 1 months. 3. lovastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 4. Paxil 20 mg Tablet Sig: One (1) Tablet PO once a day. 5. potassium chloride 20 mEq Packet Sig: One (1) PO twice a day. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: - R Distal Femur fracture s/p fall - Delirium SECONDARY DIAGNOSES: - Dementia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Ms. ___, it was a pleasure to participate in your care while you were at ___. You came to the hospital after you feel and fractured your right leg. You were taken to the operating room on ___ to repair your fracture. You had some low blood counts after your surgery so you were given som blood prodcuts. During your hospitalization you became delirious, but this improved. MEDICATION CHANGES: - Medications ADDED: ----> Please start taking lovenox as prescribed for 1 month to prevent blood clots - Medications STOPPED: ----> Hydrochlorothiazide 25 mg daily: While you were in the hospital you did not require this medication. You may not need to be on this medication in the future. Please talk to your primary care doctor about restarting this medication. - Medications CHANGED: None.</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 constipation 3. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate do not drive while on this medication, may cause drowsiness RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY:PRN constipation 5. Senna 8.6 mg PO BID:PRN constipation 6. Sertraline 50 mg PO BID 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>You came to the hospital with abdominal pain. Your abdominal imaging showed acute appendicitis. You were brought to the operating room and had your appendix removed. There were no complications. Your pain is being controlled and you are tolerating your diet. You are ready for discharge home. Please continue your recovery at home by following the instructions 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. Acetaminophen 1000 mg PO TID 2. Cephalexin 500 mg PO Q6H RX *cephalexin 500 mg 1 capsule(s) by mouth Q6hrs Disp #*18 Capsule Refills:*0 3. Sulfameth/Trimethoprim DS 2 TAB PO BID RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*9 Tablet Refills:*0 4. Allopurinol ___ mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. clotrimazole-betamethasone ___ % topical BID:PRN 7. Glucosamine Chondroitin PLUS (gluc-condr-om3-dha-epa-___-st) 375-100-36-54 mg oral DAILY 8. Hydrochlorothiazide 12.5 mg PO DAILY 9. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 10. Lisinopril 5 mg PO DAILY 11. Simvastatin 10 mg PO QPM Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hematoma with concern for infection Cellulitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you during your recent admission to ___. You were admitted with an open leg wound. You were seen by both orthopedic surgery and plastic surgery. Plastic surgery performed bedside drainage of the wound which was likely a hematoma (clotted blood). You were treated with antibiotics and you will be discharged on oral antibiotics. You should continue to change your dressing once per day. You have been scheduled for follow up with your primary care physician. Please discuss returning to work with your primary care doctor. 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 2. Docusate Sodium 100 mg PO BID 3. Enoxaparin Sodium 40 mg SC DAILY Duration: 2 Weeks 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 5. Senna 2 TAB PO HS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: L Comminuted Tib-Fib Fracture Hypernatremia Discharge Condition: Mental Status: Clear and coherent (at baseline mental status) 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 ___ because you broke your bones in the left leg after falling down. Your broken bones were fixed by the orthopedic surgeons and you tolerated the procedure very well. The surgeons placed a splint to keep you leg stabilized and allow it to heal. Your pain was treated with Tylenol. When you were admitted, your sodium was high and you were treated with fluids. Your sodium levels returned to normal at the time of discharge. Please follow your discharge instructions for the care of your left leg splint. Please take your medications as instructed. Please take Lovenox 40mg daily for 2 weeks after discharge for prophylaxis against blood clots. You are nonweightbearing in your left lower extremity until follow-up. Please followup with orthopedics as directed. It was a pleasure taking care of you. MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - You can get the wound wet/take a shower starting 3 days after your surgery. You may wash gently with soap and water, and pat the incision dry after showering. - 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. ACTIVITY AND WEIGHT BEARING: - Nonweightbearing left lower extremity</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 60 mg SC Q12H RX *enoxaparin [Lovenox] 60 mg/0.6 mL 60 mg Subcutaneous every twelve (12) hours Disp #*60 Syringe Refills:*0 2. Levothyroxine Sodium 12.5 mcg PO DAILY RX *levothyroxine 125 mcg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Calcium 500 + D (D3) (calcium carbonate-vitamin D3) 500 mg(1,250mg) -125 unit oral DAILY 4. Denosumab (Prolia) 60 mg SC EVERY 6 MONTHS 5. Docusate Sodium 240 mg PO BID 6. Ferrous Sulfate 325 mg PO EVERY OTHER DAY 7. Gabapentin 100 mg PO TID 8. Lidocaine 5% Patch 1 PTCH TD QAM knee pain 9. PredniSONE 5 mg PO DAILY 10. Ranitidine 150 mg PO BID 11. Sulfameth/Trimethoprim SS 1 TAB PO DAILY Discharge Disposition: Home Discharge Diagnosis: Pulmonary embolism and port-associated RA thrombus Constipation Metastatic bladder cancer Pembrolizumab associated COOP Fatigue Hypothyroidism Normocytic anemia L3 compression 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 with a blood clot associated with your port and pacemaker wire. Your blood thinner was switched from Apixaban to Enoxaparin (Lovenox), which you have used before. Please follow with your hematologist-oncologist in about 1 months. You will have a repeat ultrasound of the heart around the time of that visit. Additionally, your thyroid tests were abnormal. It seems like your thyroid is not producing enough hormone. After conversation with your outpatient provider, we have decided to start you on a thyroid hormone replacement and they will recheck values in about 1 month. 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. Aspirin 81 mg PO DAILY 2. Cyanocobalamin 1000 mcg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis -Vasovagal syncope Secondary diagnosis -Diarrhea, unexplained etiology -Unspecified disturbances of skin sensation 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 from ___ because you had a syncopal episode in the ER, with low heart rate and blood pressure. When you came here your vital signs were stable, and the enzyme we check for people with heart attacks (troponin) were negative. You had some changes in your EKG, but since we didn't have a comparison, we didn't know if they were new. While in the hospital we watched your heart rate on telemetry and you didn't have any unusual rhythms or more syncopal episodes. We felt the episode was likely due to a vasovagal response, which can occur in times of emotional or physiologic stress such as your recent diarrhea. We feel it's important to diagnose what's causing your diarrhea, and feel it's safe for you to be discharged home to complete the colonoscopy on ___. Please follow up with your primary care physician on your appointment ___ they may recommend additional follow-up with cardiology, but we didn't feel the need to run additional cardiac tests during your admission. Please do not drive until you feel well again. Thank you for letting take part in your medical care. Sincerely, Your ___ Health Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enalapril Maleate 5 mg PO DAILY 2. Estradiol 1 mg PO DAILY 3. Hydrochlorothiazide 25 mg PO DAILY 4. Outpatient Physical Therapy Please evaluate and provide home physical therapy. Discharge Disposition: Home Discharge Diagnosis: Primary: Acute Low Back Pain Secondary: 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 ___, It was a pleasure taking care of you. You were admitted to the hospital for low back pain. We treated you with medications to control your pain and nausea. You will follow up with your orthopedist for further management of this issue. Please do not drive or operate machinery for the rest of the day or in the future if you have used sedating medications (eg oxycodone, valium) Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 50 mg PO DAILY 2. Chlorthalidone 25 mg PO DAILY 3. Fludrocortisone Acetate 0.05 mg PO DAILY 4. Hydrocortisone 15 mg PO QAM 5. Hydrocortisone 10 mg PO QPM 6. Lorazepam 0.5 mg PO Q8H:PRN anxiety 7. Mirtazapine 15 mg PO HS 8. Sertraline 200 mg PO DAILY 9. Simvastatin 20 mg PO DAILY 10. pazopanib *NF* 400 mg Oral QD 11. Prochlorperazine 10 mg PO Q6H:PRN nausea 12. Acetaminophen 1000 mg PO Q8H:PRN headache available over the counter 13. Divalproex (DELayed Release) 750 mg PO BID RX *divalproex [Depakote] 250 mg 3 tablet(s) by mouth twice a day Disp #*90 Tablet Refills:*0 14. OxycoDONE (Immediate Release) ___ mg PO Q6H:PRN severe pain RX *oxycodone 5 mg ___ to1 tablet(s) by mouth q6hr; prn Disp #*60 Tablet Refills:*0 15. Outpatient Lab Work Dx = Convulsive Seizure ICD 345.10. Please draw "depakote" level on ___ and fax result to Dr. ___ and Dr. ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: seizure w/ fall, small head bleed metastatic renal cell carcinoma depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>You were admitted for evaluation of a seizure. For this, you were started on a new medication called depakote to help prevent further seizures. In addition, you had a head imaging (CT scan) that showed concern for a possible small bleed and you were evaluated by the neurosurgical service. In addition, you underwent an MRI that showed which did not show anyhing further though was limited by motion artifact. You were evaluated by the physical therapists as well as occupational therapists who felt that you wouild be ideally served in rehab. You declined to go to rehab so services are being increased for you at home. Please take acetaminophen and oxycodone for any residual headache. Please follow up with your physicians.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. metoprolol succinate 100 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 2. furosemide 40 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). 3. levothyroxine 75 mcg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. simvastatin 40 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 6. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation BID (2 times a day). 7. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 14 days. 8. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. insulin regular human 100 unit/mL Solution Sig: One (1) inj Injection ASDIR (AS DIRECTED): per attached sliding scale. 11. Coumadin 5 mg Tablet Sig: One (1) Tablet PO once a day: Start ___. Adjust for goal INR ___. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. colocutaneous fistula 2. cellulitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You came to the hospital because you noted fluid draining from your an area in your abdomen. You were found to have a colocutaneous fistula. It has been determined that it is not safe to surgically fix the draining fistula at this time. You have been seen by the ostomy nurse who has placed an appliance to collect the drainage. You were also noted to have an area of redness around the fistula, likely related to the drainage. A CT scan was done to ensure that there is no drainable collection of fluid under your skin. You are being treated with antibiotics for the infection of you skin in that area. You will be on antibiotics for 2 weeks. Please follow up at the appointment listed below in the ___ clinic. If you have any questions/concerns prior to your follow up appointment you can call the clinic at ___. Your coumadin has been held for short time because of the interaction it has with one of the antibiotics you were on initially. You are no longer on this antibiotic and can resume taking your coumadin on ___. 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. *If you have increase abdominal distention, abdominal pain or nausea. *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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H pain 2. Amlodipine 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Carvedilol 25 mg PO BID 5. Chlorthalidone 50 mg PO DAILY 6. Cyclobenzaprine 10 mg PO QID:PRN muscle spasm RX *cyclobenzaprine 10 mg 1 tablet(s) by mouth every 6 hours as needed Disp #*30 Tablet Refills:*0 7. Diltiazem 90 mg PO QID 8. HydrALAzine 100 mg PO Q6H 9. Lisinopril 40 mg PO DAILY 10. Ibuprofen 600 mg PO Q8H:PRN pain 11. Spironolactone 50 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Back/Neck Pain 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 the hosptial with severe upper back/neck pain. We were concern that this could be a sign of a problem with your thoracic artery stent. You were treated with muscle relaxers and pain medications. The neurology team evaluated you and did an MRI of the cervical spine. We did not see any abnormalities. THe pain improved and we have arranged for you to follow up with your PCP to discuss ___ or other therapies for your discomfort. Duing your hopitalization, your BP control was excellent on your new medication regiment. 130-110/80s. Please continue all the medications you were taking before you were admitted. You were given a prescription for a muscle relaxer to take if needed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Amlodipine 5 mg PO DAILY 3. Clopidogrel 75 mg PO DAILY 4. Doxazosin 2 mg PO HS 5. Fish Oil (Omega 3) 2400 mg PO BID 6. Losartan Potassium 100 mg PO DAILY 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Pravastatin 20 mg PO QPM 10. Niacin SR 1000 mg PO DAILY 11. Aspirin 325 mg PO DAILY 12. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain Discharge Disposition: Home Discharge Diagnosis: Primary: Chest Pain Secondary: CAD s/p attempted PCI of RCA ___ with plan re-canalization on ___ Paroxysmal Atrial Fibrillation Hypertension Hyperlipidemia PVD s/p ___ iliac and femoral stents. Gout BPH HLD 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 came to the hospital with chest pain. You were found to have no signs of worsening cardiac disease. Your chest pain resolved by the time you got to the hospital. If your pain is not responsive to nitroglycerin you should go to the emergency room. You are scheduled for your cardiac catheterization with Rotoblader treatment on ___. Dr. ___ is aware of your hospitalization. It was a pleasure meeting you. 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. ammonium lactate ___ % topical BID:PRN 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 40 mg PO QPM 5. Cyanocobalamin 1000 mcg IM/SC MONTHLY 6. Docusate Sodium 100 mg PO BID 7. Finasteride 5 mg PO DAILY 8. FLUoxetine 40 mg PO DAILY 9. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 10. melatonin 6 mg oral QHS 11. Multivitamins 1 TAB PO DAILY 12. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 13. QUEtiapine Fumarate 25 mg PO QHS 14. Terazosin 2 mg PO QHS 15. Timolol Maleate 0.5% 1 DROP BOTH EYES BID 16. Vitamin E 400 UNIT PO DAILY 17. Warfarin 7.5 mg PO DAILY16 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: metabolic encephalopathy fall weakness supratherapeutic INR Discharge Condition: fair Ambulatory with 1 person assist Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted after a fall and had some confusion/hallucinations. We think the confusion might have been related to a viral illness, which resolved promptly without intervention. Your INR was high which was likely from the antibiotics you received outpatient. We held a few doses of warfarin, but you may resume your normal dose after discharge. Our physical therapist evaluated you and think you will benefit from rehab. Please follow up with your primary care doctor in 2 weeks. It was a pleasure caring for you in ___!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aztreonam ___ mg IV Q8H Last day ___ RX *aztreonam in dextrose(iso-osm) [Azactam in dextrose (iso-osm)] 2 gram/50 mL 2 gm IV Q8hrs Disp #*240 Vial Refills:*0 2. Docusate Sodium 100 mg PO BID:PRN constipation 3. FoLIC Acid 1 mg PO DAILY 4. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain 5. Glargine 12 Units Bedtime 6. Lorazepam 0.5 mg PO Q8H:PRN nausea/anxiety 7. Ondansetron 4 mg PO Q8H:PRN nausea 8. Senna 1 TAB PO BID 9. Famotidine 20 mg PO Q12H RX *famotidine 20 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 10. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H Take until ___ RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth Q8hrs Disp #*90 Tablet Refills:*0 11. Outpatient Lab Work Please check weekly CBC, Chem 7, BUN/CR and AST/ALT and have results faxed to ___ R.N.s at ___. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Diverticulitis/Transverse Colitis Pleural effusion Secondary: Pancreatitis with pseudocysts Secondary diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you during your recent admission to ___. You were admitted with fevers and found to have inflammation surrounding your colon. You were followed by the surgical teams, and infectious diseases. A repeat CT scan showed fluid collections which are not able to be drained. You will need to continue antibiotics until you see the infectious disease doctors at which time they will discuss with you further work up and treatment. If you develop, fever, nausea/vomiting or worsening abdominal pain or other symptoms which concern you, please return to the hospital. . You were also noted to have fluid surrounding your lung. This fluid was removed and did not show an infection. . For your pancreatitis, you were continued on tube feeds and clear liquids. You will need to follow up with Dr. ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CefTRIAXone 2 gm IV Q24H RX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 2 gm IV every 24 hours Disp #*18 Intravenous Bag Refills:*0 2. Fluconazole 400 mg PO Q24H RX *fluconazole [Diflucan] 200 mg 2 tablet(s) by mouth daily Disp #*36 Tablet Refills:*0 3. Fentanyl Patch 100 mcg/h TD Q72H RX *fentanyl 100 mcg/hour 1 patch every 72 hours Disp #*5 Patch Refills:*0 4. OxyCODONE (Immediate Release) 15 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 15 mg 1 tablet(s) by mouth every four hours Disp #*60 Tablet Refills:*0 5. Famotidine 20 mg PO DAILY 6. LORazepam 1 mg PO Q4H:PRN anxiety 7. Ondansetron 8 mg IV BID n/v RX *ondansetron HCl 2 mg/mL 8 mg IV twice a day Disp #*28 Vial Refills:*0 8. Ondansetron 8 mg IV DAILY:PRN nausea RX *ondansetron HCl 2 mg/mL 8 mg IV daily Disp #*14 Vial Refills:*0 9. Oxybutynin 10 mg PO QHS 10. Pantoprazole 40 mg PO Q12H 11. Prochlorperazine 10 mg PO Q6H:PRN nausea 12. Thiamine 100 mg PO TID 13.Normal Saline 0.9% Solution Sig: Please infuse 1L of IV Normal Saline over ___ hours daily. Disp: 14 Bags of IVF Refills: 0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Cholangitis Hepatic abscess R pleural effusion Secondary: Metastatic appendiceal carcinoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ because you were having fevers. You were found to have an abscess in your liver and infection in your bile, called cholangitis. The liver abscess was aspirated, and you had two drains placed to drain your bile. You were also given antibiotics to treat your infection. Please continue to take the ceftriaxone and fluconazole until ___ and when you are seen by the infectious disease doctors. ___ will tell you when to stop taking these. You were also experiencing some shortness of breath and had fluid drained from your lung which helped this. Physical therapy also worked with you to help you get stronger. Thank you for choosing ___ for your health care. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sucralfate 1 gm PO QID Duration: 2 Weeks RX *sucralfate 1 gram/10 mL 1 mL by mouth four times a day Disp #*1 Bottle Refills:*0 2. Fluticasone Propionate NASAL 1 SPRY NU DAILY 3. Lactulose 30 mL PO TID 4. Midodrine 10 mg PO TID RX *midodrine 10 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*3 5. BuPROPion XL (Once Daily) 150 mg PO DAILY 6. BuPROPion XL (Once Daily) 300 mg PO DAILY 7. Escitalopram Oxalate 10 mg PO DAILY 8. Pantoprazole 40 mg PO Q24H 9. rifAXIMin 550 mg PO BID 10.Outpatient Lab Work ICD-9 571.5 Please collect chem 10 weekly Fax results to Dr. ___ at ___. Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS ================= Acute kidney injury SECONDARY DIAGNOSES =================== Decompensated alcoholic cirrhosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Dr. ___, ___ were hospitalized at ___ from ___. WHY WERE ___ ADMITTED? - ___ were admitted because your kidney function had declined. WHAT HAPPENED WHILE ___ WERE ADMITTED? - We stopped your diuretics, which was likely contributing to your kidney injury. - We gave ___ IV fluids and medicine that helped your kidney function to improve. - We did an endoscopy and banded three swollen blood vessels in your throat to prevent them from bleeding in the future. WHAT SHOULD ___ DO AFTER ___ LEAVE THE HOSPITAL? - Follow up with your doctors as listed in this paperwork. - Take all of your medications. - Refrain from drinking any amount of alcohol as it will damage your already unhealthy liver. It was a pleasure caring for ___. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital with nausea/vomiting and found to have a small bowel obstruction due to your pancreatic neuroendocrine tumor. In addition to your primary medicine team, the surgery, hepatology and gastroenterology teams also evaluated you. For the small bowel obstruction, your symptoms improved, and surgery decided based on the imaging and your symptoms that it is reasonable to wait to do a bypass. Please go to the follow up appointment with them. For your ascites, the hepatology team evaluated and felt that it was unlikely due to underlying cirrhosis and more likely due to portal hypertension as well as lymph node system obstruction. We did a paracentesis and will notify you of the results. In addition to your surgery follow up appointment, we also scheduled a follow up appointment with your oncologist and primary care doctor. It was a pleasure taking care of you! Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q8H:PRN Pain - Mild 2. Calcium 600 with Vitamin D3 (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral BID 3. Citalopram 20 mg PO DAILY 4. Clopidogrel 75 mg PO DAILY 5. Cyanocobalamin 100 mcg PO DAILY 6. Glargine 24 Units Breakfast Humalog 14 Units Lunch Humalog 6 Units Dinner Insulin SC Sliding Scale using HUM Insulin 7. Lisinopril 10 mg PO DAILY 8. MetFORMIN (Glucophage) 500 mg PO BID 9. Mirtazapine 7.5 mg PO QHS:PRN insomnia 10. PredniSONE 5 mg PO DAILY 11. RisperiDONE 0.25 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Urinary tract infection Hypoxia 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>Dear Ms. ___, It was a pleasure caring for you at ___ ___! WHY YOU WERE ADMITTED: -You were having difficulty breathing and we were concerned you had a urinary infection WHAT HAPPENED IN THE HOSPITAL: -You were treated with antibiotics for the infection in your urine -Imaging of your lungs showed the right side of your diaphragm is higher than usual. There is nothing that needs to be done about this -An echocardiogram of your heart was normal -Your breathing improved with treating your infection WHAT YOU SHOULD DO AT HOME: -It is very important to be cleaned well after any incontinence to prevent future infections -Follow-up with your doctors as ___ below. 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. Albuterol Inhaler ___ PUFF IH Q4H:PRN wheeze 2. Amlodipine 5 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Fluticasone Propionate 110mcg 2 PUFF IH BID 5. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain 6. Lisinopril 10 mg PO DAILY 7. Lorazepam 1 mg PO Q8H:PRN anxiety 8. Metoclopramide 10 mg PO QIDACHS 9. Nortriptyline 75 mg PO QHS 10. Omeprazole 40 mg PO BID 11. Pravastatin 40 mg PO QPM 12. PredniSONE 20 mg PO DAILY 13. Fenofibrate (fenofibrate nanocrystallized) 145 mg ORAL QAM 14. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 7 Days RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet by mouth every twelve (12) hours Disp #*14 Tablet Refills:*0 15. Magnesium Oxide 400 mg PO BID RX *magnesium oxide 400 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 16. Nystatin Cream 1 Appl TP BID Duration: 5 Days RX *nystatin 100,000 unit/gram Apply to affected area. twice a day Refills:*0 17. Oxybutynin 5 mg PO TID RX *oxybutynin chloride [Ditropan XL] 5 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 18. Phosphorus 500 mg PO TID RX *sod phos,di & mono-K phos mono [Phospha 250 Neutral] 250 mg 2 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 19. Potassium Chloride 20 mEq PO DAILY RX *potassium chloride 20 mEq 1 tablet(s) by mouth qday Disp #*30 Tablet Refills:*0 20. MetFORMIN (Glucophage) 500 mg PO BID 21. Sulfameth/Trimethoprim DS 1 TAB PO 3X/WEEK (___) 22. Ibuprofen 400 mg PO Q8H:PRN pain 23. Outpatient Lab Work Please draw Chem-10 panel on ___ Indication: ICD-9-CM ___ Fax results to Dr. ___ (FAX: ___ 24. Glargine 14 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 25. Outpatient Physical Therapy Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: - Paradoxical vocal cord dysfunction Secondary Diagnoses: - Urinary tract 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>Dear ___, ___ were admitted to ___ on ___ with worsening shortness of breath, cough, weakness and urinary incontinence. ___ were seen by our ENT, Neurology, and Pulmonary specialists and we had further discussions with our Interventional Pulmonary team who recommended that there was no acute intervention that could be offered at this time. ___ were found to have a urinary tract infection and have been prescribed antibiotics to continue taking for several days after hospital discharge. ___ also had some mild electrolyte abnormalities which were corrected with oral supplementation and we have prescribed ongoing oral supplementation for ___ to take at home on an ongoing basis. Regarding your ongoing urinary incontinence, we are in the process of setting up a follow up appointment for ___ with neurology. ___ will be called regarding scheduling this appointment. We also highly recommend that ___ follow up with your outpatient urologist for further management of this issue. Regarding your ongoing cough and shortness of breath, ___ have been scheduled follow up with your pulmonologist. It was a pleasure to take care of ___ 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. Citalopram 20 mg PO DAILY 2. Nephrocaps 1 CAP PO DAILY 3. Acetaminophen 1000 mg PO Q8H 4. Heparin 5000 UNIT SC TID 5. Lidocaine 5% Patch 1 PTCH TD QAM 6. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth q6hrs prn Disp #*30 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: Right Hip fracture s/p ORIF Secondary Diagnosis: Heart failure with preserved EF HTN Gout CKD stage V on Hemodyalisis 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 ___ at ___. ___ broke your left hip and our orthopedic surgions successfully repaired it. We observed ___ for several days and ___ have remained stable after requiring a brief stay in the ICU following your surgery. ___ will continue to work on regaining your strength at rehab.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Duloxetine 90 mg PO DAILY 2. Gabapentin 300 mg PO HS 3. Gabapentin 200 mg PO TID 4. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 5. Lisinopril 10 mg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN pain hold for RR <12 or sedation RX *oxycodone 10 mg 1 tablet(s) by mouth q4H PRN Disp #*80 Tablet Refills:*0 8. Ranitidine 150 mg PO BID 9. Simvastatin 20 mg PO DAILY 10. Timolol Maleate 0.5% 1 DROP BOTH EYES QAM 11. Acetaminophen 650 mg PO Q6H:PRN pain 12. Docusate Sodium 100 mg PO BID constipation RX *Colace 100 mg 1 capsule(s) by mouth BID PRN Disp #*30 Tablet Refills:*0 13. Nicotine Patch 14 mg TD DAILY nicotine craving RX *nicotine 14 mg/24 hour 1 patch daily Disp #*28 Transdermal Patch Refills:*0 14. Oxycodone SR (OxyconTIN) 20 mg PO Q12H hold for RR <12 or sedation RX *OxyContin 20 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*30 Tablet Refills:*0 15. Senna 1 TAB PO BID constipation RX *senna 8.6 mg 1 tab by mouth BID PRN Disp #*60 Tablet Refills:*0 16. Infliximab 800 mg IV Q5WEEKS 17. MetFORMIN (Glucophage) 1000 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Metastatic malignancy, suspected renal origin with metastases to thoracic spine, adrenal and spleen Thrombocytopenia 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 came to the hospital because of left hand weakness and numbness. Your MRI showed a new mass in the thoracic spine. A CT scan of your abdomen, pelvis and chest showed a mass on the kidney with spread to an adrenal gland and the spleen. Your underwent a biopsy of the spinal mass which showed that there are malignant (cancerous) cells present. We suspect you likely have a kidney cancer, but this needs to be finalized by the pathologist over the next few days. You were seen by oncology who is working on scheduling follow up for you (they will contact you with the appointment and time). Please follow up with your PCP and ___ liver doctor here at ___.</s>