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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ascorbic Acid ___ mg PO DAILY 2. Calcium Carbonate 1500 mg PO DAILY 3. Cyanocobalamin 1000 mcg PO DAILY 4. Fish Oil (Omega 3) 1000 mg PO DAILY 5. Hydrocerin 1 Appl TP TID:PRN patient request 6. Hydrocortisone Cream 2.5% 1 Appl TP BID itchy rash 7. HydrOXYzine 50 mg PO Q4H:PRN patient request 8. Mupirocin Ointment 2% 1 Appl TP BID 9. Nystatin Cream 1 Appl TP BID 10. Vitamin D 1000 UNIT PO BID 11. Glutamine 500 mg PO BID 12. Clindamycin 300 mg PO Q8H RX *clindamycin HCl 300 mg 1 capsule(s) by mouth every eight (8) hours Disp #*18 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Viral syndrome NOS Secondary diagnosis: Atopic dermatitis 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 while you were a patient at ___. You came to us with fever and abdominal pain. Your fever most likely represents a viral illness. Your abdominal pain is most likely mild gastritis. Your symptoms resolved overnight. On the recommendations of Dr. ___ are sending you home with 6 days of oral clindamycin to cover for a bacterial infection. We wish you all the best.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cyanocobalamin 1000 mcg IM/SC ONCE 2. mometasone 0.1 % topical ASDIR 3. Ranitidine 150 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Partial small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized for a partial obstruction of your small bowel and have undergone testing to determine the cause of your obstruction. Thus far, testing has been inconclusive. You obstruction has since resolved and you are now tolerating a low residue diet. You are now preparing for discharge to home, but will need to follow-up with your gastroenterologist for ongoing evaluation. Please note 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. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 2. Docusate Sodium 100 mg PO BID 3. LevETIRAcetam 1000 mg PO BID RX *levetiracetam 1,000 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*5 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Left subdural hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Brain Hemorrhage with Surgery Surgery • You underwent a surgery called a craniotomy to have blood removed from your brain. • Please keep your sutures or 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. Aspirin 81 mg PO DAILY 2. Carbidopa-Levodopa (___) 1 TAB PO Q3H 3. Docusate Sodium 100 mg PO DAILY 4. Selegiline HCl 5 mg PO BID 5. Tasmar (tolcapone) 50 mg ORAL Q3H 6. Mirapex ER (pramipexole) 1.125 mg oral @9pm 7. Cyanocobalamin 500 mcg PO DAILY 8. Fludrocortisone Acetate 0.1 mg PO BID 9. Vitamin D 1000 UNIT PO DAILY 10. Levothyroxine Sodium 88 mcg PO DAILY RX *levothyroxine 88 mcg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 11. Senna 8.6 mg PO HS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS 1. Fall SECONDARY DIAGNOSIS 1. ___ Disease 2. Orthostatic Hypotension 3. Hypothyroidism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___: It was our pleasure caring for you at ___ ___. You were admitted because you fell and there was concern that you may have been confused. You were evaluated by the physical therapists who determined that you were safe to return home. Please use your walker or wheelchair at all times to avoid future falls. Please also consider a bed alarm at night to avoid falls at night. Please also start taking the new dose of your Levothyroxine which has been decreased. When you arrived on the general medicine floor, there was no evidence that you were confused. Thank you for choosing ___. We wish you the best. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 3. Ciprofloxacin HCl 500 mg PO Q12H Duration: 4 Days 4. Diazepam 2 mg PO Q6H:PRN muscle spasm 5. Docusate Sodium 100 mg PO BID 6. Heparin 5000 UNIT SC BID 7. HydrALAZINE 10 mg IV Q6H:PRN SBP > 160 8. Morphine Sulfate ___ mg IV Q3H:PRN BREAKTHROUGH PAIN 9. Omeprazole 20 mg PO DAILY 10. Ondansetron 4 mg IV Q8H:PRN nausea/vomiting 11. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate 12. Polyethylene Glycol 17 g PO DAILY:PRN constipation 13. Senna 8.6 mg PO QHS 14. Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush 15. Hydrochlorothiazide 25 mg PO DAILY 16. Lisinopril 5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ ___) Discharge Diagnosis: C3-C6 spinal cord compression 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>Surgery •Your incision is closed with sutures. You will need suture removal. Please keep your incision dry until suture removal. •Do not apply any lotions or creams to the site. •Please avoid swimming for two weeks after suture removal. •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. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •No contact sports until cleared by your neurosurgeon. Medications •Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. •It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Simvastatin 80 mg PO QPM 3. Omeprazole 20 mg PO BID 4. Citalopram 20 mg PO DAILY 5. Levothyroxine Sodium 125 mcg PO DAILY 6. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation prn sob 7. Tiotropium Bromide 1 CAP IH DAILY RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 CAP IH once a day Disp #*30 Capsule Refills:*0 8. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID RX *fluticasone-salmeterol [Advair Diskus] 100 mcg-50 mcg/dose 1 IH INH twice daily Disp #*1 Disk Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: Mechanical fall with T4 compression fracture SECONDARY: CVA ___ with residual right lower extremity weakness COPD 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 ___. You were admitted because you fell and were thought to have pneumonia. Fortunately, you did not have symptoms of pneumonia. You have been started on new breathing treatments which will better management your shortness of breath and cough. Physical therapy evaluated you given your fall, and felt that you needed rehab to help improve your strength and mobility. You would prefer to go home. After discussing with you and your family decision was made to send you home. You will need to call and set up an appointment with your PCP. You a have an appointment with the ___ regarding your fracture, see below. You were seen by the speech and swallow team and they were concerned that you have some difficulty with swallowing thin liquids. They recommended thickened liquids. You will need to have this followed up. 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 1000 mg PO Q6H:PRN Pain - Mild/Fever 2. Lisinopril 20 mg PO DAILY 3. Amlodipine 4. HCTZ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Central Cord Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You have been managed for a spinal cord injury called central cord syndrome. Please see below for management of this when you are discharged from the hospital • Activity: You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit in a car or chair for more than ~45 minutes without getting up and walking around. • Rehabilitation/ Physical Therapy: ___ ___ times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. • Cervical Collar / Neck Brace: You ___ this brace if it makes you feel more comfortable - you do not need to wear it • You should resume taking your normal home medications. Follow up: ___ Please Call the office and make an appointment for 2 weeks after the day of your injury if this has not been done already.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluconazole 150 mg PO Q72H yeast infection RX *fluconazole 150 mg 1 tablet(s) by mouth every 72 hours Disp #*3 Tablet Refills:*0 2. Acetaminophen 1000 mg PO Q8H 3. Denosumab (Prolia) 60 mg SC Q6MOS 4. desvenlafaxine succinate 100 mg oral DAILY 5. Enoxaparin Sodium 40 mg SC DAILY For 28 days post-op 6. Gabapentin 600 mg PO TID 7. LevETIRAcetam 500 mg PO BID 8. Multivitamins 1 TAB PO DAILY 9. TraZODone 50 mg PO QHS:PRN insomina 10. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Crohn's disease with retained rectum Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, 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. Though your ileostomy is not new, please keep in mind the below instructions. The most common complication from an ileostomy is dehydration. You must measure your ileostomy output for the next few weeks- please bring your I&O sheet to your post-op appointment. The output should be no less than 500cc or greater than 1200cc per day. If you find that your output has become too much or too little, please call the office. Please monitor for signs and symptoms of dehydration. If you notice these symptoms, please call the office or go to the emergency room. You will need to keep yourself well hydrated, if you notice your ileostomy output increasing, drink liquids with electrolytes such as Gatorade. Please monitor the appearance of your stoma and care for it as instructed by the ostomy nurses. ___ you notice that the stoma is turning darker blue or purple please call the office or go to the emergency room. The stoma may ooze small amounts of blood at times when touched which will improve over time. Monitor the skin around the stoma for any bulging or signs of infection. Please avoid prolonged direct pressure to the area of the incision where your rectum once was for at least 2 weeks after surgery. For example, if you ride in a car, sit in the back seat with your feet up or if sitting in the front seat, sit with the back of the seat down. While sitting on the couch, swing your feet onto the couch and place pillows behind your back. When you are in bed, turn side to side frequently with a pillow behind your back. It is okay to lie on your back for a limited amount of time with your head down. For meals it is okay to sit for ___ minutes as long as you move from side to side. There is no limit to walking and you should walk as much as you can tolerate. At your follow-up appointment your surgeon will lift precautions as the incision is healing. You will be going home with your JP (surgical) drain, which will be removed at your post-op visit. Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). Maintain suction of the bulb. Note color, consistency, and amount of fluid in the drain. Call if the amount increases significantly or changes in character. Be sure to empty the drain as needed and record output. You may shower; wash the area gently with warm, soapy water. Keep the insertion site clean and dry otherwise. Avoid swimming, baths, hot tubs; do not submerge yourself in water. Make sure to keep the drain attached securely to your body to prevent pulling or dislocation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 20 mg PO DAILY 2. Naproxen 500 mg PO Q12H:PRN pain Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Alcohol intoxication Multifocal atrial tachycardia Secondary diagnosis: Hepatitis C Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>*********PATIENT ELECTED TO LEAVE AGAINST MEDICAL ADVISE********** You were hospitalized because of chest pain and abnormal, fast heart rhythm. Your fast heart rate improved with IV fluids. Your liver enzymes were also found to be elevated, likely because of your recent alcohol consumption, but they were noted to be trending down on the morning that you decided to leave. You were able to verbalize that you understood that you were leaving against medical advice and would assume the risk of leaving against medical advice in light of incomplete work-up. ****DO NOT DRINK ALCOHOL OR USE OTHER ILLEGAL SUBSTANCES**** We have *NOT* made any medication changes. Continue taking medications as prescribed by your health care providers. Please follow-up with your primary care physician at ___ ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H 2. Albuterol Inhaler 2 PUFF IH Q2H PRN wheeze sob 3. Artificial Tears 1 DROP BOTH EYES BID 4. Bisacodyl 10 mg PR PRN constipation 5. Bisacodyl 10 mg PO DAILY:PRN constipation 6. Cyanocobalamin 100 mcg PO DAILY 7. Docusate Sodium 100 mg PO BID 8. Fluoxetine 40 mg PO DAILY 9. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 10. Guaifenesin 10 mL PO Q4H:PRN cough 11. Hydrocerin 1 Appl TP TID:PRN dry/irritated skin 12. Ipratropium-Albuterol Neb 1 NEB NEB QID 13. Lactulose 30 mL PO DAILY:PRN constipation 14. Lisinopril 2.5 mg PO DAILY 15. Metoprolol Tartrate 6.25 mg PO BID 16. Milk of Magnesia 30 mL PO PRN constipation 17. Omeprazole 20 mg PO DAILY 18. Polyethylene Glycol 17 g PO BID 19. Senna 17.2 mg PO QHS 20. Simvastatin 40 mg PO QPM 21. Tiotropium Bromide 1 CAP IH DAILY 22. Torsemide 80 mg PO DAILY 23. Cephalexin 500 mg PO Q6H Duration: 4 Days RX *cephalexin 500 mg 1 tablet(s) by mouth every six (6) hours Disp #*24 Tablet Refills:*0 24. Acetaminophen 650 mg PO Q6H:PRN pain/fever do not exceed 3 g/day 25. Cepacol (Menthol) 1 lozenge Other q4h:prn sore throat 26. Fleet Enema 1 Enema PR PRN constipation 27. Fluticasone Propionate NASAL 1 SPRY NU DAILY 28. GlipiZIDE 5 mg PO BID 29. Potassium Chloride 20 mEq PO DAILY Hold for K > 30. MetFORMIN (Glucophage) 1000 mg PO BID 31. TraMADOL (Ultram) 50 mg PO Q6H:PRN severe pain 32. Aspirin 81 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnoses: Chronic venous statis, venous stasis ulcer, cellulitis Secondary diagnoses: Paroxysmal a fib, copd, obesity, DM 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 during your stay at ___. You were admitted for swelling of your legs which the medicine team believes is due to chronic venous stasis (poor circulation) with a possible overlying cellulitis. You should continue taking the prescribed antibiotics for 5 days total. Also, please use compression stockings regularly to help with the poor circulation. Your increased urination was attributed to use of your diuretic pill after periods of non-use. If you develop worsening burning, tingling, or urinary frequency, especially without taking the diuretic, please notify your primary care provider. A discussion was had concerning your need for anti-coagulation in the setting of atrial fibrillation. Because you don't like needles, you chose not to take warfarin. The alternative of ___ was presented, which does not require monitoring, and you agreed to try it. Because you are on aspirin, this will be deferred until your cardiologist approves it. Overall your vital signs were stable, you were breathing at baseline, and you were without fever, so you were deemed safe for discharge back to your nursing home. Wishing you well, Your ___ Medicine Team 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 650 mg PO Q6H 2. cefaDROXil 500 mg oral BID Duration: 10 Days RX *cefadroxil 500 mg 1 capsule(s) by mouth twice a day Disp #*20 Capsule Refills:*0 3. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN BREAKTHROUGH PAIN RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*15 Tablet Refills:*0 4. Glargine 35 Units Bedtime 5. Atorvastatin 20 mg PO QPM 6. Chlorthalidone 25 mg PO DAILY 7. Lisinopril 5 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Right forearm cellulitis and potential septic olecranon bursitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER HAND SURGERY: - You were in the hospital for hand surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Weight bearing as tolerated Right upper extremity MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTIBIOTICS: - Please take oral cefadroxil twice daily for 7 days. WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - If you have a splint in place, splint must be left on until follow up appointment unless otherwise instructed. Do NOT get splint wet. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath or coughing 2. Aspirin EC 81 mg PO DAILY 3. Atorvastatin 20 mg PO HS 4. Digoxin 0.125 mg PO DAILY 5. Glargine 48 Units Breakfast Glargine 48 Units Bedtime Insulin SC Sliding Scale using HUM Insulin RX *blood sugar diagnostic [FreeStyle Test] as directed TID before meals Disp #*1 Box Refills:*3 6. Losartan Potassium 25 mg PO DAILY 7. Omeprazole 20 mg PO BID 8. Torsemide 60 mg PO DAILY 9. traZODONE 100 mg PO HS RX *trazodone 100 mg one tablet(s) by mouth hs Disp #*30 Tablet Refills:*2 10. Nicotine Patch 14 mg TD DAILY 11. HumaLOG KwikPen (insulin lispro) 100 unit/mL Subcutaneous TID 12. TraMADOL (Ultram) 50 mg PO BID:PRN severe pain only Discharge Disposition: Home Discharge Diagnosis: Acute on chronic systolic heart failure Acue on chronic kidney injury Restrictive lung disease Diabetes Mellitus Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you at ___. You were admitted with heart failure and was given diuretics to remove the extra fluid. Your weight this morning is 187 pounds and this should be considered your ideal weight. Weigh yourself every morning, call ___ if weight goes up more than 3 lbs in 1 day or 5 pounds in 3 days. It is extremely important that you follow a low sodium diet. You were given written information about this and should feel free to call the heart failure clinic if you have any questions. Your kidneys worsened because your heart was not pumping enough blood but have now improved as the congestion has improved.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cephalexin 500 mg PO Q6H 2. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 5 Days 3. Acetaminophen 650 mg PO BID:PRN Pain - Mild/Fever 4. Amphetamine-Dextroamphetamine 10 mg PO TID 5. Baclofen 25 mg PO BID 6. Baclofen 20 mg PO QHS 7. Culturelle (Lactobacillus rhamnosus GG) 10 billion cell oral DAILY 8. Digest Probiotic (S.boulardii) (Saccharomyces boulardii) 250 mg oral DAILY 9. DULoxetine ___ 120 mg PO DAILY 10. LOPERamide 2 mg PO QID:PRN loose stool 11. Pregabalin 150 mg PO TID 12. Psyllium Powder 1 PKT PO QAM 13. Vitamin D 1000 UNIT PO DAILY 14. Vitamin E 200 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ ___: PRIMARY DIAGNOSIS ================= Right lower extremity cellulitis SECONDARY DIAGNOSIS =================== ___ Lymphoma Multiple sclerosis Lymphedema Fecal incontinence Discharge Condition: Mental Status: Alert and oriented. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a privilege taking care of you at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? =================================== You were admitted to the hospital because you had a fever and were disoriented in the setting of a skin infection in your right lower extremity. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? ========================================== - While you were in the hospital, you were closely monitored for signs of infection. You did not have a fever and your white blood cell count (cells that fight infections) returned to normal. - You received imaging (chest x-ray, CT of your right leg, ultrasound of your right leg) to determine the source and severity of the infection. The imaging and exam showed that you have a skin infection of the right lower leg. - You were treated for the skin infection in your right lower leg with IV antibiotics (vancomycin and ceftriaxone). - You did NOT receive your scheduled IVIG treatment for your ___ lymphoma. Please be sure to reschedule this appointment after your discharge from the hospital. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? ============================================ - Please take your antibiotics Bactrim and Keflex for 5 more days (last dose on ___. - Please go to your follow up appointment with your primary care physician. - Please follow up with your oncologist, Dr. ___ rescheduling your IVIG treatment. We wish you all the best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Atorvastatin 40 mg PO QPM 3. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*29 Tablet Refills:*0 4. Losartan Potassium 50 mg PO DAILY 5. Rivaroxaban 20 mg PO DAILY you must take this medication DAILY, life long. If you stop this medication, you risk limb ischemia RX *rivaroxaban [___] 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*9 6. Aspirin 81 mg PO DAILY start this medication on ___ after you stop the Plavix RX *aspirin 81 mg 1 tablet(s) by mouth Daily Disp #*90 Tablet Refills:*4 Discharge Disposition: Home Discharge Diagnosis: right limb ischemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>MEDICATION: • Take Aspirin 325mg (enteric coated) once daily • If instructed, take Plavix (Clopidogrel) 75mg once daily • Continue all other medications you were taking before surgery, unless otherwise directed • You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort WHAT TO EXPECT: It is normal to have slight swelling of the legs: • Elevate your leg above the level of your heart with pillows every ___ hours throughout the day and night • Avoid prolonged periods of standing or sitting without your legs elevated • It is normal to feel tired and have a decreased appetite, your appetite will return with time • Drink plenty of fluids and 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 ACTIVITIES: • When you go home, you may walk and use stairs • You may shower (let the soapy water run over groin 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 or band aid over the area • No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) • After 1 week, you may resume sexual activity • After 1 week, gradually increase your activities and distance walked as you can tolerate • No driving until you are no longer taking pain medications CALL THE OFFICE FOR: ___ • Numbness, coldness or pain in lower extremities • Temperature greater than 101.5F for 24 hours • New or increased drainage from incision or white, yellow or green drainage from incisions • Bleeding from groin puncture site SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site) • Lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. If bleeding stops, call vascular office ___. If bleeding does not stop, call ___ for transfer to closest Emergency Room.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Citalopram 20 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Calcium Carbonate 1000 mg PO DAILY 4. Cyanocobalamin 1000 mcg PO DAILY 5. Donepezil 10 mg PO HS 6. Glargine 5 Units Breakfast 7. Labetalol 300 mg PO BID Hold for HR <60, SBP <100 8. Lisinopril 10 mg PO DAILY Hold for SBP <100 9. Memantine 5 mg PO DAILY 10. Multivitamins 1 TAB PO DAILY 11. Simvastatin 10 mg PO DAILY 12. Vitamin D 1000 UNIT PO DAILY 13. Niaspan Extended-Release *NF* (niacin) 500 mg Oral daily Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Hypoglycemia Hypothermia Discharge Condition: Mental Status: Confused - sometimes (however, back to baseline per friend/healthcare proxy who visited) Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, It was a pleasure taking part in your care at ___ ___. As you know, you were admitted for confusion due to low blood sugar in the setting of your known diabetes, as well as low temperature. It is likely that you were receiving more insulin than necessary at home, and it is very important that you and your caretakers follow your new insulin regimen. It is also very important that you eat 3 meals every day. Please follow up with your primary care doctor on ___ regular basis so that she can adjust your insulin regimen as needed. If you feel ill or nauseated, experience vomiting or diarrhea, of are not eating as much as usual, please let you caretakers know since your insulin regimen may need to be adjusted. Also, if you experience confusion, lightheadedness, nausea, or sense of shakiness, please let your caretaker know since these may be signs of low blood sugar. After you were warmed with a warming device and warmed intravenous fluids, your temperature remained normal throughout admission. Please weigh yourself every morning, and call your doctor if your weight goes up more than 3 pounds. The following changes were made to your medications: - Please STOP insulin NPH entirely. Please DECREASE insulin glargine to 5 units at breakfast. Please STOP Humalog insulin sliding scale. It is extremely important that you follow this new insulin regimen in order to avoid low blood sugar in the future. Your primary care doctor may adjust this regimen as needed. - Please STOP metoprolol, clonidine, and nifedipine since these blood pressure medications are no longer needed and in combination may cause your blood pressure to become too low. - Please STOP spironolactone for now. This medication may be restarted by your primary care doctor if needed. - Please DECREASE calcium carbonate to 1000mg daily. - Please INCREASE vitamin D to 1000 units daily.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID RX *apixaban [Eliquis] 5 mg 1 tablet by mouth twice daily Disp #*60 Tablet Refills:*3 2. Cyclobenzaprine 5 mg PO TID:PRN muscle spasms RX *cyclobenzaprine 5 mg 1 tablet by mouth three times a day Disp #*60 Tablet Refills:*0 3. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine 5 % Place one patch on affected area daily Disp #*30 Patch Refills:*0 4. Metoprolol Succinate XL 300 mg PO DAILY RX *metoprolol succinate 100 mg 3 tablets by mouth every morning Disp #*90 Tablet Refills:*3 5. Polyethylene Glycol 17 g PO DAILY 6. Atorvastatin 40 mg PO QPM 7. Creon 12 2 CAP PO TID W/MEALS PRN heavy meals 8. Diazepam 5 mg PO Q8H:PRN Muscle relaxant 9. DULoxetine 30 mg PO BID 10. losartan-hydrochlorothiazide 100-12.5 mg oral Other 11. Omeprazole 40 mg PO DAILY 12. Ondansetron ODT 4 mg PO Q8H:PRN Nausea/vomiting 13. oxyCODONE-acetaminophen ___ mg oral Other Pain 14. Tamsulosin 0.4 mg PO QHS 15. TraMADol 50 mg PO Q6H:PRN Pain - Moderate Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: TIA, chronic left-sided weakness Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to the neurology stroke service after being transferred from another ___'s Emergency Department where they were concerned you were having a stroke because of your left face, arm, and leg weakness. You received a mediation called tPA to help dissolve a possible clot. Fortunately, your brain MRI did not show evidence of a stroke -- making it possible that the tPA worked and prevented permanent brain damage; alternatively, it is possible that your symptoms were caused by a TIA (transient ischemic attack or "mini-stroke") or that they were due to your known spinal disease. You have several factors that put you at risk for having strokes in the future, including: - Atrial fibrillation - Hypertension (high blood pressure) - Hyperlipidemia (high cholesterol), although this has been well controlled with your Atorvastatin Because atrial fibrillation is your biggest risk for a stroke, we discontinued your aspirin and started apixaban (Eliquis), which is an anticoagulant or "blood thinner." You had an echocardiogram (ultrasound of your heart) which showed that the systolic (squeezing) function of your heart is severely low at 23% (normal is >55%). We strongly recommend you follow up with your primary cardiologist for ongoing management of your systolic heart dysfunction. You developed severe left neck and shoulder pain while in the hospital which is musculoskeletal in nature. You were treated with your home pain medications as well as lidocaine patches, Flexiril (muscle relaxant). Your heart rhythm was in atrial fibrillation during your admission, occasionally beating too fast in what we call "rapid ventricular response." Because of this, we increased your metoprolol dose and then changed it to a once daily medication called metoprolol succinate. Please note that this medication may need to be increased in the future if you continue to go into rapid ventricular response.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. lipase-protease-amylase 5,000-17,000 -27,000 unit Capsule, Delayed Release(E.C.) Sig: Three (3) Cap PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 2. venlafaxine 75 mg Capsule, Ext Release 24 hr Sig: Four (4) Capsule, Ext Release 24 hr PO DAILY (Daily). 3. hydroxyzine HCl 25 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 4. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). 5. senna 8.6 mg Tablet Sig: ___ Tablets PO DAILY (Daily). 6. oxybutynin chloride 5 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 7. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 9. lithium carbonate 450 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO DAILY (Daily). 10. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig: ___ Puffs Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 11. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) ml Injection TID (3 times a day). 12. amphetamine-dextroamphetamine 20 mg Capsule, Ext Release 24 hr Sig: Two (2) Capsule, Ext Release 24 hr PO daily (). 13. ciprofloxacin 250 mg Tablet Sig: Three (3) Tablet PO Q12H (every 12 hours) for 2 days. 14. silver sulfadiazine 1 % Cream Sig: One (1) Appl Topical BID (2 times a day): Apply to blisters on left forearm BID . 15. tramadol 50 mg Tablet Sig: One (1) Tablet PO QID (4 times a day). Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: s/p Motor vehicle crash Injuries: Nasal bone fracture Left ulnar & radius fractures Right ___ phalanx fracture Pneumonia Discharge Condition: Awake and alert, conversant w/ some dysathria Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after a motor vehicle crash where you sustained a broken nasal bone, fractures of your right middle finger fracture and left arm. Your injuries required several operations to repair the fractures. It is important that you do not put any full weight on your left arm and right hand and be sure to keep your left arm elevated as high as possible to minimize the swelling. You are being recommneded for rehab after discharge from the hospital to help with rebuilding your strength and endurance from all of your injuries.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID hold for diarrhea RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: Trauma: motor vehicle accident left orbital floor blowout fracture sacral fracture bifrontal subdural hematoma subarachnoid hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane)(crutches) Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after you were involved in a motor vehicle accident. You sustained a small bleed to your head, a fracture around your left eye, and a fracture to your lower back. You did not require any surgery. You were seen by physical therapy in preparation for discharge home with the following instructions: Because of your head injury, please report: *change in severity of headache *visual changes *drooping face *difficulty speaking *weakness in upper or lower ext. You also had a fracture to the bones around your left eye: please report: *change in vision *inability to move eye *double vision *spots, flashes light left eye Sacral fracture: *lower back pain *weakness in lower ext. *difficulty urinating *inability to hold urine *inability to control your bowel movements *numbness in lower ext.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain RX *acetaminophen 325 mg ___ tablet(s) by mouth every 6 hours Disp #*60 Tablet Refills:*2 2. Cephalexin 500 mg PO Q8H RX *cephalexin 500 mg 1 tablet(s) by mouth every 8 hours Disp #*30 Capsule Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice daily Disp #*30 Capsule Refills:*2 4. Senna 1 TAB PO BID *AST Approval Required* RX *sennosides [senna] 8.6 mg 1 tab by mouth twice daily Disp #*30 Tablet Refills:*2 5. Vitamin D 400 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 1 tablet(s) by mouth daily Disp #*60 Capsule Refills:*3 6. Simvastatin 10 mg PO DAILY 7. Pioglitazone 30 mg PO DAILY 8. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 3 hours Disp #*61 Tablet Refills:*0 9. Lisinopril 20 mg PO DAILY 10. Enoxaparin Sodium 40 mg SC DAILY Duration: 14 Days RX *enoxaparin 40 mg/0.4 mL 40 mg SC daily Disp #*14 Syringe Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1. Right tibia/fibular fracture. 2. Open right ___ metatarsophalangeal dislocation, great toe. 3. ___ and ___ proximal phalanx fractures, right foot. 4. ___ interphalangeal toe dislocation. 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 ANTIBIOTICS: - Please take Keflex for 10 days after discharge as instructed 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: - Heel weightbearing as tolerated in right lower extremity - Please remain in short aircast boot Physical Therapy: Heel weightbearing as tolerated. Please remain in short aircast boot until follow-up. Treatments Frequency: Daily dressing changes, leave open to air when dry. Any sutures/staples will be removed on follow-up appointment.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 12 Days 2. Docusate Sodium 100 mg PO BID 3. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q3H:PRN pain Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Left index finger laceration with flexor tendon and digital nerve injury complicated by infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>1. Change dressing with Xeroform and DSD daily 2. You can shower. Pat the incision dry afterwards. Do not immerse the incision in water, e.g. swimming or hot tub. 3. Take your antibiotics as directed until completed. 4. Continue your OT exercises Physical Therapy: Activity: Ambulate Treatments Frequency: Wound care: Site: left index finger Type: Surgical Cleansing agent: Saline Dressing: Xeroform with DSD daily Splint: Dorsal blocking orthoplast splint</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 ___ at ___. ___ came to the hospital for confusion, and were found to have hepatic encephalopathy. ___ were given 60mL lactulose every 2 hours, with resolution of your symptoms. ___ were also given some albumin for dehydration, and blood for anemia. Your blood levels stabilized and ___ were safe for discharge with close follow up. While ___ were in the hospital, ___ had back pain. An XRAY showed compression deformity of one of your vertebra. ___ should take tylenol ___ every 8 hours as needed for pain, use hot packs, and start physical therapy. If your pain worsens, ___ can talk to your doctor about getting an MRI. ___ should also talk to Dr. ___ protecting your bones in the future. Your lactulose regimen has been changed to 30mL four times a day, with a goal of ___ bowel movements a day. If ___ find yourself having less than 4 bowel movements or feeling confused in any way, take an extra dose of lactulose and call ___ at the ___ to let her know. She can inform ___ how to increase your dose hopefully keep ___ out of the hospital. Taking your lactulose as directed is an important part of the transplant process. We wish ___ the best of health, Your medical team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Benzonatate 100 mg PO TID 2. Escitalopram Oxalate 20 mg PO DAILY 3. Fluticasone Propionate NASAL 1 SPRY NU DAILY 4. Furosemide 20 mg PO DAILY 5. Lorazepam 1 mg PO QID 6. Omeprazole 20 mg PO DAILY 7. Senna 8.6 mg PO BID 8. TraZODone 50 mg PO QHS 9. Verapamil SR 240 mg PO BID 10. Vitamin D ___ UNIT PO DAILY 11. Lisinopril 5 mg PO DAILY 12. PredniSONE 30 mg PO DAILY Duration: 7 Days Rx 1 of 3: starting ___. Take 30mg prednisone for 7d. 13. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheeze 14. Dulera (mometasone-formoterol) 200-5 mcg/actuation inhalation BID 15. ipratropium bromide 0.06 % nasal QID 16. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation INHALATION 2 PUFFS TWICE DAILY 17. Tudorza Pressair (aclidinium bromide) 400 mcg/actuation inhalation 1 inhalation twice daily 18. Azithromycin 250 mg PO Q24H 19. Hydrocortisone Cream 1% 1 Appl TP TID 20. PredniSONE 20 mg PO DAILY Duration: 7 Days Rx 2 of 3: starting ___. Take 20mg prednisone for 7d. 21. PredniSONE 10 mg PO DAILY Duration: 7 Days Rx 3 of 3: starting ___. Take 10mg prednisone for 7d. 22. Ipratropium-Albuterol Neb 1 NEB NEB Q6H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: ------------------ - COPD exacerbation - Emphysema/COPD - GOLD stage 4 - Chronic hypoxemic-hypercarbic respiratory failure SECONDARY DIAGNOSIS: -------------------- - Hypertension, essential - Essential tremor - Periocular dermatitis - anxiety 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 during your hospital stay at ___. You came in because you were acutely short of breath. We treated you for an exacerbation of your COPD and your symptoms improved. You should continue on your home oxygen. Our physical therapists evaluated you and recommended rehabilitation. You also had a red rash around your eyes that seemed to improve without treatment. Your home captopril (blood pressure medication) was changed to a once daily pill called lisinopril. It is now safe for you to be discharged. Please be sure to take all of your medications as prescribed and keep your follow-up appointments. We wish you the very best ! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 40 mg PO BID RX *omeprazole 40 mg 1 capsule(s) by mouth Every 12 hours Disp #*60 Capsule Refills:*0 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO QPM 4. Clopidogrel 75 mg PO DAILY 5. GlipiZIDE 5 mg PO DAILY 6. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 7. Metoprolol Succinate XL 100 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 10. Tamsulosin 0.4 mg PO QHS 11. Valsartan 80 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Duodenal ulcer Melena GI-Bleed 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 ___ ___. You were admitted to the hospital because you were found to be bleeding from an area in your GI tract near your stomach. You were given medicine and the GI doctors put ___ ___ into your stomach to help treat some of the ulcers. Your bleeding stopped and you did well so you were able to go home with medicine. It is important that you take the new medicine every day. The medicine is in a class called "proton pump inhibitors". We gave you a prescription for omeprazole, but if your co-pay is too high we can write you a prescription for any other medicine in the same class. Please call us if you will need another prescription. It is very important that you NEVER take NSAIDs for pain. These include ibuprofen, Advil, naproxen, Aleve, and Motrin. These medicines can worsen your ulcers and make you bleed again. If you have pain, please take Tylenol or acetaminophen. You will also need to make an appointment with the GI doctors for ___ in 8 - 10 weeks. It was a pleasure caring for you! Sincerely, 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 with a prolonged seizure, and you were confused afterward. Your infectious work-up did not reveal a urinary infection or a pneumonia. However, it's possible that a cold may have increased your risk of seizures. We started you on a new medication in consultation with Dr. ___. Also, we changed your omeprazole to famotidine to minimize interactions with clobazam. It was a pleasure meeting you! Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 5 mg PO DAILY 2. Propranolol 20 mg PO TID 3. Amantadine 100 mg PO DAILY 4. Atorvastatin 10 mg PO QPM 5. Carbidopa-Levodopa (___) 1 TAB PO BID 6. Cyanocobalamin ___ mcg PO DAILY 7. Digoxin 0.125 mg PO DAILY 8. Fluphenazine 10 mg PO TID 9. Levothyroxine Sodium 100 mcg PO DAILY 10. LORazepam 0.5 mg PO BID 11. Nuedexta (dextromethorphan-quinidine) ___ mg oral BID 12. Vitamin D ___ UNIT PO QMONTH ON THE ___ 13. HELD- Aspirin 81 mg PO DAILY This medication was held. Do not restart Aspirin until you discus it with your Neurologist Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnoses ========================== # Urinary Tract Infection # Right Frontal lobe mass #Acute encephalopathy likely secondary to UTI induced delirium, on top of underlying cognitive impairment Secondary Diagnoses: ___ # Schizoaffective/Bipolar # Hyperlipidemia # Anxiety # Hypothyroidism # Pseudobulbar affect Discharge Condition: Level of Consciousness: Alert and interactive, A0X1-2 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 your at ___ ___. WHY WERE YOU ADMITTED? You came to the hospital because you were confused. WHAT HAPPENED IN THE HOSPITAL? While in the hospital you were found to have an infection of your urine. This was treated with antibiotics and your confusion improved. We did a scan of your brain to make sure nothing else was going on and found a lesion in your right frontal lobe. Neurology saw you and recommend you follow up with a vascular neurologist as an outpatient. WHAT SHOULD YOU DO AT HOME? You should follow up with you PCP and schedule an appointment with your primary neurologist within 2 weeks. You should also schedule an appointment with your outpatient neurologist Dr. ___ in Vascular ___ within 2 weeks of leaving the hospital. We have made you an appointment, but please call to see if you can change it to be seen within ___ weeks of discharge. The phone number is ___. 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. Glargine 10 Units Breakfast Insulin SC Sliding Scale using HUM Insulin RX *insulin glargine [Lantus Solostar] 100 unit/mL (3 mL) AS DIR 10 Units before BKFT; Disp ___ Milliliter Refills:*2 RX *insulin lispro [Humalog KwikPen] 100 unit/mL AS DIR Up to 10 Units QID per sliding scale Disp #*2 Syringe Refills:*2 2. Lovaza (omega-3 acid ethyl esters) 4 grams oral DAILY RX *omega-3 acid ethyl esters 1 gram 4 capsule(s) by mouth daily Disp #*160 Capsule Refills:*0 3. amLODIPine 10 mg PO DAILY 4. Cialis (tadalafil) 20 mg oral DAILY:PRN 5. Gemfibrozil 600 mg PO BID 6. Losartan Potassium 50 mg PO DAILY 7. MetFORMIN (Glucophage) 500 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Pancreatitis Hypertriglyceridemia Type 2 Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came in with pancreatitis related to having a type of high cholesterol called triglycerides. We treated you with insulin which helps bring this level of cholesterol down. You will continue to take insulin after you leave as well metformin for your diabetes and a new omega-three fatty acid called Lovaza (in addition to gemfibrozil). Please also discuss with your PCP about an ___ referral as these issues are relatively complex and may require follow-up with a subspecialist.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. DICYCLOMine 20 mg PO QID pain RX *dicyclomine 20 mg 1 tablet(s) by mouth QID as needed Disp #*30 Tablet Refills:*0 2. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity 3. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 4. Cetirizine 10 mg PO DAILY 5. Cyanocobalamin 1000 mcg PO DAILY 6. Dexamethasone 1 mg PO ASDIR 7. DiphenhydrAMINE ___ mg PO QHS:PRN insomnia, muscle aches/pains 8. Lidocaine-Prilocaine 1 Appl TP PRN R chest port pain 9. LOPERamide 2 mg PO QID:PRN diarrhea 10. Multivitamins 2 TAB PO DAILY 11. OLANZapine (Disintegrating Tablet) 5 mg PO QHS 12. Ondansetron ODT 4 mg PO Q8H:PRN Nausea/Vomiting - First Line 13. Pantoprazole 40 mg PO Q12H 14. Polyethylene Glycol 17 g PO Q12H:PRN Constipation - Third Line 15. Prochlorperazine 10 mg PO Q6H:PRN Nausea/Vomiting - First Line 16. Senna 17.2 mg PO BID 17. Vitamin D ___ UNIT PO 1X/WEEK (___) 18. HELD- HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN Pain - Moderate This medication was held. Do not restart HYDROmorphone (Dilaudid) until you speak to a doctor Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS. abdominal pain secondary to metastatic gastric cancer SECONDARY DIAGNOSES. anal fissure fibromyalgia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear, Ms. ___ ___ was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - You were admitted for stomach pain, body aches, and fever recorded at home WHAT HAPPENED TO ME IN THE HOSPITAL? - We treated your pain symptomatically with improvement - You saw our palliative care doctors who helped recommend a treatment to better control your pain. They asked that you stop taking the Dilaudid and only take the Oxycodone instead. This will make it easier to adjust your pain medications in the future. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - We started a new medication you can take for your abdominal pain - If you experience any of the danger signs listed below, please contact your oncologist or go to an emergency room immediately We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 20 mg PO DAILY RX *atorvastatin 20 mg 1 tablet(s) by mouth daily Disp #*90 Tablet Refills:*3 2. HumaLOG Mix ___ KwikPen (insulin lispro protam-lispro) 40 UNITS subcutaneous BID 3. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth daily Disp #*90 Tablet Refills:*3 4. HumaLOG (insulin lispro) 100 unit/mL subcutaneous QACHS as directed per sliding scale RX *insulin lispro [Humalog] 100 unit/mL ___ unit SC QACHS Disp #*1 Unit Refills:*3 Discharge Disposition: Home Discharge Diagnosis: DKA uncontrolled Type I diabetes hypertriglyceridemia 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 DKA due to not taking insulin. There was no evidence of infection on imaging or blood work. Your blood sugar improved with restarting humalog ___ and a humalog sliding scale. You were also started on lisinopril (to help protect your kidneys) and Lipitor (to help improve your cholesterol). Please see below for your follow up appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Becaplermin Gel 0.01% 1 Appl TP DAILY 2. Collagenase Ointment 1 Appl TP DAILY 3. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN dypsnea or wheezing 4. Miconazole Powder 2% 1 Appl TP TID:PRN Rash 5. Ramelteon 8 mg PO QHS:PRN insomnia Should be given 30 minutes before bedtime 6. Glargine 64 Units Breakfast Glargine 64 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 7. MetFORMIN (Glucophage) 500 mg PO BID 8. Torsemide 120 mg PO DAILY 9. Torsemide 80 mg PO QPM 10. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 11. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheeze, cough 12. amLODIPine 10 mg PO DAILY 13. Aspirin 81 mg PO DAILY 14. Atorvastatin 80 mg PO QPM 15. BusPIRone 12.5 mg PO TID 16. Cyanocobalamin 500 mcg PO DAILY 17. Docusate Sodium 100 mg PO BID 18. Fluticasone-Salmeterol Diskus (250/50) 2 INH IH BID 19. Gabapentin 300 mg PO TID 20. HydrOXYzine 75 mg PO TID:PRN anxiety 21. LevoFLOXacin 750 mg PO Q24H 22. Lisinopril 40 mg PO DAILY 23. Methadone 10 mg PO BID Consider prescribing naloxone at discharge RX *methadone 10 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 24. MetroNIDAZOLE 500 mg PO Q8H 25. Nicotine Patch 21 mg/day TD DAILY 26. Omeprazole 20 mg PO DAILY 27. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth up to four times daily as needed Disp #*20 Tablet Refills:*0 28. Senna 8.6 mg PO BID:PRN Constipation - First Line 29. TraZODone 50 mg PO QHS:PRN insomnia 30. Venlafaxine XR 37.5 mg PO DAILY 31. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Hypoglycemia Uncontrolled type 2 diabetes mellitus Hypoxic hypercapnic respiratory failure Obesity hypoventilation syndrome Suspected sleep apnea Congestive heart failure with hypervolemia Chronic foot wounds complicated by calcaneal osteomyelitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, You were admitted for low blood sugar and low oxygen levels. You received IV diuresis and your breathing improved. While in the hospital your blood sugars have improved with adjustments to your insulin regimen. We continued care for the heel and abdominal wounds and treating with antibiotics. It was a pleasure taking care of you! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheeze 2. Chloraseptic Throat Spray 1 SPRY PO Q4H:PRN sore throat 3. Aluminum-Magnesium Hydrox.-Simethicone 15 mL PO Q4H:PRN GI upset 4. Docusate Sodium 100 mg PO BID 5. Fluticasone Propionate NASAL 2 SPRY NU DAILY 6. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 7. Gabapentin 600 mg PO TID 8. Guaifenesin-CODEINE Phosphate ___ mL PO Q4H:PRN cough 9. Hydroxychloroquine Sulfate 200 mg PO BID 10. HydrOXYzine 50 mg PO Q8H:PRN itch 11. Lactulose 30 mL PO BID 12. Levothyroxine Sodium 88 mcg PO DAILY 13. Lorazepam 1 mg PO TID 14. Morphine SR (MS ___ 30 mg PO Q12H 15. Multivitamins W/minerals 1 TAB PO DAILY 16. OxycoDONE (Immediate Release) 20 mg PO Q4H:PRN pain 17. Pantoprazole 40 mg PO Q24H 18. Polyethylene Glycol 17 g PO DAILY:PRN constipation 19. QUEtiapine Fumarate 25 mg PO QAM 20. Senna 17.2 mg PO BID 21. Tiotropium Bromide 1 CAP IH DAILY 22. Tizanidine 4 mg PO TID:PRN muscle spasm 23. Furosemide 40 mg PO DAILY 24. Systane (peg 400-propylene glycol) 0.4-0.3 % ophthalmic TID:PRN dry eyes 25. Bisacodyl 10 mg PO DAILY:PRN constipation 26. Nicotine Patch 21 mg TD DAILY 27. Baclofen 5 mg PO TID 28. Cetirizine 10 mg PO DAILY 29. Lidocaine 5% Patch 2 PTCH TD QAM 30. Zolpidem Tartrate 2.5 mg PO QHS 31. Acetaminophen 650 mg PO Q6H:PRN pain/fever 32. melatonin 5 mg oral QHS 33. Pramipexole 1 mg PO BID:PRN restlessleg 34. Senna 17.2 mg PO DAILY:PRN constipation 35. Enoxaparin Sodium 40 mg SC DAILY Start: Today - ___, First Dose: Next Routine Administration Time 36. Clindamycin 450 mg PO Q6H Duration: 7 Days RX *clindamycin HCl 150 mg 3 capsule(s) by mouth Q6hrs Disp #*84 Capsule Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Cellulitis Secondary: COPD Chronic pain Schizoaffective disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted for recurrent cellulitis. You were started on IV daptomycin and ID was consulted. Wound care nurses helped with your wounds. You had CT scan which did not show a bone infection or an area that needs to be drained. You improved with IV antibiotics and will be transitioned to Oral antibiotics to complete an additional 7 days. You will need to follow up with Dr. ___ infectious disease. You were also seen by orthopedics who would consider removing your ankle hardware, although at this time, it does not seem to be infected.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Albuterol Inhaler ___ PUFF IH Q6H:PRN sob 3. Aspirin 81 mg PO DAILY 4. Calcitriol 0.25 mcg PO DAILY 5. Diltiazem Extended-Release 240 mg PO BID RX *diltiazem HCl 240 mg 1 capsule,extended release 24hr(s) by mouth twice a day Disp #*30 Capsule Refills:*0 6. Fluoxetine 80 mg PO DAILY 7. Fluticasone Propionate 110mcg ___ PUFF IH BID 8. Furosemide 40 mg PO DAILY RX *furosemide 20 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 9. HydrALAzine 100 mg PO Q8H 10. Labetalol 300 mg PO TID 11. Lisinopril 40 mg PO DAILY 12. Lorazepam ___ mg PO Q6H:PRN anxiety 13. TraZODone 100 mg PO HS:PRN insomnia 14. Warfarin 7.5 mg PO DAILY16 RX *warfarin [Coumadin] 7.5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 15. Calcium Citrate + D (calcium citrate-vitamin D3) 200mg-125Unit tablet oral BID 16. Outpatient Lab Work please check chem10 and INR on ___ and call in or fax results to Dr. ___: ___, Fax: ___ and to Dr. ___: ___ Discharge Disposition: Home Discharge Diagnosis: acute on chronic diastolic heart failure exacerbation 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 while you were admitted to the ___. You were admitted because you were having shortness of breath and difficulty doing your normal activities. Your weight was up slightly and you were having palpitations. You were found to have high heart rates given your atrial fibrillation. We gave you some IV diuresis that initially helped get some fluid off, but then we saw a decrease in your kidney function. We held diuresis for a day and in the meantime increased your diltiazem in order to control your ventricular response to your Afib. We think that this will improve your shortness of breath because your heart will not have to work as hard, thus you will have less congestion in your lungs. We increased your home lasix as well. Please continue to take all of your medications and keep your follow-up appointments. Best, The ___ Cardiology Team TRANSITIONAL ISSUES: #Please have your INR checked ___ since we have increased your coumadin to 7.5 daily from your home dosing #Weigh yourself every morning, call Dr. ___ your weight goes up by more than 3 lbs. #please make sure you that your diet is low in sodium (NO fast food) since salty food can lead to another exacerbation and hospital admission</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Amlodipine 2.5 mg PO DAILY please hold for sbp<100 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 40 mg PO HS 5. Calcitriol 0.25 mcg PO DAILY 6. Calcium Carbonate 500 mg PO BID 7. cilostazol *NF* 100 mg Oral qod 8. Desipramine 50 mg PO DAILY 9. Duloxetine 90 mg PO DAILY 10. Gabapentin 800 mg PO BID 11. Levothyroxine Sodium 137 mcg PO DAILY 12. Lorazepam 0.5 mg PO Q8H:PRN anxiety 13. Metoprolol Succinate XL 12.5 mg PO DAILY please hold for sbp<100 please hold for hr<60 14. Mycophenolate Mofetil 500 mg PO BID 15. PredniSONE 7.5 mg PO DAILY 16. Promethazine 25 mg PR Q6H:PRN nausea 17. Promethazine 25 mg PO BID:PRN nausea 18. Ranitidine 150 mg PO HS 19. Tacrolimus 1.5 mg PO QAM 20. Tacrolimus 1 mg PO QPM 21. traZODONE 50 mg PO HS:PRN insomnia 22. Valsartan 20 mg PO DAILY 23. Vitamin D 800 UNIT PO DAILY 24. Warfarin 3 mg PO DAILY16 25. Zolpidem Tartrate 10 mg PO HS:PRN insomnia 26. esomeprazole magnesium *NF* 40 mg ORAL BID 27. Hydrocodone-Acetaminophen (5mg-500mg ___ TAB PO Q4H:PRN pain please hold for rr<12 or increased somnolence 28. Acetaminophen 1000 mg PO BID:PRN pain 29. Nitrofurantoin Monohyd (MacroBID) 100 mg PO Q12H RX *Macrobid ___ mg 1 capsule(s) by mouth every 12 hours Disp #*12 Tablet Refills:*0 30. Nystatin Oral Suspension 5 mL PO QID:PRN thrush, throat pain RX *nystatin 100,000 unit/mL 5 mL by mouth four times a day Disp #*200 Milliliter Refills:*1 31. Outpatient Lab Work You should have your tacrolimus level checked one week after discharge from the hospital; on ___. 32. Nitroglycerin SL 0.3 mg SL PRN chest pain 33. Glargine 40 Units Breakfast Glargine 30 Units Bedtime Insulin SC Sliding Scale using HUM Insulin Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: -Diabetic ketoacidosis -Urinary tract infection -Acute renal insufficiency Secondary diagnoses: -Type I diabetes mellitus Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ on ___ for nausea, vomiting, and weakness. You were found to have a very high blood sugar and acidic blood due to a condition called 'diabetic ketoacidosis'. Your kidney function was also temporarily decreased, most likely due to dehydration. Your blood sugars and your kidney function improved with continuous insulin and intravenous fluids. This episode of 'diabetic ketoacidosis' was likely triggered by a urinary tract infection, for which you were treated with the antibiotic medicine Vancomycin, and were switched to the oral medicine nitrofurantoin (Macrobid) before discharge, which you will take every 12 hours until the evening of ___. Finally, your INR was found to be higher than normal, so several doses of your home warfarin were held until the INR came back down to a normal level, at which time your warfarin was restarted. Please note that your INR subsequently decreased to 1.1 which is below the desired level, so please continue checking your INR at home and call your ___ clinic with the results so that they can adjust your dose. You should also have your tacrolimus level checked at the outpatient laboratory in one week, on ___. You should continue to administer your long-acting insulin every morning and every evening. You should also administer short-acting insulin before each meal based on your blood sugar levels and carbohydrate counting, as you have been in the past. When it is necessary to catheterize yourself for urination, you should make sure to use good sterile technique. Please not the following change in your medication: -ADDITION of nitrofurantion (to treat urinary tract infection)</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO DAILY 2. Lactulose 30 mL PO TID 3. Acyclovir 400 mg PO Q12H 4. amLODIPine 10 mg PO DAILY 5. Ascorbic Acid ___ mg PO DAILY 6. Atovaquone Suspension 1500 mg PO DAILY 7. Ferrous Sulfate 325 mg PO DAILY 8. FoLIC Acid 1 mg PO DAILY 9. Furosemide 80 mg PO DAILY 10. Glargine 4 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 11. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 12. Multivitamins W/minerals 1 TAB PO DAILY 13. Phenytoin Sodium Extended 200 mg PO TID 14. rifAXIMin 550 mg PO BID 15. Spironolactone 200 mg PO DAILY 16. Thiamine 100 mg PO DAILY 17. Triamcinolone Acetonide 0.1% Cream 1 Appl TP DAILY Discharge Disposition: Extended Care Discharge Diagnosis: PRIMARY DIAGNOSIS: Hepatic encephalopathy SECONDARY DIAGNOSIS: Cirrhosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you at ___ ___. WHY WERE YOU ADMITTED? - You were confused and had abdominal pain. WHAT HAPPENED IN THE HOSPITAL? - You were treated with lactulose and your confusion improved. - There was initial concern that you might have a urinary tract infection, but ultimately we did not find any evidence of infection, which can cause confusion. - You were discharged back to your rehab with a new prescription for lactulose. WHAT SHOULD YOU DO AT HOME? - Take your medications as written. - Go to your follow up appointments as scheduled. 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. Ciprofloxacin HCl 500 mg PO Q12H Duration: 4 Days 3. LevETIRAcetam 750 mg PO BID 4. Atorvastatin 40 mg PO QPM 5. Finasteride 5 mg PO DAILY 6. Levothyroxine Sodium 137 mcg PO DAILY 7. melatonin 10 mg oral QHS 8. pimozide 6 mg oral BID 9. Sertraline 200 mg PO DAILY 10. Tamsulosin 0.4 mg PO QHS 11. TraZODone 300 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: L MCA territory Stroke likely Cardioembolic in nature Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of <> 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: Possible heart arrhythmia We are changing your medications as follows: 1. Stop taking Aspirin 81 mg 2. Start taking Eliquis 5 mg Twice a day Please take your other medications as prescribed. Please followup 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</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. wheelchair miscellaneous ONCE RX *wheelchair Use as needed Disp #*1 Each Refills:*0 2. B12 (cyanocobalamin-cobamamide) 5,000-100 mcg sublingual DAILY 3. Levothyroxine Sodium 75 mcg PO DAILY 4. Vitamin D ___ UNIT PO 1X/WEEK (___) ___ 5.Walker Dispense 1 Rolling Walker ICD9 386.10 Duration: Ongoing Attending: Dr. ___, ___ 6.Outpatient Physical Therapy Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Benign Paroxysmal Positional Vertigo Meningioma 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 episodes of difficulty walking as well as an abnormal finding on head imaging. We did a test on you called the ___ Hall Pike Maneuver which was positive and recreated your symptoms. Because of this, we feel that you have a condition called BPPV or Benign paroxysmal positional vertigo. We asked our physical therapists to evaluate you and show you some exercises to help reduced these sensations. Prior to your arrival at ___, you had a head CT which showed a mass that was consistent with a benign brain tumor called a meningioma. Because of your history of breast cancer, we sent you to the MRI to characterize this mass more and confirmed that it is consistent with a meningioma. This mass is not responsible for any of your symptoms. If you have any additional episodes of room spinning, please perform the maneuvers provided by the physical therapist. We have also ordered home ___ for you as well. You do not need to follow up with neurology for this condition. Please call your PCP to schedule ___ follow up appointment in ___ weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Carvedilol 25 mg PO BID RX *carvedilol 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Losartan Potassium 50 mg PO BID RX *losartan 50 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 4. amLODIPine 10 mg PO DAILY 5. Anoro Ellipta (umeclidinium-vilanterol) 62.5-25 mcg/actuation inhalation DAILY 6. Apixaban 2.5 mg PO BID 7. Aspirin 81 mg PO DAILY 8. Gabapentin 100 mg PO QHS 9. Levothyroxine Sodium 100 mcg PO DAILY 10. Multivitamins 1 TAB PO DAILY 11. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 12. Pravastatin 80 mg PO QPM 13. PreserVision AREDS (vitamins A,C,E-zinc-copper) ___ unit-mg-unit oral DAILY 14. Ranexa (ranolazine) 500 mg oral BID 15. Ranitidine 150 mg PO DAILY 16. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Unstable angina, acute on chronic heart failure with preserved ejection fraction SECONDARY DIAGNOSES: Hypertension, Atrial fibrillation, Chronic kidney disease, Peripheral vascular disease, history of CVA, Hyperlipidemia, Type 2 diabetes mellitus, Chronic obstructive pulmonary disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure of taking care of you at ___! You were here because you were having left chest pain and arm pain. While you were here, you were given medications in your IV to help get extra fluid off. This was changed to a pill prior to leaving the hospital. You also had your blood pressure medication increased because your blood pressure was elevated. When you leave, make sure to take your medications as prescribed. Also you should attend all of your follow-up appointments as listed below. Weigh yourself every morning, call MD if weight goes up more than 3 lbs in 1 day or 5 lbs in 3 days. Your weight on discharge is 174 lbs. If you have anymore chest pain, shortness of breath, or palpitations, please seek medical care immediately. 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. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 2. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 3. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 4. ammonium lactate 12 % topical DAILY 5. Aspirin 81 mg PO DAILY 6. Cyanocobalamin 100 mcg PO DAILY 7. Doxazosin 4 mg PO HS 8. Fluticasone Propionate NASAL 2 SPRY NU DAILY 9. FoLIC Acid 1 mg PO DAILY 10. leflunomide 20 mg oral DAILY 11. Loratadine 10 mg PO DAILY 12. Simvastatin 20 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: -Atrial fibrillation with rapid ventricular response -Prior gastrointestinal bleeding -Diarrhea -Hypertension -Hyperlipidemia -Type 2 diabetes mellitus -Rheumatoid arthritis -Gastroesophageal reflux disease -Vocal hoarseness -Weight loss -Anorexia -Benign prostatic hypertrophy 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 your abnormal heart rhythm. This was improved with intravenous and oral medicine. We imaged your heart which did not show any abnormalities. We also started you back on a lower dose of your ___ medicine. Please follow up in Health Care Associates Episodic in the next week for a blood pressure check. You can make an appointment at ___. You were also noted to have weight loss and a hoarse voice. We deemed that this should be worked up on an outpatient basis with your primary care doctor. Please make an appointment with your primary care doctor within the next ___ weeks. Dr ___ be reached at ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you had a fever, a low white blood cell count, and diarrhea. WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - You had a test that showed you had a C difficile infection. - You received IV and oral antibiotics to treat your C difficile colitis. - You improved and were ready to leave the hospital. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Please take all of your medications as prescribed and go to your follow up appointments with your doctors ___ below) - Please get laboratory work on ___. - Seek medical attention if you have new or concerning symptoms or you develop. It was a pleasure participating in your care. 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. Albuterol Inhaler ___ PUFF IH Q6H:PRN Wheezing 2. Cyanocobalamin 50 mcg PO DAILY 3. FoLIC Acid 1 mg PO DAILY 4. Lactulose 30 mL PO BID 5. LaMOTrigine 50 mg PO BID 6. Levothyroxine Sodium 100 mcg PO DAILY 7. Multivitamins 1 TAB PO DAILY 8. Omeprazole 40 mg PO BID 9. Ondansetron 4 mg PO BID:PRN nausea 10. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 11. Rifaximin 550 mg PO BID 12. Simethicone 40-80 mg PO QID:PRN gas/abdominal pain 13. Spironolactone 150 mg PO DAILY 14. Sucralfate 1 gm PO QID 15. Thiamine 100 mg PO DAILY 16. TraZODone 50 mg PO HS:PRN insomnia 17. Triamcinolone Acetonide 0.025% Cream 1 Appl TP DAILY 18. Ursodiol 750 mg PO QHS 19. Furosemide 60 mg PO DAILY 20. Vitamin D 50,000 UNIT PO EVERY 2 WEEKS 21. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth Twice Daily Disp #*3 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: 1. Viral Syndrome 2. Clogged feeding tube 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 us with a temperature and with feelings of maliase and fatigue most likely from a viral illness. Your symptoms improved with supportive care. We did a paracentesis which did not show any signs of infection. Your symptoms improved during the course of this hospital stay. Unfortuantely on the day of your discharge your dobhoff tube became clogged. We spoke to Dr. ___ reocmmended taking out your feeding tube and monitoring you on oral feeding. Please follow up with your PCP and Dr. ___ further care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You were hospitalized with a GI bleed resulting from gastric ulcers and inflammation of your duodenum. You should avoid all NSAID medications and also avoid alcohol use. You will now be treated for H. Pylori infection. You are recommended to have a repeat endoscopy to evaluate these ulcers and look for healing. You are also being treated for possible pneumonia vs. aspiration pneumonitis. The antibiotics that treat h. pylori infection are also effective at treating pneumonia. Please take these medications as instructed and take with food to avoid nausea. You are also on an antacid. Take the prevpac that has the 2 antibiotics and the antacid for 2 weeks to treat the h.pylori. Then you should take the protonix twice a day as instructed following the completion of the prevpac. You should also talk with your PCP about evaluation for fatty liver disease.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atovaquone Suspension 1500 mg PO DAILY 2. Clotrimazole 1 TROC PO QID 3. Dexamethasone 4 mg PO DAILY 4. Dronabinol 2.5 mg PO BID 5. FoLIC Acid 1 mg PO DAILY 6. LeVETiracetam 500 mg PO BID 7. Lorazepam 0.5 mg PO QHS:PRN Insomnia, Nausea 8. Omeprazole 40 mg PO DAILY 9. OxyCODONE SR (OxyconTIN) 10 mg PO QHS 10. Prochlorperazine 10 mg PO Q6H:PRN Nausea 11. TraMADOL (Ultram) 50 mg PO Q4H:PRN Pain 12. TraZODone 50 mg PO QHS:PRN Insomnia 13. Vitamin D ___ UNIT PO DAILY 14. Vancomycin Oral Liquid ___ mg PO Q6H RX *vancomycin 125 mg 1 capsule(s) by mouth every six (6) hours Disp #*48 Capsule Refills:*0 15. B Complete (vitamin B complex) 1 tablet ORAL DAILY 16. Multivitamins 1 TAB PO DAILY 17. Ocuvite (vit C-vit E-lutein-min-om-3) 150-30-5-150 mg-unit-mg-mg oral DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: C. difficile infection Adrenal insufficiency 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 with low blood pressure and low heart rates. You were found to have recurrent c. diff and are being treated with Vancomycin by mouth. Your blood pressure improved and you had no further episodes of dizziness.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Amlodipine 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Carvedilol 12.5 mg PO BID RX *carvedilol 12.5 mg Take 1 tablet by mouth twice a day. Disp #*60 Tablet Refills:*1 5. Omeprazole 40 mg PO DAILY 6. Vitamin D 500 UNIT PO DAILY 7. Atorvastatin 20 mg PO QPM RX *atorvastatin 20 mg Take 1 tablet by mouth daily. Disp #*30 Tablet Refills:*1 8. Citalopram 10 mg PO DAILY 9. Docusate Sodium 100 mg PO DAILY:PRN constipation 10. Dorzolamide 2%/Timolol 0.5% Ophth. 2 DROP BOTH EYES QHS 11. Glargine 26 Units Bedtime 12. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 13. HydrALAzine 75 mg PO Q8H RX *hydralazine 50 mg Take 1 tablet by mouth three times a day. Disp #*90 Tablet Refills:*1 RX *hydralazine 25 mg Take 1 tablet by mouth three times a day. Disp #*90 Tablet Refills:*1 14. Isosorbide Mononitrate (Extended Release) 90 mg PO DAILY RX *isosorbide mononitrate 60 mg Take 1 tablet by mouth daily. Disp #*30 Tablet Refills:*1 RX *isosorbide mononitrate 30 mg Take 1 tablet by mouth daily. Disp #*30 Tablet Refills:*1 15. Torsemide 20 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: - Acute on Chronic Diastolic Heart Failure - Complicated UTI Secondary Diagnosis: - Hypertension - Hyperlipidemia - CAD s/p MI and CABG - Diabetes Mellitus Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to the hospital because you had trouble breathing due to your heart failure. This may have occurred because you had a urinary tract infection. You were given antibiotics for the infection and intravenous medicines to help remove the fluid. Medications were adjusted. You were able to come off the oxygen. Once your volume appeared to be normal, you underwent right heart catheterization with showed slightly high pressures on both left and right sides of your heart. Please limit your salt intake and avoid eating salty foods. Continue to weight yourself every morning. Your weight at discharge is 73.7 kg (162 lbs). It is very important to call your doctor if your weight goes up by more than 3 lbs in one day or five pounds in one week to avoid needing to be admitted to the hospital again. It was a pleasure taking care of you during your stay in the hospital. - Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CefTAZidime 1 g IV Q12H last day ___. Fluconazole 200 mg PO Q24H continue while foley in place 3. Fluticasone Propionate 110mcg 3 PUFF IH BID 4. Lactulose 30 mL PO BID 5. Lidocaine 5% Patch 1 PTCH TD QAM 6. Linezolid ___ mg PO Q12H ___ will contact to narrow 7. Midodrine 15 mg PO TID 8. Pantoprazole 40 mg PO Q24H 9. Simethicone 40-80 mg PO QID:PRN gas pain 10. clonazePAM 1 mg oral QHS:PRN 11. FoLIC Acid 1 mg PO DAILY 12. Furosemide 20 mg PO DAILY 13. Mirtazapine 15 mg PO QHS 14. Multivitamins 1 TAB PO DAILY 15. Rifaximin 550 mg PO BID 16. Spironolactone 50 mg PO DAILY Discharge Disposition: Extended Care Discharge Diagnosis: Primary Diagnosis ================== Septic shock Alcoholic cirrhosis Hepatic hydrothorax Urinary tract infection Respiratory failure Renal failure Secondary Diagnosis ================ Hyponatremia Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you here at ___. What happened while you were admitted? - You were admitted to ___ because you were having weight loss and difficulty eating. You were found to have decompensation in your liver cirrhosis likely due to infection and recent alcohol use. - You were very sick in the ICU. You were on multiple antibiotics and at one point required resuscitation and mechanical ventilation. - You had difficulty breathing and were found to have fluid accumulating in your right lower lung fields near you liver. You were seen by the interventional pulmonary team who placed a chest tube to drain the fluid. You had improvement, although the fluid started to accumulate again and you had difficulty breathing. We also increased your diuretic medications to help eliminate this fluid. You required more oxygen and were transfused to the ICU for further care. - Despite antibiotics, another catheter placed for your fluid, you got very sick. After transferring out of the ICU, you improved significantly. - You were treated for pneumonia. - On discharge, you were sent to ___ for continued care What to do after discharge? - Follow up with your hepatologist and primary care doctor. - You will be discharged to rehab to get stronger. - Please refrain from consuming any alcohol. Your liver is still very sick and even a little bit can be life threatening. We are happy to see you feeling better. We are wishing 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. Artificial Tears ___ DROP BOTH EYES QID 2. Atenolol 25 mg PO BID 3. Hydrochlorothiazide 25 mg PO DAILY 4. Levothyroxine Sodium 100 mcg PO 6X/WEEK (___) 5. Lisinopril 20 mg PO BID 6. Simvastatin 40 mg PO QPM 7. Terazosin 5 mg PO QHS 8. Vitamin D ___ UNIT PO DAILY 9. Chloraseptic Throat Spray 1 SPRY PO Q4H:PRN sore throat RX *phenol [Chloraseptic] 0.5 % 1 Spray q4h:prn Disp #*1 Bottle Refills:*0 10. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine 5 % 1 Patch Daily:prn Disp #*30 Patch Refills:*0 11. dutasteride 0.5 mg oral daily 12. Fluticasone Propionate NASAL 2 SPRY NU PRN allergies 13. magnesium hydroxide 2 tablespoons ORAL QOD:PRN constipation do not take within 4 hours of levothyroxine 14. Warfarin 5 mg PO DAILY16 15. Acetaminophen 1000 mg PO Q8H:PRN pain Take 1000mg every 8 hours as needed for pain RX *acetaminophen 500 mg 2 tablet(s) by mouth q8h:prn Disp #*60 Tablet Refills:*0 16. Outpatient Lab Work ICD-10 I48.1 Atrial Fibrillation Please draw INR on ___ and send results to Dr. ___: ___: ___, ___ Phone: ___ Fax: ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: S/p motor vehicle accident Musculoskeletal pain Atrial Fibrillation Discharge Condition: Discharge Condition: Stable Mental Status: AOx3 Ambulatory Status: Independent Followup Instructions: ___ [/INST] </s><s>Mr ___, It was a pleasure taking care of you at ___. As you know, you were admitted after a significant care accident for observation to ensure that you were ok. Fortunately you did not seem to suffer any significant injury and had only bruises. You will need to follow up with your primary care doctor on discharge. For the area of bruising/swelling inside your mouth, we would like you to call the ear, nose, and throat doctors to ___ a follow up appointment.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl ___AILY constipation 2. Lidocaine 5% Patch 1 PTCH TD QAM 3. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth every 4 hours Disp #*18 Tablet Refills:*0 4. Sarna Lotion 1 Appl TP DAILY 5. Acetaminophen 1000 mg PO TID 6. sevelamer CARBONATE 1600 mg PO TID W/MEALS 7. amLODIPine 5 mg PO DAILY 8. Amoxicillin ___ mg PO PREOP dental procedures 9. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 10. Aspirin 81 mg PO DAILY 11. Calmoseptine (menthol-zinc oxide) 0.44-20.6 % topical other 12. CarBAMazepine 300 mg PO TID 13. Cinacalcet 90 mg PO DAILY 14. Docusate Sodium 100 mg PO BID 15. Ezetimibe 10 mg PO DAILY 16. Famotidine 20 mg PO DAILY 17. Fluticasone Propionate NASAL 2 SPRY NU DAILY 18. Gold Bond Medicated Foot (menthol) 1 % topical DAILY:PRN 19. Guaifenesin-Dextromethorphan 5 mL PO Q6H:PRN cough 20. Lactulose 30 mL PO TID constipation 21. linaGLIPtin 5 mg oral DAILY 22. LORazepam 0.5 mg PO BID:PRN anxiety 23. Lotrisone (clotrimazole-betamethasone) ___ % topical BID:PRN 24. Nephrocaps 1 CAP PO DAILY 25. Nepro Carb Steady (nut.tx.imp.renal fxn,lac-reduc) 0.08 gram-1.8 kcal/mL oral QPM 26. RisperiDONE 3 mg PO QHS 27. RisperiDONE 1 mg PO DAILY 28. Rosuvastatin Calcium 40 mg PO QPM 29. Senna 8.6 mg PO BID:PRN constipation 30. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnoses: Cord compression Spinal mass Secondary diagnoses: End stage renal disease Anemia Seizure disorder Developmental delay Urothelial renal cancer Urothelial bladder cancer 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. ___, What brought you into the hospital? -You came into the hospital with weakness What happened while you were here? -We took pictures of your back and it showed a mass in your spine -This mass was removed by our orthopedic spine doctors -___ weakness improved ___ should you do when you leave the hospital? -You should continue to try and get strong at rehab -We made some changes to your medicines that you can see below It was a pleasure taking care of your Mr. ___! Best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY 2. Brimonidine Tartrate 0.15% Ophth. 1 DROP RIGHT EYE Q12H 3. Zebeta (bisoprolol fumarate) 5 mg oral Daily 4. Levofloxacin 750 mg PO Q48H RX *levofloxacin 750 mg 1 tablet(s) by mouth Q48H Disp #*5 Tablet Refills:*0 5. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*30 Tablet Refills:*0 6. Aspirin 81 mg PO DAILY 7. Simvastatin 20 mg PO DAILY 8. Travatan Z (travoprost) 0.004 % ophthalmic Daily Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Cholangitis/cholecystitis RLL pneumonia Delirium Abdominal aortic aneurysm 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>It was a pleasure looking after you, Mr. ___. As you may know, you were admitted to the hospital for confusion, fever, and nausea. You were found to have infection of the bile duct with possible involvement of the gallbladder. You also had a pneumonia. You were treated with antibiotics with significant improvement. Please complete a 2-week course of antibiotic (last day ___. Your other medications remain unchanged.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q6H:PRN pain 2. Allopurinol ___ mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Bisacodyl ___AILY:PRN constipation 5. BuPROPion 100 mg PO BID 6. Docusate Sodium 100 mg PO BID constipation 7. Furosemide 40 mg PO DAILY 8. Milk of Magnesia 30 mL PO Q8H:PRN constipation 9. NIFEdipine CR 90 mg PO DAILY 10. Omeprazole 20 mg PO BID 11. OxycoDONE (Immediate Release) 15 mg PO Q3H:PRN pain; L1 compression fracture RX *oxycodone 15 mg 1 tablet(s) by mouth q3h Disp #*112 Tablet Refills:*0 12. Prazosin 2 mg PO HS 13. Senna 8.6 mg PO BID:PRN constipation 14. Simvastatin 40 mg PO DAILY 15. Tiotropium Bromide 1 CAP IH DAILY 16. Warfarin 7.5 mg PO DAILY16 17. Enoxaparin Sodium 120 mg SC BID DVT/PE prevention Start: Tomorrow - ___, First Dose: First Routine Administration Time Please overlap with warfarin 24hours once INR is therapeutic (2.0-3.0). RX *enoxaparin 120 mg/0.8 mL 120 mg SC every twelve (12) hours Disp #*20 Syringe Refills:*0 18. Sarna Lotion 1 Appl TP TID:PRN itch 19. Lidocaine 5% Patch 1 PTCH TD QPM back pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: ================== Lumbar radiculopathy Secondary Diagnoses: ==================== History of DVT/PE COPD Obstructive Sleep Apnea Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for thigh pain. We evaluated you with an ultrasound and did not find any blood clots in your leg. You also did not have any problems with your breathing other than your baseline COPD and sleep apnea, so a pulmonary embolism is not likely. Your symptoms sounded more consistent with lumbar radiculopathy and you should continue to take your pain medications and work with your physical therapists at your rehab facility. In regards to your anticoagulation, we decided to start enoxaparin therapy which you are able to get at your rehab facility until your INR is therapeutic on the warfarin. Please take your medications as prescribed and follow up with your doctors as detailed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amitriptyline 20 mg PO QHS 2. Aspirin 81 mg PO DAILY 3. Diltiazem Extended-Release 180 mg PO DAILY 4. Docusate Sodium 100 mg PO BID 5. HYDROcodone-Acetaminophen (5mg-325mg) 1 TAB PO Q8H:PRN Pain - Mild 6. Letrozole 2.5 mg PO DAILY 7. LORazepam 0.5 mg PO Q12H:PRN agitation? 8. Omeprazole 20 mg PO DAILY 9. Oxybutynin 15 mg PO DAILY 10. Pravastatin 20 mg PO QPM 11. PreserVision AREDS (vitamins A,C,E-zinc-copper) ___ unit-mg-unit oral BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Mechanical fall Fractured humerus Secondary: Supraventricular tachycardia 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 in the hospital? - You had a fall and there was concern that you would have more difficulty at home with everyday tasks What was done while I was in the hospital? - You were seen by our physical and occupational therapists, who recommended going to acute rehab; you prefer to stay at home with additional services - You were started on a medication to help control your heart rate because it was going quite fast What should I do when I get home from the hospital? - Be sure to take all of your medications as prescribed, especially your diltiazem, which is supposed to help lower your heart rate - Please go to all of your follow up appointments listed below - If you have fevers, chills, dizziness, fall, have increased pain, or generally feel unwell, please call your doctor or go to the emergency room Sincerely, Your ___ Treatment Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gabapentin 800 mg PO TID 2. Lisinopril 40 mg PO DAILY 3. Paroxetine 40 mg PO DAILY 4. Ranitidine 150 mg PO BID 5. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth daily Disp #*30 Capsule Refills:*0 7. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. ClonazePAM 1 mg PO BID:PRN anxiety 9. Ibuprofen 800 mg PO Q8H:PRN pain 10. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q4H:PRN Pain 11. Viagra (sildenafil) 25 mg oral 30 min prior to sexual activity erectile dysfunction 12. Methadone 20 mg PO DAILY Duration: 5 Days 13. Amlodipine 7.5 mg PO DAILY RX *amlodipine 2.5 mg 3 tablet(s) by mouth daily Disp #*90 Tablet Refills:*0 14. CloniDINE 0.3 mg PO TID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES: Heroin and cocaine intoxication and withdrawal, acute kidney injury SECONDARY: Hypertension 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 ___. You were admitted when you were found down after using heroinn and you had a seizure. You were intubated and monitored in the intensive care unit. Please follow-up in the ___ clinic. Please return to the emergency room if you experience fevers, chills, chest pain, shortness of breath or any other new or concerning symptoms. 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. Lorazepam 0.5 mg PO BID:PRN Anxiety Duration: 30 Days 2. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain Duration: 30 Days 3. Acetaminophen 500 mg PO Q8H:PRN pain 4. Citalopram 10 mg PO DAILY 5. Creon 12 1 CAP PO TID W/MEALS 6. Docusate Sodium 100 mg PO BID:PRN constipation 7. Enoxaparin Sodium 120 mg SC Q24H Start: ___, First Dose: Next Routine Administration Time 8. Omeprazole 40 mg PO DAILY 9. Ondansetron 4 mg PO Q8H:PRN nausea 10. Losartan Potassium 25 mg PO DAILY 11. Labetalol 200 mg PO BID 12. Furosemide 20 mg PO DAILY 13. Amlodipine 10 mg PO DAILY 14. NPH 35 Units Breakfast NPH 35 Units Dinner Insulin SC Sliding Scale using HUM Insulin 15. Ertapenem Sodium 1 g IV DAILY Duration: 1 Dose Continue until instructed by your infectious disease doctor Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: - Hepatic abscess - Biliary obstruction - Hyponatermia Secondary: - Headache - Anemia - GERD - OSA - Depression - Anxiety - T2DM 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 ___ for progressive fatigue, headaches, and poor appetite. A CAT scan of your abdomen revealed a liver abscess, or an infection ___ your liver. A catheter was placed to help drain the abscess and you were started on antibiotics, and your condition improved. Additionally, an ERCP procedure was performed to replace your old biliary stent, which was clogged. Once your symptoms improved and you showed good response to the antibiotics and drainage, you were discharged to a rehab facility for continued antibiotics administration and to improve you physical strength before returning home. It was a pleasure take care of you at ___ and we wish you all the best during your ongoing recovery. If you have any questions about your care, please do not hesitate to ask. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>•Take your pain medicine as prescribed if needed. You do not need to take it if you do not have pain. •Exercise should be limited to walking; no lifting, straining, or excessive bending. •Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •DO not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. until follow up. •***You have been discharged on Keppra (Levetiracetam) for anti-seizure medicine, you will not require blood work monitoring. Please take this for a total of 7 days since your admission. •Do not drive until your follow up appointment. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING •New onset of tremors or seizures. •Any confusion, lethargy or change in mental status. •Any numbness, tingling, weakness in your extremities. •Pain or headache that is continually increasing, or not relieved by pain medication. •New onset of the loss of function, or decrease of function on one whole side of your body.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ondansetron ODT 4 mg PO Q8H:PRN nausea 2. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*12 Tablet Refills:*0 3. GuaiFENesin ER 600 mg PO Q12H 4. Loratadine 10 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: # Biliary obstruction secondary to pancreatic Head Mass # Hyperbilirubinemia # Ovarian Mass # Abnormal EKG # Hydroureter # Hyponatremia # Hypomagnesemia # Abnormal CXR # Coagulopathy Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Ms. ___: It was a pleasure caring for you at ___. You were admitted with jaundice (yellowing of the skin). We discussed with your guardian who agreed that you would want to focus on comfort and that you would not want any invasive testing. You are now ready for discharge back to your nursing home, with a plan to establish with hospice services.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen IV 1000 mg IV Q6H:PRN fever, pain Duration: 24 Hours 2. Glycopyrrolate 0.1 mg IV Q6H:PRN excess secretions 3. LORazepam 0.5-2 mg PO Q2H:PRN anxiety/distress 4. Morphine Sulfate ___ mg IV Q15MIN:PRN Pain or respiratory distress 5. Ondansetron 4 mg IV Q8H:PRN nausea/vomiting 6. Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Intraparenchymal Hemorrhage Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the neurology service at ___ after diagnosis of a hemorrhagic stroke (intraparenchymal hemorrhage). After discussion with your family members, it was decided to go forward with measures to make you as comfortable as possible, rather to pursue invasive tests and procedures. We have arranged for you to have continued palliative care with inpatient hospice.</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 six (6) hours Disp #*100 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right pneumothorax 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 a right pneumothorax, requiring placement of a chest drain to help remove the excess air and reinflate the lung. You have improved with the tube in but will need more time for the lung to heal and the air leak to resolve. You are being discharged to home with the tube in place, connected to a pneumostat, which is a one way valve that allows the excess air to escape. You will see Dr. ___ week to see if the leak has resolved and potentially have the tube removed. The ___ will also come by to check you and assure that the pneumostat is functioning properly. * You may shower with the pneumostat in place. Place the device in a zip lock bag to keep it as dry as possible. * If you have any increased shortness of breath, fevers > 101 or any trouble with the chest drain, call Dr. ___ at ___. Caring for your Chest Tube with Pneumostat 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. 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 every other day. Showering/Bathing: Showering with a chest tube is all right as long as you don't submerge the tube or device in water. No baths, swimming, or hot tubs. The pneumostat can be placed in a zip lock bag for showers. 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. Cefpodoxime Proxetil 400 mg PO Q12H Duration: 10 Days please stop taking if you have a rash or allergic symptoms RX *cefpodoxime 200 mg 2 tablet(s) by mouth every 12 hours Disp #*20 Tablet Refills:*0 2. Acetaminophen 650 mg PO Q6H:PRN pain 3. Amlodipine 10 mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. Bisacodyl 10 mg PR HS:PRN constipation 6. Citalopram 20 mg PO DAILY 7. Furosemide 20 mg PO DAILY 8. Labetalol 100 mg PO DAILY 9. Losartan Potassium 100 mg PO DAILY 10. Senna 8.6 mg PO BID:PRN constipation 11. GlipiZIDE 5 mg PO DAILY 12. methenamine hippurate 1 gram oral BID 13. PredniSONE 5 mg PO DAILY 14. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: #Complicated cystitis (urinary tract infection) #Ground level fall, multifactorial etiology Secondary: #Mild new widening of the atlantodens interval #Chronic congestive heart failure, compensated #Chronic kidney disease #Dementia Discharge Condition: Discharged in stable condition back to ___ living facility. Her mental status and ambulatory function are at baseline (she require mobility assistance at baseline in the form of a walker). 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. ___, Thank you for receiving your care at ___! You were admitted for after sustaining a fall at your assisted living facility. You underwent a CT scan of your head and spine and Xrays of your pelvis and your right femur. No signficant injuries were noted though the CT of your spine showed some mild widening at the "atlantodens interval" in your neck. Because of this widening we would like you to wear a soft neck collar for 1 week at which point we would like you to see one of our orthopedists, Dr. ___. As well, during your workup you were found to have a urinalysis and an elevated white blood cell count that was concerning for a urinary tract infection. You were treated with antibiotics during your admission but we would like you to continue taking another antibiotic called cefpodoxime for the next ___ days. Please take your medications as directed and follow up in clinic as directed.</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 81 mg PO DAILY 3. Atorvastatin 10 mg PO DAILY 4. Diltiazem Extended-Release 240 mg PO DAILY 5. Docusate Sodium 100 mg PO DAILY 6. Fluticasone Propionate NASAL 1 SPRY NU DAILY 7. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 8. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H:PRN SOB/dysnpea 9. Isosorbide Mononitrate 20 mg PO BID 10. Lidocaine 5% Patch 3 PTCH TD QAM prn pain 11. Loratadine 10 mg PO DAILY 12. Lorazepam 0.5 mg PO HS:PRN insomnia 13. Metoprolol Tartrate 25 mg PO BID 14. Nitroglycerin SL 0.4 mg SL PRN chest pain 15. Omeprazole 40 mg PO DAILY 16. Warfarin 2.5 mg PO DAILY16 RX *warfarin [Coumadin] 2.5 mg one tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 17. Ferrous Sulfate 325 mg PO DAILY RX *ferrous sulfate 325 mg (65 mg iron) one tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 18. Baclofen 10 mg PO HS 19. Multivitamins 1 TAB PO DAILY 20. Vitamin D 400 UNIT PO DAILY 21. Outpatient Physical Therapy Physical therapy Activity as tolerated ICD 9 code 428.0 congestive heart failure 22. Furosemide 20 mg PO 3X/WEEK (___) RX *furosemide 20 mg one tablet(s) by mouth every ___, ___ Disp #*30 Tablet Refills:*0 23. Citalopram 20 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: Heart Failure with Preserved Ejection Fraction Paroxysmal atrial fibrillation Secondary: Coronary Artery Disease Mild Aortic Stenosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your stay. You were admitted for dizziness and shortness of breath. Your dizziness may be due to your heart arrhythmia. You will go home with a heart monitor to further monitor your heart rhythm and to see if it is contributing to the dizziness. Please follow up with Dr. ___ electrophysiologist, after dicharge. In addition, you will follow up with neurology. PLEASE call Dr. ___ office to schedule an appointment with him within 2 weeks of discharge. Your shortness of breath may be due to increased pressures in your heart, causing fluid buildup in your lungs. You were given diuretics with improvement of your breathing. You will go home with lasix (a new medicaton) to be taken three times per week. Please follow up with your PCP and Dr. ___ discharge. We wish you the best! Your ___ care team 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 325 mg PO Q6H:PRN pain 2. Citalopram 40 mg PO DAILY 3. Multivitamins 1 TAB PO DAILY 4. OxycoDONE Liquid ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg/5 mL 15 mL by mouth Every four hours Refills:*0 5. Xeljanz (tofacitinib) 5 mg oral BID 6. Calcium 500 + D (D3) (calcium carbonate-vitamin D3) 500-125 mg-unit oral daily 7. Lorazepam 1 mg PO BID:PRN anxiety 8. Omeprazole 40 mg PO BID 9. Probiotic (B.breve-L.acid-L.rham-S.thermo;<br>L.acidophilus-Bif. animalis;<br>L.rhamn ___ acidophilus;<br>lactobacillus comb no.10;<br>lactobacillus combination no.4;<br>lactobacillus combo no.11) 0 1 ORAL DAILY 10. Sumatriptan Succinate 100 mg PO DAILY:PRN headache 11. Hyoscyamine SO4 (Time Release) 0.375 mg PO BID RX *hyoscyamine sulfate 0.375 mg 1 tablet(s) by mouth Twice a day Disp #*14 Tablet Refills:*0 12. Lidocaine 5% Patch 1 PTCH TD QAM Old ostomy site RX *lidocaine 5 % (700 mg/patch) Apply 1 patch to affected area every morning Disp #*7 Patch Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Abdominal pain, nausea, vomiting Secondary: Ileocolonic Crohn's disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___ were admitted because ___ had worsening abdominal pain, nausea, vomitting, and increased stool output. This was causing ___ to be unable to eat or drink enough and ___ were starting to feel weak. ___ also were unable to take your Xaljenz (Tofacitinib) because ___ had left your pills here on your last visit. Before discharge, your pain was under better control and ___ were able to eat and drink without problems. We also started Hyoscyamine which was recommended by the GI team. This should also help with your pain ___ are now ready to be discharged. Please follow up with Dr. ___ your PCP within one week. It was a pleasure taking care of ___, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. sevelamer CARBONATE 2400 mg PO TID W/MEALS RX *sevelamer carbonate 800 mg 3 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 2. Warfarin 3 mg PO DAILY16 Please start on ___. Please have INR drawn ___ RX *warfarin 3 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Labetalol 400 mg PO TID RX *labetalol 200 mg 2 tablet(s) by mouth three times a day Disp #*60 Tablet Refills:*0 4. PredniSONE 5 mg PO DAILY RX *prednisone 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Tacrolimus 5 mg PO Q12H RX *tacrolimus 5 mg 1 capsule(s) by mouth q12 Disp #*60 Capsule Refills:*0 6. amLODIPine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7.Outpatient Lab Work Please draw: INR on ___ Fax to: (1) Dr. ___, fax ___ (2) Dr. ___, fax ___ ICD-10: ___.___ Discharge Disposition: Home Discharge Diagnosis: PRIMARY: ========================= End stage renal disease secondary to IgA nephropathy Chronic rejection with allograft renal failure SECONDARY: ========================= Immunosuppression Anasarca Hypertensive urgency vs emergency Pancytopenia Abnormal liver function tests 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 did you come to the hospital? -You came to the hospital because you were feeling short of breath and you were having more swelling in your body. What was done for you while you were here? -You were evaluated and it was found that your kidney is failing. -You had a tube placed in your kidney called a PCN that was then converted to an inside tube call the PCNU. -You had a tunneled line placed in your right neck for hemodialysis. -You restarted on hemodialysis. -Your tunneled line developed a clot and you underwent an angioplasty to clear the clot. -You was started on a blood thinner called warfarin so that you do not develop another clot. What should you do when you go home? -You must have your INR checked at hemodialysis every week to make sure that your blood is not too thick or thin. -You will follow-up with your primary care physician on ___, ___. -You will have hemodialysis on ___ and ___. We wish you the best. Sincerely, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ClonazePAM 1 mg PO QHS:PRN anxiety 2. Dapsone 100 mg PO DAILY 3. Darunavir 600 mg PO DAILY 4. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 5. Gabapentin 100 mg PO DAILY 6. LaMOTrigine 75 mg PO QHS 7. Mirtazapine 30 mg PO HS 8. OxycoDONE (Immediate Release) 10 mg PO BID:PRN pain 9. RiTONAvir 100 mg PO BID 10. Tiotropium Bromide 1 CAP IH DAILY 11. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 12. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet,chewable(s) by mouth daily Disp #*30 Capsule Refills:*0 13. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 14. meloxicam 7.5 mg ORAL QDAY Please take per your home prescription dose Discharge Disposition: Home Discharge Diagnosis: Transaminitis Chronic back pain Alcohol intoxication 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 admission to the ___. You were admitted because you had elevated liver enzymes, ___ were feeling weak and fatigued and you were intoxicated with alcohol. You were concerned about your heart and we did an EKG and cardiac enzymes that ruled out heart attack. You also had a chest x-ray that did not show any signs of pneumonia or other infection. You had an ultrasound of your liver that showed liver damage called cirrhosis that can be consistent with alcohol use. You were given some IVF and your nausea was controlled with some medications. We strongly encourage you to stop drinking and avoid further damage to your liver. You have some labs about your liver that we did not get back yet, so it is very important that you follow-up with your primary care doctor in order to obtain the results. Please continue to take all of your medications at home and keep all of your follow-up appointments. All the Best, The ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 2. Etravirine 200 mg PO BID 3. Labetalol 300 mg PO BID 4. Lisinopril 5 mg PO DAILY 5. Morphine SR (MS ___ 100 mg PO Q12H 6. Raltegravir 400 mg PO BID 7. Symbicort *NF* (budesonide-formoterol) 160-4.5 mcg/actuation Inhalation BID 8. PredniSONE 60 mg PO DAILY Duration: 2 Days RX *prednisone 20 mg 3 tablet(s) by mouth Daily Disp #*6 Tablet Refills:*0 9. Azithromycin 250 mg PO Q24H Duration: 2 Days RX *azithromycin 250 mg 1 tablet(s) by mouth Daily Disp #*2 Tablet Refills:*0 10. Albuterol Inhaler ___ PUFF IH Q6H:PRN cough/wheeze 11. Tiotropium Bromide 1 CAP IH DAILY RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 CAP INH Daily Disp #*30 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: COPD Exacerbation HIV 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 a cough and shortness of breath. X-ray showed no signs of pneumonia. You have been treated for a COPD exacerbation and are improving. Please continue to take the medications as directed below. We are adding a new inhaled medication called Spiriva to help with your breathing on a daily basis. Please follow-up at the appointments listed below. It was a pleasure taking care of you, Mr ___.</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 RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet(s) by mouth every six (6) hours Disp #*60 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. Lisinopril 20 mg PO DAILY 4. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain RX *oxycodone [Oxecta] 5 mg 1 tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 5. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 by mouth twice a day Disp #*60 Tablet Refills:*0 6. Verapamil SR 240 mg PO Q24H 7. Enoxaparin Sodium 40 mg SC QHS Start: ___, First Dose: STAT RX *enoxaparin 40 mg/0.4 mL 1 at bedtime Disp #*14 Syringe Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right distal femur fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: 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. ACTIVITY AND WEIGHT BEARING: - Touch down weight bearing, unlocked ___ ROM as tolerated Physical Therapy: TDWB Unlocked ___ and ROM knee as tolerated Treatments Frequency: Unlocked ___ and ROM knee as tolerated</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Famotidine 40 mg PO BID 3. Hydrochlorothiazide 25 mg PO DAILY 4. Levothyroxine Sodium 25 mcg PO DAILY 5. Lorazepam 0.5 mg PO HS:PRN insomnia 6. Vitamin D 1000 UNIT PO DAILY 7. Torsemide 10 mg PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Multivitamins 1 TAB PO DAILY 10. Mirtazapine 30 mg PO HS 11. FoLIC Acid 1 mg PO DAILY 12. Metoprolol Succinate XL 50 mg PO DAILY 13. Tricor (fenofibrate nanocrystallized) 145 mg oral daily 14. TraMADOL (Ultram) 50 mg PO DAILY 15. pramipexole 0.125 mg oral daily 16. Magnesium Oxide 400 mg PO DAILY 17. Potassium Chloride 20 mEq PO DAILY 18. Creon (lipase-protease-amylase) 5K-18.75K-16.6K unit oral daily 19. Calcium Carbonate 500 mg PO DAILY 20. Outpatient Physical Therapy Patient found to have acute compression fracture of L1 vertebrae. Patient was seen by Physical Therapy who recommended outpatient physical therapy. 21. walker 1 walker miscellaneous Daily Diagnosis: L1 compression fracture, Reason: ambulation, Prognosis: good, Length of Use: Lifetime. RX *walker Use walker with ambulation daily Disp #*1 Each Refills:*0 22. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg Take ___ tablets by mouth every 6 hours Disp #*60 Tablet Refills:*0 23. Acetaminophen 650 mg PO Q6H:PRN pain RX *acetaminophen 325 mg Take 2 tablets by mouth every 6 hours Disp #*50 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Acute T1 Vertebral Compression Fracture Secondary Diagnosis: CKD, MS, GERD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___. You were admitted to the hospital because you were having severe back pain. You had an MRI that showed you had a new compression fracture in your lumbar vertebrae (L1 ___. You were seen by the ___ doctors who recommended that you wear a brace and follow-up with them in 3 weeks. You were also seen by physical therapy who recommended that you participate in outpatient physical therapy. All the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aluminum-Magnesium Hydrox.-Simethicone 15 mL PO TID:PRN acid reflux/chest pain 2. Acetaminophen 1000 mg PO Q8H:PRN pain 3. Aspirin 81 mg PO DAILY 4. Benztropine Mesylate 1 mg PO QHS 5. DiphenhydrAMINE 25 mg PO QHS:PRN insomnia 6. Docusate Sodium 100 mg PO BID 7. Haloperidol 1 mg IM Q12H:PRN agitation 8. Omeprazole 20 mg PO DAILY 9. Simvastatin 20 mg PO QPM 10. TraZODone 50 mg PO QHS:PRN insomnia 11. Venlafaxine XR 150 mg PO DAILY 12. ZIPRASidone Hydrochloride 80 mg PO BID 13. Nicotine Patch 14 mg TD DAILY 14. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID Duration: 7 Days Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: #Major depressive disorder, recurrent, severe with psychotic symptoms with psychotic features #Expressive aphasia #History of left ischemic stroke with residual deficits #Encephalomalacia #Dental caries Discharge Condition: Mental Status: Alert, responsive, expressive aphasia Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, you were seen in the ___ emergency room for facial swelling and tooth pain. You also had chest pain and thoughts of suicide there. You did not have a lung infection (pneumonia) or heart attack to explain your chest pain. A CT scan of your head showed stable findings from your old stroke and some areas of inflammation around the teeth in the right upper jaw. Psychiatry evaluated you and thought that you needed to be admitted to psychiatric hospital. We recommend that you see a dentist within a few weeks to discuss removing any teeth that are infected.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Atorvastatin 10 mg PO QPM 3. Calcium Carbonate 500 mg PO TID 4. Docusate Sodium 100 mg PO BID 5. Heparin 5000 UNIT SC BID RX *heparin (porcine) 5,000 unit/mL (1 mL) 1 cartridge subcutaneous twice a day Disp #*28 Cartridge Refills:*0 6. Multivitamins 1 TAB PO DAILY 7. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain RX *oxycodone [Oxaydo] 5 mg ___ tablet(s) by mouth every 4 hours as needed for pain Disp #*40 Tablet Refills:*0 8. Senna 8.6 mg PO BID 9. Vitamin D 400 UNIT PO DAILY 10. Alendronate Sodium 70 mg PO QWED 11. Aspirin 81 mg PO DAILY 12. Tretinoin 0.025% Cream 1 Appl TP EVERY OTHER NIGHT Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: L acetabulum 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>Ms. ___, - ___ were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Touch down weightbearing Left lower extremity MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so ___ should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take 5000 units subcutaneous heparin for 2 weeks WOUND CARE: - ___ may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if ___ experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___ ___ will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for and any new medications/refills. Physical Therapy: touchdown weight bearing for left lower extremity Treatments Frequency: Wound care: Site: Incision Type: Surgical Dressing: Gauze - dry Site: L hip Description: dsg c/d/Ichanged by MD ___ Care: keep dressing clean, dry intact.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath 2. Enoxaparin Sodium 80 mg SC DAILY Hx of PE Start: ___, First Dose: Next Routine Administration Time 3. Prochlorperazine 10 mg PO Q8H:PRN Nausea/Vomiting - Second Line 4. Tiotropium Bromide 1 CAP IH DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: #metastatic SCLC # Failure to thrive # Weakness # Malnutrition Secondary: # Oral candidiasis: # Atrial fibrillation: # History of pulmonary embolism # COPD: Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You presented with fatigue, weakness and shortness of breath. This was believed to be from progression of your cancer. You decided that you wanted to go to hospice so we discharged you to a hospice house. We wish you the best. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Carvedilol 25 mg PO BID RX *carvedilol 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*5 2. Apixaban 2.5 mg PO BID RX *apixaban [Eliquis] 2.5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*5 3. Multivitamins 1 TAB PO DAILY 4. Timolol Maleate 0.5% 1 DROP BOTH EYES BID 5. Vitamin B Complex 1 CAP PO DAILY 6. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: transient ischemic attack exudative pleural effusion atrial fibrillation hypertension suspected cervical stenosis 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 hospitalized due to symptoms of difficulty speaking and difficulty walking. We believe that these occurred because of a TRANSIENT ISCHEMIC ATTACK. This is a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot which then clears. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: - atrial fibrillation - hypertension You had a collection of fluid around your right lung. We drained this collection of fluid. There are still tests which are pending to find out exactly what caused this collection to appear. You will follow up in the pulmonary clinic in ___ weeks to discuss the lab results and any further tests. We are changing your medications as follows: - starting apixaban (a blood thinning medication) - stopping furosemide (lasix) - stopping aspirin - increased carvedilol We are starting you on apixaban (Eliquis) to thin your blood. This is instead of the coumadin. Just like the coumadin, this medication increases the risk of bleeding. We saw that you have weakness in your arms and legs. We believe this is due to arthritis in your neck. We have given you a cervical collar to wear at nighttime in order to help support your neck which can relieve some of these symptoms. Please take your other medications as prescribed. Please followup with Neurology and your primary care physician. Sincerely, Your ___ Neurology Team</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 ___ tablet(s) by mouth every 6 hours as needed Disp #*50 Tablet Refills:*3 2. Cefpodoxime Proxetil 200 mg PO Q12H RX *cefpodoxime 100 mg 1 tablet(s) by mouth twice per day Disp #*20 Tablet Refills:*0 3. Ibuprofen 600 mg PO Q6H RX *ibuprofen 600 mg 1 tablet(s) by mouth every 8 hours as needed Disp #*50 Tablet Refills:*2 4. MetroNIDAZOLE 500 mg PO TID RX *metronidazole 500 mg 1 tablet(s) by mouth three times per day Disp #*30 Tablet Refills:*0 5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Severe RX *oxycodone 5 mg ___ or 1 tablet(s) by mouth every 4 hours as needed Disp #*15 Tablet Refills:*0 6. Carvedilol 25 mg PO BID 7. Lisinopril 40 mg PO DAILY 8. Simvastatin 20 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: RIGHT OVARIAN TORSON, ENCASED LEFT OVARY 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 gynecology service after your procedure. You have recovered well and the team believes you are ready to be discharged home. Please call Dr. ___ office with any questions or concerns. Please follow the instructions below. General instructions: * Take your medications as prescribed. * Do not drive while taking narcotics. * Take a stool softener such as colace while taking narcotics to prevent constipation. * Do not combine narcotic and sedative medications or alcohol. * Do not take more than 4000mg acetaminophen (APAP) in 24 hrs. * No strenuous activity until your post-op appointment. Incision care: * You may shower and allow soapy water to run over incision; no scrubbing of incision. No tub baths for 6 weeks. * Since you have steri-strips, leave them on. They will fall off on their own or be removed during your followup visit. Constipation: * Drink ___ liters of water every day. * Incorporate 20 to 35 grams of fiber into your daily diet to maintain normal bowel function. Examples of high fiber foods include: Whole grain breads, Bran cereal, Prune juice, Fresh fruits and vegetables, Dried fruits such as dried apricots and prunes, Legumes, Nuts/seeds. * Take Colace stool softener ___ times daily. * Use Dulcolax suppository daily as needed. * Take Miralax laxative powder daily as needed. * Stop constipation medications if you are having loose stools or diarrhea. 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. Allopurinol ___ mg PO DAILY 2. Atenolol 50 mg PO DAILY 3. Atorvastatin 80 mg PO QPM 4. MetFORMIN (Glucophage) 850 mg PO BID 5. Verapamil SR 240 mg PO Q24H 6. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 7. LevETIRAcetam 750 mg PO BID To prevent seizures. Please take this unless told to stop by a neurologist. RX *levetiracetam 250 mg 3 tablet(s) by mouth twice a day Disp #*180 Tablet Refills:*4 8. Sildenafil Dose is Unknown PO DAILY:PRN Erectile Dysfunction 9. Outpatient Occupational Therapy For vision services Discharge Disposition: Home Discharge Diagnosis: Left occipital stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for flashing and your vision and difficulty seeing on the right. You had imaging of your brain (CT and MRI) which showed a stroke in your brain. You had an ultrasound of your heart which showed slightly abnormal function but no large clot in your heart. Your aspirin was stopped and you were started on Plavix (clopidogrel) instead. You had an EEG (brain wave test) which did not show any seizure during the study, but you did not have any flashing in your vision during the study. You were started on a medication called levetiracetam (Keppra) to prevent seizures. By law, you may not drive until you have had no seizures for six months. You should continue to take the levetiracetam (Keppra) to prevent seizures unless told to stop by your neurologist. Some of your blood pressure medications were held or reduced in the hospital just after your stroke. You should re-start these at your usual doses at the time of hospital discharge. You will have follow up with your primary care doctor who will arrange followup with a Neurologist, Ophthalmologist, and Cardiologist. You should also have occupational therapy for vision services. You will have a heart monitor; please follow the instructions given to you in the hospital. Dear Mr. ___, You were hospitalized due to symptoms of vision problems and flashing 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, high blood pressure, heart disease, high cholesterol We are changing your medications as follows: Stopping aspirin. Starting clopidogrel and levetiracetam. Please take your other medications as prescribed. Please followup 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 Thank you. Sincerely, Your ___ Neurology Stroke Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN fever, pain 2. Docusate Sodium 100 mg PO BID 3. Fluoxetine 60 mg PO DAILY 4. Fluticasone Propionate 110mcg 2 PUFF IH BID only during bronchitis 5. Ketoconazole 2% 1 Appl TP BID 6. Lorazepam 0.5 mg PO Q8H:PRN anxiety 7. Metoprolol Tartrate 25 mg PO BID 8. Oxybutynin 5 mg PO BID:PRN bladder spasm 9. QUEtiapine Fumarate 50 mg PO QHS 10. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing 11. AndroGel (testosterone) 1 %(50 mg/5 gram) Transdermal Daily 12. Biafine Emulsion (emollient combination no.10) 0 TOPICAL BID 13. calcium citrate-vitamin D3 200 -250 unit ORAL DAILY 14. Diphenoxylate-Atropine ___ TAB PO ___ TIMES DAILY PRN diarrhea 15. Fosfomycin Tromethamine 3 g PO Q4 DAYS 16. Sildenafil 50-100 mg ORAL PRN one hour before sexual activity Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: primary diagnosis: fever, hyponatremia secondary diagnosis: neurogenic bladder 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 caring for you while you were admitted to the hospital. You were admitted with fever and initially started on IV antibiotics. You had a number of tests to look for the source of infection and all of them were negative. We think that your fever was likely due to a viral infection. Also your sodium level was low. You should hold your Triamterene-Hydrochlorothiazide for now and make an appointment to see your doctor next week to have your blood pressure and electrolytes checked (blood test). At that time you can decide if your should restart this medication or change to a different blood pressure medication. Please continue to take all the rest of your medications as prescribed and follow up with your doctors as ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>An area of your brain has had an ischemic insult. Please be careful to avoid falling (use a cane or walker if you feel unstable, remove any loose carpets in your home, sit or lie down if you feel unstable). Be sure to follow up with your outpatient appointments to try to find a source for the problem that brought you in, to treat it and avoid it happening again. Dear ___, ___ was a pleasure taking care of you at ___. You were admitted to the hospital because of seizures and had to be intubated and stabilized in the medical ICU. An MRI scan showed evidence of multiple small strokes, likely due to blood clots. We did an extensive work-up but were unable to determine the exact cause of these potential clots. We did not find evidence of any heart structural or rhythm abnormalities, and laboratory results suggest against any predisposing condition for clot formation. We started you on aspirin to try to prevent further strokes, and you will follow up in a stroke clinic ___ months after discharge. You have a heart monitor to take home for 90 days for further monitoring of your heart rhythm. We were also investigating an infectious cause of your seizures, but the laboratory sample could not be used. Because the risk for an HSV infection is low, you have been taken off antiviral medications. During this hospitalization, your kidney function also declined. This was thought to be due to low blood volume going to your kidneys or from the antiviral medication, acyclovir, that has now been stopped. Your kidney function improved greatly prior to discharge, but you will need to have this re-checked on ___, and follow up with the kidney doctors. ___ you were in the hospital, you did not take your antidepressant medications, which you stated you preferred. It is recommended that you follow up with your psychiatrist, Dr. ___ further management. It is very important to remember: Follow up with Dr. ___. Follow up with your kidney doctor. See your new primary care doctor as well. Also as we discussed, absolutely NO driving for the next 6 months in ___ given your recent seizure. Thank you for letting us participate in your care. -Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Alendronate Sodium 70 mg PO QSAT RX *alendronate 70 mg 1 tablet(s) by mouth oncee a week Disp #*4 Tablet Refills:*0 2. Ascorbic Acid ___ mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Glucagon 1 mg IM DAILY as directed for hypoglycemia RX *glucagon (human recombinant) [Glucagon Emergency] 1 mg give 1 injection once Disp #*4 Syringe Refills:*0 5. Mycophenolate Mofetil 500 mg PO BID 6. Pravastatin 20 mg PO DAILY 7. Tacrolimus 2 mg PO Q12H 8. Vitamin E 400 UNIT PO DAILY 9. Glargine 10 Units Breakfast RX *insulin glargine [Lantus] 100 unit/mL 10 units before breakfast Disp #*1 Unit Refills:*0 10. Insulin Pump SC (Self Administering Medication)Insulin Aspart (Novolog) (non-formulary) Basal rate minimum: 0.55 units/hr Basal rate maximum: 0.85 units/hr Bolus minimum: 1.29 units Bolus maximum: 1.33 units Target glucose: ___ Fingersticks: QAC and HS RX *insulin aspart [Novolog] 100 unit/mL please use to replenish insulin pump per insulin pump settings Disp #*1 Unit Refills:*2 Discharge Disposition: Home Discharge Diagnosis: Primary Hyperglycemic HyperOsmolar Nonketotic State Secondary Type I diabetes End Stage Renal Disease s/p transplant Chronic transplant rejection Left leg amputation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent (with left leg prosthesis) Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital because you were having nausea and vomiting in the setting of very high blood sugars. This was likely due to replenishing your insulin pump with a bad batch of insulin. You improved with receiving good insulin. You were seen by the ___ diabetes doctors who confirmed that your pump was working properly. In the future, if you have problem with the pump or the insulin in the pump, please yourself lantus injection 10 units daily for basal coverage until the pump insulin problem can be corrected.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth Two times daily Disp #*60 Tablet Refills:*0 2. Midodrine 10 mg PO TID RX *midodrine 10 mg 1 tablet(s) by mouth Three times a day Disp #*90 Tablet Refills:*0 3. Senna 8.6 mg PO BID:PRN Constipation - First Line RX *sennosides [senna] 8.6 mg 1 tablet by mouth Two times daily as required Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Syncope - likely orthostatic hypotension 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 Mr. ___, WHY YOU CAME TO THE HOSPITAL You were admitted to ___ following an episode of collapse, during which you fell to the ground. WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL - You had a number of scans which ruled out any evidence of injury - Your pacemaker was reviewed and was found to be working well - You had a scan of your heart, which did not show any cause for your collapse - You had a further episode of collapse while walking with the physical therapist - Your blood pressure readings showed a drop when moving from a lying/sitting to standing position, with subsequent collapse, which may be responsible for these episodes. WHAT YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL - You need to follow-up with a PCP to ensure you are receiving adequate care - We would recommend follow-up with a neurologist It was a pleasure taking care of you. Your ___ Healthcare Team MEDICATION CHANGES: [] started midodrine 10mg three times a day [] started docusate 100mg two times a day [] started senna 8.6mg two times a day as required</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. Crestor 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation Q 24H (Every 24 Hours). 4. metformin 1,000 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet Extended Rel 24 hr PO qam. 5. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. oxycodone 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for back pain. 7. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for pain. 8. lipase-protease-amylase 12,000-38,000 -60,000 unit Capsule, Delayed Release(E.C.) Sig: One (1) Cap PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 9. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 10. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 12. carvedilol 25 mg Tablet Sig: One (1) Tablet PO twice a day. 13. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO QAM (once a day (in the morning)). Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2* 14. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. furosemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 16. sucralfate 1 gram Tablet Sig: One (1) Tablet PO TID (3 times a day). 17. olmesartan 40 mg Tablet Sig: One (1) Tablet PO once a day. 18. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) nebulizer treatment Inhalation every six (6) hours as needed for shortness of breath or wheezing. 19. Atrovent HFA 17 mcg/actuation HFA Aerosol Inhaler Sig: One (1) puff Inhalation twice a day as needed for shortness of breath or wheezing. 20. levalbuterol tartrate 45 mcg/actuation HFA Aerosol Inhaler Sig: One (1) puff Inhalation three times a day as needed for shortness of breath or wheezing. Discharge Disposition: Home With Service Facility: ___ ___: Primary diagnosis: - Chronic lower back pain Secondary diagnosis: - coronary artery disease - chronic obstructive pulmonary disease - fibromyalgia 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 our hospital for back pain and lightheadedness. Both problems have been going on for a long time. Your symptoms are likely a result of medication and possibly a mild viral illness. In the ED, you also complained of chest pain, and has been ruled out for heart attack. Your condition is stable, and can go home now. Based on the description of your symptoms of excessive daytime sleepiness, snoring at night, and poor nighttime sleep, you may have a condition called sleep apnea. We strongly recommend going to your sleep study (and perhaps moving it up), and physical therapy for further improvement of your symptoms. . Please note that the following medication has been changed: - Please STOP taking meclizine - Please STOP taking cyclobenzaprine (Flexeril) - Please decrease carvedilol dose to 25 mg twice a day - Please decrease your Imdur dose to 30 mg daily, and please take it in the morning - Please take your metformin in the morning rather than before bed - There are no further changes to your medication. . It has been a pleasure taking care of you here at ___. We wish you a speedy recovery. 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. Linzess (linaCLOtide) 145 mcg oral DAILY 2. Methylnaltrexone 12 mg Subcut ONCE Duration: 1 Dose 3. Senna 17.2 mg PO BID RX *sennosides [senna] 8.6 mg 1 tablets by mouth daily Disp #*60 Tablet Refills:*0 4. Acetaminophen 650 mg PO BID:PRN Pain - Mild 5. Ciprofloxacin HCl 500 mg PO DAILY 6. Escitalopram Oxalate 20 mg PO DAILY 7. FoLIC Acid 1 mg PO DAILY 8. HYDROmorphone (Dilaudid) 2 mg PO DAILY PRN Pain - Moderate RX *hydromorphone 2 mg 1 tablet(s) by mouth daily Disp #*15 Tablet Refills:*0 9. Lactulose 30 mL PO Q6H 10. LevETIRAcetam Oral Solution 1000 mg PO BID 11. Metoclopramide 5 mg PO Q6H 12. Midodrine 10 mg PO TID 13. Multivitamins 1 TAB PO DAILY 14. Neutra-Phos 2 PKT PO TID 15. Omeprazole 40 mg PO DAILY 16. Polyethylene Glycol 17 g PO DAILY 17. Rifaximin 550 mg PO BID 18. Simethicone 40-80 mg PO QID:PRN bloating 19. Thiamine 100 mg PO DAILY 20. Torsemide 20 mg PO DAILY 21. TraMADol 50 mg PO BID 22. Vitamin D ___ UNIT PO 1X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Abdominal pain Constipation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. - sometimes holds on to walls/furniture for support Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. Why did you come to the hospital? -You came to the hospital because you were having severe abdominal pain. What was done for you while you were here? -You had a CT scan of your abdomen which did not show an obstruction. -We started you on a laxative called senna which she will take twice daily to keep your bowels moving. -We continued your lactulose and gave you an extra dose. What should you do when you go home? -You should continue taking all of her medications as directed on this paperwork. -If you do not have a bowel movement one day, you should call your primary liver doctor. Your abdominal pain will worsen if you become constipated and stool builds up in your abdomen. We wish you the best. Sincerely, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ibuprofen 400 mg PO Q6H:PRN Pain - Moderate Discharge Disposition: Home Discharge Diagnosis: musculoskeletal pain chronic right ptosis 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 neck pain and eye blurriness. We saw that you your right eyelid was drooping, but this looks like it is old. We did an MRI of your brain, which shows no sign of a stroke. Your blood vessels did not show a sign of a tear. We believe that your neck pain is caused by muscle strain. We recommend treatment with heat, stretching and ibuprofen. In order to avoid taking too much ibuprofen we recommend alternating with Tylenol. We are not making any changes to your medications. We do recommend that you do not take more than 3200mg of ibuprofen (16 200-mg tablets) a day because there is a risk of injuring your kidneys. Also, if you take pain medications every day you can get medication rebound headaches. Therefore, once your shoulder is feeling better we recommend that you cut back on the amount of ibuprofen you are taking. Please followup with Neurology and your primary care physician. Sincerely, Your ___ Neurology 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. Docusate Sodium 100 mg PO BID 3. Enoxaparin Sodium 40 mg SC QPM 4. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN Pain - Moderate RX *hydromorphone 2 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 5. Senna 8.6 mg PO BID 6. Amphetamine-Dextroamphetamine 10 mg PO BID 7. Valsartan 160 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: left oblique tibial shaft fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: -Weight bearing as tolerated MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 3 hours as needed x 1 day, then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take Lovenox 40mg SC daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE <30 DAYS OF REHAB Physical Therapy: weight bearing as tolerated in the left lower extremity Treatments Frequency: Any staples or superficial sutures you have are to remain in place for at least 2 weeks postoperatively. Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. You may shower and allow water to run over the wound, but please refrain from bathing for at least 4 weeks postoperatively.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Losartan Potassium 25 mg PO DAILY heart failure RX *losartan 25 mg 25 mg(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Spironolactone 25 mg PO DAILY RX *spironolactone 25 mg 25 mg by mouth once a day Disp #*30 Tablet Refills:*0 3. Torsemide 40 mg PO DAILY RX *torsemide 20 mg 2 tablets by mouth once a day Disp #*60 Tablet Refills:*0 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 80 mg PO QPM 6. Cyanocobalamin 1000 mcg PO DAILY 7. Ferrous Sulfate 325 mg PO DAILY 8. NPH 5 Units Breakfast NPH 5 Units Bedtime 9. MetFORMIN (Glucophage) 850 mg PO BID 10. Metoprolol Succinate XL 50 mg PO DAILY 11. Milk of Magnesia 30 mL PO DAILY:PRN Constipation - First Line 12. Multivitamins W/minerals 1 TAB PO DAILY 13. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 14. TiCAGRELOR 90 mg PO BID 15. Trulicity (dulaglutide) 1.5 mg/0.5 mL subcutaneous 1X/WEEK Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: - Fluid overload due to ischemic cardiomyopathy - 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>====================== DISCHARGE INSTRUCTIONS ====================== Dear Mr. ___, It was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - Heart failure - Fluid overload - Pneumonia WHAT HAPPENED TO ME IN THE HOSPITAL? - You received an x-ray and labs - You took antibiotics for pneumonia - You took diuretic medications to take fluid off of your lungs WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Weigh yourself daily, keep a weight journal, and call your primary doctor if you gain >3 pounds in 24 hours. - Attend your primary care doctor at 3:30PM on ___ with Dr. ___ - ___ your cardiology appointment at 4PM on ___ with Dr. ___ - ___ to take all your medicines and keep your appointments. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Calcium Carbonate 500 mg PO BID 3. Docusate Sodium 100 mg PO BID 4. Miconazole Powder 2% 1 Appl TP TID:PRN rash 5. Ramelteon 8 mg PO QHS 6. Senna 8.6 mg PO BID 7. TraMADol 25 mg PO Q6H:PRN pain RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth Every 8 hours Disp #*5 Tablet Refills:*0 8. Aspirin 81 mg PO DAILY 9. Gabapentin 100 mg PO Q8H 10. Valsartan 80 mg PO BID 11. Atorvastatin 80 mg PO QPM 12. Carvedilol 25 mg PO BID 13. Ferrous Sulfate 325 mg PO DAILY 14. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: PRIMARY: - L1 compression fracture - Lumbar spinal stenosis - Cauda Equina Syndrome SECONDARY: - Toxic-metabolic encephalopathy - Orthostatic hypotension - Acute kidney injury - Asymptomatic bacteriuria - Chronic systolic congestive heart failure - Hypertension - Hyperlipidemia 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. ___, It was a pleasure caring for you at ___. WHY WAS I IN THE HOSPITAL? - You came to the hospital because you were having back pain. WHAT HAPPENED TO ME IN THE HOSPITAL? - We found that your spinal canal was narrow and was pressing on your spinal cord. - You had urgent surgery to fix this. - After the surgery, your blood pressures were low. You were given fluids and blood transfusions, and your blood pressures became normal. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? Surgery •Your incision is closed with staples or sutures. You will need suture/staple removal. •Do not apply any lotions or creams to the site. •Please keep your incision dry until removal of your sutures/staples. •Please avoid swimming for two weeks after suture/staple removal. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •*** You must wear your brace at all times when out of bed. You may apply your brace sitting at the edge of the bed. You do not need to sleep with it on. •*** You must wear your brace while showering. •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •No contact sports until cleared by your neurosurgeon. •Do NOT smoke. Smoking can affect your healing and fusion. Medications •***Please do NOT take any blood thinning medication (Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. It is OK to take a baby aspirin. •Do not take any anti-inflammatory medications such as Motrin, Advil, Aspirin, and Ibuprofen etc until cleared by your neurosurgeon. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •New weakness or changes in sensation in your arms or legs. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. PredniSONE 40 mg PO DAILY RX *prednisone 20 mg 2 tablet(s) by mouth Daily Disp #*4 Tablet Refills:*0 2. Warfarin 3 mg PO DAILY16 Please continue until you have your INR drawn ___. 3. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever 4. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB/Cough 5. Albuterol Inhaler ___ PUFF IH Q4H:PRN Cough/SOB/Wheeze 6. Atorvastatin 40 mg PO QPM 7. AtroVENT HFA (ipratropium bromide) 17 mcg/actuation inhalation Q6H:PRN SOB 8. Digoxin 0.125 mg PO DAILY 9. Fluticasone Propionate NASAL 2 SPRY NU DAILY 10. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 11. ipratropium bromide 0.02 % inhalation QID:PRN wheezing 12. Magnesium Oxide 500 mg PO DAILY 13. Metoprolol Succinate XL 25 mg PO BID 14. Montelukast 10 mg PO DAILY 15. rOPINIRole 0.25 mg PO QPM Restless Leg Syndrome 16. Sacubitril-Valsartan (24mg-26mg) 1 TAB PO BID 17. Spironolactone 12.5 mg PO DAILY 18. Tamsulosin 0.4 mg PO QHS 19. Torsemide 10 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY ======= Asthma exacerbation SECONDARY ========= Atrial Fibrillation Heart Failure with Reduced Ejection Fraction Coronary artery disease Hyperlipidemia Normocytic Normochromic Anemia Prostate Cancer Restless Leg Syndrome 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 care for you at the ___ ___. Why did you come to the hospital? - You came to the hospital due to difficulties breathing, and concerns for an asthma exacerbation. What did you receive in the hospital? - While in the hospital, we gave you multiple medications to help resolve your exacerbation. This included inhalers, steroids, and magnesium. You continued to remain symptomatic in the emergency room, and thus we admitted you to the hospital overnight. Thankfully, in the morning your symptoms had improved, and we felt you were safe for discharge home. What should you do once you leave the hospital? - Please continue to take your medications as prescribed - We would recommend you try and avoid sick friends and family so as to not exacerbate your asthma. - Weigh yourself every morning, call MD if weight goes up more than 3 lbs. - Continue taking 3mg warfarin until you have a chance to have your INR drawn 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: [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital with difficulty breathing. We found that you had the flu, and we gave you treatment for that. We also felt that you had some extra fluid in your lungs due to an exacerbation of your heart failure that was triggered by the flu, so we gave you additional medication to help you to urinate more to decrease that fluid. We also gave you oxygen to help with your breathing. You are improving but still symptomatic with the flu. To prevent spreading it to others, please try to limit close contact with others (especially children) and stay at home while you are still recovering. It was a pleasure taking care of you. Sincerely, Your ___ Cardiology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Triamcinolone Acetonide 0.1% Cream 1 Appl TP TID poison ___ right hand RX *triamcinolone acetonide 0.1 % apply to skin three times a day Disp #*30 Gram Gram Refills:*0 2. Acetaminophen 325-650 mg PO Q6H:PRN pain / fever 3. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Last dose on the evening of ___ RX *amoxicillin-pot clavulanate [Augmentin] 875 mg-125 mg 1 tablet(s) by mouth twice a day Disp #*19 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Pyelonephritis Poison ___ - right hand 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 presented to the hospital with a recurrent urinary tract infection. You were treated with strong intravenous antibiotics and a urine culture was sent, which returned without a clear answer. As the urine culture done at ___ also did not give us a clear answer, you were seen by Infectious Disease who recommended a particular oral antibiotic based on your prior infections. You will need to continue these antibiotics THROUGH ___ (last dose that evening). As we discussed, it is strongly recommended you see a Urologist given your recurrent infections. Your PCP can help refer you to one at the ___ based on your preference to be seen here.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Aripiprazole 15 mg PO DAILY 3. Aspirin 325 mg PO DAILY 4. BuPROPion (Sustained Release) 100 mg PO BID 5. Citalopram 40 mg PO DAILY 6. Fentanyl Patch 75 mcg/h TD Q72H 7. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*40 Tablet Refills:*0 8. Ranitidine 300 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Small bowel perforation Colonic volvulus Incarcerated ventral hernia 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 for operative treatment of perforated small intestine, colonic volvulus and an incarcerated ventral hernia. This took place on ___, and the operation performed was a subtotal colectomy with an end-ileostomy. Here are some instructions for your post-operative period: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for 6 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap.) You may start some light exercise when you feel comfortable. 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. Heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. You may resume sexual activity unless your doctor has told you otherwise. HOW YOU MAY FEEL: You may feel weak or "washed out" for 6 weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. You could have a poor appetite for a while. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Your incision may be slightly red aroudn the stitches or staples. This is normal. You may gently wash away dried material around your incision. 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). It is normal to feel a firm ridge along the incision. This will go away. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing r clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. Ove the next ___ months, your incision will fade and become less prominent. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription from your surgeon for pain medicine to take by mouth. It is important to take this medicine as directied. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. IF you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the folloiwng, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. In some cases you will have a prescription for antibiotics or other medication. If you have any questions about what medicine to take or not to take, please call your surgeon. OSTOMY CARE: *Keep well hydrated. *Replace fluid loss from ostomy daily. *Avoid only drinking plain water. Include Gatorade and/or other vitamin drinks to replace fluid. *Try to maintain ostomy output between 1000mL to 1500mL per day. *If Ostomy output >1 liter, take 4mg of Imodium, repeat 2mg with each episode of loose stool. Do not exceed 16mg/24 hours.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever 2. Aspirin EC 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 3. Docusate Sodium 100 mg PO BID hold for loose stool RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 5. Furosemide 20 mg PO DAILY Duration: 5 Days RX *furosemide 20 mg 1 tablet(s) by mouth once a day Disp #*5 Tablet Refills:*0 6. Metoprolol Tartrate 50 mg PO TID RX *metoprolol tartrate 50 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*1 7. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals [Vitamins and Minerals] 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 8. Omeprazole 20 mg PO DAILY Duration: 30 Days RX *omeprazole 20 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*0 9. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*40 Tablet Refills:*0 10. Potassium Chloride 20 mEq PO DAILY Duration: 5 Days RX *potassium chloride 20 mEq 1 packet(s) by mouth once a day Disp #*5 Tablet Refills:*0 11. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 12. Glargine 60 Units Breakfast Glargine 44 Units Dinner Humalog 12 Units Breakfast Humalog 12 Units Lunch Humalog 12 Units Dinner Insulin SC Sliding Scale using HUM Insulin RX *insulin lispro 100 unit/mL AS DIR Up to 15 Units QID per sliding scale 12 Units before LNCH; Units QID per sl scale 12 Units before DINR; Units QID per sliding scale Disp #*3 Vial Refills:*3 RX *insulin syringe-needle U-100 [BD Insulin Syringe Ultra-Fine] 30 gauge X ___ 1 four times a day Disp #*100 Syringe Refills:*1 13. Atorvastatin 20 mg PO QPM 14. Gabapentin 300 mg PO TID:PRN Pain, insomnia Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Multifocal pneumonia, likely due to aspiration Alcohol withdrawal Hypoglycemia Hypoxic respiratory failure Severe mitral regurgitation Secondary: Hypertension Diabetes mellitus type 2 ETOH dependence/Alcohol withdrawal seizures Hypomagnesemia Endocarditis Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage Followup Instructions: ___ [/INST] </s><s>Please shower daily -wash incisions gently with mild soap, no baths or swimming, look at your incisions daily Please - NO lotion, cream, powder or ointment to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics Clearance to drive will be discussed at follow up appointment with surgeon No lifting more than 10 pounds for 10 weeks Encourage full shoulder range of motion, unless otherwise specified **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ALPRAZolam 0.5 mg PO DAILY:PRN anxiety 2. Pantoprazole 40 mg PO Q12H 3. Simvastatin 40 mg PO QPM 4. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*6 Tablet Refills:*0 5. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*9 Tablet Refills:*0 6. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain RX *hydromorphone 2 mg ___ tablet(s) by mouth q4h:prn Disp #*2 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Biliary leak Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. CARVedilol 12.5 mg PO BID 3. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 4. Spironolactone 12.5 mg PO DAILY 5. Torsemide 80 mg PO DAILY 6. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath 7. amLODIPine 10 mg PO DAILY 8. Atorvastatin 80 mg PO QPM 9. HydrALAZINE 50 mg PO TID 10. MetFORMIN (Glucophage) 500 mg PO BID 11.Outpatient Lab Work N17: Acute kidney injury Please obtain chem-7, calcium, magnesium, phosphorus on ___. Please fax results to Pt's cardiologist, ___ (___). Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: # Acute-on-chronic Heart failure with preserved ejection fraction exacerbation # Unstable angina Secondary: # Thoracic aneurysm # Abdominal aortic aneurysm 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 WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you were experiencing shortness of breath. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? - You were given a water pill to help you get rid of the extra fluid buildup. - You had a catheterization to look at your heart vessels. You did not receive any stents. 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: 71.7 kg. 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. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild RX *acetaminophen 500 mg ___ tablet(s) by mouth every 8 hours Disp #*30 Tablet Refills:*0 2. Polyethylene Glycol 17 g PO DAILY:PRN constipation Please take only if becoming constipation. RX *polyethylene glycol 3350 [Gavilax] 17 gram/dose 17g powder(s) by mouth every day Refills:*0 3. Psyllium Powder 1 PKT PO TID constipation RX *psyllium husk (aspartame) [___] 3.4 gram/5.8 gram 1 powder(s) by mouth three times daily with 8oz of water Refills:*0 4. ALPRAZolam 0.25 mg PO TID:PRN anxiety 5. Bevacizumab (Avastin) unknown IV Q 8 WEEKS to left eye 6. bumetanide 1 mg oral DAILY 7. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -400 unit oral DAILY 8. Digoxin 125 mcg oral DAILY 9. Fexofenadine 180 mg PO DAILY 10. Levothyroxine Sodium 50 mcg PO DAILY 11. Livalo (pitavastatin) 2 mg oral QHS 12. Lunesta (eszopiclone) 2 mg oral QHS:PRN 13. lutein 20 mg oral DAILY 14. Omeprazole 20 mg PO DAILY 15. Sotalol 40 mg PO BID 16. Taztia XT (dilTIAZem HCl) 360 mg oral DAILY 17. Warfarin 2 mg PO DAILY16 18.Outpatient Lab Work INR ICD10: ___ ___ Fax results: Dr. ___ ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: Chronic, multi-organ polycystic process of unclear etiology. Secondary diagnosis: atrial fibrillation, fibrotic lung disease, psoriasis, cardiomyopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, ====================================== Why did you come to the hospital? ====================================== -You were having abdominal pain. ====================================== What was done for you at the hospital? ====================================== -An imaging study of your belly showed many large fluid collections known as "cysts". They were located in various organs including your liver, spleen, kidney, and pancreas. Some of these cysts were pressing on your stomach, and our team believes this is the source of your pain and lack of appetite. -We drained one of these large liver cysts and your symptoms improved, though did not completely resolve. ================================================= What needs to happen when you leave the hospital? ================================================= -Follow up with your primary care doctor -___ up with our liver team -Have your INR checked on ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Rolling walker Prog:good. Length of need 13 months 724.3 diagnosis sciatica 2. Pantoprazole 40 mg PO Q24H 3. Quinapril 40 mg PO DAILY 4. Acetaminophen 650 mg PO Q6H:PRN headache RX *acetaminophen 325 mg 2 tablet(s) by mouth every 6 hours Disp #*30 Tablet Refills:*0 5. Diazepam 10 mg PO Q6H:PRN back pain RX *diazepam 10 mg 1 tablet by mouth every 6 hours Disp #*20 Tablet Refills:*0 6. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*15 Capsule Refills:*0 7. Ibuprofen 600 mg PO Q6H:PRN back pain RX *ibuprofen 600 mg 1 tablet(s) by mouth every 6 hours Disp #*20 Tablet Refills:*0 8. OxycoDONE (Immediate Release) ___ mg PO Q6H:PRN severe pain if NSAIDS not working RX *oxycodone 5 mg 1 tablet(s) by mouth every 6 hours Disp #*20 Tablet Refills:*0 9. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 capsule by mouth twice daily Disp #*14 Capsule Refills:*0 10. Outpatient Physical Therapy Diagnosis: Sciatica ICD-9: 724.3 Discharge Disposition: Home Discharge Diagnosis: L5/S1 radiculopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for back pain related to a recent back injury. You were found to have a pinched sciatic nerve due to slipped disk in back that was seen on MRI. The surgery team saw you and decided the following: ******. We treated your pain with oral Morphine and Ibuprofen. Physical therapy saw you twice and recommended *****. You will also receive home physical therapy for your back. We wish you all the best. From, Your care team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 100 mg PO Q12H Duration: 4 Days RX *cefpodoxime 100 mg 1 tablet(s) by mouth twice daily Disp #*8 Tablet Refills:*0 2. Cyclobenzaprine 5 mg PO DAILY:PRN back pain 3. Furosemide ___ mg PO DAILY 4. LamoTRIgine 100 mg PO QHS 5. Levothyroxine Sodium 150 mcg PO DAILY 6. LORazepam 1 mg PO QHS 7. LORazepam 0.5 mg PO BID:PRN anxiety 8. Potassium Chloride 20 mEq PO DAILY 9. rizatriptan 10 mg oral DAILY:PRN 10. Sertraline 200 mg PO DAILY 11. Topiramate (Topamax) 75 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Generalized weakness Urinary tract infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ due to generalized weakness and fatigue. To look into your symptoms, we did an MRI of your entire spine as well as an MRI of your brain. These studies did not reveal any significant abnormalities or changes compared to prior imaging. We also checked for infections or electrolyte changes, and found that you had a urinary tract infection. By the morning, you had some improvement in your lower extremity strength. You were evaluated by Physical and Occupational Therapy and determined to be safe for discharge. Moving forward, it will be important for you to go to a number of follow up visits. We have arranged for you to follow up in the Cognitive Neurology clinic for an evaluation of your gait, and to check in with Dr. ___ to see how things are going. You should also follow up with Dr. ___ as scheduled in ___. Finally, we ask that you see the social worker in our cognitive neurology clinic to make sure your stressors are controlled. It was a pleasure taking care of you. 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 Ms. ___, It was a pleasure taking care of you during your stay at ___. You were recently admitted because of a fall at your rehab facility in the setting of fever. Because you had recent surgery on your neck, the neurosurgeon evaluated the wound in the emergency room and did not notice any signs of infection. You were found to be retaining urine as well, which can result from some of your medications. However, the urine was not infected. The most likely cause of your fever after an operative procedure result from not breathing in deeply enough because of pain. During your hospitalization, we optimized your pain medication and you had no more fevers. You will have to wear your hard c-collar until your follow-up with Dr. ___ ___ receive physical therapy at rehab. Sincerely, Your ___ care team</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 g IV once a day Disp #*11 Intravenous Bag Refills:*0 2. MetroNIDAZOLE 500 mg IV Q8H RX *metronidazole in NaCl (iso-os) [Metro I.V.] 500 mg/100 mL 500 mg IV every eight (8) hours Disp #*11 Intravenous Bag Refills:*0 3. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever 4. Cal-Citrate (calcium citrate-vitamin D2) 250-200 mg oral BID 5. estradiol 0.01 % (0.1 mg/gram) vaginal DAILY:PRN 6. Estring (estradiol) 10 mcg vaginal 2X 7. HYDROcodone-Acetaminophen (5mg-325mg) 2 TAB PO Q8H:PRN Pain - Moderate 8. Lactobacillus acidophilus 1 tab oral DAILY 9. Lansoprazole Oral Disintegrating Tab 30 mg PO BID 10. metaxalone 800 mg oral BID:PRN Neck pain 11. Multivitamins W/minerals 1 TAB PO DAILY 12. Ranitidine 150 mg PO BID 13. Vitamin D 1000 UNIT PO DAILY 14. HELD- Amoxicillin-Clavulanic Acid ___ mg PO Q12H This medication was held. Do not restart Amoxicillin-Clavulanic Acid until Dr. ___ you to Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES ================== Secondary sclerosing cholangitis due to biliary strictures SECONDARY DIAGNOSES ===================== Recurrent pancreatitis Chronic suppressive antibiotic therapy 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 ___ ___. WHY WAS I IN THE HOSPITAL? - You were admitted for abdominal pain, nausea, and inability to eat or drink WHAT HAPPENED TO ME IN THE HOSPITAL? - While you were in the hospital, we started you on IV antibiotics - We did an MRI of your liver and gallbladder which did not show any evidence of abscess. Your symptoms improved significantly with IV antibiotics. - You were seen by our infectious disease specialists who recommended you get a 2 week course of IV antibiotics and follow up with your outpatient specialist after this is done. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, You were admitted with sore throat and difficulty eating and breathing. This is likely due to mono. You were given steroids and pain medications in the hospital which controlled your symptoms. Please follow up with your primary care doctor.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Loestrin ___ (21) (norethindrone ac-eth estradiol) 1.5-30 mg-mcg oral daily 2. Sertraline 100 mg PO DAILY 3. ValACYclovir 500 mg PO Q24H Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS ================= Syncope Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You fainted. WHAT HAPPENED TO ME IN THE HOSPITAL? - You had blood tests which were all normal. - You had imaging of your chest and head which was normal. - You were seen by Cardiology and were kept on a heart monitor which was normal. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? -Please continue to take all of your medications and follow-up with your appointments as listed below. -Please follow the instructions below to make sure you schedule a heart ultrasound/Echo, get an event heart monitor, and make Cardiology and PCP appointments as below. Please take care! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BuPROPion (Sustained Release) 300 mg PO QAM 2. Digoxin 0.25 mg PO DAILY 3. Fludrocortisone Acetate 0.1 mg PO TID 4. Metoprolol Tartrate 12.5 mg PO BID 5. Midodrine 10 mg PO BID 6. Midodrine 5 mg PO QPM 7. Acetaminophen 650 mg PO TID RX *acetaminophen 650 mg 1 tablet(s) by mouth three times a day Disp #*60 Tablet Refills:*0 8. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*40 Capsule Refills:*0 9. Senna 17.2 mg PO HS RX *sennosides [senna] 8.6 mg 1 softgel by mouth at bedtime Disp #*30 Capsule Refills:*0 10. TraZODone 25 mg PO HS:PRN insomnia RX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth at bedtime Disp #*20 Tablet Refills:*0 11. Warfarin 6 mg PO DAILY16 12. Potassium Chloride 10 mEq PO DAILY 13. Enoxaparin Sodium 40 mg SC DAILY Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 40 mg sc once a day Disp #*20 Syringe Refills:*0 14. CeftriaXONE 2 gm IV Q24H RX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 2 GM IV once a day Disp #*20 Intravenous Bag Refills:*0 15. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush 16. HYDROmorphone (Dilaudid) ___ mg PO Q6H:PRN pain RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth every six (6) hours Disp #*70 Tablet Refills:*0 17. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 18. Vancomycin 1000 mg IV Q 12H RX *vancomycin 500 mg 2 Vial IV once a day Disp #*20 Vial Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis Infected right revised THA Secondary Diagnosis Urinary Incontinence Atrial Fibrillaiton Orthostatic Hypotension Chronic Systolic Heart Failure Depression 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 taking care of you during your hospitalization at ___. Briefly, you were hospitalized with pain in your right hip. The prosthesis was found to be dislocated from the hip socket. This was thought to be caused by chronic infections in the tissue surrounding the hip joint for which you were treated with antibiotics. You underwent several surgeries with orthopedics and plastic surgery ad you prosthesis was remove due to surgery and infection was controlled and your wound was closed. You were in the hospital for surgery and It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Non Weigh Bearing in Right Lower Extremity MEDICATIONS: - You were restarted on intravenous antibiotics, Vancomcyin and Ceftriaxone to treat hip joint infection - 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. - You have been given medications for pain control. Please do not drive, operate heavy machinery, or drink alcohol while taking these medications. As your pain decreases, take fewer tablets and increase the time between doses. This medication can cause constipation, so you should drink plenty of water daily and take a stool softener (such as Colace) as needed to prevent this side effect. Call your surgeons office 3 days before you are out of medication so that it can be refilled. These medications cannot be called into your pharmacy and must be picked up in the clinic or mailed to your house. Please allow an extra 2 days if you would like your medication mailed to your home. ANTICOAGULATION: - Please take lovenox with coumadin until INR >2, then just take coumadin. If you were taking aspirin prior to your surgery, it is OK to continue at your previous dose while taking this medication. WOUND CARE: - Please keep your incision clean and dry.Please place a dry sterile dressing on the wound each day if there is drainage, otherwise leave it open to air. No dressing is needed if wound continues to be non-draining. - It is okay to shower five days after surgery but no tub baths, swimming, or submerging your incision until after your four (4) week checkup. - Check wound regularly for signs of infection such as redness or thick yellow drainage. Staples will be removed by the visiting nurse or rehab facility in two (2) weeks. Please return to the emergency department or notify your physician if you experience any of the following: severe pain not relieved by medication, increased swelling, decreased sensation, difficulty with movement, fevers greater than 101.5, shaking chills, increasing redness or drainage from the incision site, chest pain, shortness of breath or any other concerns.</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 three times a day as needed for constipation. 2. senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as needed for constipation. 3. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 4. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). 5. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. furosemide 20 mg Tablet Sig: One (1) Tablet PO ONCE (Once) for 1 doses. 8. lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 9. lorazepam 0.5 mg Tablet Sig: ___ Tablet PO HS (at bedtime) as needed for sleep. 10. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 11. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain: Up to 3 doses 5 minutes apart. If pain dose not resolve, call ___. 12. pravastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 ___. Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: - Epistaxis (nose bleed) SECONDARY DIAGNOSIS: - Coronary Artery Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, it was a pleasure to participate in your care while you were at ___. You came to the hospital after an episode of nose bleeding that did not stop at home. While you were in the emergency department you had a procedure to stop the bleeding from your nose. You experienced some chest pain and were admitted to the cardiology service. While you were here we ruled out a heart attack as the cause of your chest pain. You have chronic angina which is likely what caused your pain. Given your recent stress test that did not show any areas of heart that needed any intervention, we did not feel that you needed any futher evaluation while you were here. You chest pain did not recur in the hospital. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. MEDICATION INSTRUCTIONS: - Medications ADDED: None. - Medications CHANGED: None. - Medications STOPPED: None.</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/fever 2. Vitamin D 50,000 UNIT PO DAILY 3. Pravastatin 10 mg PO DAILY 4. Levothyroxine Sodium 25 mcg PO QHS 5. Metoprolol Tartrate 12.5 mg PO DAILY 6. Gabapentin 300 mg PO Q12H 7. Lorazepam 1 mg PO TID anxiety 8. Senna 1 TAB PO HS 9. Vitamin B Complex 1 CAP PO DAILY 10. Phenytoin Infatab 100 mg PO TID 11. Warfarin 3 mg PO DAILY16 12. Thiamine 100 mg PO DAILY 13. Quetiapine Fumarate 50 mg PO QHS please monitor QTC 14. Quetiapine Fumarate 25 mg PO QAM Please monitor QTC 15. Quetiapine Fumarate 12.5 mg PO QID:PRN severe agitation use only if necessary. MOnitor QTC 16. LeVETiracetam 500 mg PO BID Duration: 2 Days for ___ and ___. LeVETiracetam 250 mg PO BID Duration: 3 Days x3 days. For ___ 18. LeVETiracetam 250 mg PO HS Duration: 3 Days x3 days. For ___ and then STOP. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: delerium/agitation due to medication (keppra) . H.o SDH and TBI afib CVA hypothyroidism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted for evaluation of confusion and agitation. For this, you were evaluated by the geriatrics, psychiatry and neurology teams. A work up was performed including lab testing, CT of the head, and looking for infection and was unremarkable. You symptoms were felt to be a medication effect from keppra. Therefore, you are being tapered off this medication. Please see below for instructions. You will need to follow up with the neurology team after discharge. .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Amlodipine 2.5 mg PO DAILY 3. FoLIC Acid 1 mg PO DAILY 4. Metoprolol Tartrate 50 mg PO BID 5. Omeprazole 20 mg PO DAILY 6. Sertraline 100 mg PO DAILY 7. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID 8. Cyanocobalamin 50 mcg PO DAILY 9. Minocycline 100 mg PO Q12H 10. Pyridoxine 100 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Volume overload, peripheral edema Anemia 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 weight gain, lower extremity edema, shortness of breath, and anemia. You received 2 units of PRBC's during this admission. You received an IV diuretic with good urine output, leading to resolution of your edema and shortness of breath. You had ultrasounds done of your heart and legs. The ultrasound of your leg showed no evidence of blood clots. The echocardiogram of your heart did NOT show significant left sided heart failure. It did show moderate pulmonary hypertension. The cause of your symptoms was likely multi-factorial, including your history of pulmonary hypertension, recent Prednisone course and possible side effects from your chemotherapy (Vidaza). . Your CXR showed a mild abnormality and will require repeat CXR in ___ weeks. Please ask your PCP or ___ MD to repeat a CXR.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. lipase-protease-amylase 12,000-38,000 -60,000 unit Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO ASDIR. Disp:*90 Capsule, Delayed Release(E.C.)(s)* Refills:*0* 2. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a day. Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 3. simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO three times a day. 4. morphine concentrate 100 mg/5 mL (20 mg/mL) Solution Sig: ___ mg PO Q1H (every hour) as needed for pain: Hold in mouth for 20seconds and then swallow. Disp:*20 ml* Refills:*0* 5. ZOFRAN ODT 4 mg Tablet, Rapid Dissolve Sig: ___ Tablet, Rapid Dissolves PO every four (4) hours as needed for nausea. Disp:*90 Tablet, Rapid Dissolve(s)* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: pancreatic 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 to ___ due to a bowel obstuction from your pancreatic cancer. You had a gastric tube place to help relieve the discomfort from this obstruction. Medication Changes: You have oral morphine for pain control. You may discontinue other medications if you do not want to take them. You may take Creon with meals if you would like.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acetaminophen 650 mg/20.3 mL Solution Sig: One (1) PO Q6H (every 6 hours) as needed for pain. 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. warfarin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnoses: - infarct with small central component of hemorrhagic transformation, involving the right basal ganglia and posterior limb of the internal capsule, with extension into the right corona radiata - embolic infarcts in the right MCA distribution in the setting of Right Internal Carotid Artery Occlusion, Right Middle Cerebral Artery Occlusion (since recanalized) Secondaty Diagnoses: Hypertension, Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. . Neurological Exam Prior to Discharge: Mental Status: Awake, Alert, Oriented to person, place, month, day year, able to name months of year backwards Cranial Nerves: Notable for Left Facial droop, on left lateral gaze does not entirely bury the sclerae, saccadic intrusions on lateral gaze, sensation equal V1-V3 bilaterally, tongue midline, unable to raise Left shoulder (CN XI), inconsistent visual fields (on one trial extinguished to visual double simultaneous stimulation) Motor: ___ in left upper and left lower extremity Reflexes: unable to elicit reflexes on the L, right biceps and right patella 2; upgoing toe on right Sensory: No extinguishing to double simultaneous tactile stimulation (using face and arm) Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, . It was a pleasure taking care of you at ___. You were admitted initally due to having lightheadedness, difficulty speaking, and an acute onset of left-sided weakness. We performed inital imaging of your head and found out that you had a clot in several of the arteries (Right Internal Carotid and Middle Cerebral Arteries) that supply the right side of the brain. There was a resultant stroke in the region of the brain supplied by thses vessels, which accounts for the symptoms you have. You were given an IV medication to break up the clot, and then taken for an intervention to help remove the clot, although this was unsuccessful. . To treat you, we started a blood thinning medication (heparin) and are giving you another medication to keep your blood thin (coumadin). Your blood levels were checked routinely, and one of the markers in your blood of how thin it is, is known as an INR. Your goal INR range is ___. This will be followed at your rehabilitation facility, and when you are discharged from rehab. . Your stroke risk factors were assessed, and it was found that you had an elevated cholesterol. For this reason we recommended starting a cholesterol medication (Atorvastatin). Plesae take this as prescribed. Please note that this medication can cause muscle pain, and notify your primary care physician if you start to have any symptoms concerning for this. Your liver function tests should be checked in the next few weeks to confirm the medication is not having adverse side effects. . You have appoinmtents scheduled for follow-up with a primary care provider, as well as Dr. ___ Neurology. Please see below. We made the following changes to your medications: START Atorvastatin 80mg take one tablet by mouth daily START Warfarin 5mg tablet (take one tablet by mouth daily at 4pm, your blood will be checked to see how thin it is with a blood test known as INR with a goal INR of ___ START Lisinopril 20mg tablet take one tablet by mouth daily START Docusate 100mg take one tablet by mouth two times a day STOP Aspirin 325 START Acetaminophen 650mg take one tablet by mouth every 6 hours as needed for pain</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Timolol Maleate 0.5% 1 DROP BOTH EYES BID Discharge Disposition: Home Discharge Diagnosis: Pancreatitis Choledocal cyst with sphincterotomy performed 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 abdominal pain and found to have pancreatitis, or an inflammation of the pancreas. You had an ERCP procedure, the results of which have been discussed and printed for you to review. Biopsies were obtained from the choledochal cyst, which needs to be followed up and a referral made to a local gastroenterologist who regularly performs endoscopy. Dr. ___, gastroenterology (performed your procedure) ___ of Gastroenterology/GI /West ___ Phone: ___ Fax: ___ Please make sure to contact Dr. ___ if you do not hear back from them in 2 weeks' time in order to get the results of the biopsies. Please also give this information to your primary care physician in order for a proper referral to be made.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO TID 2. Acyclovir 400 mg PO Q8H 3. Aspirin 81 mg PO DAILY 4. Cyclosporine 0.05% Ophth Emulsion 0.05 % ophthalmic BID 5. Docusate Sodium 100 mg PO BID 6. Donepezil 10 mg PO QHS 7. Hydrochlorothiazide 12.5 mg PO DAILY 8. melatonin 3 mg oral QHS 9. Mirtazapine 7.5 mg PO QHS 10. Senna 17.2 mg PO DAILY 11. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: orthostatic hypotension syncope 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 because you had a fainting spell. You underwent an extensive workup. We believe your symptoms are due to orthostasis. At this time we feel that you are safe for discharge back to your skilled nursing facility. It was a pleasure to be a part of your care, Your ___ treatment team</s>