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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 400 mg PO Q12H RX *cefpodoxime 200 mg 2 tablet(s) by mouth twice a day Disp #*9 Tablet Refills:*0 2. GuaiFENesin 10 mL PO Q6H:PRN cough RX *guaifenesin 100 mg/5 mL 10 ml by mouth every six (6) hours Refills:*0 3. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals 1 tab-cap by mouth once a day Disp #*30 Tablet Refills:*0 4. Naloxone Nasal Spray 4 mg IH ONCE Duration: 1 Dose RX *naloxone [Narcan] 4 mg/actuation 1 spray Nasal As needed for heroin/opioid overdose Disp #*1 Spray Refills:*2 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES ================= Acute hypoxic respiratory failure Aspiration pneumonia Opiate use disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at ___. Why was I here? - You were admitted to the ICU with difficulty breathing and a lung infection after CPR. What was done while I was here? - You needed a breathing tube which was removed when your breathing improved. - You were given medications to treat pneumonia. - You were seen by the addiction psychiatry team to discuss substance abuse resources and counseling. What should I do when I get home? - Please take all of your medications as prescribed. You will need to continue taking the antibiotic (called cefpodoxime) until ___. - You are being provided a prescription for narcan which you should make sure to have at home. Make sure those around you know to use it in case of another overdose. - It has been a pleasure to care for you. Your team sincerely wishes you luck with your recovery. Please continue to work with your outpatient providers in this regard. 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. Allopurinol ___ mg PO DAILY 2. Ferrous Sulfate 325 mg PO DAILY 3. Vitamin D 1000 UNIT PO DAILY 4. Metoprolol Succinate XL 200 mg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. Acetaminophen w/Codeine 1 TAB PO Q6H:PRN pain 7. Ranitidine 300 mg PO DAILY 8. Torsemide 20 mg PO DAILY 9. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB, wheezing 10. Aspirin 81 mg PO DAILY 11. Dymista *NF* (azelastine-fluticasone) 137-50 mcg/spray NU BID PRN swelling, irritation of the nose 12. Calcium Carbonate 500 mg PO BID 13. Polyethylene Glycol 17 g PO DAILY:PRN constipation 14. Lidocaine 5% Patch 1 PTCH TD DAILY 15. Artificial Tears ___ DROP BOTH EYES PRN dry eye 16. DiCYCLOmine 10 mg PO BID 17. Ketoconazole Shampoo 1 Appl TP 3X/WEEK (___) 18. Omeprazole 20 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Acute on chronic diastolic Congestive heart failure Mitral stenosis Acute on Chronic kidney injury 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 shortness of breath and fatigue consistent with your known congestive heart failure. You were treated with an infusion of lasix (furosemide) to remove extra fluid. Your breathing improved with this treatment. It is possible that you may need another mitral valve replacement as this may be causing the heart failure or fluid buidlup. You had an echocardiogram through your esophagus to better evaluate the valve and you will see Dr ___ in ___ to discuss the valve. Please weigh yourself daiy and call Dr ___ your weight increases more than 3 pound sin 1 day or 5 pounds in 3 days. Your weight at discharge is 192 pounds.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. crutch Standard crutches miscellaneous as needed L knee pain Duration: 13 Months Diagnosis: M25.562. Prognosis: Good. Length of need: 13 months. RX *crutch 1 set crutches as needed Disp #*1 Package Refills:*0 2. Acetaminophen 650 mg PO Q6H:PRN pain/fever RX *acetaminophen 325 mg 2 tablets by mouth every 6 hours Disp #*50 Tablet Refills:*0 3. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*0 4. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet by mouth daily Disp #*30 Tablet Refills:*0 5. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*0 6. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY RX *emtricitabine-tenofovir [Truvada] 200 mg-300 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Darunavir 800 mg PO DAILY RX *darunavir [Prezista] 800 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. RiTONAvir 100 mg PO DAILY RX *ritonavir [Norvir] 100 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Sepsis Pneumonia Pericarditis HIV Lymphadenopathy Secondary: Reactive arthritis Anemia Alcohol abuse Acute renal failure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (crutches). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You came into the hospital with shortness of breath, cough, and chest pain. You were found to have pneumonia and fluid in the lining surrounding your heart. You were treated with antibiotics. For the fluid surrounding your heart, you were given colchicine throughout your hospital stay, but it was discontinued once you were started on HIV medications due to potentially severe drug interactions. You may take Tylenol or ibuprofen as needed for pain. You had pain and swelling in your left knee after falling. Knee x-ray showed no fracture, which was confirmed by a CT scan. The fluid in your knee was not obviously infected, but you were treated with antibiotics until the Infectious Disease specialists thought that your knee pain and swelling was most likely not due to infection. You may continue taking ibuprofen or Tylenol as needed for pain. During your hospitalization, you were found to have HIV. You were started on antiviral therapy for your HIV with medications called Truvada, darunavir, and ritonavir. You must take these medications every day as prescribed. If you don't, your HIV virus may develop resistance to the medication, and the medication would no longer be effective in fighting the virus. You should keep in contact with ___, the case worker at AIDS Action Committee ___ number ___ main number ___. Please notify AIDS Action Committee about any location changes or any change in your living situation. You were found to have swollen lymph nodes in your chest. One of them was removed, which showed that the swelling was not due to cancer or an infection called tuberculosis but was most likely a reaction to your recent pneumonia and HIV infection. Thank you for allowing us to be involved in your care. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>ACTIVITY: DO NOT lift anything greater than 10 lbs for 2 weeks. ___ 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. You will be more comfortable if you do not sit or stand more than ~45 minutes without changing positions. BRACE: You have been given a brace. This brace should be worn for comfort when you are walking. You may take it off when sitting in a chair or while lying in bed. WOUND: Remove the external dressing in 2 days. If your incision is draining, cover it with a new dry sterile dressing. If it is dry then you may leave the incision open to air. Once the incision is completely dry, (usually ___ days after the operation) you may shower. Do not soak the incision in a bath or pool until fully healed. If the incision starts draining at any time after surgery, cover it with a sterile dressing. Please call the office. Please call the office if you have a fever>101.5 degrees Fahrenheit and/or drainage from your wound. MEDICATIONS: You should resume taking your normal home medications. Refrain from NSAIDs immediately post operatively. You have also been given Additional Medications to control your post-operative pain. Please allow our office 72 hours for refill of narcotic prescriptions. Please plan ahead. You can either have them mailed to your home or pick them up at ___ ___, ___. We are not able to call or fax narcotic prescriptions to your pharmacy. In addition, per practice policy, we only prescribe pain medications for 90 days from the date of surgery. Physical Therapy: activity as tolerated; lumbar corset brace when OOB. Treatments Frequency: ACTIVITY: DO NOT lift anything greater than 10 lbs for 2 weeks. ___ 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. You will be more comfortable if you do not sit or stand more than ~45 minutes without changing positions. BRACE: You have been given a brace. This brace should be worn for comfort when you are walking. You may take it off when sitting in a chair or while lying in bed. WOUND: Remove the external dressing in 2 days. If your incision is draining, cover it with a new dry sterile dressing. If it is dry then you may leave the incision open to air. Once the incision is completely dry, (usually ___ days after the operation) you may shower. Do not soak the incision in a bath or pool until fully healed. If the incision starts draining at any time after surgery, cover it with a sterile dressing. Please call the office. Please call the office if you have a fever>101.5 degrees Fahrenheit and/or drainage from your wound. MEDICATIONS: You should resume taking your normal home medications. Refrain from NSAIDs immediately post operatively. You have also been given Additional Medications to control your post-operative pain. Please allow our office 72 hours for refill of narcotic prescriptions. Please plan ahead. You can either have them mailed to your home or pick them up at ___ Spine Specialists, ___. We are not able to call or fax narcotic prescriptions to your pharmacy. In addition, per practice policy, we only prescribe pain medications for 90 days from the date of surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO TID 2. Multivitamins W/minerals 1 TAB PO DAILY 3. Zinc Sulfate 220 mg PO DAILY Duration: 14 Days 4. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate 5. Colchicine 0.6 mg PO DAILY 6. Finasteride 5 mg PO DAILY 7. Hydrochlorothiazide 25 mg PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Rivaroxaban 15 mg PO DAILY 10. Tamsulosin 0.4 mg PO QHS 11. Xtandi (enzalutamide) 40 mg oral DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: #Multiple acute vs pathologic spinal fractures #Spinal metastases #Rhabdomyolysis #Sacral decubitus ulcer #Fall SECONDARY DIAGNOSES: #Atrial fibrillation 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 after you had a fall at home. Your scalp laceration was repaired during your stay. Additionally, you were diagnosed with multiple spinal fractures. Orthopedic surgery assessed these fractures and thought that they did not require surgery. You are to wear your ___ J collar constantly for a total of 6 weeks, except you may remove it for eating and bathing. You do not require a brace for the fractures in your lower back at this time, and you can move as tolerated with assistance. If you have lower back pain that is interfering with your ability to move, then you may wear a TLSO brace as needed. Please call your doctor 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 mobilize with appropriate assistance, 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. Warm regards, Your ___ Surgery and Medicine Teams</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. Gabapentin 800 mg PO TID 3. LaMOTrigine 300 mg PO QHS 4. Multivitamins 1 TAB PO DAILY 5. OLANZapine 20 mg PO HS 6. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H 7. Paroxetine 60 mg PO QHS 8. Raltegravir 400 mg PO BID 9. Rifaximin 550 mg PO BID 10. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 11. Lactulose 30 mL PO Q2H RX *lactulose 20 gram/30 mL 30 mL by mouth three times a day Disp #*2 Liter Refills:*0 12. Nicotine Patch 14 mg TD DAILY RX *nicotine 14 mg/24 hour apply one patch to the skin daily Disp #*30 Transdermal Patch Refills:*0 13. calcium carbonate-vitamin D3 *NF* 500 mg(1,250mg) -200 unit Oral BID 14. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Fall with head strike Secondary: Cirrhosis, Encephalopathy, Balance disturbance 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 part in your care at ___ ___. You were admitted following a fall at home. You have had chronic problems with dizziness and balance, and this is likely an interplay of both your liver disease and the sedating medications that you are taking. While in the hospital, we saw that you did not have an intracranial bleed. We also gave you lactulose to help reduce the contribution of the liver disease. Please follow up with your PCP, the ___, and your neurologist after discharge.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Creon 12 1 CAP PO TID W/MEALS 2. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 7 Days RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet by mouth twice a day Disp #*14 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: 1. common bile duct stricture 2. dehydration 3. acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Stable. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You are now being discharged from ___ after being admitted due to nausea/vomiting, dehydration, hypotension and acute kidney injury following exchange of your biliary drainage catheter. The plan is for you to have a biliary stent placed next week by Interventional Radiology, and they will call you to notify you of when this will be. In the interim, please call your doctor or nurse practitioner if you experience the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain is not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. . PTBD Drain Care: *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). *Wash the area gently with warm, soapy water and place a drain sponge. Change daily and as needed. *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. Acetaminophen (Liquid) 650 mg PO Q6H 2. Artificial Tear Ointment 1 Appl BOTH EYES PRN dry eyes 3. Aspirin 81 mg PO DAILY 4. Diltiazem 30 mg PO QID 5. Docusate Sodium (Liquid) 100 mg PO BID:PRN constipation hold for loose stool 6. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 7. Multivitamins 1 TAB PO DAILY 8. OxycoDONE Liquid 2.5-5 mg PO Q6H:PRN pain 9. Senna 8.6 mg PO BID:PRN constipation 10. Tamsulosin 0.4 mg PO QHS 11. Lisinopril 10 mg PO DAILY 12. Atorvastatin 10 mg PO QPM 13. Milk of Magnesia 30 mL PO Q12H:PRN no BM>24 hrs 14. dutasteride .5 mg ORAL QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: C2 transverse process fracture T1, T3, T5 vertebral body fracture T9 fracture extending into disc space Pelvic hemorrhage Left parietal subdural hematoma Left anterior column acetabular fracture Right sacral fracture Left ___ rib fractures bilateral super pubic rami fracture right inferior rami fracture left anterior acetabular fracture left iliac wing fracture with hematoma sternal fracture and substernal hematoma Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ on ___ after a fall. You had a large bleed in your pelvis for which you went to interventional radiology and had gel foam placed to stop the bleeding. You had multiple blood transfusions and now your blood levels are stable. You had a small bleed in your head. The neurosurgery team was consulted and the bleed is stable and does not require surgery. You have left rib fractures which will continue to heal over time. You have a pelvic, sacral, and lumbar (spine) fracture. You were taken to the operating room by the orthopedic surgery team and had a screw placed in your hip. The orthopedic team recommend non-weight bearing on the left leg and weight bearing as tolerated on the right leg. For your lumbar fractures, the orthopedic spine team recommended that you wear a back and neck brace when you are out of bed for support. During this hospitalization your breathing was assisted by a ventilator. In order to help you breath on your own and better clear your secretions, a tracheostomy tube was placed. You had chest tubes placed to help drain extra fluid from your lungs which are now removed. You are now able to cough and breath effectively on your own. You have a fast, irregular heart rate called atrial fibrillation that is difficult to control. You were evaluated the the cardiology team and a pace maker was placed to help regulate your heart rate. You had a foley catheter placed to measure your urine output. After removal of this catheter you were initially unable to urinate on your own. You are not urinating on your own without difficulty. We recommend you follow up with a urologist if this problem persists. You are now breathing more comfortably, your pain is better controlled, and you are ready to be discharge to a rehabilitation center to continue your recovery. Please note the following discharge instructions. Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. 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. albuterol sulfate 90 mcg/actuation INHALATION Q4H:PRN shortness of breath 2. Calcipotriene 0.005% Cream 1 Appl TP DAILY 3. Calcium Carbonate 500 mg PO BID 4. Fluoxetine 40 mg PO DAILY 5. Furosemide 80 mg PO DAILY 6. Loratadine 10 mg PO DAILY 7. Lorazepam 0.5 mg PO DAILY:PRN anxiety 8. Magnesium Oxide 800 mg PO BID 9. Omeprazole 20 mg PO DAILY 10. Clobetasol Propionate 0.05% Cream 1 Appl TP BID 11. Docusate Sodium 100 mg PO BID 12. Simvastatin 40 mg PO QPM 13. Spironolactone 200 mg PO DAILY 14. TraZODone 200 mg PO QHS:PRN insomnia 15. Ursodiol 300 mg PO BID 16. Vitamin D 4000 UNIT PO DAILY 17. Ciprofloxacin HCl 500 mg PO Q12H Duration: 7 Days RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*9 Tablet Refills:*0 18. B Complete (vitamin B complex) 1 pill oral DAILY 19. biotin 5 mg oral DAILY 20. budesonide-formoterol 160-4.5 mcg/actuation INHALATION BID 21. canagliflozin 100 mg ORAL DAILY 22. Ferrous Sulfate 325 mg PO DAILY 23. insulin regular hum U-500 conc 500 unit/mL subcutaneous BID 24. Lisinopril 5 mg PO DAILY 25. MetFORMIN XR (Glucophage XR) 500 mg PO BID Do Not Crush 26. nystatin 100,000 unit/gram topical BID 27. Vitamin B Complex 1 CAP PO DAILY 28. Vitamin E 400 UNIT PO DAILY 29. Lactulose 30 mL PO Q8H:PRN constipation RX *lactulose [Enulose] 10 gram/15 mL 30 mL by mouth three times a day Refills:*3 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: -Gastrointestinal bleeding -Nonalcoholic steatohepatitis Cirrhosis complicated by ascites Discharge Condition: Hemodynamically stable, A&Ox3, no BRBPR. Able to ambulate with cane (baseline at home). Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to the hospital because of bleeding from your GI tract while going to the bathroom. While in the hospital, you underwent a colonoscopy which showed dilated veins in your rectum and hemorrhoids, but no active bleeding. You had no further bleeding while in the hospital, and your blood counts were stable. You were seen by physical therapy in the hospital. They recommended physical therapy visit your home after discharge. After discharge, because of your live disease, please weigh yourself every morning, call MD if weight goes up more than 3 lbs. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Duloxetine 30 mg PO BID 2. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY RX *emtricitabine-tenofovir [Truvada] 200 mg-300 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Etravirine 200 mg PO BID 4. Fluoxetine 20 mg PO DAILY 5. Fosamprenavir 2100 mg PO Q12H RX *fosamprenavir [Lexiva] 700 mg 3 tablet(s) by mouth twice daily Disp #*180 Tablet Refills:*0 6. Lorazepam 1 mg PO Q6H:PRN anxiety RX *lorazepam 1 mg 1 tab by mouth every 6 hours Disp #*30 Tablet Refills:*0 7. Maraviroc 300 mg PO BID 8. Metoprolol Tartrate 25 mg PO BID 9. QUEtiapine Fumarate 400 mg PO QHS 10. Raltegravir 400 mg PO BID 11. TraMADOL (Ultram) 50 mg PO Q8H:PRN pain RX *tramadol 50 mg 1 tablet(s) by mouth every 8 hours Disp #*90 Tablet Refills:*0 12. Zidovudine 300 mg PO BID 13. Tamsulosin 0.4 mg PO QHS 14. Glucometer Please dispense 1 glucometer (whichever brand/make approved by patient's insurance) with 1 month supply of testing lancets (for testing qAC/HS) and test strips. DX: 250.0 15. Miconazole Powder 2% 1 Appl TP TID 16. GlipiZIDE XL 2.5 mg PO WITH DINNER RX *glipizide 2.5 mg 1 tablet(s) by mouth Please take 1 tablet daily with dinner. Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: diabetes mellitus Secondary diagnoses: HIV infection, CAD, sCHF (EF 50-55%), HTN, HLD, IBS, MDD, vocal cord paralysis s/p reconstruction x2 Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to ___ for a fast heart rate. Your fast heart rate was caused by dehydration. You were dehydrated because of diabetes, which is a new diagnosis for you. We rehydrated you and got your blood sugars under good control. Your fatigue, body aches and joint pains, as well as changes in your voice, are likely from a viral cold-type syndrome. Your liver enzymes were found to be elevated while in the hospital. We belive this is secondary to _________. Please follow up with your doctors ___ appointments below). It was a pleasure taking care of you! We wish you the very best. -- Your inpatient team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Metoprolol Succinate XL 12.5 mg PO BID RX *metoprolol succinate 25 mg 0.5 (One half) tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 3. Apixaban 2.5 mg PO BID 4. Colchicine 0.6 mg PO DAILY 5. Donepezil 5 mg PO DAILY 6. Doxazosin 4 mg PO HS 7. Ensure (food supplemt, lactose-reduced) 1 bottle oral DAILY 8. Finasteride 5 mg PO DAILY 9. Loratadine 10 mg PO DAILY 10. Phosphorus 250 mg PO TID 11. Psyllium Powder 1 PKT PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS ================== Aspiration pneumonia SECONDARY DIAGNOSIS ==================== Hypernatremia Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you here at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you were found to have very low oxygen levels at your facility. WHAT WAS DONE WHILE I WAS HERE? - You were given antibiotics to treat a pneumonia. - You were seen by our speech and swallow team to evaluate how well you swallow foods and liquids; at first we didn't allow you to eat, but then you tried eating pureed foods and thick liquids and did well with those. WHAT DO I NEED TO DO ONCE I LEAVE? - Go to all your appointments and take all your medicines. - All your food should be pureed and all your drinks should be thickened to "nectar thick" consistency. Best wishes, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Pantoprazole 40 mg PO Q24H 3. LeVETiracetam 1000 mg PO BID 4. Amlodipine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Metoprolol Succinate XL 200 mg PO DAILY RX *metoprolol succinate 200 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Furosemide 20 mg PO DAILY 7. MetFORMIN (Glucophage) 500 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnoses: - Leukocytosis - Atrial fibrillation - HTN - Abnormal LFT's Secondary Diagnoses: - History of CVA 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 during your admission to ___ ___. You were admitted with concern for a heart attack but were actually found to have a severe infection. We are still not entirely sure what caused your infection, but you improved on antibiotics. During your hospitalization, you had elevated liver enzymes which may be related to a medication reaction. You also had a decrease in your kidney function, which is probably related to being dehydrated from your infection. Your kidney function returned to the normal range and your liver enzymes were significantly improved at the time of discharge. We made the following changes to your medications: - STOP atenolol - STOP cardizem (diltiazem) - START metoprolol succinate (for atrial fibrillation and blood pressure) - START amlodipine (for blood pressure)</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, headache 2. Amlodipine 10 mg PO DAILY HTN 3. Aspirin 81 mg PO DAILY 4. Calcium Carbonate 500 mg PO BID 5. Docusate Sodium 100-200 mg PO DAILY 6. Lisinopril 40 mg PO DAILY 7. Glargine 25 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 8. Nephrocaps 1 CAP PO DAILY 9. Pantoprazole 40 mg PO Q12H 10. Sarna Lotion 1 Appl TP QID:PRN itching 11. sevelamer CARBONATE 800 mg PO TID W/MEALS 12. Simethicone 40-80 mg PO QID:PRN Gas/bloating 13. Sucralfate 1 gm PO BID 14. Tamsulosin 0.8 mg PO HS 15. Vitamin D 50,000 UNIT PO 1X/WEEK (___) 16. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Take ___ tablets every 4 hours if you need it to control the pain. 17. Senna 1 TAB PO BID:PRN constipation 18. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H c. difficile Duration: 14 Days Please take 3 times a day for 14 days. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnoses: Jejunitis Anemia Urinary retention Clostridium difficile infection Secondary Diagnoses: Diabetes Mellitus Type 1 Hypertension Hyperlipidemia ESRD Diabetic Retinopathy Erectile Dysfunction Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were seen at the ___ for abdominal pain. You were found to have inflammation of your small bowel on cat scan and also had a scope to look into you small intestine, which also found inflammation and swelling, which is likely the cause of your abdominal pain. On admission your sugars were in the 600's and were quickly brought back down to more normal levels. During your stay, you were unable to urinate without the foley catheter, so we had to replace the foley catheter and reschedule a follow up urology appointment for further workup of your urinary retention. Finally, you were anemic, and required one unit of blood to raise your reb blood cells. Otherwise you were managed with pain medications and continued on your ___ hemodialysis schedule. Please make sure to continue taking your medications as prescribed and follow up with your outpatient providers. You need to see your primary care provider, urologist, and the diabetes specialists. All of the scheduled appointments are listed below. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Thank you for letting us take care of you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Please restart your rivaroxaban on ___. Otherwise, make sure to follow up in the ___ clinic on ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 3. Clobetasol Propionate 0.05% Cream 1 Appl TP DAILY 4. Docusate Sodium 100 mg PO BID 5. Ferrous Sulfate 325 mg PO DAILY 6. FoLIC Acid 1 mg PO DAILY 7. Ibuprofen 800 mg PO Q8H:PRN Pain - Moderate 8. Multivitamins 1 TAB PO DAILY 9. Nicotine Patch 14 mg TD DAILY 10. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth up to every 4 hours Disp #*90 Tablet Refills:*0 11. Senna 8.6 mg PO BID 12. Thiamine 100 mg PO DAILY 13. urea 20 % topical DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Inflammatory arthritis T5 Fracture Alcohol use disorder Anemia Psoriasis Discharge Condition: Activity Status: Ambulatory - requires assistance or aid (walker or cane). Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure caring for you at ___. You were admitted to us after a fall. You were found to have a fracture in your spine. Fortunately, there is no surgery that will be needed for this. You were also noted to have joint pains and fevers. For this, you were seen by the Rheumatologists. You will need a biopsy of your wrist to help the Rheumatologists determine how to best treat you. Our hand surgeons will be communicating with your rehab, and the Rheumatologists, to help schedule this. Your rash was found to be due to Psoriasis, and will improve slowly, over time, with treatment. You are scheduled to see the skin doctors in ___. We wish you all the best, ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ceftriaxone in dextrose,iso-os 2 gram/50 mL Piggyback Sig: Two (2) g Intravenous Q24H (every 24 hours) for 14 days. Disp:*28 g* Refills:*0* 2. Sodium Chloride 0.9% Flush 3 mL IV Q8H:PRN line flush Peripheral line: Flush with 3 mL Normal Saline every 8 hours and PRN. 3. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for anxiety. 4. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for pain. 5. acetaminophen 500 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours). 6. ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO Q8H (every 8 hours) as needed for nausea. Disp:*60 Tablet, Rapid Dissolve(s)* Refills:*0* 7. metoclopramide 10 mg Tablet Sig: One (1) Tablet PO QIDACHS (4 times a day (before meals and at bedtime)). Disp:*50 Tablet(s)* Refills:*2* 8. nystatin 100,000 unit Tablet Sig: One (1) Tablet Vaginal HS (at bedtime). 9. Saline Flush 0.9 % Syringe Sig: One (1) syrine Injection every eight (8) hours for 14 days: flush ___ q8h. Disp:*42 syringes* Refills:*0* 10. Heparin Flush 10 unit/mL Kit Sig: One (1) flush Intravenous once a day for 14 days: please flush PICC qday and prn. Disp:*21 flushes* Refills:*0* 11. metronidazole 500 mg Tablet Sig: One (1) Tablet PO every six (6) hours for 14 days. Disp:*56 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Lap Band erosion with retained foreign body Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications , unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 2. Aspirin 81 mg PO DAILY 3. brexpiprazole 0.5 mg oral DAILY 4. ClonazePAM 0.5 mg PO QHS 5. Multivitamins 1 TAB PO DAILY 6. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate 7. PARoxetine 30 mg PO DAILY 8. ValACYclovir 1000 mg PO Q8H 9. Vitamin A ___ UNIT PO DAILY 10. Vitamin D 1000 UNIT PO DAILY 11. Zolpidem Tartrate 5 mg PO QHS 12. HELD- Propranolol 10 mg PO DAILY This medication was held. Do not restart Propranolol until you are seen by Dr. ___ ___ Disposition: Home With Service Facility: ___ ___: PRIMARY: ========= #Acute on chronic normocytic anemia #Guaic positive stool SECONDARY: ========== #Chronic fatigue syndrome #Depression/anxiety #Arthritis s/p R TKA Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___. Why did you come to the hospital? - You were experiencing nausea, lightheadedness and palpitations and you were found to have worsened anemia. What did you receive in the hospital? - You received 2 transfusions of red blood cells with improvement of your anemia. - You had a CT scan of you abdomen. - You felt better and you were ready to leave the hospital. What should you do once you leave the hospital? - Please make sure you follow up with your gastroenterologist as scheduled on ___. - Please take your medications as prescribed and go to your future appointments. - You should call your doctor and return to the emergency room if you experience any of the warning signs listed below. We wish you all the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin EC 325 mg PO DAILY 2. Ranitidine (Liquid) 150 mg PO BID 3. Nystatin Oral Suspension 5 mL PO QID:PRN pain 4. Diltiazem 30 mg PO TID RX *diltiazem HCl [Cardizem] 30 mg 1 tablet(s) by mouth Three times daily Disp #*90 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: 1. Unsteady gait/lightheadedness Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, it was a pleasure taking care of you during your hospitalization at ___. You were admitted for evaluation of unsteady gait, lightheadedness, and worsening tremor. You had imaging of your head which did not show any signs of stroke. You were seen by neurologist specialists who did not think you had seizures and recommended outpatient follow up for further evaluation. It is possible that some of your symptoms may be from taking a long acting dilitiazem. Therefore you were switched to short acting diltiazem. You were seen by physiacl theapy who recommended home physical therapy at home but your refused physical therapy. Please follow up with your primary care physician, gastroenterologist and cardiologist for further evaluation and discussion regading possibly starting you back on metoprolol.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. albuterol sulfate 90 mcg/actuation inhalation Q6H:PRN wheezing 3. Amlodipine 10 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. Docusate Sodium 100 mg PO BID 6. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 7. Hydrochlorothiazide 25 mg PO DAILY 8. Metoprolol Succinate XL 25 mg PO DAILY 9. Milk of Magnesia 30 mL PO Q12H:PRN constipation 10. Omeprazole 20 mg PO BID 11. Aspirin 325 mg PO DAILY 12. Potassium Chloride 20 mEq PO DAILY 13. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every four (4) hours Disp #*45 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Recurrent 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 for lung surgery and you've recovered well. You are now ready for discharge. * Continue to use your incentive spirometer 10 times an hour while awake. * Check your incisions daily and report any increased redness or drainage. Cover the area with a gauze pad if it is draining. * Your chest tube dressing may be removed in 48 hours. If it starts to drain, cover it with a clean dry dressing and change it as needed to keep site clean and dry. * You will continue to need pain medication once you are home but you can wean it over a few weeks as the discomfort resolves. Make sure that you have regular bowel movements while on narcotic pain medications as they are constipating which can cause more problems. Use a stool softener or gentle laxative to stay regular. * No driving while taking narcotic pain medication. * Take Tylenol ___ mg every 6 hours in between your narcotic. * Continue to stay well hydrated and eat well to heal your incisions * Shower daily. Wash incision with mild soap & water, rinse, pat dry * No tub bathing, swimming or hot tubs until incision healed * No lotions or creams to incision site * Walk ___ times a day and gradually increase your activity as you can tolerate. Call Dr. ___ ___ if you experience: -Fevers > 101 or chills -Increased shortness of breath, chest pain or any other symptoms that concern you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gabapentin 200 mg PO BID 2. Lactulose 30 mL PO QID 3. Rifaximin 550 mg PO BID 4. Ursodiol 300 mg PO TID 5. Lantus (insulin glargine) 15 units/mL subcutaneous DAILY 6. tazarotene 0.1 % topical DAILY 7. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain 8. Triamcinolone Acetonide 0.1% Cream 1 Appl TP BID 9. Outpatient Lab Work ICD 10 K74.60 Cirrhosis labs should be drawn on ___ CBC INR LFTs Chem10 and faxed to ___ Hepatology ___ ___ 10. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 11. Sucralfate 1 gm PO QID Duration: 7 Days RX *sucralfate 1 gram/10 mL 1 suspension(s) by mouth four times daily Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary -Hepatic encephalopathy -Hypokalemia -Leukocytosis -Decompensated cirrhosis Secondary -Type 2 Diabetes -Chronic Kidney disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted due to confusion. Studies showed you had no infection but you did have electrolyte abnormalities which we corrected. We increased your lactulose to help you get rid of extra toxins that were making you confused. If you notice any confusion in the future, increase your lactulose so you have ___ bowel movements per day. It is very important that you follow up with your liver doctor as scheduled. You will also need to have your labs drawn ___ ___. New medications: omeprazole 40 mg daily, Carafate 1 mg four times daily for 7 days (___). Please drink only clear liquids today, ___, and a soft diet tomorrow (___). On the ___, you can have a regular diet. It was a pleasure to care for you! -Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. Gabapentin 600 mg PO QHS 3. Loratadine 10 mg PO DAILY 4. Lorazepam 0.5-1 mg PO Q6H:PRN anxiety/nausea/vomiting 5. Multivitamins 1 TAB PO DAILY 6. OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN pain 7. OxyCODONE SR (OxyconTIN) 30 mg PO Q12H 8. Prochlorperazine 10 mg PO Q6H:PRN nausea 9. Senna 8.6 mg PO BID:PRN constipation 10. Simvastatin 40 mg PO QPM 11. MetFORMIN (Glucophage) 1000 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Neutropenic Fever Myxofibrosarcoma 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 a neutropenic fever. No source of infection was found and your blood counts improved. You did not have a fever while admitted.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. cephalexin 500 mg Capsule Sig: One (1) Capsule PO four times a day for 6 days. Disp:*24 Capsule(s)* Refills:*0* 2. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day) for 6 days. Disp:*24 Tablet(s)* Refills:*0* 3. mupirocin 2 % Ointment Sig: as directed Topical twice a day: Apply to open area on right ankle twice daily. Disp:*60 grams* Refills:*0* 4. mupirocin 2 % Ointment Sig: as directed Topical once a day: Apply to psoriatic area on scalp daily. Disp:*60 grams* Refills:*0* 5. betamethasone dipropionate 0.05 % Lotion Sig: as directed Topical once a day: Apply to psoriatic area on scalp daily. Disp:*1 bottle* Refills:*0* 6. econazole 1 % Cream Sig: as directed Topical twice a day: Apply to athlete's foot twice daily. Disp:*60 grams* Refills:*1* Discharge Disposition: Home Discharge Diagnosis: Primary: 1. Cellulitis . Secondary: 1. 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>You came to the hospital with swelling and redness of your right leg. You had an ultrasound, which was negative for blood clots. You were treated for cellulitis with an intravenous antibiotic called vancomycin, which was subsequently changed to two oral antibiotics (Keflex and Bactrim). You should continue the oral antibiotics for another 6 days. You were seen by the dermatology service, who recommended applying mupiricin ointment to the area of skin breakdown on your right ankle. They also recommended using mupiricin ointment and betamethasone lotion for your scalp psoriasis, and econazole cream for your athlete's foot. The dermatology service recommended that you be seen by Dr. ___ or by the resident who saw you here in the hospital (Dr. ___ within the next ___ weeks. Please call the dermatology office on ___ to schedule an earlier appointment. Please also call Dr. ___ office on ___ to schedule an appointment to be seen within the next week. Please do not take Humira until at least 1 week after your infection resolve. Discuss restarting Humira with your gastroenterologist once the infection resolves. There are some changes to your medications: START Keflex (cephalexin) and Bactrim (trimethoprim-sulfamethoxazole) for another 7 days. START mupiricin ointment for area of skin breakdown on right ankle. START betamethasone lotion and mupiricin ointment for psoriasis on scalp. START econazole cream for athlete's foot. STOP Humira for now and discuss with your gastroenterologist when it is okay to restart this. Do not take the medications that you were prescribed in ___, as one of them (metamizole) can cause severe bone marrow problems and was banned in the ___ in ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM 2. Lisinopril 5 mg PO DAILY 3. omeprazole 20 mg oral DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS/ES: -Hypertensive Urgency SECONDARY DIAGNOSIS/ES: -Leukocytosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because you were having very high blood pressures. You were closely monitored in the intensive care unit because of these blood pressures. Please see below for a more detailed account of your hospital course. WHY WERE YOU ADMITTED TO THE HOSPITAL: -You had very high blood pressures -You were feeling nauseated, sweaty, and short of breath WHAT WAS DONE FOR YOU IN THE HOSPITAL: -You were given medications to lower your blood pressure quickly -You had multiple scans of your head and your kidney to try and figure out why your blood pressures were so high -You had many blood tests run to try and figure out why your blood pressures were so high WHAT YOU SHOULD DO AFTER LEAVING THE HOSPITAL: -PLEASE follow up with your outpatient doctor -___ pick up a 24-hour urine collection container at ___ on the ___ floor of the ___ Building -Please take your medications as prescribed -Come back to the ED right away if you have another episode Best Wishes, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Furosemide 20 mg PO DAILY RX *furosemide [Lasix] 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Gabapentin 300 mg PO TID RX *gabapentin 300 mg 1 capsule(s) by mouth three times a day Disp #*90 Capsule Refills:*0 7. NPH 18 Units Breakfast NPH 18 Units Dinner RX *insulin NPH isoph U-100 human [Humulin N NPH U-100 Insulin] 100 unit/mL AS DIR 18 Units before BKFT; 18 Units before DINR; Disp #*1 Vial Refills:*0 8. LevETIRAcetam 500 mg PO Q12H RX *levetiracetam 500 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 9. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing RX *albuterol sulfate [ProAir HFA] 90 mcg 1 puff every 4 hours Disp #*1 Inhaler Refills:*0 10. FLUoxetine 20 mg PO DAILY RX *fluoxetine 20 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 11. Lactulose 30 mL PO TID RX *lactulose 20 gram/30 mL 30 ml by mouth three times daily Disp #*1 Bottle Refills:*0 12. Nadolol 40 mg PO DAILY RX *nadolol 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 13. Nicotine Patch 14 mg/day TD DAILY RX *nicotine 14 mg/24 hour Apply 1 patch daily Disp #*30 Patch Refills:*0 14. Rifaximin 550 mg PO BID RX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 15. Spironolactone 25 mg PO BID RX *spironolactone 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Alcoholic Cirrhosis Alcohol Use Disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you while you were admitted at ___, Why was I admitted to the hospital? -You were having dark black stools which were concerning for bleeding. Your liver disease puts you at high risk for bleeding. What was done while I was admitted? -We performed several laboratory tests to confirm that you were not bleeding. -We monitored your blood pressure and heart rate very carefully -We ensured that you would not have withdrawal symptoms from alcohol. What should I do when I go home? -It is very important for you to stop drinking alcohol. -Attend AA sessions to assist you in stop drinking alcohol -See your primary care physician -___ doctor. We have scheduled an appointment for you (time and location are noted below) -Continue taking all of your medications as prescribed in the discharge paperwork.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 1 PUFF IH Q4H:PRN wheeze 2. Aspirin 81 mg PO DAILY 3. Betimol (timolol) 0.5 % ophthalmic (eye) DAILY 4. Cyanocobalamin 1000 mcg IM/SC ONCE MONTHLY 5. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 6. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 7. Levothyroxine Sodium 75 mcg PO 6X/WEEK (___) 8. Levothyroxine Sodium 150 mcg PO ONCE WEEKLY 9. LORazepam 0.5 mg PO BID:PRN anxiety 10. Vitamin D ___ UNIT PO 1X/WEEK (___) 11. HELD- Hydrochlorothiazide 25 mg PO DAILY This medication was held. Do not restart Hydrochlorothiazide until Your primary care provider thinks it is nessesary again Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Syncope, Orthostatic Hypotension, Subarachnoid Hemorrhage, Hypokalemia, Viral gastroenteritis Secondary: Stage IB Grade 2 endometriod endometrial adenocarcinoma, HTN, Asthma, Anxiety, Glaucoma, Hypothyroidism 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 ADMITTED? - You came to us because you fainted and hit your head WHAT WAS DONE FOR ME WHILE I WAS IN THE HOSPITAL? - We performed a CT of your head to see if you had any bleeding around your brain - We performed an EKG and monitored your heart to see how your heart was functioning - We performed an echocardiogram to see if there was any abnormality in the structure or function of your heart - We performed a number of blood tests to monitor the electrolytes in your blood - We gave you IV fluid with potassium to hydrate you and increase the level of potassium in your blood - We stopped giving you your diuretic because it may have been contributing to your low potassium levels WHAT SHOULD I DO WHEN I LEAVE THE HOSPITAL? - Please take all of your medications as prescribed. - Please stop taking your hydrochlorothiazide as this may have reduced your potassium - Please follow up with your primary care physician as described in this summary - If you have chest pain, shortness of breath, lightheartedness or other danger signs listed below please call your PCP or come to the emergency department Best Wishes, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear ___, You were admitted to the hospital because you were having some unsteady gait and confusion. You were found to have new masses in your brain from spread of your lung cancer. While you were here, you were started on radiation therapy for the masses in your brain. You were also seen by physical therapy, who recommended you go to rehabilitation to help make you stronger. You were discharged in good condition. When you leave the hospital, it is important you continue to go to your radiation appointments. It is also important you take you medications as prescribed. If you have any increasing confusion, nausea, vomiting, headaches, or increasing sedation, it is important you go to the ER immediately. It was a pleasure to care for your, and we wish you the best of luck! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clindamycin 300 mg PO Q6H RX *clindamycin HCl 300 mg 1 capsule(s) by mouth four times daily Disp #*40 Capsule Refills:*0 2. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 3. Buprenorphine-Naloxone Tablet (8mg-2mg) 1 TAB SL BID 4. Docusate Sodium 100 mg PO BID:PRN Constipation - First Line 5. FoLIC Acid 1 mg PO DAILY 6. Ibuprofen 400 mg PO Q8H:PRN Pain - Mild 7. Pregabalin 100 mg PO TID 8. Propranolol LA 60 mg PO DAILY 9. Venlafaxine 150 mg PO DAILY 10. Vitamin B Complex 1 CAP PO DAILY 11. Vitamin D 800 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Cellulitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>___, You were admitted to the hospital for a skin infection of your left leg. This improved with antibiotics. You will be discharged with antibiotic pills to complete two weeks of treatment. Please keep your left leg elevated at all times while sitting during healing process. You will need to follow-up with your primary care provider after hospital discharge. It was a pleasure taking care of you! Sincerely, your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Mr. ___, It was a pleasure taking care of you while you were admitted at ___. You were admitted due to nausea and vomiting with low blood pressure due to a viral gastroenteritis. You were given IV fluids and managed with supportive care, and your blood pressure came up to normal. Your symptoms resolved and you were discharged the following day. Some of your blood pressure medications were held while you were in the hospital because your blood pressure had been low. We restarted your metoprolol but not your lisinopril or hydrochlorothiazide. You will talk to your primary doctor about restarting these when you see him next ___.</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 capsule(s) by mouth twice a day Disp #*20 Capsule Refills:*0 2. Enoxaparin Sodium 30 mg SC QHS RX *enoxaparin [Lovenox] 30 mg/0.3 mL 1 (One) syringe subcutaneous once a day Disp #*28 Syringe Refills:*0 3. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 4. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 (One) ml by mouth twice a day Disp #*20 Tablet Refills:*0 5. Atenolol 50 mg PO DAILY 6. Citalopram 20 mg PO DAILY 7. Diltiazem Extended-Release 240 mg PO DAILY 8. Pravastatin 40 mg PO QPM 9. Prazosin 2 mg PO DAILY 10. Quinapril 40 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right ankle fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: -Nonweightbearing right lower externally 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 daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - Splint must be left on until follow up appointment unless otherwise instructed. - Please keep plaster splint dry, using a protective bag or covering if necessary to shower. 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 Physical Therapy: ASSESSMENT/CLINICAL IMPRESSION: Pt is a ___ y/o F hospitalized for ankle fx, now POD ___ s/p ORIF. pt presents with progress including: increased strength, endurance and functional mobility, however is limited by decreased endurance due to NWB status, and inappropriate HDR to mobility. Due to patients strong home supports, ability to live on 1 level, and progress demonstrated so far with mobility, I recommend the patient DC to home with home ___, a WC and commode. Family reports they can move a bed to the ___ living level, and have 2 people assist with WC transfer up/down her front stairs. patient will require ___ more ___ sessions for family education on WC management and stair negotiation. patient may require rehab placement if family unable to comply. Recommended Discharge: (X)see clinical impression PLAN: Progress functional mobility including bed mobility, transfers, gait and stairs as tolerated. Balance training Pt/caregiver education RE: fall risk D/C planning Recommendations for Nursing: OOB for all meals and at least 3 hours a day no more than 1 hour at a time to prevent skin breakdown. Treatments Frequency: WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - Splint must be left on until follow up appointment unless otherwise instructed. - Please keep plaster splint dry, using a protective bag or covering if necessary to shower.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN pain 2. Aspirin 81 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Furosemide 20 mg PO DAILY 5. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH Q12H 6. Tiotropium Bromide 1 CAP IH DAILY 7. Ipratropium Bromide MDI 2 PUFF IH Q4H:PRN wheezing 8. Ipratropium-Albuterol Neb 1 NEB NEB Q4H:PRN wheezing 9. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain do not drive while on this medication 10. Albuterol Inhaler 2 PUFF IH Q4-6H:PRN chest tightness/wheezing 11. Allopurinol ___ mg PO DAILY 12. brimonidine 0.2 % ophthalmic 1 drop in each eye 3 times a day 13. Calcitriol 0.5 mcg PO 3 TIMES A WEEK (___) 14. Diltiazem Extended-Release 180 mg PO DAILY 15. Ferrous Sulfate 325 mg PO DAILY 16. Fluticasone Propionate NASAL 2 SPRY NU DAILY as needed 17. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 18. Losartan Potassium 25 mg PO DAILY 19. Magnesium Oxide 500 mg PO DAILY 20. Multivitamins 1 TAB PO DAILY 21. Pantoprazole 40 mg PO Q24H 22. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP RIGHT EYE AS NEEDED Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: cecal volvulus Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came to the hospital with abdominal pain and white blood count of 15 on ___. You were found to have a cecal volvulus. You underwent an emergent exploratory laparotomy with right colectomy and primary anastamosis. Your abdomen was left open so you were again brought to the operating room and underwent a washout and closure on ___. After extubation on ___ you had difficulty with phonation so otolaryngology was consulted to assist with laryngeal exam. You started to feel better and were advanced to a regular diet which you are now tolerating. You are ready to be discharged to a rehabilitation facility. Please adhere to the following instructions for discharge. 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. Benzonatate 100 mg PO TID:PRN cough RX *benzonatate 100 mg 1 capsule(s) by mouth three times daily Disp #*20 Capsule Refills:*0 2. Pantoprazole 40 mg PO 2X/DAY RX *pantoprazole 40 mg 1 tablet(s) by mouth 2X/DAY Disp #*60 Tablet Refills:*0 3. Sucralfate 1 gm PO QID Please crush in 30 cc's of water to form a slurry. RX *sucralfate 1 gram 1 tablet(s) by mouth four times daily Disp #*40 Tablet Refills:*0 4. Periogard (chlorhexidine gluconate) 0.12 % mucous membrane BID Brush 15 mL on teeth 2x daily (dip toothbrush in solution and brush on teeth, repeat until solution gone) 5. Cyanocobalamin 1000 mcg PO AM 6. Atenolol 25 mg PO QAM 7. Bengay Cream 1 Appl TP TID:PRN pain Apply to left knee three times a day as needed for pain 8. Guaifenesin ___ mL PO Q4H:PRN cough, congestion 9. Tenofovir Disoproxil (Viread) 300 mg PO QAM 10. calcium carbonate-vitamin D3 600 mg(1,500mg) -400 unit oral BID 11. Sodium Fluoride 1.1% (Dental Gel) 1 Appl TP HS Apply a thin ribbon to toothbrush. Brush thoroughly for two minutes at bed time. 12. Allopurinol ___ mg PO QAM 13. Acetaminophen 500 mg PO Q6H:PRN pain, fever 14. Phosphorus 500 mg PO DAILY RX *sod phos,di & mono-K phos mono [Phospha 250 Neutral] 250 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnoses: # Severe esophagitis c/b UGIB # Duodenal stricture # Fever/Cough/Leukocytosis Chronic diagnoses: # Chronic Hepatitis B # CKD # History of HCV # HTN # Gout # Pernicious anemia # Peridontal disease # OA Discharge Condition: Mental Status: Clear and coherent (some communication limitation). 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 after vomiting blood and we also noticed you had a fever and cough. We looked into your stomach with a camera and found that you have irritation of the throat, called esophagitis. We gave you some medications for the irritation. Your cough also gradually improved with medications and we think it is from an upper respiratory infection. We discharged you back to your group home. When you return home, you do not have to return to work right away; we have written you a letter for work. Our GI doctors ___ be calling your home to set up a follow-up appointment for an ultrasound. If you experience additional episodes of vomiting blood, please call clinic right away or go to the Emergency Department.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain/fever 2. Cetirizine 10 mg PO DAILY 3. estrogens-methyltestosterone 1.25-2.5 mg oral DAILY 4. Fish Oil (Omega 3) 1000 mg PO BID 5. Furosemide 40 mg PO DAILY 6. Levothyroxine Sodium 88 mcg PO DAILY 7. Vitamin D 1000 UNIT PO DAILY 8. Warfarin 2 mg PO DAILY Started lower due to elevated INR. Previous home dose: ___: 3.5mg, other days: 3mg 9. Metoprolol Succinate XL 150 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Viral upper respiratory infection Atrial fibrillation with rapid ventricular response Weakness Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear ___ was a pleasure taking care of you. Thank you for choosing ___ for your care. You were admitted to the hospital with weakness and trouble breathing. We found that you had too much fluid in your body, and likely had a viral upper respiratory infection. Your heart rate was also fast, likely due to your atrial fibrillation and your infection. We increased your heart rate medication (metoprolol) to help better control your heart rate as well. Your doctors ___ continue to increase your medication as needed. If you have trouble breathing, or other symptoms that worry you, please let your doctor know or return to the hospital for further care. Thank you, ___, M.D.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate [Augmentin] 875 mg-125 mg 1 tablet by mouth every twelve (12) hours Disp #*10 Tablet Refills:*0 2. Renagel 1600 mg oral QID 3. AcetaZOLamide 250 mg PO Q12H 4. amLODIPine 10 mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. brimonidine 0.2 % ophthalmic (eye) TID 8. Cinacalcet 60 mg PO DAILY 9. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP RIGHT EYE BID 10. Fluticasone Propionate NASAL 2 SPRY NU DAILY 11. GlipiZIDE 10 mg PO BID 12. Latanoprost 0.005% Ophth. Soln. 1 DROP RIGHT EYE QHS 13. Metoprolol Tartrate 12.5 mg PO BID 14. Nephrocaps 1 CAP PO DAILY 15. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP RIGHT EYE QID 16. Ranitidine 150 mg PO BID 17. sevelamer CARBONATE 1600 mg PO QID 18. HELD- Doxercalciferol Dose is Unknown PO 3X/WEEK (___) This medication was held. Do not restart Doxercalciferol until you confirm with your PCP dose and duration 19. HELD- Epoetin Alfa Dose is Unknown IV Frequency is Unknown This medication was held. Do not restart Epoetin Alfa until your PCP confirms dose and duration Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right third toe Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires heel weightbearing surgical shoe Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the vascular surgery department at ___ and you were found to have osteomyelitis of the right toe. You underwent a right third toe amputation and are now ready to be discharged. ACTIVITY •Keep your foot elevated to prevent swelling. •It is very important that you put no weight or pressure on your toe to allow the wound to heal properly. •You may use the opposite foot for transfers and pivots, if applicable. MEDICATION •Before you leave the hospital, you will be given a list of all the medicine you should take at home. If a medication that you normally take is not on the list or a medication that you do not take is on the list please discuss it with the team! •You will likely be prescribed narcotic pain medication on discharge which can be very constipating. If you take narcotics, please also take a stool softener such as Colace. If constipation becomes a problem, your pharmacist can suggest an additional over the counter laxative. •You should take Tylenol ___ every 6 hours, as needed for pain. If this is not enough, take your prescription narcotic pain medication. You should require less pain medication each day. Do not take more than a daily total of 3000mg of Tylenol. Tylenol is used as an ingredient in some other over-the-counter and prescription medications. Be aware of how much Tylenol you are taking in a day. BATHING/SHOWERING: •You may shower when you feel strong enough but no tub baths or pools until you have permission from your surgeon and the incision is fully healed. •After your shower, gently dry the incision well. Do not rub the area. WOUND CARE: •Please keep the wound clean and dry. It is very important that there is no pressure on the wound. If there is no drainage, you may leave the incision open to air. •If used, any staples/sutures will remain in place until follow-up with ___ clinic CALL THE OFFICE FOR: ___ •Opening, bleeding or drainage or odor from your stump incision •Redness, swelling or warmth at your amputation site. •Fever greater than 101 degrees, chills, or worsening incisional/stump pain It has been a pleasure looking after you and we wish you a speedy recovery. Best, Vascular Surgery Team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*25 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID 4. MetroNIDAZOLE 500 mg PO TID RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*37 Tablet Refills:*0 5. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate 6. Polyethylene Glycol 17 g PO DAILY:PRN constipation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Intra abdominal fluid collection due to perforated appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the Acute Care Surgery Service on ___ with an drainable collection in your abdomen due to perforated appendicitis. You were given IV antibiotics and taken to Interventional Radiology for drainage of the infection. You are now doing better, tolerating a regular diet, and pain is better controlled. You are now ready to be discharged to home with your 2 drains to continue your recovery. Please note the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. 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. Drain Care: *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). *If the drain is connected to a collection container, please note color, consistency, and amount of fluid in the drain. Call the doctor, ___, or ___ nurse if the amount increases significantly or changes in character. Be sure to empty the drain frequently. Record the output, if instructed to do so. *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: [/INST] </s><s>You were admitted for further evaluation of abdominal pain due to stones in your bile ducts and an inflammation of your colon (diverticulitis). For this, you were monitored by the surgery and GI teams. You were given antibiotic therapy with good effect. In addtion, you underwent an ERCP where attempts were made to remove the stones in your bile ducts. However, you were found to have some large stones and these were unable to be removed at this time. Therefore, you have a stent in place to keep the area opened. You will need to return in 2 week's time for repeat ERCP and stent removal. You will also need to follow up with general surgery for consideration of having your gallbladder out. Your symptoms improved and your diet was successfully advanced. . Medication changes: 1.cipro/flagyl - take for another 5 days 2.stop asa and cilostazol - can be restarted in 5 days. You should stop cilastazol 3 days before your next ERCP. 3. You were start on a PPI called omeprazole for GERD. . Please take all of your medications as prescribed and follow up with the appointments below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID opiod dependence home med 2. Risperidone 1 mg PO BID home med 3. Nicotine Patch 21 mg TD DAILY 4. Cyanocobalamin 50 mcg PO DAILY 5. Pyridoxine 25 mg PO DAILY 6. FoLIC Acid 1 mg PO DAILY 7. Aspirin 325 mg PO DAILY stroke secondary prophylaxis RX *aspirin 325 mg 1 tablet(s) by mouth once a day Disp #*100 Tablet Refills:*2 Discharge Disposition: Home Discharge Diagnosis: ACUTE ISSUES: 1. Left face tingling, word finding difficulties - suspect TIA CHRONIC ISSUES: 1. Embolic right cortical stroke 2. Hepatitis C 3. Patent foramen ovale 4. Polysubstance abuse Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital for left-sided facial tingling and mild word-finding difficulties concerning for a new stroke. You had a CT scan and MRI, both of which were reassuring and showed no new stroke. We checked some more labs to see whether you have a coagulation disorder predisposing you to strokes, which showed.... Please attend your previously-scheduled follow up appointment with neurology with Dr. ___ cardiac surgeon with Dr. ___ below. We made the following changes to your medications: 1. INCREASED aspirin from 81mg daily to 325mg daily</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY RX *atenolol 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Levofloxacin 500 mg PO Q24H RX *levofloxacin 500 mg 1 tablet(s) by mouth daily Disp #*9 Tablet Refills:*0 3. MetroNIDAZOLE 500 mg PO/NG BID RX *metronidazole 500 mg 1 tablet(s) by mouth twice a day Disp #*18 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: septic abortion hyperthyroidism chlamydia 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 take more than 4000mg acetaminophen (APAP) in 24 hrs. * Nothing in the vagina (no tampons, no douching, no sex) for 2 weeks. * You may eat a regular diet. You were admitted to the gynecology service after your miscarriage. You had a procedure done in the operating room to remove pregnancy tissue. You were found to have an infection. Your infection was treated antibiotics. Please complete your entire antibiotic course as instructed, even when you start feeling better. You were also diagnosed with hyperthyroidism during this admission and had a high heart rate. You were started on a medication called atenolol to help bring your heart rate down to a normal range. Please continue taking it as instructed. You were also diagnosed with chlamydia during this admission and you were treated for it.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Mr ___, It was a pleasure participating in your care while you were admitted to ___. As you know you were admitted because you had an infection in your finger. A collection of fluid was drained by the plastic surgeons. You were given antibiotics which you will need to continue for 12 more days. You will also need to soak your finger in betadine three times a day. We made the following changes to your medications 1. START Augmentin 500 mg daily for 12 more days 2. DECREASE simvastatin to 20 mg daily 3. START Tylenol ___ mg three times a day as needed for pain You should continue to take all your other medications as instructed. Please feel free to call with any questions or concerns.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB, wheezing 2. Aspirin 325 mg PO DAILY 3. Benzonatate 100 mg PO TID:PRN cough 4. Clopidogrel 75 mg PO DAILY 5. Ezetimibe 10 mg PO DAILY 6. Metoprolol Succinate XL 25 mg PO DAILY 7. Pantoprazole 40 mg PO Q24H 8. Paroxetine 20 mg PO DAILY 9. Rosuvastatin Calcium 10 mg PO DAILY 10. Spironolactone 25 mg PO DAILY 11. Boniva (ibandronate) 150 mg oral Qmonthly 12. Cetirizine 10 mg PO DAILY 13. Estrogens Conjugated 0.625 gm VG DAILY 14. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 15. Potassium Chloride (Powder) 40 mEq PO DAILY Hold for K > 16. Qvar (beclomethasone dipropionate) 80 mcg/actuation inhalation BID 17. Vitamin D2 (ergocalciferol (vitamin D2)) 50,000 unit oral Qweekly 18. Supplemental oxygen Portable oxygen delivery system, ___ titrate to O2 sats >92%. ___: V46.2 (dependence on supplemental oxygen). Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS Neisseria meningitis Oxygen dependence SECONDARY DIAGNOSIS asthma hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mrs. ___, ___ was a pleasure taking care of you at ___. You were transferred for further management of neisseria meningitis. You were continued on the correct dose of antibiotics and completed the appropriate IV antibiotic course. You also took 2 days of oral meds to clear any colonization in your upper airway. All of your close contacts should take the prescribed prophylactic antibiotics to prevent infection. During your stay you were found to have episodes of low oxygen when walking around. You have been told in the past that you might benefit from oxygen at home and it was reordered while you were here. Of note, our radiologists commented on small nodularities on your right upper lung, which is likely from an old infection. This should be followed by a 3 month chest ___. You should follow up with your primary doctor when you return to ___. Wishing you well, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H:PRN pain 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheeze, SOB 3. Ascorbic Acid (Liquid) 500 mg PO BID 4. Docusate Sodium 100 mg PO BID 5. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 6. FoLIC Acid 1 mg PO DAILY 7. Hydroxychloroquine Sulfate 200 mg PO BID 8. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN wheezes, SOB 9. Loratadine *NF* 10 mg Oral daily 10. Naphazoline-Pheniramine Ophth. Solution 2 DROP BOTH EYES QID:PRN dry eyes 11. Multivitamins 1 TAB PO DAILY 12. Omeprazole 20 mg PO DAILY 13. PredniSONE 15 mg PO DAILY 14. Promethazine 25 mg PO Q6H:PRN nausea 15. Thiamine 100 mg PO DAILY 16. Warfarin 5 mg PO DAYS (___) 17. Alendronate Sodium 70 mg PO QMON 18. Hydrocortisone Cream 2.5% 1 Appl TP BID 19. Oyst-Cal-500 *NF* (calcium carbonate) 500 mg calcium (1,250 mg) Oral daily 20. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation Inhalation Q6H:prn wheezing 21. OxycoDONE (Immediate Release) 15 mg PO Q6H:PRN pain RX *oxycodone 15 mg 1 tablet(s) by mouth every six (6) hours Disp #*25 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hip Pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted because you were feeling unwell. You appeared very dehydrated and we gave you lots of fluid and held your lasix. The CAT scan of your abdomen did not reveal the cause for your pain. You also complained of vision loss however the eye doctors did not find a reason for this. At discharge you were able to tolerate food. You will need to follow up with your doctor to work this pain up further.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 2. Omeprazole 20 mg PO DAILY 3. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice daily as needed Disp #*60 Capsule Refills:*1 4. Lidocaine Viscous 2% 20 mL PO QID:PRN mouth pain RX *lidocaine HCl 20 mg/mL 20 mL PO four times daily as needed Disp #*1 Bottle Refills:*0 5. Senna 1 TAB PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*1 6. Indapamide 2.5 mg PO DAILY 7. Lorazepam 0.5 mg PO BID:PRN anxiety 8. Metoprolol Succinate XL 25 mg PO DAILY 9. Ondansetron 8 mg PO Q12H:PRN nausea 10. Prochlorperazine 5 mg PO Q6H:PRN nausea 11. ValACYclovir 1000 mg PO Q12H RX *valacyclovir 1,000 mg 1 tablet(s) by mouth every ___ hours Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY: Febrile neutropenia SECONDARY: Breast cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, you were admitted because of a fever. We thought this was from a herpes outbreak because of your oral and vaginal lesions. The lesions in your mouth are probably related to chemotherapy because that can cause breakdown of mucous membranes. We treated you with acyclovir for the outbreak and we are sending you home with a prescription for this medication which you should continue throughout the duration of your chemotherapy unelss you hear otherwise from your oncologist. We also had some concern that your port site could have an infection but we monitored you carefully and it seemed to be fine. Please call your doctor immediately if that site develops any drainage or redness or tenderness.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN pain 2. Allopurinol ___ mg PO DAILY 3. Bisacodyl 10 mg PO BID:PRN constipation 4. Ferrous Sulfate 325 mg PO DAILY 5. Fluticasone Propionate 110mcg 2 PUFF IH BID 6. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN SOB 7. Metoprolol Tartrate 100 mg PO TID 8. Montelukast Sodium 10 mg PO DAILY 9. Multivitamins 1 TAB PO DAILY 10. Senna 1 TAB PO BID:PRN constipation 11. Torsemide 60 mg PO DAILY 12. Triamcinolone Acetonide 0.1% Cream 1 Appl TP PRN itch and pain 13. Vitamin D 400 UNIT PO BID 14. Warfarin 5 mg PO DAILY16 15. Docusate Sodium 100 mg PO BID 16. Vancomycin 750 mg IV Q48H 17. Omeprazole 20 mg PO BID 18. Finasteride 5 mg PO DAILY 19. Aspirin 81 mg PO DAILY 20. Calcium Carbonate 500 mg PO BID 21. Outpatient Lab Work Weekly CBC with differential, chem-7, vancomycin trough, and ESR/CRP faxed to ___. 22. OLANZapine (Disintegrating Tablet) 5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnosis: -Septic arthritis -Septic shock -Hemarthrosis -Supratherapeutic INR -Healthcare associated pneumonia -Delirium Secondary diagnoses: -Diastolic heart failure -Atrial fibrillation -Hypertension -Chronic kidney disease Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It has been a pleasure taking care of you in the hospital. You were admitted for chest pain and trouble breathing. You were treated with intravenous antibiotics for pneumonia and diuretics for your heart failure. During your hospital course, you were found to have an infection in your knee. You had surgery and are now on antibiotics which will require treatment for several weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q8H:PRN Pain - Mild Reason for PRN duplicate override: Alternating agents for similar severity 2. Docusate Sodium 100 mg PO BID hold for loose stool 3. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate please take stool softener or laxative with this med, it can cause constipation RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp #*10 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY:PRN constipation 5. Senna 8.6 mg PO BID:PRN constipation 6. gabapentin 800 mg oral TID 7. lamoTRIgine 50 mg oral DAILY 8. OLANZapine 5 mg PO BID:PRN agitation 9. Venlafaxine XR 150 mg PO QAM Discharge Disposition: Home Discharge Diagnosis: Grade 1 liver laceration 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 ___ after a car crash and you sustained a head laceration which was repaired with staples, as well as a minor liver laceration. Your blood levels were trended and have remained stable. Your diet was advanced to a regular diet, which you are tolerating, and your pain is better controlled with pain medication. You are now ready to be discharged home to continue your recovery. Please note the following discharge instructions: Liver/ Spleen lacerations: *AVOID contact sports and/or any activity that may cause injury to your abdominal area for the next ___ weeks. *If you suddenly become dizzy, lightheaded, feeling as if you are going to pass out go to the nearest Emergency Room as this could be a sign that you are having internal bleeding from your liver or spleen injury. *AVOID any blood thinners such as Motrin, Naprosyn, Indocin, Aspirin, Coumadin or Plavix for at least ___ days unless otherwise instructed by the MD/NP/PA.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H RX *acetaminophen 325 mg 2 tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 2. Cephalexin 500 mg PO Q6H Duration: 6 Doses RX *cephalexin 500 mg 1 capsule(s) by mouth every six (6) hours Disp #*6 Capsule Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*20 Capsule Refills:*0 4. Gabapentin 300 mg PO TID RX *gabapentin 300 mg 1 capsule(s) by mouth three times a day Disp #*90 Capsule Refills:*1 5. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram 1 powder(s) by mouth once a day Disp #*20 Packet Refills:*0 6. Senna 17.2 mg PO DAILY RX *sennosides [senna] 8.6 mg 2 by mouth once a day Disp #*20 Tablet Refills:*0 7. TraMADol 50 mg PO Q6H:PRN Pain - Severe Reason for PRN duplicate override: Alternating agents for similar severity RX *tramadol 50 mg 1 tablet(s) by mouth every six (6) hours Disp #*25 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Central cord syndrome Complex right perineal and scrotal closure Left inferior orbital floor fracture Bilateral nasal bone fractures Left lamina propecea fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ after a fall. You were experiencing numbness, pain and tingling in your extremities, MRI obtained was concerning for cord injury at C3/C4. You were seen by Neurosurgery and they recommended hard cervical collar to be worn at all times and outpatient follow-up. You also had facial fractures, a scalp laceration, and a scrotal laceration. Plastic Surgery evaluated you and recommended bacitracin to the scalp laceration and non-operative management of the facial fractures. Because you fractured the bones around your left eye, Ophthalmology did an eye exam which was normal. If you do experience any vision changes, you should have your eye re-examined. Urology was consulted and determined the scrotal injury did not involve the genitourinary system. You were taken to the operating room for a washout and repair of this injury. There is a surgical drain that will remain in place until your follow-up in clinic. You are regaining your sensation and are medically cleared for discharge home. Please note the following: 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</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild 2. Docusate Sodium 100 mg PO BID 3. Heparin 5000 UNIT SC BID 4. LevETIRAcetam 500 mg PO BID Duration: 10 Days 5. OxyCODONE--Acetaminophen (5mg-325mg) 1 TAB PO Q4H:PRN pain no greater than 4gram of APAP in 24 hours 6. Senna 17.2 mg PO HS 7. Acyclovir 400 mg PO Q8H 8. Albuterol Inhaler ___ PUFF IH Q4H:PRN cough, SOB 9. amLODIPine 5 mg PO DAILY 10. Finasteride 5 mg PO DAILY 11. Fluticasone Propionate NASAL 2 SPRY NU DAILY 12. Furosemide 20 mg PO DAILY 13. Metoprolol Tartrate 6.25 mg PO Q6H 14. Pravastatin 10 mg PO QPM 15. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Subdural hematoma Atrial fibrillation Discharge Condition: Stable Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Hemorrhage with Surgery Surgery •You underwent a surgery called a craniotomy to have blood removed from your brain. •Please keep your 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. Onc: - Will consider restarting chemotherapy after wound evaluation at first follow-up. - Check at least 1 CBC w/ diff at rehab per oncology team 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, Xarelto) until cleared by the neurosurgeon. •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 Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*2* 2. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. bupropion HCl 150 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO QAM (once a day (in the morning)). Disp:*30 Tablet Extended Release(s)* Refills:*0* 4. lansoprazole 15 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 5. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2* 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day): hold for diarrhea. Disp:*60 Capsule(s)* Refills:*2* 7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. Disp:*60 Tablet(s)* Refills:*2* 8. warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 ___: Please get your blood level checked by your PCP and adjust warfarin dose according to their direction. Disp:*30 Tablet(s)* Refills:*0* 9. Tylenol ___ mg Tablet Sig: ___ Tablets PO every eight (8) hours as needed for pain. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: deep vein thrombosis pleural effusion acute on chronic kidney injury Secondary: anemia of chronic kidney disease polycystic kidney disease congenital hepatic fibrosis thrombocytopenia (low platelet count) 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 participating in your care at ___. You were admitted to the hospital and found to have a blood clot in your leg and possibly lungs. You have been treated with blood thinning medicine for this. You were also found to have extra fluid in your chest outside of the right lung called a pleural effusion. You have decided to follow up with Interventional Pulmonology as an outpatient for possible drainage of this liquid. REGARDING YOUR MEDICATIONS... Medications STARTED that you should continue: colace, senna, warfarin (blood thinner), tylenol Medications STOPPED this admission: lisinopril (given kidney function) - this should be addressed with your primary care doctor regarding resuming this medicine. Medication DOSES CHANGED that you should follow: metoprolol succinate was decreased from 75mg daily to 25mg daily. Otherwise, it is very important that you take all of your usual home medications as directed in your discharge paperwork. ** It is very important that you call your PCP or come into ED for any changes in your breathing or for fevers given your pleural effusion (fluid around the lung)**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Pradaxa 150 mg Capsule Sig: One (1) Capsule PO twice a day. Disp:*60 Capsule(s)* Refills:*2* 2. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 3. sotalol 80 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). Disp:*90 Tablet(s)* Refills:*2* 4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day. Disp:*30 Tablet, Chewable(s)* Refills:*2* 5. metoprolol succinate 200 mg Tablet Extended Release 24 hr Sig: Two (2) Tablet Extended Release 24 hr PO once a day. Disp:*60 Tablet Extended Release 24 hr(s)* Refills:*2* 6. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2* 7. lisinopril 20 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 8. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*2* 9. furosemide 40 mg Tablet Sig: One (1) Tablet PO every other day prn as needed for leg swelling. Discharge Disposition: Home Discharge Diagnosis: unstable angina Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ for chest pain. We treated you with medications for your chest pain and then you underwent a cardiac cath. You cardiac cath revealed 2 blockages that will be treated with medications. You will need to start new medications (see below for details). Please follow up with your primary care doctor and your cardiologist. Medication Changes: START taking dabigatran (pradaxa) 150mg by mouth every 12 hours START taking clopidogrel (plavix) 75mg by mouth daily START taking lisinopril 20mg by mouth daily START taking isosorbide mononitrate (imudr) 30mg by mouth daily START taking aspirin 81mg by mouth daily START taking atorvastatin 80mg by mouth daily INCREASE metoprolol succinate to 400mg by mouth daily STOP taking Warfarin STOP taking simvastatin Continue taking sotalol 120mg by mouth daily Continue taking Furosemid 40mg by mouth as needed for ankle edema</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Haloperidol 5 mg PO BID 4. Lisinopril 10 mg PO DAILY 5. Thiamine 100 mg PO DAILY 6. LeVETiracetam 500 mg PO BID Duration: 7 Days RX *levetiracetam 500 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 7. DiphenhydrAMINE 50 mg PO Q12H 8. Milk of Magnesia 30 mL PO QHS:PRN constipation 9. Mylanta 30 ml oral Q4H:PRN dyspepsia 10. Acetaminophen ___ mg PO Q8H:PRN pain RX *acetaminophen 500 mg ___ tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnoses ================== Syncope Orthostatic Hypotension Fall traumatic ___ Secondary Diagnoses =================== C4 on C5 anterolithesis Schizophrenia Delirium Abnormal EKG: RBBB, left anterior fascular block, ?nodal conduction disease Elevated CK Hypertension Discharge Condition: Level of Consciousness: Alert and interactive. Mental Status: Confused - sometimes. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking part in your care during your hospitalization at ___. You underwent diagnostic work up because you lost conciousness, fell, and struck your head while at ___. Your fall was most likely due to orthostatic hypotension, low blood pressure when you are standing. We recommend that you drink plenty of fluids, and that you rise slowly when changing from sitting to standing. Because you struck your head, we did a CT-scan to look at your brain. A small amount of blood was seen in your brain. Blood can irritate the brain and cause seizures. We have put you on a medication to prevent seizures for 1 week. You have already had 2 days of this medication and only need to take it for 5 more days. You have schizophrenia and were being seen at ___ for psychosis. It is important for you to continue in patient treatment for pyschosis. Managing mental illness is challenging, continue to take your antipsychotic medications and keep intouch with your providers. You had some abnormalities on EKG, a study of electrical conduction in your heart, howevever, these do not seem to be new. You had no evidence of a heart attack. You did not have any symptoms while in the hospital, and an ECHO of your heart showed normal heart function. You should discuss with your primary care provider if you have questions about these findings. It was a pleasure participating in your care. We wish you the best of luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. Labetalol 100 mg PO TID 3. Lisinopril 40 mg PO DAILY 4. Senna 8.6 mg PO BID:PRN Constipation - First Line Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: left frontoparietal intraparenchymal hemorrhage. hyptertension oropharyngeal dysphagia 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 difficulty speaking and right sided weakness resulting from an ACUTE HEMORRHAGIC STROKE, a condition where there is bleeding in the brain. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: - High blood pressure We are changing your medications as follows: - continue lisinopril 40mg daily - continue labetalol 100mg three times daily Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain 2. Atenolol 25 mg PO DAILY 3. Duloxetine 120 mg PO DAILY 4. Furosemide 40 mg PO BID 5. Gabapentin 600 mg PO QID 6. Levothyroxine Sodium 125 mcg PO DAILY 7. Lorazepam 0.25 mg PO Q8H:PRN Anxiety 8. Nortriptyline 75 mg PO HS 9. Omeprazole 40 mg PO BID 10. Oxycodone SR (OxyconTIN) 40 mg PO Q12H 11. Simvastatin 10 mg PO DAILY 12. Tizanidine 4 mg PO TID 13. Zolpidem Tartrate 5 mg PO HS 14. CeleBREX (celecoxib) 200 mg ORAL DAILY 15. OxycoDONE (Immediate Release) 10 mg PO Q8H:PRN pain Do not take until you have stopped the liquid oxycodone 16. OxycoDONE Liquid 10 mg PO TID:PRN Pain RX *oxycodone 5 mg/5 mL 10 ml by mouth Every 8 hours as needed Disp ___ Milliliter Refills:*0 17. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 5 Days RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth Twice daily Disp #*10 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: # SIRS related to cellulitis # Musculoskeletal chest pain Secondary Dianoses: # Chronic pain # Anxiety # Hypertension # Hypothyroidism # Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you at ___ ___. You were admitted to manage an infection in your legs. You were given antibiotics and your infection appeared to resolve rapidly. We discharged you with a short course of antibiotics to complete your therapy. Please be sure to complete your antibiotic course and attend all follow-up appointments. Thank you for allowing us to be part of your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Clopidogrel 75 mg PO DAILY 3. Fluticasone Propionate NASAL 1 SPRY NU DAILY 4. Levothyroxine Sodium 50 mcg PO DAILY 5. Pantoprazole 40 mg PO Q24H 6. Pravastatin 40 mg PO DAILY 7. Acetaminophen 650 mg PO TID 8. Diltiazem 30 mg PO TID RX *diltiazem HCl 30 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 9. Docusate Sodium 100 mg PO BID:PRN constipation 10. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheeze Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Orthostatic Hypotension 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 and found to have orthostatic hypotension. Your blood pressure drops when you go from a lying to standing position. We have adjusted your medications, and you are now only on diltiazem 30mg three times per day for your blood pressure. When you go from a lying or sitting to standing we recommend that you sit for ___ minutes before standing. Once you stand, give yourself a minute before you begin walking. We have set up a visiting nurse to come to the house and check your blood pressures. If you continue to feel dizzy despite following these recommendations please call our office, or your PCP, ___. ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/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. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet ACTIVITY AND WEIGHT BEARING: - NWB LLE Physical Therapy: NWB LLE Treatments Frequency: Splint: please leave splint on until follow-up appointmen with Dr. ___ in ___ days.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fexofenadine 180 mg PO DAILY 2. Sarna Lotion 1 Appl TP QID:PRN Itchiness 3. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole [Flagyl] 500 mg One tablet(s) by mouth Every 8 hours Disp #*21 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: 1. SBO 2. ___ Disease 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 on this admission. You came to the hospital because of abdominal pain. You were found to have a small bowel obstruction related to your ___ Disease. You were seen by the gastroenterology team and your symptoms were treated conservatively. On hospital day ___ you were passing gas and having stool. You tolerated a liquid diet and we advanced you to a soft diet. You will need to follow-up with gastroenterology about further treatment of your ___ Disease. You wanted a prescription for flagyl to take home. Please take 500mg every 8 hours for 7 days. Do not drink alcohol while taking this medication. You should see your primary care doctor about receiving the hepatitis B vaccine series. Your prednisone was being tapered by your outpatient GI team. Your last dose was 5mg on ___. You should not take more prednisone unless directed by your outpatient gastroenterologists.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. budesonide-formoterol *NF* 160-4.5 mcg/actuation Inhalation BID 2. Ferrous Sulfate 325 mg PO BID 3. Montelukast Sodium 10 mg PO DAILY 4. Acetaminophen 1000 mg PO Q8H Use this three times a day for a week for leg pain RX *acetaminophen 500 mg 2 tablet(s) by mouth three times a day Disp #*42 Tablet Refills:*0 5. albuterol sulfate *NF* 90 mcg/actuation Inhalation q4h sob 6. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain RX *tramadol 50 mg 1 tablet(s) by mouth every 6 hours Disp #*40 Tablet Refills:*0 7. Senna 1 TAB PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a day Disp #*30 Capsule Refills:*0 8. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*28 Capsule Refills:*0 9. Enoxaparin Sodium 80 mg SC Q12H RX *enoxaparin [Lovenox] 80 mg/0.8 mL 80 mg SC twice a day Disp #*20 Syringe Refills:*0 10. OxycoDONE (Immediate Release) 2.5 mg PO Q6H:PRN pain use this if ultram and tylenol are not sufficient RX *oxycodone 5 mg 0.5 (One half) tablet(s) by mouth every 6 hours Disp #*10 Tablet Refills:*0 11. Outpatient Lab Work Please draw INR on ___ and FAX to the patient's primary care physician: ___. attn: ___: ___ Fax: ___ 12. Warfarin 2 mg PO DAILY16 take 2.5 tablets to make 5 mg dose RX *warfarin [Coumadin] 2 mg 2.5 tablet(s) by mouth daily Disp #*25 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: deep vein thrombosis Secondary diagnosis: menorrhagia, iron deficiency anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking care of you in the hospital. You were admitted for evaluation of calf pain and found to have a DVT - deep vein thrombosis - a clot in your leg. You were started on Lovenox and warfarin to thin your blood. You will need close monitoring of your blood levels for the first part of treatment until the levels stabilize. Please go to your primary care physician's office on ___ morning to have your blood drawn (see below). The office will help you adjust your dose. Use the Lovenox injections until they tell you to stop. This will be when your INR (warfarin level) is > 2. You began to have bleeding again after your Provera was stopped. We discussed your case with Dr. ___, and they will see you on ___ during your scheduled appointment. **Please call their office immediately if you have bleeding that requires more than one pad per hour for more than one hour at ___ Please see the attached medication list for your updated medication list. Please STOP Provera.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 20 mg PO DAILY 2. Verapamil SR 360 mg PO Q24H 3. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 4. Atorvastatin 20 mg PO QPM RX *atorvastatin 20 mg 1 tablet(s) by mouth every night Disp #*30 Tablet Refills:*3 5. Ascorbic Acid ___ mg PO DAILY 6. Ferrous Sulfate 325 mg PO DAILY 7. Multivitamins 1 TAB PO DAILY 8. Terazosin 8 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neurology: subtle right pronation without drift Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of weakness resulting from an ACUTE ISCHEMIC STROKE, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: - High cholesterol - High blood pressure We are changing your medications as follows: - Start aspirin 81mg daily - Start atorvastatin 20mg daily 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 You are being advised not to drive at this time. Please follow up with a driving assessment as outpatient. You can get this referral through your primary care doctor's office. It was a pleasure taking care of you in the hospital, and we wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Dabigatran Etexilate 150 mg PO BID RX *dabigatran etexilate [Pradaxa] 150 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 2. Digoxin 0.125 mg PO EVERY OTHER DAY RX *digoxin 125 mcg 1 tablet(s) by mouth every other day Disp #*15 Tablet Refills:*0 3. Diltiazem Extended-Release 120 mg PO DAILY RX *diltiazem HCl 120 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*0 4. Furosemide 60 mg PO DAILY RX *furosemide 40 mg 1.5 tablet(s) by mouth once a day Disp #*45 Tablet Refills:*0 5. Metoprolol Succinate XL 200 mg PO QHS RX *metoprolol succinate 200 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 6. Calcium 500 (calcium carbonate) 500 mg calcium (1,250 mg) oral DAILY 7. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: -Atrial fibrillation, paroxysmal, with rapid ventricular rate -Acute left ventricular systolic heart failure with reduced ejection fraction -Right atrial thrombus -Right calf acute deep vein thrombosis -Hypertension -Hyperkalemia -Musculoskeletal chest pain -Escherichia coli urinary tract infection -Vitamin D deficiency Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital because you had chest pain and felt short of breath. This is because your heart was not pumping as well as it should, and so fluid built up in your lungs. You were given a diuretic medication to help get the fluid out of your lungs. Also, your heart was beating abnormally fast with an abnormal rhythm called A Fib, and so we gave you medications to slow down your heart rate. Finally, we found that you had a clot in your heart and also in your leg. We started you on a blood thinner to help the clots dissolve. You were started on a number of new medications in the hospital. Please continue to take these medications as prescribed when you go home. Please weigh yourself every morning when you go home, and call your doctor if your weight goes up by 3lb. It was a pleasure taking care of you! - Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. pravastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 6. lisinopril 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). 7. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Discharge Disposition: Home Discharge Diagnosis: lung mass Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please follow up with the appropriate studies. You will see the interventional pulmonologists on ___. On ___ you should see your primary care doctor and call Dr. ___ office to discuss getting pulmonary function tests (spirometry and DlCO), a PET scan and a VQ scan.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Furosemide 40 mg PO DAILY Duration: 4 Days RX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*4 Tablet Refills:*0 2. Zofran ODT (ondansetron) 4 mg oral q8h RX *ondansetron 4 mg 1 tablet,disintegrating(s) by mouth every eight (8) hours Disp #*15 Tablet Refills:*0 3. Potassium Chloride 20 mEq PO DAILY Duration: 4 Days Hold for K > RX *potassium chloride 10 mEq 2 tablets by mouth daily Disp #*8 Packet Refills:*0 4. Warfarin 5 mg PO DAILY16 RX *warfarin 1 mg 5 tablet(s) by mouth daily Disp #*50 Tablet Refills:*0 5. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram/dose 17 gm by mouth daily Disp #*10 Packet Refills:*0 6. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth Twice a day Disp #*20 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: - acute diastolic congestive heart failure - atrial fibrillation - constipation Secondary diagnoses: - atrial fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, It was our pleasure participating in your care here at ___. You were admitted on ___ with shortness of breath and vomiting. Fortunately, you did not have a blood clot as the cause of your symptoms. You were instead found to have fluid in your lungs that was treated with a diuretic, lasix (furosemide). You urinated well after this and your breathing improved. You should take oral lasix for 4 days, with some potassium tablets as well to keep your potassium levels normal. You were also very constipated. It will be important for you to continue to take medications to help move your bowels especially while taking narcotic pain medicines. You should not resume taking your sotalol on discharge. You will need to see Dr. ___ in 2 weeks to address whether you should restart this or begin another medication. If you should have worsening shortness of breath, chest pain, or any other concerning symptom, please let your doctors ___. Again, it was our pleasure participating in your care. We wish you the best, -- Your ___ Medicine Team --</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 975 mg PO Q6H do not exceed 4g of acetaminophen in 24 hrs 2. Aspirin EC 325 mg PO DAILY start in 2 weeks after you finish the lovenox prescription RX *aspirin [Ecotrin] 325 mg 1 tablet(s) by mouth once a day Disp #*14 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 40 mg SC QPM RX *enoxaparin 40 mg/0.4 mL ___t bedtime Disp #*14 Syringe Refills:*0 5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain do not drink or drive while taking RX *oxycodone 5 mg ___ capsule(s) by mouth q4 hr prn Disp #*30 Capsule Refills:*0 6. Amphetamine-Dextroamphetamine XR 30 mg PO DAILY 7. Amphetamine-Dextroamphetamine 30 mg PO DAILY:PRN inability to focus 8. BuPROPion XL (Once Daily) 300 mg PO DAILY 9. Sertraline 50 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Right trimalleolar ankle fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: -Nonweightbearing right lower extremity in the splint 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 daily for 2 weeks then ASA 325mg for 2 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - 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 THIS PATIENT IS EXPECTED TO REQUIRE ___ DAYS OF REHAB FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___. You will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for any new medications/refills.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin EC 81 mg PO DAILY 2. Atorvastatin 40 mg PO DAILY 3. ClonazePAM 0.5 mg PO DAILY 4. Cyanocobalamin 1000 mcg PO DAILY 5. Fluticasone Propionate 110mcg 2 PUFF IH BID 6. Hydrochlorothiazide 25 mg PO DAILY 7. HydrOXYzine 50 mg PO QHS 8. Levothyroxine Sodium 75 mcg PO DAILY 9. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation QID 10. Sertraline 150 mg PO DAILY 11. Vitamin D 1000 UNIT PO BID 12. Warfarin 2 mg PO DAILY mechanical MV Dose to change daily per Dr. ___ goal INR 2.5-3.5 13. Amiodarone 200 mg PO TID RX *amiodarone 200 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 14. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 15. Magnesium Oxide 400 mg PO BID RX *magnesium oxide 400 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 16. Ranitidine 150 mg PO BID 17. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: AFib - Mitral regurgitation - Pulmonary Hypertension - Hypertension - Asthma with DLCO decrease, no recent PFTs - Hyperlipidemia - History of TIA ___ (thought to be secondary to tamoxifen) - History of left temporal CVA ___ - reports ongoing mild cognitive delays, difficulty focusing, and difficulty with reading. - GERD - History of Hodgkin's Lymphoma ___, s/p radiation - Diabetes, new diagnosis not yet started on any medications - Chest pain syndrome - LCIS / breast calcification- treated with Tamoxifen for chemoprevention - Anemia, no GI source identified, now resolved - Depression/Anxiety - Hypothyroid st Surgical History: s/p Splenectomy s/p Hysterectomy s/p Myomectomy s/p C7 fusion s/p Nissen fundoplication ___ s/p Tonsillectomy s/p Appendectomy Discharge Condition: Alert and oriented x3 nonfocal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage Edema- trace Followup Instructions: ___ [/INST] </s><s>Please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns ___ **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours** Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID 2. Aspirin 81 mg PO DAILY 3. Furosemide 20 mg PO DAILY 4. Gabapentin 200 mg PO BID 5. Levobunolol 0.5% 1 DROP BOTH EYES BID 6. Levothyroxine Sodium 88 mcg PO DAILY 7. Lovastatin 20 mg oral DAILY 8. Lumigan (bimatoprost) 0.01 % ophthalmic (eye) DAILY 9. MetFORMIN (Glucophage) 500 mg PO DAILY 10. Metoprolol Succinate XL 200 mg PO QAM 11. Metoprolol Succinate XL 100 mg PO QHS 12. Mirtazapine 7.5 mg PO QHS 13. Multivitamins 1 TAB PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Fatigue Fall 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. You came to the hospital because you had a fall. We did a workup, and you had no injuries. You were safe to go home. Please see you Doctor on ___ for followup</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl ___AILY constipation 2. Docusate Sodium 100 mg PO BID 3. Magnesium Oxide 400 mg PO BID 4. Multivitamins W/minerals 1 TAB PO DAILY 5. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild/Fever 6. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID 7. Desitin (zinc oxide;<br>zinc oxide-cod liver oil) 40 % topical QID:PRN 8. Diastat AcuDial (diazePAM) 2.5 mg Other Q12H:PRN seizure 9. Isosource 1.5 Cal (lactose-reduced food with fibr) 0.07 gram-1.5 kcal/mL Other Q12H 10. Ketoconazole Shampoo 1 Appl TP ASDIR 11. LACOSamide 150 mg PO BID 12. LevETIRAcetam ___ mg PO BID 13. Multivitamins 1 TAB PO DAILY 14. Polyethylene Glycol 17 g PO Q3DAYS: PRN constipation 15. Senna 17.2 mg PO BID:PRN Constipation - First Line 16. Simethicone 80 mg PO QID 17. Trivora (28) (levonorg-eth estrad triphasic) 50-30 (6)/75-40 (5)/125-30(10) oral DAILY 18. Vitamin D 5000 UNIT PO EVERY 4 WEEKS (MO) 19. Vitamin D 400 UNIT PO DAILY 20. water 150 cc oral QID 21. Zonisamide 400 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Seizure Gastroenteritis Discharge Condition: Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Mental Status: Confused - always. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You came to the hospital because you had breakthrough seizures likely due to nausea and vomiting from a gastroenteritis. Your seizure medicine was switched to IV formulation until you could tolerate medicine in your enteral tube. You stopped vomiting and your tube feeds were resumed. Then, your medicines were switched back to enteral formulation. Now that you are leaving the hospital, you will continue to take your medicines as previously prescribed. Please follow-up with your doctors, as listed below. 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. Nystatin Oral Suspension 5 mL PO QID 5 more days RX *nystatin 100,000 unit/mL 5 ml by mouth four times per day Refills:*0 2. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing 3. Docusate Sodium 100 mg PO BID 4. FLUoxetine 20 mg PO DAILY 5. Fluticasone Propionate 110mcg 2 PUFF IH BID 6. LamoTRIgine 125 mg PO DAILY 7. LORazepam 1 mg PO BID 8. Morphine Sulfate ___ 15 mg PO Q6H:PRN Pain - Moderate 9. Omeprazole 40 mg PO BID 10. Polyethylene Glycol 17 g PO BID 11. Prazosin 3 mg PO QHS 12. Rexulti (brexpiprazole) 2 mg oral QHS 13. Sucralfate 1 gm PO QID 14. TraZODone 100 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Primary: Thrush Odynophagia Secondary: Abdominal mass Depression/Anxiety Asthma Sleep Apnea Discharge Condition: Activity Status: Ambulatory - Independent. Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure caring for you at ___. You were seen in our hospital for trouble swallowing. We found evidence of a fungal infection, called "thrush," in your mouth. We also did an EGD (endoscopy) to evaluate for any obstruction or mass or infection to cause your trouble swallowing. Fortunately, this test did not show any abnormalities. Please continue all your medications as prescribed. Please continue the Nystatin rinse for 5 more days. Follow up with your surgeon, PCP, and GI doctors as ___. If you have a question, do not hesitate to ask.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild/Fever 2. Docusate Sodium 100 mg PO BID 3. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth once a day Disp #*31 Tablet Refills:*1 4. LevETIRAcetam 1000 mg PO BID RX *levetiracetam 1,000 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*8 Tablet Refills:*0 5. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals 1 tablet(s) by mouth once a day Disp #*31 Tablet Refills:*1 6. OxyCODONE (Immediate Release) 5 mg PO Q8H:PRN Pain - Moderate Duration: 7 Days ___ request partial fill. RX *oxycodone 5 mg 1 tablet(s) by mouth every eight (8) hours Disp #*21 Tablet Refills:*0 7. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth once a day Disp #*31 Tablet Refills:*1 8. QUEtiapine Fumarate 25 mg PO QHS insomnia RX *quetiapine 25 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 9. Senna 8.6 mg PO BID:PRN Constipation - First Line RX *sennosides [Senna Laxative] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 10. Thiamine 200 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 2 tablet(s) by mouth once a day Disp #*62 Tablet Refills:*1 11. Lactulose 30 mL PO TID RX *lactulose 20 gram/30 mL 30 ml by mouth three times a day Disp #*1 Bottle Refills:*1 12. Diltiazem Extended-Release 120 mg PO DAILY 13. Furosemide 20 mg PO DAILY 14. Spironolactone 50 mg PO DAILY 15.Outpatient Physical Therapy Discharge Disposition: Home Discharge Diagnosis: Bilateral acute-on-chronic subdural hematomas 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 left-sided mini craniotomy to have blood removed from your brain. - You underwent a surgery to embolize the vessels contributing to the bleed in 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. This is to prevent bleeding from your groin. - 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. - You may gradually return to your normal activities, but we recommend you take it easy for the next ___ hours to avoid bleeding from your groin. - Do not go swimming or submerge yourself in water for five (5) days after your procedure. - You make take a shower. 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. Care of the Puncture Site: - Keep the site clean with soap and water and dry it carefully. - You may use a band-aid if you wish. What You ___ Experience: - Mild tenderness and bruising at the puncture site (groin). - 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 - Bleeding from your groin incision 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. Cefpodoxime Proxetil 400 mg PO Q12H RX *cefpodoxime 200 mg 2 tablet(s) by mouth every twelve (12) hours Disp #*12 Tablet Refills:*0 2. Creon ___ CAP PO QIDWMHS RX *lipase-protease-amylase [Creon] 3,000 unit-9,500 unit-15,000 unit ___ capsule(s) by mouth Four times a day with meals and snack Disp #*360 Capsule Refills:*0 3. MetroNIDAZOLE 500 mg PO Q8H RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*9 Tablet Refills:*0 4. Midodrine 10 mg PO Q8H RX *midodrine 10 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 5. Enoxaparin Sodium 100 mg SC Q24H Start: ___, First Dose: Next Routine Administration Time 6. ARIPiprazole 30 mg PO DAILY 7. Diazepam 5 mg PO TID 8. Docusate Sodium 100 mg PO BID 9. Fluticasone-Salmeterol Diskus (250/50) 2 INH IH BID 10. Fluvoxamine Maleate 150 mg PO BID 11. FoLIC Acid 1 mg PO DAILY 12. Milk of Magnesia 15 mL PO Q12H:PRN Constipation 13. Ondansetron 8 mg PO Q8H:PRN Nausea 14. OxyCODONE (Immediate Release) 10 mg PO Q6H:PRN Pain - Severe Reason for PRN duplicate override: Alternating agents for similar severity 15. OxyCODONE SR (OxyconTIN) 30 mg PO Q12H 16. Polyethylene Glycol 17 g PO DAILY 17. Prochlorperazine 10 mg PO Q6H:PRN Nausea 18. Senna 8.6 mg PO BID 19. Zolpidem Tartrate 10 mg PO QHS:PRN Insomnia 20.Bedside Commode Bedside Commode Limited mobility due to orthostatic hypotension (I95.1) 21.Shower chair Shower chair Orthostatic hypotension (I95.1) Discharge Disposition: Home Discharge Diagnosis: Sepsis Acute Bacterial Colitis Pancreatic insufficiency Chronic hypotension / Orthostatic hypotension Stage III Pancreatic Cancer Portal Vein Thrombosis 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 a severe infection to your colon. We treated ___ with antibiotics and fluids. ___ fortunately improved and are feeling better. Please continue your medications as explained further down. We strongly recommended ___ to have a visiting nurse to help ___ with medications and home safety but ___ declined. It was a pleasure to take care of ___. Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: -Weightbearing as tolerated left lower extremity MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: 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 daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - Splint must be left on until follow up appointment unless otherwise instructed. - Do NOT get splint wet. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever ___ 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE ___ DAYS OF REHAB</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, It was our pleasure to care for you at ___. You came to the hospital because of abdominal pain and low blood pressures. WHAT HAPPENED IN THE HOSPITAL? - you had blood work done which showed a decrease in your liver function which was suspected to be possibly from your cancer treatment - you were started on oral steroids to help your liver function - your liver numbers started to improve WHAT SHOULD YOU DO WHEN YOU LEAVE THE HOSPITAL? - follow up closely with your oncologist - continue taking all your medications as directed - please continue taking your prednisone (steroid) at the current dose until instructed to decrease it by your oncologist We wish you all the best! Sincerely, Your care team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY 2. Levothyroxine Sodium 112 mcg PO DAILY 3. Lisinopril 20 mg PO DAILY 4. Paroxetine 20 mg PO DAILY 5. Tiotropium Bromide 1 CAP IH DAILY 6. Acetaminophen 650 mg PO Q8H:PRN pain/HA do NOT exceed 3gm in 24 hours 7. Docusate Sodium 100 mg PO BID please hold for loose stools 8. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 9. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation INHALATION BID 10. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q4H:PRN sob Discharge Disposition: Home Discharge Diagnosis: Gallstone Pancreatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, You presented to ___ on ___ after having an abdominal CT scan at an outside hospital which was concerning for gallstones and fluid collection. At ___, you had a MRI of abdomen which was concerning for inflammation of your pancreas. You were admitted to the Acute Care Surgery team and were transferred to the surgery floor for further medical management. On ___, you underwent an ERCP with sphincterotomy procedure and your gallstones were removed. You tolerated this procedure well. On ___, you underwent a laparoscopic cystectomy where your gallblader was removed. You tolerated this procedure well. You were given IV fluids for rehydration and bowel rest. You were then advanced to a regular diet which you tolerated. You tolerated oral medicine and ambulated and are now medically cleared to be discharged to home to continue your recovery. Please note the following discharge instructions: ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 400 mg PO BID Duration: 1 Week Tapered dose to maintenance 200 daily, see instructions on prescriptions RX *amiodarone 400 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 2. Amiodarone 200 mg PO BID Duration: 1 Week To begin after you complete week of 400 twice daily RX *amiodarone 200 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 3. Amiodarone 200 mg PO DAILY To begin after finish 2 weeks of loading; this is your maintenance dose RX *amiodarone 200 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 4. Enoxaparin Sodium 100 mg SC Q12H 5. Metoprolol Succinate XL 25 mg PO DAILY 6. Multivitamins W/minerals 1 TAB PO DAILY 7. Ondansetron 8 mg PO Q8H:PRN Nausea/Vomiting - First Line 8. Pantoprazole 40 mg PO Q12H 9. Venlafaxine XR 150 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: syncope orthostasis pulmonary embolism pancreatic adenocarcinoma anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you. You were admitted because you passed out. This was likely caused by a dehydration ("hypovolemia") which may or may not have led to atrial fibrillation with rapid heart rate. You got better with IV fluids and better oral intake, and controlling your heart rate. We wish you the best in your recovery! Sincerely, your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital for abdominal pain and management of your pain medications and constipation medications. Your regimens were readjusted and you were started on a fentanyl patch. You should continue to take your pain medications and constipation medications as prescribed. You are now safe for discharge home with close follow up. It was a pleasure caring for you - we wish you all the best! Sincerely, Your ___ Oncology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Ferrous Sulfate 325 mg PO BID RX *ferrous sulfate [iron] 325 mg (65 mg iron) 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 3. NPH 28 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 4. MedroxyPROGESTERone Acetate 10 mg PO DAILY Duration: 7 Days RX *medroxyprogesterone 10 mg 1 tablet(s) by mouth daily Disp #*7 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: vaginal bleeding firboid uterus 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 heavy vaginal bleeding, likely attributable to a fibroid. Please take the provera as prescribed and continue your oral contraceptive pills. You also need to take iron twice daily. If your bleeding increases or you feel dizzy or lightheaded, please call your gyn provider or our office at ___ right away. You have a follow up appt with your primary gyn on ___, it is important that you go to this appointment. If you have any problems with this please feel free to call the ___ clinic at ___. 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. Acetaminophen 650 mg PO Q6H standing dose 2. Acetaminophen-Caff-Butalbital ___ TAB PO Q6H:PRN headache 3. Docusate Sodium 100 mg PO BID 4. Ferrous Sulfate 325 mg PO DAILY 5. Fluticasone Propionate NASAL 1 SPRY NU DAILY 6. Lansoprazole Oral Disintegrating Tab 15 mg PO DAILY 7. Lisinopril 20 mg PO DAILY hold for SBP < 110, HR < 60 8. MetFORMIN XR (Glucophage XR) 1500 mg PO QPM Do Not Crush 9. Metoprolol Succinate XL 25 mg PO DAILY hold for SBP < 110, HR < 60 10. Senna 1 TAB PO BID 11. Tizanidine ___ mg PO HS:PRN pain, spasm 12. Vitamin D 50,000 UNIT PO 1X/WEEK (___) 13. fenofibrate *NF* 160 mg Oral daily 14. testosterone cypionate *NF* 200 mg/mL Injection every 2 weeks 15. Aspirin 81 mg PO DAILY 16. Outpatient Lab Work Check CBC/diff, ESR/CRP, BMP, LFTs - Check weekly and fax results to ___ 17. Aluminum-Magnesium Hydrox.-Simethicone ___ ml PO Q6H:PRN Dyspepsia 18. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 19. Calcium Carbonate 500 mg PO TID calcium repletion 20. Diazepam 10 mg PO Q6H:PRN pain please encourage more PRN use if needed, patient only taken 1 tab today and 1 tab yesterday per pharmacy 21. DiphenhydrAMINE 12.5-50 mg PO/IV Q6H:PRN Insomnia/Pruritis 22. Gabapentin 600 mg PO Q6H 23. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using HUM Insulin 24. Milk of Magnesia 30 ml PO BID:PRN Constipation 25. Multivitamins 1 CAP PO DAILY 26. Nortriptyline 25 mg PO HS 27. CefePIME 2 g IV Q8H 28. Morphine Sulfate ___ ___ mg PO Q4H:PRN pain 29. Morphine SR (MS ___ 30 mg PO Q12H RX *morphine 30 mg 1 capsule(s) by mouth every twelve (12) hours Disp #*60 Capsule Refills:*0 30. Lidocaine 5% Patch 1 PTCH TD DAILY 31. Fluconazole 400 mg PO Q24H 32. Enoxaparin Sodium 40 mg SC DAILY stop date is ___. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right hip osteoarthritis s/p total hip arthroplasty ___ Postoperative hematoma within right gluteus medius s/p ___ and evacuation of hematoma on ___ ___ right total hip arthroplasty s/p ___, explant of all components, cement spacer placement, and wound vac placement on ___ ___ and vac changes for septic right total hip arthroplasty on ___ ___ ___ 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>1. 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. 2. Please follow up with your primary physician regarding this admission and any new medications and refills. 3. Resume your home medications unless otherwise instructed. 4. 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. 5. You may not drive a car until cleared to do so by your surgeon. 6. Please keep your wounds clean. You may shower starting five (5) days after surgery, but no tub baths or swimming for at least four (4) weeks. No dressing is needed if wound continues to be non-draining. Any stitches that need to be removed will be taken out at your follow-up visit. 7. Please call your surgeon's office to schedule or confirm your follow-up appointment. 8. Please DO NOT take any non-steroidal anti-inflammatory medications (NSAIDs such as celebrex, ibuprofen, advil, aleve, motrin, etc). 9. ANTICOAGULATION: Please continue your lovenox for four (4) weeks to help prevent deep vein thrombosis (blood clots). If you were taking aspirin prior to your surgery, it is OK to continue at your previous dose while taking this medication. ___ STOCKINGS x 6 WEEKS. 10. WOUND CARE: Please keep your incision clean and dry. 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. Please place a dry sterile dressing on the wound each day if there is drainage, otherwise leave it open to air. Check wound regularly for signs of infection such as redness or thick yellow drainage. Sutures will be removed at yoru follow-up visit. 11. ___ (once at home): Home ___, dressing changes as instructed, wound checks, PICC line assessment, IV infusions. Weekly labs - CBC/diff, Chem 7, LFTs and send to ID RNs at ___. 12. ACTIVITY: Weight bearing as tolerated on the operative extremity. No strenuous exercise or heavy lifting until follow up appointment. Mobilize frequently. Physical Therapy: WBAT Mobilize Treatments Frequency: dry, sterile dressing changes daily and as needed for drainage wound checks ice TEDs **staple removal will be at first follow up appt.**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 10 mg PO DAILY 2. Fluticasone Propionate NASAL 2 SPRY NU DAILY 3. Doxazosin 4 mg PO HS 4. MetFORMIN XR (Glucophage XR) 500 mg PO DAILY 5. Ranitidine 150 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: - 1.3 cm cystic pancreatic head mass - Biliary obstruction Secondary: - Hypertension - Non insulin dependent 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>Dear Mr. ___, It was a pleasure taking care of you during your hospitalization at ___. You were admitted for a mass in your pancreas. You had a procedure to look in your bowels and there was a narrowing found near your pancreas. This was opened up and sample were taken. You also had an MRI (picture of your abdomen) to better look at the lesion in your pancreas. After your procedure, you had vomiting that was brown and concerning for blood. Your blood count remained stable and you did not have any further episodes. Because your blood pressure was well controlled while you were in the hospital, we are only restarting Doxazosin upon your discharge. Please talk with your PCP about restarting the other medications. Please continue to take your current medications as directed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Home meds: DEXTROAMPHETAMINE-AMPHETAMINE [AMPHETAMINE SALT COMBO] - Amphetamine Salt Combo 30 mg tablet. 1 (One) tablet(s) by mouth once a day - (Prescribed by Other Provider) TAMSULOSIN - tamsulosin 0.4 mg capsule. 1 (One) capsule(s) by mouth once a day - (Prescribed by Other Provider) Medications - OTC ACETAMINOPHEN - acetaminophen 500 mg tablet. 1 (One) tablet(s) by mouth every six (6) hours as needed for pain - (Prescribed by Other Provider) ASCORBIC ACID [VITAMIN C] - Dosage uncertain - (Prescribed by Other Provider) ASPIRIN - aspirin 81 mg tablet,delayed release. 1 (One) tablet(s) by mouth once a day - (Prescribed by Other Provider) FLAXSEED - Dosage uncertain - (Prescribed by Other Provider) FOLIC ACID - Dosage uncertain - (Prescribed by Other Provider) MULTIVITAMIN [MEN\'S MULTI-VITAMIN] - Men\'s Multi-Vitamin tablet. 1 (One) tablet(s) by mouth once a day - (Prescribed by Other Provider) OMEGA 3-DHA-EPA-FISH OIL [FISH OIL] - Dosage uncertain - (Prescribed by Other Provider) SAW-VIT E-SOD SEL-LYC-BETA-PYG [PROSTATE HEALTH] - Prostate Health 160 mg-100 unit-100 mcg tablet. 1 (One) tablet(s) by mouth once a day - (Prescribed by Other Provider) New meds: 1. Acetaminophen 325-650 mg PO Q6H:PRN fever/pain 2. Ciprofloxacin HCl 500 mg PO Q12H Discharge Disposition: Home Discharge Diagnosis: Urinary infection Discharge Condition: Good condition; ambulatory Followup Instructions: ___ [/INST] </s><s>Return to ED for temperature > 101.5 Take cipro for 10 days</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 70 mg SC Q24H RX *enoxaparin 300 mg/3 mL 70 mg SC Daily Disp #*7 Vial Refills:*3 2. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY RX *isosorbide mononitrate 30 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 3. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 1 powder(s) by mouth Daily Refills:*3 5. Simethicone 40-80 mg PO QID:PRN gas RX *simethicone 80 mg 1 tab by mouth every six (6) hours Disp #*30 Tablet Refills:*0 6. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 7. Acyclovir 400 mg PO 5X/DAY:PRN Herpes outbreak 8. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate 9. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES: ================== Common hepatic duct stricture Occlusive thrombosis of the central portal venous system Metastatic gallbladder adenocarcinoma Fever related to malignancy SECONDARY DIAGNOSES: ==================== Coagulopathy Normocytic anemia Thrombocytopenia Dyslipidemia Type 2 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 ___, It was a pleasure taking part in your care here at ___! Why was I admitted to the hospital? - You were admitted for recurrent fevers What was done for me while I was in the hospital? - You were treated with broad spectrum antibiotics while we searched for a cause of your infection. - Your fevers were determined to be caused by your cancer. - A CT scan of your belly revealed a blood clot in one of your veins. You were started on a blood thinner to help treat the clot. - You had an endoscopic biopsy of your lymph nodes to help guide your chemotherapy regimen. - You were started on FOLFOX chemotherapy. - You were treated with stunting for a blockage in your biliary drainage system. - You improved and were ready to leave the hospital. You did have a fever and elevated white blood cell count before you left, but we believe this is related to your cancer rather than a new infection. What should I do when I leave the hospital? - Take your medications as prescribed and go to the follow up appointments that we have arranged for you. 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. Lisinopril 40 mg PO DAILY 2. Multivitamins 1 TAB PO DAILY 3. Amlodipine 5 mg PO DAILY RX *amlodipine 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: primary: hypertension secondary: left ventricular hypertrophy and 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 ___, ___ was a pleasure taking care of your during your stay here at ___. You came to the hospital because of a headache and high blood pressure. You were found to have a blood pressure in theh 200s/100s. We gave you medication to lower your blood pressure which worked. We started you on a new medication which we would like for you to take every day and follow up with your primary care doctor about your blood pressure. It is also very important that you avoid salty foods such as ___ sausage etc. Please check your blood pressures while at home in the morning. If the top number is above 180 please call your primary care doctor. The following changes have been made to your medication regimen: START amlodipine</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Docusate Sodium 200 mg PO BID 3. Fluticasone Propionate NASAL 1 SPRY NU BID 4. Morphine SR (MS ___ 45 mg PO Q12H RX *morphine [MS ___ 15 mg 3 tablet extended release(s) by mouth every twelve (12) hours Disp #*90 Tablet Refills:*0 5. Omeprazole 40 mg PO DAILY 6. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN breakthrough pain RX *oxycodone 5 mg ___ capsule(s) by mouth q3h Disp #*100 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY 8. Senna 1 TAB PO BID 9. Benzonatate 100 mg PO TID 10. Bisacodyl ___AILY constipation 11. Dexamethasone 4 mg PO QAM 12. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB, wheeze 13. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN SOB, wheeze 14. Amlodipine 5 mg PO DAILY 15. Hydrocortisone (Rectal) 2.5% Cream ___ID PRN rectal irritation 16. Metamucil (psyllium;<br>psyllium husk;<br>psyllium husk (with sugar);<br>psyllium seed (sugar)) 0.52 gram oral daily 17. Metoprolol Succinate XL 100 mg PO DAILY 18. Lactulose ___ mL PO DAILY constipation Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: pneumonia, malignant pleural effusion Secondary: metastatic non small cell lung cancer, atrial fibrillation with rapid ventricular rate Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital with a fast heart rate, diarrhea and shortness of breath. It was found that you had some fluid in your lungs which was drained. This fluid had cancer cells in it that were consistent with your known lung cancer. You also had a lung infection which was treated with antibiotics and your symptoms improved. Your condition has improved and you can be discharged to your facility.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ascorbic Acid ___ mg PO DAILY 2. Atorvastatin 10 mg PO QPM 3. ClonazePAM 0.5 mg PO QHS:PRN anxiety 4. Hydrochlorothiazide 12.5 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Valsartan 160 mg PO DAILY 7. Vitamin D 50,000 UNIT PO DAILY 8. Acyclovir 400 mg PO Q12H 9. Fish Oil (Omega 3) 1000 mg PO DAILY 10. Magnesium Oxide 400 mg PO ONCE 11. Meclizine 12.5 mg PO Q6H:PRN dizziness RX *meclizine 25 mg 1 tablet(s) by mouth every 6 hours as needed for dizziness Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: 1. Benign Paroxysmal Postional Vertigo 2. Hypertension 3. Hyperlipidemia 4. Diverticulitis s/p colon resection 5. Aortic insufficiency 6. Arthritis 7. Obstructive Sleep Apnea 8. History of head trauma as a teenager 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 for work up of vertigo or dizziness. There are 2 main reasons for dizziness. One reason is due to the peripheral nerves in the inner ear and the other reason is due to the brain such as a stroke. Due to the fact that you have had many short episodes of dizziness before, it was improved with a maneuver to dislodge the calcium crystals in your inner ear and now you do not have any more symptoms, we believe that most likely the cause of your dizziness is because of a nerve problem and not because of a stroke. Your MRI did not show a stroke or blood clot in your head.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q3H (every 3 hours) as needed for Pain. Disp:*60 Tablet(s)* Refills:*0* 3. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 4. trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as needed for anxiety. 5. sertraline 25 mg Tablet Sig: One (1) Tablet PO once a day. 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 7. nimodipine 30 mg Capsule Sig: Two (2) Capsule PO Q4H (every 4 hours) for 7 days. Disp:*84 Capsule(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Subarachnoid Hemorrhage Right vertebral Artery Aneurysm hydrocephalus / mild Intraventricular hemorrhage Headache Alcohol withdrawal Delirium Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Angiogram with Embolization of Right Vertebral Artery Dissecting Aneurysm Medications: •Take Aspirin 325mg (enteric coated) 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 activities you can and cannot do: •When you go home, you may walk and go up and down 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 that is draining, as needed •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 What to report to office: •Changes in vision (loss of vision, blurring, double vision, half vision) •Slurring of speech or difficulty finding correct words to use •Severe headache or worsening headache not controlled by pain medication •A sudden change in the ability to move or use your arm or leg or the ability to feel your arm or leg •Trouble swallowing, breathing, or talking •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 our 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. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 2. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN 3. Ascorbic Acid ___ mg PO BID 4. Atorvastatin 40 mg PO QPM 5. Bisacodyl ___AILY:PRN constipation/stool impaction 6. ClonazePAM 2 mg PO TID 7. Cyanocobalamin 1000 mcg PO DAILY 8. Docusate Sodium 200 mg PO BID 9. Ferrous Sulfate 325 mg PO BID 10. FoLIC Acid 1 mg PO DAILY 11. Gabapentin 800 mg PO TID 12. Hydrocortisone Cream 1% 1 Appl TP QID:PRN pruritus right lower extremity 13. Ipratropium-Albuterol Neb 1 NEB NEB Q4H 14. Lactulose 30 mL PO DAILY:PRN constipation 15. Methadone 80 mg PO DAILY 16. Metoprolol Succinate XL 25 mg PO DAILY 17. Multivitamins 1 TAB PO DAILY 18. Omeprazole 40 mg PO DAILY 19. Polyethylene Glycol 17 g PO DAILY:PRN constipation 20. Senna 17.2 mg PO QHS 21. Tamsulosin 0.4 mg PO QHS 22. Tiotropium Bromide 1 CAP IH DAILY 23. Torsemide 20 mg PO DAILY 24. Warfarin 2.5 mg PO DAILY DVTs Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Chronic pain Opioid Use disorder Chronic DVT Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Atorvastatin 80 mg PO QPM 3. Lisinopril 10 mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. atenolol-chlorthalidone 100-25 mg oral daily 6. MetFORMIN (Glucophage) 500 mg PO BID 7. Vitamin D 1000 UNIT PO DAILY 8. Acetaminophen-Caff-Butalbital ___ TAB PO Q6H:PRN headache 9. Dexamethasone 4 mg PO Q8H RX *dexamethasone 4 mg 1 tablet(s) by mouth three times a day Disp #*42 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Brain mass, likely metastasis Lung mass 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 during your recent admission to ___. You were admitted after your MRI showed three brain tumors. You were seen by our neuro-oncology, neurosurgery and interventional pulmonary teams. You had a CT scan of your body which showed a mass in your lung which is also suspicious for cancer. You will need to have a sample of the lung and possible brain surgery. You need to return to the hospital on ___ at 10am. Do not eat or drink anything after midnight on ___ night. You also have an MRI scheduled on ___ at 3pm. Stop taking your Plavix.</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. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. lamotrigine 25 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day) for 5 days: through ___, then increase by 25 mg bid per week. 5. Seroquel 25 mg Tablet Sig: 0.5 Tablet PO once a day. 6. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 7. trazodone 50 mg Tablet Sig: 0.5 Tablet PO twice a day. 8. Calcium with Vitamin D 600 mg(1,500mg) -400 unit Tablet Sig: One (1) Tablet PO twice a day. 9. amoxicillin-pot clavulanate 875-125 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 3 days. 10. metoprolol tartrate 100 mg Tablet Sig: One (1) Tablet PO twice a day: Hold for HR < 55, SBP < 100. 11. Tylenol Extra Strength 500 mg Tablet Sig: Two (2) Tablet PO every eight (8) hours. 12. levetiracetam 100 mg/mL Solution Sig: Two Hundred Fifty (250) ML PO once a day: IN AM. 13. levetiracetam 100 mg/mL Solution Sig: 5 ML ML PO HS (at bedtime): AND TAPER AS PER ___. ___, 250 MG/WEEK TAPER UNTIL OFF. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Aspiration pneumonia Dementia Seizure disorder Leukopenia, possibly related to anti-seizure medication Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Bedbound or out of bed with significant assistance. Followup Instructions: ___ [/INST] </s><s>It was a pleasure to care for you during this admission. You were treated for pneumonia. Your blood pressure was low when you were admitted, and you were sleepy. These things improved with intravenous fluids and antibiotics. We stopped the bladder irrigation and this should not be restarted. Medication changes: Augmentin 875 mg po bid for 4 more days Lamictal increased to 75 mg po bid Keppra decreased to 250 mg/500 mg po bid</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 80 mg PO HS 3. Clopidogrel 75 mg PO DAILY 4. Methimazole 2.5 mg PO EVERY OTHER DAY 5. Metoprolol Succinate XL 100 mg PO DAILY RX *metoprolol succinate 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Omeprazole 20 mg PO DAILY 7. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY RX *isosorbide mononitrate 30 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain RX *nitroglycerin 0.4 mg 1 tablet(s) sublingually every 5 min Disp #*10 Tablet Refills:*0 9. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral BID 10. GlipiZIDE 2.5 mg PO DAILY 11. Multivitamins 1 TAB PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Unstable angina, coronary artery disease Secondary Diagnosis: Hyperlipidemia, hypertension, diabetes mellitus II Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for chest pain. In the Emergency Department there were some mild changes in your EKG, which made us concerned about your heart. Your chest pain resolved. To further evaluate your heart you had a nuclear stress test on ___, which showed that some areas of your heart could be at risk for a heart attack. On ___, we planned to take you for a cardiac catheterization, however since your pain had resolved, you preferred to go home. The risks of not having a catheterization were described to you, however you still wished to go home. Your medications were adjusted to hopefully decrease your chest pain in the future. Please take all medications as prescribed and follow-up at your scheduled appointments. If you develop any chest pain while you are at home you should present to the Emergency Department immediately. It was a pleasure taking care of you, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet extended release(s) by mouth every 8 hours Disp #*40 Tablet Refills:*0 2. Cholestyramine 4 gm PO BID 3. Duloxetine 90 mg PO DAILY 4. Gabapentin 600 mg PO TID 5. Fentanyl Patch 25 mcg/h TD Q72H 6. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every ___ hours Disp #*60 Tablet Refills:*0 7. Psyllium Wafer ___ WAF PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Drainage from intraabdominal phlegmonous collection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you here at ___ ___. You were admitted to our institution for your increased pain and drainage from a collection inside your abdomen. Your antibiotics and parenteral nutrition were maintained throughout your brief hospital course. We were able to drain of your collections and sent the samples for microbiological analysis. Upon evaluation by Infectious Disease specialist, it was determined that you were not benefitting from your current antibiotic therapy. We thus have stopped antibiotics for the time being. Upon stabilization and control of your pain, we now feel comfortable sending you home provided you follow these recommendations: -You may resume all your medications -Please continue TPN -Follow-up with infectious disease specialists as indicated -Call or come to the emergency department if you develop fever to 101.3F, chills, persistent nausea and/or vomiting, increasing pain not controlled with medications, increased drainage from your wounds, or any other symptom of your concern.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q8H:PRN Pain - Mild/Fever 2. ALPRAZolam 1 mg PO BID:PRN anxiety 3. Atorvastatin 40 mg PO QPM 4. Bisacodyl 10 mg PO DAILY:PRN Constipation - Second Line 5. Cyclobenzaprine 10 mg PO TID:PRN muscle spasm 6. DULoxetine 60 mg PO BID 7. Enalapril Maleate 20 mg PO DAILY 8. Gabapentin 1200 mg PO QHS 9. Latuda (lurasidone) 40 mg oral DAILY 10. Levothyroxine Sodium 150 mcg PO DAILY 11. MetFORMIN (Glucophage) 1000 mg PO BID 12. Naproxen 500 mg PO BID:PRN Pain - Moderate 13. Senna 8.6 mg PO DAILY:PRN Constipation - First Line 14. TraZODone 200 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS ================== Recurrent syncope Seroma Back pain SECONDARY DIAGNOSIS ==================== Diabetes Mellitus II Hypertension Functional Neurologic Disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking part in your care here at ___! Why was I admitted to the hospital? - You were admitted for lower back pain and fainting. What was done for me while I was in the hospital? - You had imaging of your spine that showed no sign of infection. - You had imaging of your head that showed no sign of bleed. - The Chronic Pain doctors saw ___ and helped us come up with a good pain management plan. What should I do when I leave the hospital? - Please follow up with your chronic pain doctors ___. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lacosamide 250 mg PO BID RX *lacosamide [Vimpat] 50 mg 5 tablet(s) by mouth twice a day Disp #*300 Tablet Refills:*2 Discharge Disposition: Home Discharge Diagnosis: seizures Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital after havin several seizures at home. We monitored you on EEG and you did not have any more seizures. Per recommendation of Dr. ___ outpatient epileptologist, we increased your dose of Vimpat to 250mg twice per day. On discharge, please follow up with Dr. ___ as scheduled below. It was a pleasure taking care of you, we wish you all the best!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluoxetine 20 mg PO DAILY 2. Gabapentin 100 mg PO TID 3. LeVETiracetam 500 mg PO BID 4. Docusate Sodium 100 mg PO BID 5. Heparin 5000 UNIT SC BID Duration: 6 Weeks 6. Acetaminophen 650 mg PO TID 7. Aspirin 81 mg PO DAILY 8. LORazepam 0.5 mg PO Q6H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS/ES: - Right displaced greater trochanter fracture - Right sacral fracture - Right inferior pubic ramus fracture - Right superior pubic ramus fracture w/ extension into acetabulum - Right hip/upper thigh hematoma - Anemia due to acute bleed (from hematoma) and nutritional deficiency - Acute kidney injury due to pre-renal azotemia - Chronic kidney disease, Stage IV - Acute toxic-metabolic encephalopathy SECONDARY DIAGNOSIS/ES: - Chronic Dementia - History of stroke complicated by seizures - Dyspohagia, unspecified - Hypertension - Hypercholesterolemia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure meeting you and taking care of you. You were admitted to ___ with a fracture of your right hip after you had fallen at home. You also had low blood counts from bleeding around the hip. You were evaluated by our orthopaedic surgery service who felt that you did not need immediate surgery and should be able to walk with a walker. We noted that your blood levels dropped during your hospital stay which could be due to your fractured hip and a collection of blood underneath your skin which was stable. You were given IV fluids to improved your blood pressure. Please take your medications as prescribed and follow up with your appointments as listed below. It was a pleasure taking care of you at the ___ we wish you all the best You ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BuPROPion (Sustained Release) 100 mg PO BID 2. BusPIRone 30 mg PO BID 3. Levothyroxine Sodium 75 mcg PO DAILY 4. Omeprazole 20 mg PO DAILY 5. Ranitidine 150 mg PO QHS 6. Sertraline 200 mg PO DAILY 7. TraZODone 100 mg PO QHS:PRN insomnia 8. Polyethylene Glycol 17 g PO BID RX *polyethylene glycol 3350 [ClearLax] 17 gram/dose 17 grams powder(s) by mouth twice a day Refills:*0 9. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H RX *oxycodone 20 mg 1 tablet(s) by mouth twice a day Disp #*40 Tablet Refills:*0 10. OxyCODONE (Immediate Release) 10 mg PO Q6H:PRN pain RX *oxycodone [Oxaydo] 5 mg ___ tablet(s) by mouth every six hours as needed Disp #*40 Tablet Refills:*0 11. Bisacodyl 10 mg PO DAILY:PRN constipation RX *bisacodyl [Ducodyl] 5 mg 1 tablet(s) by mouth every other day as needed Disp #*20 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: 1. Pancreatic mass 2. Hypothyroidism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with abdominal pain, nausea and vomiting and were found to have a mass in the pancreas. You had a biopsy of this mass, and results are pending at this time. You will followup for this on ___. Please follow up at the multidisciplinary conference on ___ and with your PCP. Our palliative care doctors ___ help manage your pain and appetite.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM 2. Lisinopril 2.5 mg PO DAILY 3. Metoprolol Succinate XL 25 mg PO DAILY 4. Pantoprazole 40 mg PO Q12H 5. Polyethylene Glycol 17 g PO DAILY 6. Senna 8.6 mg PO BID:PRN Constipation - First Line 7. Torsemide 80 mg PO DAILY 8. Apixaban 5 mg PO BID 9. Aspirin 81 mg PO DAILY 10. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID 11. FoLIC Acid 1 mg PO DAILY 12. Ipratropium-Albuterol Neb 1 NEB NEB Q4H:PRN Dyspnea 13. Levothyroxine Sodium 88 mcg PO DAILY 14. MetFORMIN XR (Glucophage XR) 500 mg PO DAILY 15. Pregabalin 100 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS heart failure with reduced ejection fraction atrial flutter (resolved) SECONDARY DIAGNOSIS Upper gastrointestinal bleed (stable) Acute kidney injury (resolved) 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 ___, WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted because you were short of breath and were found to have excess fluid due to poor heart function and an abnormal heart rhythm WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL? - You received water pills through the IV to help with the extra fluid - You had a shock delivered to your heart to put your heart back in normal rhythm. You had a special ultrasound (TEE) done first to rule out the presence any blood clots in your heart - You had a gastrointestinal bleed for a few days that fortunately resolved without intervention - Your heart failure medications were optimized - You began to feel better and were ready to leave the hospital WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Take all of your medications as prescribed (listed below) - Follow up with your doctors as listed below - Your weight at discharge is 188 pounds. Weigh yourself every morning, seek medical attention 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. - If you are experiencing new chest pain please call the heartline at ___ Please see below for more information on your hospitalization. It was a pleasure taking part in your care here at ___! We wish you all the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Triamcinolone Acetonide 0.025% Ointment 1 Appl TP DAILY RX *triamcinolone acetonide 0.025 % apply to vaginal lesions once a day Refills:*0 2. U-500 Conc 80 Units Breakfast U-500 Conc 80 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 3. Acetaminophen ___ mg PO Q8H:PRN Pain - Mild 4. Allopurinol ___ mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. Betamethasone Valerate 0.1% Cream 1 Appl TP QD 8. Carvedilol 12.5 mg PO BID 9. Clotrimazole Cream 1 Appl TP BID 10. Colchicine 0.6 mg PO BID:PRN Gout flare ups 11. Docusate Sodium 100 mg PO BID:PRN hard stools 12. Hydrocortisone Cream 2.5% 1 Appl TP QD 13. Ketoconazole Shampoo 1 Appl TP ASDIR 14. Levothyroxine Sodium 175 mcg PO DAILY 15. Polyethylene Glycol 17 g PO DAILY:PRN Constipation 16. psyllium husk (aspartame) 3 gram/5.95 gram oral DAILY:PRN 17. sevelamer CARBONATE 800 mg PO TID W/MEALS 18. SITagliptin 50 mg oral DAILY 19. Torsemide 60 mg PO BID 20. Venlafaxine XR 75 mg PO DAILY 21. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnoses ================= UTI Vaginitis Hyperglycemia Constipation Chest pain Secondary Diagnoses =================== Chronic kidney disease Heart failure with preserved ejection fraction Hypertension Obstructive sleep apnea Hypothyroidism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you in the hospital! Why was I admitted to the hospital? -You came to the hospital because you had high blood sugars, vaginal irritation, and urinary symptoms What happened while I was admitted to the hospital? -Your insulin regimen was adjusted by ___ -You were given antibiotics for urinary tract infection and completed your course while in the hospital -Your given a steroid cream for her vaginal irritation –Your given an antifungal medication to treat your vaginal infection -Your lab numbers were closely monitored and you were given medications What should I do after I leave the hospital? -Please continue taking all of your medications as prescribed, details below -Keep all of your appointments as scheduled -Weigh yourself every morning, call MD if weight goes up more than 3 lbs -It is very important that you take your insulin as prescribed and also use your sliding scale as discussed -If you miss more than 2 doses of insulin or if your blood sugars are >250 on 3 separate occasions, you should call your diabetes doctor or your primary care doctor immediately We wish you the very best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID:PRN constipation 2. Multivitamins 1 TAB PO DAILY 3. Voriconazole 200 mg PO Q12H 4. Acyclovir 400 mg PO Q8H 5. moxifloxacin 400 mg ORAL DAILY RX *moxifloxacin 400 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 6. Pantoprazole 40 mg PO Q24H 7. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 8. Ursodiol 300 mg PO DAILY 9. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: -Presyncope Secondary: -AML -Anemia -Neutropenia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to care for you. You were admitted due to a fall at home. We did not find a specific cause for the fall. Imaging and monitoring of your heart did not show any significant abnormalities. You were given fluids. Your blood counts were monitored, and you were given blood products to increase your blood counts. You had a bone marrow biopsy to help guide future treatment of your leukemia. Please take your medications as prescribed and attend your follow up appointments. You should no longer take amlodipine for high blood pressure.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Atorvastatin 20 mg PO DAILY 3. Hydrochlorothiazide 25 mg PO DAILY 4. Levothyroxine Sodium 88 mcg PO MON/WEDS/FRI/SAT/SUN 5. Levothyroxine Sodium 44 mcg PO TUES/THURS 6. Valsartan 160 mg PO DAILY 7. Verapamil SR 240 mg PO Q24H Discharge Disposition: Home With Service Facility: ___ ___: PRIMARY DIAGNOSES Benign paroxysmal positional vertigo Presyncope SECONDARY DIAGNOSES Hypertension Hypothyroidism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospitalization at the ___. You were admitted because you have been having lightheadness, spinning, and blurry vision over the past few months. You had a scan of your head done, and this did not show a cause for your symptoms. You were evaluated by the neurology team (the brain doctors) and there was no concern for a stroke or head bleed. Your symptoms are likely a combination of your previous diagnosis of benign vertigo, along with a side effect of taking extra blood pressure medications. You should see an eye doctor about your blurry vision, as you shared with us that you think this is because you need new glasses. You were also evaluated by physical therapy, and they determined it's safest if you go to rehab to gain strength before you go home. You and your family decided you preferred to go home, and we strongly recommend you have someone at home with you at all times. Please take your medication as prescribed. It may be beneficial to you to have a pillbox that helps lay out which medications to take when. The medications alprazolam and meclizine have both been stopped as these can cause lightheadedness, falls and confusion. Please go to your doctor's appointment this ___, this is very important you follow up. We wish you the best of luck with your health. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr ___, It was a pleasure to care for you at ___. You were admitted to the hospital because you had a drug overdose causing multiorgan failure and hypothermia. You required a breathing tube for respiratory failure, and your kidneys and liver failed. You also had significant muscle breakdown (called 'rhabdo' or rhabdomyolysis), which made your kidneys worse. You required dialysis for 9 days, and because you were previously healthy, you are very lucky, and your kidneys recovered, as did your liver. You should continue to eat a low potassium and low phosphate diet while your kidneys recover. You will need to follow up with Dr ___ kidney doctor) in clinic in 2 weeks. They will call you with the follow up appointment. We wish you all the best! We hope that you will take care of yourself. -Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 2.5 mg PO DAILY RX *amlodipine 2.5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 3. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet,chewable(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Calcitriol 0.25 mcg PO DAILY RX *calcitriol 0.25 mcg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 5. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 6. QUEtiapine Fumarate 12.5 mg PO QHS RX *quetiapine 25 mg 0.5 (One half) tablet(s) by mouth daily Disp #*15 Tablet Refills:*0 7. Parnate (tranylcypromine) 20 mg oral BID RX *tranylcypromine [Parnate] 10 mg 2 tablet(s) by mouth twice a day Disp #*120 Tablet Refills:*0 8. Tranylcypromine Sulfate (tranylcypromine) 10 mg ORAL DAILY16 RX *tranylcypromine [Parnate] 10 mg 1 tablet(s) by mouth daily at 3pm Disp #*30 Tablet Refills:*0 9. compression stockings Venous compression stockings Orthostatic hypotension 458.0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Orthostatic hypotension Secondary HTN CKD Bipolar disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted because you became confused and had a fall. We think your sleep medication dose was too high and made you confused so we decreased this. Also, your blood pressure drops when you stand up so we recommend: 1. Drink eight 8-oz glasses of water daily to prevent dehydration. 2. Wear compression stockings every day to help improve blood flow 3. Do simple exercises before you get out of bed to help increase your heart rate You can keep these instructions by your bedside so you remember these tips! We have also decreased your blood pressure medications to help prevent falls.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 1000 mg PO BID 2. Citalopram 20 mg PO DAILY 3. Desonide 0.05% Cream 1 Appl TP BID 4. Ferrous Sulfate 325 mg PO BID 5. FoLIC Acid 1 mg PO DAILY 6. Ibuprofen 600 mg PO Q6H:PRN pain 7. MetFORMIN (Glucophage) 500 mg PO BID 8. Methylprednisolone 10 mg PO DAILY 9. Metoprolol Succinate XL 75 mg PO DAILY hold for HR < 55, SBP < 100 10. Morphine Sulfate ___ 15 mg PO Q8H:PRN pain 11. Multivitamins 1 TAB PO DAILY 12. Mycophenolate Mofetil 1500 mg PO BID 13. Omeprazole 40 mg PO DAILY 14. Ondansetron 4 mg PO Q8H:PRN nasuea 15. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 16. Torsemide 80 mg PO DAILY hold for SBP < 100 17. traZODONE 50 mg PO HS:PRN insomnia 18. Warfarin 7.5 mg PO DAILY16 19. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB, cough 20. Guaifenesin ___ mL PO Q6H:PRN cough 21. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN cough, SOB 22. Alendronate Sodium 70 mg PO QSUN 23. Sodium Chloride Nasal ___ SPRY NU QID:PRN congestion Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: viral bronchitis polymyositis 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>Ms. ___, It has been a pleasure taking care of you at ___ ___. You came to the hospital with symptoms of a viral bronchitis, as well as increased mucle pain and weakness. You rheumatologist is working on getting you rituximab for your polymyositis, but for now we did not change your medicines. We gave you breathing treatments for your cough, which seemed to help. Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Docusate Sodium 100 mg PO BID 3. Omeprazole 20 mg PO DAILY 4. Simvastatin 10 mg PO QPM Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS - Chest pain secondary to demand ischemia SECNDARY DIAGNOSES - Aortic stenosis - Lung carcinoma with metastasis to multiple lymph nodes - Anemia 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. You were admitted to ___ ___ for chest pain. While you were here, you were evaluated by our cardiology team; you were not having a heart attack, and you did not require a surgical procedure for your chest pain. Your blood counts were very low, so you received a unit of blood cells, and your counts improved. We also had an important family meeting with you, your son, and our full team. You completed the MOLST form, which expresses your wishes when you leave the hospital. We will set you up with services at home so that you can get help with medications and assistance around the house. We wish you all the best in the future. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. oxycodone 30 mg Tablet Extended Release 12 hr Sig: One (1) Tablet Extended Release 12 hr PO Q12H (every 12 hours). Disp:*60 Tablet Extended Release 12 hr(s)* Refills:*0* 2. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO DAILY (Daily). 3. amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. megestrol 400 mg/10 mL (40 mg/mL) Suspension Sig: One (1) PO BID (2 times a day). 5. chlorpromazine 10 mg Tablet Sig: One (1) Tablet PO QID (4 times a day) as needed for hiccups. 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 7. senna 8.6 mg Tablet Sig: ___ Tablets PO BID (2 times a day). 8. vitamin E 400 unit Capsule Sig: One (1) Capsule PO DAILY (Daily). 9. multivitamin Tablet Sig: ___ Tablets PO DAILY (Daily). 10. Ensure Liquid Sig: One (1) PO twice a day. 11. Vitamin D-3 1,000 unit Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day. 12. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H (Every 8 Hours). 13. atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 15. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 16. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours). Disp:*120 Tablet(s)* Refills:*0* 17. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day for 5 days. Disp:*5 Tablet(s)* Refills:*0* 18. oxycodone 10 mg Tablet Sig: One (1) Tablet PO every four (4) hours as needed for pain. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Metastatic Renal Cell Cancer Secondary Diagnosis: 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. ___, You were admitted with altered mental status and fever. Your mental status improved after decreasing your pain medication doses. You were treated with antibiotics for a possible pneumonia, and should complete a course of Levofloxacin. You were discharged home with hospice services to make you more comfortable at home. The following medication changes have been made to your regimen: START: Levofloxacin 750 mg by mouth daily until ___ DECREASE: Oxycontin 30 mg by mouth twice daily CONTINUE: Oxycodone 10 mg every 4 hours as needed for pain START: Acetaminophen 1000 mg every 8 hours START: Ibuprofen 400 mg by mouth every 6 hours STOP: Krill Oil Please continue all other medication as prescribed. Please contact your hospice team or primary oncologist if you have any medical concerns while at home. It is important that you take your pain medications as prescribed to avoid future problems with confusion and lethargy. Your hospice team should be contacted if your pain worsens and is not well controlled with the current medication regimen.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Pt was discharged against medical advice. He and his wife refused to wait for their discharge paperwork.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO QPM 2. Isosorbide Mononitrate (Extended Release) 120 mg PO DAILY 3. Levothyroxine Sodium 137 mcg PO DAILY 4. Metoprolol Succinate XL 50 mg PO DAILY 5. NIFEdipine CR 90 mg PO DAILY 6. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 7. Omeprazole 20 mg PO DAILY 8. Calcium 600 with Vitamin D3 (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral BID 9. glimepiride 2 mg oral QHS 10. MetFORMIN (Glucophage) 500 mg PO DAILY 11. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*3 12. Senna 17.2 mg PO HS RX *sennosides [___] 8.6 mg 2 by mouth daily Disp #*60 Tablet Refills:*3 13. Bisacodyl 10 mg PO DAILY:PRN constipation RX *bisacodyl 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 14. Aspirin EC 325 mg PO DAILY 15. Outpatient Lab Work anemia ICD 285.0 Please repeat CBC. 16. Ferrous Sulfate 325 mg PO DAILY iron def anemia RX *ferrous sulfate [Feosol] 325 mg (65 mg iron) 1 tablet(s) by mouth once Disp #*30 Tablet Refills:*3 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: hemoptysis Secondary Diagnosis: hypertension, recent pulmonary embolism, diabetes. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a privilege to care for you at the ___ ___. You were admitted to the hospital for coughing up blood and your pulmonary doctors wanted to take another look at your lungs with a camera to assess for a source of bleeding. During this procedure, a few oozing sites of bleeding were identified and treated with electrocautery. Each morning, we monitored your labs for signs of worsening anemia from blood loss. At the time of discharge, we did not feel that you needed a transfusion. Please be sure to schedule a ___ appointment with your Primary Care doctor within 1 week of discharge. You should have a repeat "Complete Blood Count" at that visit. Also, since you recently had bleeding, you should not take your blood thinner coumadin for one month in order to allow your lungs time to heal. After one month, it is advised that you resume this medication due to your long term risk of developing a clot, which may cause another pulmonary embolism or other adverse event. Please follow closely with your outpatient doctors regarding continued ___ of these issues. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Mesalamine 1000 mg PO QID 3. Pantoprazole 40 mg PO Q24H PRN heartburn 4. Vitamin D ___ UNIT PO DAILY 5. Ondansetron 8 mg PO Q8H:PRN nausea 6. Ferrous Sulfate 325 mg PO DAILY RX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth DAILY Disp #*30 Tablet Refills:*5 Discharge Disposition: Home Discharge Diagnosis: Acute blood loss anemia Inflammatory bowel disease Palpitations Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking care of you. You were admitted to the hospital with palpitations and found to be extremely anemic. This is most likely due to slow bleeding from your intestines. We gave you blood transfusions to treat your anemia. Your blood counts remained stable throughout your time here. We did an EGD (endoscopy) that was normal. We also did a colonoscopy that showed an obstruction at the end of your small bowel, likely due to your colitis. We are not able to rule out other causes for the obstruction, including cancer. We recommended that you remain in the hospital for further evaluation by the colorectal surgeons, but you declined and said you prefer to follow up with your gastroenterologist at ___ ___ prior to any surgical evaluation. You understood the risk of leaving prior to completing this evaluation. With your permission, we have contacted Dr. ___ at ___ to let her know you were here and the details of your stay. If you have blood in your stool, shortness of breath, chest pain, or other symptoms that concern you, please contact your doctor or return to the hospital for further care. Sincerely, Your ___ Team</s>