Datasets:

Jarmac

/

llama2_di_dataset_train_prompt

like 0

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO/NG BID 2. Metoprolol Succinate XL 200 mg PO DAILY 3. Sacubitril-Valsartan (97mg-103mg) 1 TAB PO BID 4. Spironolactone 25 mg PO DAILY 5. Torsemide 10 mg PO EVERY OTHER DAY 6. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild/Fever 7. Diazepam 2 mg PO DAILY:PRN anxiety 8. Docusate Sodium 100 mg PO BID 9. EPINEPHrine (EpiPEN) 0.3 mg IM ONCE:PRN allergic reaction with trouble breathing 10. Ferrous Sulfate 325 mg PO BID 11. FoLIC Acid 1 mg PO DAILY 12. Ibuprofen 600 mg PO Q6H:PRN Pain - Mild 13. LaMICtal XR (lamoTRIgine) 300 mg oral qAM 14. LaMICtal XR (lamoTRIgine) 400 mg oral QHS 15. Omeprazole 20 mg PO BID 16. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Third Line 17. Senna 8.6 mg PO DAILY:PRN Constipation - First Line 18. Symbicort (budesonide-formoterol) 2 PUFF IH BID 19. HELD- Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB, wheeziness This medication was held. Do not restart Albuterol Inhaler until you meet with your primary care doctor. 20. HELD- norethindrone (contraceptive) 0.35 mg oral DAILY This medication was held. Do not restart norethindrone (contraceptive) until you meet with your outpatient gynecologist. You received the Depot Provera injection while you were hospitalized. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: Peripartum cardiomyopathy Secondary diagnoses: Non-sustained ventricular tachycardia Supraventricular tachycardia Anemia Thrombocytosis Acute hypoxemic respiratory failure Seizure disorder Asthma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (uses walker at baseline). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted to the hospital due to problems breathing. WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL? - While here, you were found to have decreased function of your heart, which was likely the cause of your symptoms. - Unfortunately, you needed to be intubated to help you breathe. - We gave you medications to get the extra water out of your lungs, and antibiotics to help treat for pneumonia. 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. - Weigh yourself every morning. Call your outpatient cardiologist if your weight goes up more than 3 lbs in one day or 5 lbs over three days. - 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. 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. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild/Fever 2. Allopurinol ___ mg PO DAILY 3. amLODIPine 10 mg PO DAILY 4. Cyanocobalamin 1000 mcg PO DAILY 5. diflunisal 250 mg oral DAILY 6. FoLIC Acid 1 mg PO DAILY 7. Furosemide 80 mg PO DAILY 8. Losartan Potassium 50 mg PO DAILY 9. Omeprazole 20 mg PO DAILY 10. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate 11. Pravastatin 40 mg PO QPM 12. Tacrolimus 0.5 mg PO Q12H 13. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were seen here at ___ for a small bowel obstruction causing nausea, vomiting, and abdominal discomfort. A nasogastric tube was used to suction out some of the contents in your stomach/bowel and you were given IV fluids to prevent dehydration. You have recovered well and we wish you all the best when you return home! As you prepare to leave, please remember to 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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Rolling walker 2. Aspirin 81 mg PO DAILY 3. HydrALAZINE 10 mg PO TID RX *hydralazine 10 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 4. Metoprolol Tartrate 50 mg PO TID RX *metoprolol tartrate 25 mg 2 tablet(s) by mouth three times a day Disp #*180 Tablet Refills:*0 5. Mycophenolate Mofetil 1000 mg PO DAILY RX *mycophenolate mofetil 500 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 6. NIFEdipine CR 60 mg PO DAILY 7. Pantoprazole 40 mg PO Q24H 8. PredniSONE 40 mg PO DAILY RX *prednisone 20 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 9. Propantheline Bromide 15 mg PO TID 10. Propantheline Bromide 30 mg PO QHS 11. Pyridostigmine Bromide 60 mg PO Q8H 12. Vitamin D 1000 UNIT PO DAILY 13. Fosfomycin Tromethamine 3 g PO ONCE Duration: 1 Dose Dissolve in ___ oz (90-120 mL) water and take immediately RX *fosfomycin tromethamine [Monurol] 3 gram 1 packet(s) by mouth once Disp #*1 Packet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: myasthenia ___ cervical spondylosis lumbar spondylosis urinary tract infection acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital for evaluation of your weakness and difficulty walking. We believe that this is related to arthritis in your neck and lower back causing compression of your nerves and weakness. Your myasthenia appears to be stable. We made some changes to your medications to try to reduce the diarrhea. You will follow up with your outpatient neurologist. When you arrived we saw that you were dehydrated, likely due to the diarrhea. This improved with fluids and while you were here the diarrhea improved in frequency. It will be important for you to keep drinking fluids, especially if the diarrhea worsens, to protect your kidneys. We saw that you had a urinary tract infection and we have been treating you for it. You will need to take oral antibiotics at home. We are giving you a medication, fosfomycin, which you take once. You should take this on the morning of ___ ___. THIS MEDICATION CAUSES DIARRHEA IN SOME PEOPLE. It is not a dangerous side effect, but please make sure to continue to have water and salty foods if this happens. We sent stool samples to the lab to look for an infectious cause of diarrhea. We did not see one and we believe this is most likely an effect of your medications. It was a pleasure taking care of you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. PARoxetine 20 mg PO DAILY Duration: 30 Doses Discharge Disposition: Home Discharge Diagnosis: Small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted for a bowel obstruction and are now ready for discharge. We managed your obstruction with bowel rest and IV fluids. During your hospitalization your obstruction resolved. Your diet was also been advanced and you are now tolerating a regular diet. Please give us a call if you develop fevers, chills, nausea, vomiting, or your abdominal pain returns. You can follow up with your primary care doctor. Please let us know if you have any questions. It was a pleasure taking care of you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cephalexin 500 mg PO Q6H Duration: 7 Days RX *cephalexin 500 mg 1 capsule(s) by mouth every six (6) hours Disp #*28 Capsule Refills:*0 2. Doxycycline Hyclate 100 mg PO Q12H cellulitis Duration: 7 Days RX *doxycycline hyclate 100 mg 1 capsule(s) by mouth every twelve (12) hours Disp #*14 Capsule Refills:*0 3. Fluconazole 100 mg PO/NG Q24H Duration: 6 Days RX *fluconazole [Diflucan] 100 mg 1 tablet(s) by mouth once daily Disp #*2 Tablet Refills:*0 4. Albuterol Inhaler ___ PUFF IH Q4H:PRN shortness of breath/wheezing 5. Allopurinol ___ mg PO DAILY 6. Atenolol 50 mg PO DAILY 7. BuPROPion (Sustained Release) 150 mg PO BID 8. FLUoxetine 80 mg PO DAILY 9. Gabapentin 900 mg PO QHS 10. Letrozole 2.5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Hypoxemic respiratory failure Cellulitis Toxic metabolic encephalopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - uses walker. Followup Instructions: ___ [/INST] </s><s>Your admitted to the hospital with respiratory failure and cellulitis. Your breathing improved and we are ultimately able to wean you off of oxygen. We also treated a skin infection called cellulitis with 2 antibiotics, called cipro and vancomycin. He received 7 days of antibiotics but we extended your course after discharge from the hospital.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Albuterol Inhaler ___ PUFF IH Q6H:PRN SOB, wheezing 3. Baclofen 10 mg PO QID 4. CefazoLIN 2 g IV Q8H 5. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN Pain RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 6. Venlafaxine XR 225 mg PO DAILY 7. QUEtiapine Fumarate 25 mg PO BID 8. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 9. Polyethylene Glycol 17 g PO DAILY 10. Docusate Sodium 100 mg PO BID 11. OxyCODONE SR (OxyconTIN) 80 mg PO TID pain Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Infected Spinal Cord Stimulator Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>•Your dressing may come off on the second day after surgery. •Your incision is closed with sutures. You need suture removal. •Please keep your incision dry until removal of sutures. •Please avoid swimming for two weeks. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •No contact sports until cleared by your neurosurgeon. •Do NOT smoke. Smoking can affect your healing and fusion. Medications •***Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •Do not take any anti-inflammatory medications such as Motrin, Advil, Aspirin, and Ibuprofen etc… for 2 weeks. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. •It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 500 mg PO DAILY RX *calcium carbonate 500 mg calcium (1,250 mg) 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. oxygen hypoxic. ambulatory saturations of 82% on room air. please provide supplemental oxygen. 3. Furosemide 40 mg PO DAILY Duration: 1 Doses RX *furosemide 40 mg 1 tablet(s) by mouth once daily in morning Disp #*30 Tablet Refills:*0 4. Lisinopril 20 mg PO DAILY RX *lisinopril 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Simvastatin 40 mg PO DAILY RX *simvastatin 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Vitamin D 400 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Nicotine Patch 14 mg TD DAILY RX *nicotine 14 mg/24 hour apply patch to skin once daily Disp #*30 Transdermal Patch Refills:*5 8. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 1 Days RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth once in morning, once at night Disp #*4 Tablet Refills:*0 9. Albuterol-Ipratropium ___ PUFF IH Q6H:PRN shortness of breath RX *ipratropium-albuterol [Combivent] 18 mcg-103 mcg (90 mcg)/actuation ___ puffs inh every 6 hours as needed Disp #*1 Inhaler Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: CHF exacerbation, Pneumonia (CAP), UTI Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, you were admitted to ___ ___ shortness of breath. While you were here, a chest Xray showed you had some fluid in your lungs. You were given Lasix (furosemide) to help with this, and were started on antibiotics for your cough and bacteria in your urine.</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. Lactulose 25 mL PO DAILY 4. Simvastatin 40 mg PO DAILY 5. Aciphex (RABEprazole) 20 mg oral daily 6. Metoprolol Succinate XL 25 mg PO DAILY 7. Mirtazapine 7.5 mg PO TID 8. Probiotic (B.breve-L.acid-L.rham-S.thermo;<br>L.acidophilus-Bif. animalis;<br>L.___ acidophilus;<br>lactobacillus comb no.10;<br>lactobacillus combination no.4;<br>lactobacillus combo no.11) 10 billion cell oral daily 9. Vitamin B-100 Complex (vitamin B complex) 0 SUBQ WEEKLY 10. Vitamin D3 (cholecalciferol (vitamin D3)) 1,000 unit oral daily 11. Phenytoin Sodium Extended 300 mg PO HS RX *phenytoin sodium extended 300 mg 1 capsule(s) by mouth At night Disp #*30 Capsule Refills:*5 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Seizures 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 ___, You were admitted to an outside hospital after being found at home looking to your left side with loss of motor function on your left. You had a witnessed seizure at that hospital and were transferred to ___ for seizure management. You were treated with a large amount of anti-seizure medications. This made you very drowsy for a couple of days but eventually it left your system and you started to act more like your self. We started an anti-seizure medication called dilantin and we would like you to continue this medication as an outpatient. You were evaluated by ___ who recommended discharge to a rehab. We recommend you follow up with your PCP as needed. You were discharged in stable condition to the rehab. It was a pleasure caring for you during your stay.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO/PR Q4H:PRN temperature >38.0 2. Albuterol Inhaler ___ PUFF IH Q6H:PRN dyspnea 3. Amiodarone 200 mg PO DAILY 4. Aspirin 81 mg NG DAILY 5. Atorvastatin 20 mg PO DAILY 6. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 7. Lidocaine 5% Patch 1 PTCH TD DAILY 8. Lidocaine Viscous 2% 10 mL PO QID:PRN mouth sores 9. Neomycin-Polymyxin-Bacitracin 1 Appl TP ASDIR 10. PredniSONE 10 mg PO 3X/WEEK (___) 11. PredniSONE 5 mg PO 4X/WEEK (___) 12. Vancomycin Oral Liquid ___ mg PO Q6H Please take through ___ 13. Vitamin D ___ UNIT PO DAILY 14. Fluconazole 200 mg PO Q24H Duration: 3 Days Continue through ___ 15. LeVETiracetam 500 mg PO BID 16. Bisacodyl ___AILY:PRN constipation 17. caspofungin *NF* 250 ml Injection daily 18. Docusate Sodium 100 mg PO BID 19. Florastor *NF* (saccharomyces boulardii) 250 mg Oral daily 20. Ipratropium Bromide MDI 6 PUFF IH Q6H 21. Magnesium Oxide 400 mg PO TID 22. MethylPHENIDATE (Ritalin) 2.5 mg PO BID 23. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 24. QUEtiapine Fumarate 25 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnosis: Candidemia Secondary diagnoses: Clostridium dificile colitis, urinary tract infection, gram-positive cocci bacteremia, seizure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at the ___ ___. You were admitted because there was fungus in your blood, which can be a very dangerous situation. You were started on anti-fungal medications, and we monitored you for fevers and other signs of infection. You will need to continue this medication for roughly one more week. During your hospitalization, you were also noted to have a possible urinary tract infection, which you were treated for. You had also had diarrhea prior to coming to the hospital which was caused by a bacteria known as "C. Diff". You will continue to receive antibiotics for this process. You also were switched to a different seizure medication, as our testing showed you may have some activity related to seizures during your hospitalization. You had received a tracheostomy during your prior hospitalization. The lung specialists put a cap on the tracheostomy, and you were able to breathe well without it. After watching you for 2 days, you were safe to have the tube taken out. We now have it covered with a dressing, and the vast majority of patients have natural closing within a few weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ascorbic Acid ___ mg PO BID 2. Aspirin 81 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 30 mg SC Q12H Start: Today - ___, First Dose: Next Routine Administration Time 5. Ferrous Sulfate 325 mg PO DAILY 6. LaMOTrigine 150 mg PO BID 7. Multivitamins 1 TAB PO DAILY 8. Scopolamine Patch 1 PTCH TD Q72H 9. Senna 8.6 mg PO BID:PRN constipation 10. Vitamin D 800 UNIT PO DAILY 11. CefTAZidime 2 g IV Q8H Duration: 12 Days 12. Glycopyrrolate 1 mg PO BID 13. Sulfameth/Trimethoprim Suspension 40 mL PO BID Duration: 10 Days 14. Triamcinolone Acetonide 0.025% Cream 1 Appl TP DAILY Duration: 2 Weeks Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Acinetobacter Baumannii Pneumonia Psuedomonas Aeruginosa Pneumonia Enterococcal colonization of the urine Secondary: Chronic Tracheostomy Discharge Condition: Mental Status: Confused - always. Activity Status: Bedbound. Level of Consciousness: Lethargic but arousable. Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, It was a pleasure having you here at the ___ ___ ___ ICU. You were admitted to the ICU from your rehab after you were found to have a fever and increased secretions through your tracheostomy. You were found to have a pneumonia which required a prolonged course of antibiotics. You will need to continue the Bactrim for another 10 days and the Ceftazadime for another 12 days. We wish you the best in your recovery. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate Do not take and operate heavy machinery. 2. Adderall 20mg XR QAM, 10mg ___ Qpm Discharge Disposition: Home Discharge Diagnosis: Uncomplicated 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 hospital with acute uncomplicated appendicitis. You were taken to the operating room and had your appendix removed laparoscopically. You tolerated the procedure well and are now being discharged home to continue your recovery with the following instructions. Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. Sincerely, The ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q8H 2. Ampicillin 500 mg PO Q6H END DATE ___, will complete 7 day course for UTI then 3. Lidocaine 5% Patch 1 PTCH TD DAILY:PRN Rib pain 4. Spironolactone 25 mg PO DAILY 5. Glargine 10 Units Breakfast 6. Lisinopril 30 mg PO DAILY 7. Metoprolol Succinate XL 50 mg PO BID 8. Torsemide 40 mg PO BID 9. Aspirin 325 mg PO DAILY 10. Donepezil 10 mg PO QHS 11. MetFORMIN (Glucophage) 250 mg PO BID 12. Multivitamins 1 TAB PO DAILY 13. Omeprazole 20 mg PO DAILY 14. Sertraline 100 mg PO DAILY 15. Simvastatin 20 mg PO QPM 16. Tamsulosin 0.4 mg PO QHS 17. Vitamin D ___ UNIT PO 1X/WEEK (WE) 18.Outpatient Lab Work Please check electrolytes on ___ (Na, K, Cl, HCO3, BUN, Cr, Mg) and fax them to ___ at ___ Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnoses: ===================== Acute on chronic systolic heart failure exacerbation Right subsegmental pulmonary embolism Secondary Diagnoses: ====================== Right rib fracture Dementia Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___! Why was I admitted to the hospital? -You were admitted to the hospital because your weight had increased -You also had a blood clot in your lung What happened while I was in the hospital? -You received medicine to remove fluid and decrease your weight -You received medicine to thin your blood What should I do after leaving the hospital? - Continue to take your medicines as prescribed. The people at your rehab facility will help you with this. - Please weigh yourself every morning, call MD if weight goes up more than 3 lbs. Thank you for allowing us to be involved in your care. Sincerely, Your ___ healthcare team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PR Q6H:PRN Pain or Fever 2. Hyoscyamine 0.125 mg SL QID:PRN excess secretions 3. LORazepam 0.5 mg PO Q2H:PRN anxiety/distress RX *lorazepam [Ativan] 0.5 mg 1 tablet by mouth every two (2) hours Disp #*12 Tablet Refills:*0 4. Morphine Sulfate (Concentrated Oral Solution) 20 mg/mL 5 mg PO Q3H:PRN Pain - Mild RX *morphine concentrate 100 mg/5 mL (20 mg/mL) 0.25 mL by mouth every three (3) hours Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right basal ganglia infarct Infarct involving the left centrum semiovale and corpus callosum Hemorrhagic conversion Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized due to symptoms of confusion and left sided 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. Given your large stroke burden and other medical problems, it was decided to make you comfortable and stop all tests and therapies. We are changing your medications as follows: - Discontinued all home medications - Provide comfort medications (please see med list) Please take your medications as prescribed. Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Senna 17.2 mg PO BID 2. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever 3. HumaLOG Mix ___ KwikPen (insulin lispro protamin-lispro) 54 units subcutaneous BREAKFAST 4. HumaLOG Mix ___ KwikPen (insulin lispro protamin-lispro) 26 units subcutaneous DINNER 5. Lisinopril 20 mg PO DAILY 6. MetFORMIN (Glucophage) 500 mg PO BID 7. Pantoprazole 40 mg PO Q24H 8. Polyethylene Glycol 17 g PO DAILY 9. PredniSONE 10 mg PO DAILY 10. Rosuvastatin Calcium 10 mg PO QPM Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis ================ Constipation Nausea Hypoxia Secondary diagnosis =================== Diabetes Mellitus Type II Rheumatoid arthritis Hypertension Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dr. ___ ___ was a pleasure taking care of you at the ___ ___! WHY WAS I IN THE HOSPITAL? ========================== - You were constipated, vomiting and required oxygen WHAT HAPPENED IN THE HOSPITAL? ============================== - Because of your recent abdominal surgery, there was concern that you had an obstruction in your belly, however a CT scan of your belly did not show any obstruction. You were given medication to treat your nausea and pain. You were also given medication to have a bowl movement. You improved and where ready to leave the hospital. WHAT SHOULD I DO WHEN I GO HOME? ================================ - Please continue to take all of your medications as directed - Please follow up with all the appointments scheduled with your doctor Thank you for allowing us to be involved in your care, we wish you all the best! Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LORazepam 0.5 mg PO DAILY:PRN anxiety 2. MetFORMIN XR (Glucophage XR) 1000 mg PO DAILY 3. HELD- Bystolic (nebivolol) 5 mg oral DAILY This medication was held. Do not restart Bystolic until told to do so by your primary care doctor 4. HELD- valsartan-hydrochlorothiazide 160-12.5 mg oral DAILY This medication was held. Do not restart valsartan-hydrochlorothiazide until told to do so by your primary care doctor Discharge Disposition: Home Discharge Diagnosis: Seizure Hyponatremia Rhabdomyolysis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you at ___ ___. You were in the hospital because you had multiple seizures. We believe these were caused by your sodium level being very low. Your sodium was most likely low because of your blood pressure medication (HCTZ) as well as dehydration. In the hospital, we gave you fluid to bring your sodium level back to normal. You also developed a condition called rhabdomyolysis, which refers to muscle breakdown, likely caused by the seizure. We treated this with IV fluids. When you leave the hospital, you should stop taking your HCTZ. This can cause a low sodium level. We are also holding your blood pressure medications until you see your PCP. According to ___ state law, you are not allowed to drive for 12 months following a seizure. You should also avoid swimming or bathing unsupervised, as well as heights including ladders. Best wishes, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to ___ because you were feeling short of breath and more tired than usual. While you were here, your care team found that your heart was not beating in a coordinated way, which might have been causing your symptoms. We discussed all of your options, and you opted to have a pacemaker put in. The pacemaker acts as a backup for your heart, to help make sure that it beats fast enough. You tolerated the procedure well and you were discharged with the following changes to your medications: - Increased statin from pravastatin 20mg daily to atorvastatin 40mg daily - Stopped lisinopril. Do not restart this medication until you see your doctor as an outpatient. - Please take Keflex, the antibiotic, for your new pacemaker. It was a pleasure caring for you! 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 RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 2. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth Q4 hours Disp #*60 Tablet Refills:*0 3. Penicillin G Potassium 2 Million Units IV Q4H Duration: 4 Weeks RX *penicillin G pot in dextrose 2 million unit/50 mL 2 million iv every four (4) hours Disp #*168 Bag Refills:*0 4. iv iv pump and supplies 5. Atenolol 25 mg PO DAILY 6. Hydrochlorothiazide 37.5 mg PO DAILY 7. Lisinopril 5 mg PO DAILY 8. Simvastatin 40 mg PO HS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right elbow septic arthritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. - Please take the full course of antibiotics as prescribed. WOUND CARE: - You can get the wound wet/take a shower starting 3 days after your surgery. You may wash gently with soap and water, and pat the incision dry after showering. - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. ACTIVITY AND WEIGHT BEARING: - Weight bearing as tolerated in the right upper extremity. - Range of motion as tolerated in your right upper extremity. Physical Therapy: Activity: Activity as tolerated Right upper extremity: Full weight bearing Sling: when OOB WBAT, ROMAT right upper extremity, sling for comfort. Treatments Frequency: Site: R elbow Description: surgical incision covered with DSD Care: Change dsg daily and prn. Assess surgical incision for s&s of infection.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cyanocobalamin 500 mcg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Ipratropium Bromide Neb 1 NEB IH Q6H 4. Lactulose 30 mL PO DAILY 5. Levofloxacin 500 mg PO Q24H 6. Levothyroxine Sodium 25 mcg PO DAILY 7. Lidocaine 5% Patch 1 PTCH TD QAM 8. Torsemide 40 mg PO DAILY 9. Thiamine 100 mg PO DAILY 10. Spironolactone 100 mg PO DAILY 11. OxycoDONE (Immediate Release) 5 mg PO Q8H:PRN pain 12. Nystatin Oral Suspension 5 mL PO TID 13. Rifaximin 550 mg PO BID 14. Acetaminophen 650 mg PO Q6H:PRN Pain 15. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN dyspnea / wheezing 16. Pantoprazole 40 mg PO Q24H 17. TraZODone 50 mg PO QHS:PRN insomnia Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: #Cirrhosis complicated by diuretic-refractory ascites and hydrothorax #Anemia, acute on chronic #Coagulopathy, secondary to chronic liver disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It has been our pleasure to care for you at ___. You were admitted to the hospital with anemia (a low blood count). For your anemia you received a blood transfusion and responded well. Since that time your blood counts have been high enough that you have not needed another blood transfusion. Your doctor with continue to follow your blood counts after you are discharged. You have chronic liver disease called cirrhosis. As a result, you may bleed more easily and for longer. To treat your bleeding, you were given transfusions of platelets and Fresh Frozen Plasma. Also as result of you liver disease, you collect fluid in your abdomen and chest chronically. To treat this, you get the fluid removed every ___ weeks. While you were in the hospital, you got fluid removed from your chest by a procedure called a thoracentesis. During your hospital stay we put in a special intravenous line called a PICC. A PICC is a tube that goes into your arm and to a major vein just above your heart. The PICC can stay in for a long time and you will go home with your in place. You PICC line will be used for giving medicines and transfusions of blood products. Your PICC line will require daily flushes and dressing changes. A ___ service will help you do this at home. Thank you for choosing to get your medcial care here at ___. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cinacalcet 30 mg PO DAILY 2. Mycophenolate Mofetil 500 mg PO BID 3. PredniSONE 5 mg PO DAILY 4. CycloSPORINE (Sandimmune) 100 mg PO Q12H 5. Amlodipine 10 mg PO DAILY 6. Cefpodoxime Proxetil 400 mg PO Q12H Please continue antibiotics for a ___ay ___ and to be completed ___. RX *cefpodoxime 200 mg Take 2 tablets by mouth every 12 hours Disp #*42 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Urinary Tract Infection, End Stage Renal Disease secondary to Polycystic Kidney Disease s/p Renal Transplant 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. ___, It was a pleasure taking care of you at the ___ ___. You were admitted to the hospital because of a urinary tract infection. You were treated with IV antibiotics and improved. Please continue taking your oral antibiotics at home. Please call the kidney ___ at ___ immediately if you develop any recurrence of symptoms of your urinary tract infection (burning on urination, increased frequency, increased hesitancy, or dribbling). All the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Acetaminophen 1000 mg PO Q8H RX *acetaminophen 500 mg 2 tablet(s) by mouth every 8 hours as needed Disp #*100 Tablet Refills:*1 OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity don't drink/drive/operate heavy machinery while taking RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours as needed Disp #*60 Tablet Refills:*0 Omeprazole 20 mg PO DAILY Rosuvastatin Calcium 20 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: left shoulder dislocation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>YOU ARE LEAVING AGAINST MEDICAL ADVICE. WE RECOMMEND THAT YOU STAY BECAUSE YOUR SODIUM IS LOW (120). WE DISCUSSED THAT LOW SODIUM CAN LEAD TO MENTAL STATUS CHANGES. WE DISCUSSED THAT YOU SHOULD RETURN TO THE ED IF YOU EXPERIENCE MENTAL STATUS CHANGES. WE ALSO DISCUSSED THAT YOU NEED TO RESTRICT FREE WATER CONSUMPTION. PLEASE FOLLOW UP WITH YOUR PCP AS SOON AS POSSIBLE. 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 left upper extremity w/ no shoulder range of motion; in sling and swathe at all times; range of motion as tolerated in wrist, digits 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. WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Please remain in your dressing and do not change unless it is visibly soaked or falling off.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM 2. Gabapentin 100 mg PO TID 3. Losartan Potassium 50 mg PO DAILY 4. Clopidogrel 75 mg PO DAILY Once 30 day course is complete, please resume Aspirin RX *clopidogrel 75 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 5. Rivaroxaban 15 mg PO BID Duration: 2 Weeks Please take 15 mg twice a day for two weeks. After two weeks take 20 mg once per day RX *rivaroxaban [___] 15 mg (42)- 20 mg (9) 1 tablets(s) by mouth twice a day Disp #*1 Dose Pack Refills:*0 6. Rivaroxaban 20 mg PO DAILY Please take 20 mg once per day AFTER you have completed a two week course of 15 mg twice per day RX *rivaroxaban [___] 20 mg 1 tablet(s) by mouth Daily Disp #*90 Tablet Refills:*2 Discharge Disposition: Home Discharge Diagnosis: Right popliteal artery rethrombosis 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 ___ and underwent lysis of a blood clot in your right leg, and placing of a stent in your right popliteal artery. You have now recovered from surgery and are ready to be discharged. Please follow the instructions below to continue your recovery: MEDICATION: • Take Plavix (Clopidogrel) 75mg once daily for 1 month • After you finish your course of Plavix in 1 month, restart taking Aspirin 81mg once daily • Start taking Xarelto. You will take 15 mg twice a day for the first 2 weeks, and then 20mg once daily after that • Continue all other medications you were taking before surgery, unless otherwise directed • You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort WHAT TO EXPECT: It is normal to have slight swelling of the legs: • Elevate your leg above the level of your heart with pillows every ___ hours throughout the day and night • Avoid prolonged periods of standing or sitting without your legs elevated • It is normal to feel tired and have a decreased appetite, your appetite will return with time • Drink plenty of fluids and eat small frequent meals • It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing • To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication ACTIVITIES: • When you go home, you may walk and use stairs • You may shower (let the soapy water run over groin incision, rinse and pat dry) • Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area • No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) • After 1 week, you may resume sexual activity • After 1 week, gradually increase your activities and distance walked as you can tolerate • No driving until you are no longer taking pain medications CALL THE OFFICE FOR: ___ • Numbness, coldness or pain in lower extremities • Temperature greater than 101.5F for 24 hours • New or increased drainage from incision or white, yellow or green drainage from incisions • Bleeding from groin puncture site SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site) • Lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. If bleeding stops, call vascular office ___. If bleeding does not stop, call ___ for transfer to closest Emergency Room.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 100 mg PO DAILY 2. Bisacodyl 10 mg PO DAILY 3. Cyanocobalamin 500 mcg PO DAILY 4. Levothyroxine Sodium 50 mcg PO DAILY 5. Losartan Potassium 25 mg PO BID 6. MetFORMIN (Glucophage) 500 mg PO BID 7. Metoprolol Tartrate 12.5 mg PO BID 8. Multivitamins 1 TAB PO DAILY 9. Senna 2 TAB PO DAILY 10. Magnesium Oxide 400 mg PO DAILY ASDIRECTED 11. Acidophilus *NF* (L.acidoph & ___ acidophilus) 1 cap ORAL DAILY Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Primary Diagnoses: Dementia Hyponatremia Secondary Diagnoses: Mechanical fall Hypertension Atrial fibrillation Discharge Condition: Stable, Alert and oriented x 2 Ambulatory with walker Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to care for you during your hospitalization at ___. You were admitted for confusion we believe is due to worsening of your dementia. Your recent head injury, bladder infection that required antibiotics, and problems with regulating the sodium level in your blood may have also contributed. We checked a CT scan of your head and you had no bleeding. During your hospitalization, we stopped your antibiotics, and gave you IV fluids while carefully monitoring your sodium levels. Your confusion improved during the hospitalization we believe your dementia is continuing to worsen. You worked with physical therapy while you were here, and enjoyed playing your word finding games. You had a fall overnight during your hospitalization while getting up to go to the bathroom. Your physical exam was normal, and you did not appear to be more confused. A head CT scan showed no bleeding in the brain or any new abnormalities. We recommend that you have someone help you in and out of bed and to the bathroom to prevent any more falls or injuries, and continue to work with physical therapy. Your salt levels were low, but were carefully monitored to ensure it did not fall lower to worsen your confusion. We restricted the amount of water you drank to 1 liter (4 cups). You should continue drinking no more than 4 cups of water at home and eat foods that are high in salt. Your daughter and nurses ___ help you with this. It will be important for you to follow up with your physician and have your sodium level monitored as well as any signs of headache or changes in neurologic function.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clopidogrel 75 mg PO DAILY 2. Pravastatin 40 mg PO HS 3. Donepezil 5 mg PO HS RX *donepezil 5 mg 1 tablet(s) by mouth daily Disp #*90 Tablet Refills:*3 4. TraZODone 25 mg PO HS RX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth daily Disp #*45 Tablet Refills:*3 5. Venlafaxine XR 37.5 mg PO DAILY Duration: 1 Week Take daily for 1 week. Then stop this medication. RX *venlafaxine 37.5 mg 1 capsule(s) by mouth daily Disp #*7 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: ___ Body Dementia Eosinophilia, etiology unknown REM sleep behavior disorder Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted for symptoms of progressive memory loss and visual hallucinations. You have been diagnosed with ___ Body Dementia. Your MRI did not show lesions in your brain, and a CT scan showed two hemangiomas (groups of blood vessels) between your skull and your brain. Your EEG was normal. Your spinal fluid analysis did not show infection or autoimmune disease in your central nervous system. Additional tests for Alzheimer's disease are still pending. You were started on donepezil to treat your dementia. You will have outpatient Neuropsychiatric testing and will follow up with Cognitive Clinic (Dr. ___ and with your Neurologist Dr. ___. You have REM sleep behavior disorder, and you were started on trazodone at night to help suppress REM-type sleep, to improve the nightmares and behaviors you have at night. We will also taper off your venlafaxine, because this could be making your REM sleep behavior disorder worse. You have a high white blood cell count, with many eosinophils. This could be due to infection, allergic reaction, or cancer. You have been evaluated by Infectious Diseases and you have many tests pending to check for infection. You will follow up with your PCP and your PCP will need to refer you to Infectious Disease clinic if any of your tests for infection return positive. You will also have an appointment in ___ to assess for cancer as a cause for eosinophilia. It is less likely that this is due to an allergic reaction, but if all of the tests result as negative, drug allergies will need to be investigated. It was a pleasure taking care of you during this admission.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every 12 hours Disp #*10 Tablet Refills:*0 2. MetroNIDAZOLE 500 mg PO TID RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth every 8 hours Disp #*15 Tablet Refills:*0 3. Ferrous Sulfate 325 mg PO DAILY 4. Metoprolol Succinate XL 50 mg PO BID 5. Simvastatin 10 mg PO 3X/WEEK (___) 6. Valsartan 80 mg PO DAILY 7. Vitamin D 1000 UNIT PO DAILY 8. HELD- Rivaroxaban 20 mg PO DAILY This medication was held. Do not restart Rivaroxaban until ___ or as directed otherwise by your Cardiologist Discharge Disposition: Home Discharge Diagnosis: Cholangitis Afib Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came in with chills and jaundice. We found that you had some gallstones blocking your bile ducts. We did a procedure called an ERCP with sphincterotomy to relieve this blockage and you tolerated this procedure well. Please discuss with your PCP and your ___ regarding timing of a cholecystectomy or a surgery to remove your gallbladder. Please return if you have worsening abdominal pain, nausea/vomiting, jaundice, fevers/chills, or if you have any other concerns. It was a pleasure taking care of you at ___ ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Psyllium Powder 1 PKT PO DAILY 2. ALPRAZolam 0.5 mg PO BID:PRN anxiety 3. DULoxetine 20 mg PO DAILY 4. Ferrous Sulfate 325 mg PO DAILY 5. FoLIC Acid 1 mg PO DAILY 6. Lactulose 15 mL PO BID 7. Lidocaine 5% Ointment 1 Appl TP DAILY 8. Multivitamins W/minerals 1 TAB PO DAILY 9. Omeprazole 40 mg PO DAILY 10. OxyCODONE (Immediate Release) 10 mg PO Q4H:PRN Pain - Moderate 11. Pancreaze (lipase-protease-amylase) 21,000-37,000 -61,000 unit oral TID W/MEALS 12. Pregabalin 75 mg PO BID 13. Rifaximin 550 mg PO BID 14. Ursodiol 250 mg PO BID 15. Vitamin D ___ UNIT PO 1X/WEEK (TH) Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: syncope, symptomatic bradycardia Secondary Diagnoses: ___ fracture, chronic abdominal pain, etoh cirrhosis, B12 deficiency, HTN, anxiety Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ because you were experiencing episodes of losing consciousness. You care team at the hospital looked carefully at many possible causes of these episodes. We monitored your heart closely, and found that your heart rate was too slow. This slow heart rate could contribute to passing out, especially if you are not able to eat and drink enough. One of your medications (nadolol) works by slowing your heart rate, and we stopped this medication while you were in the hospital. We closely monitored your heart rate, which improved when we stopped the nadolol. Your blood pressure remained stable. While you were here, we performed an MRI of your ankle, which showed that you have a fracture of your heel bone. We spoke with your orthopedist, who recommended that we set you up with a special boot and have you go to a rehab facility. We also evaluated your abdominal pain, and imaging and laboratory results were reassuring. We are discharging you on your home pain regimen, with plan to follow-up with your PCP. It was a pleasure caring for you! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Atrovent HFA 17 mcg/Actuation HFA Aerosol Inhaler Sig: Four (4) puffs Inhalation twice a day. 3. beclomethasone dipropionate 80 mcg/Actuation Aerosol Sig: One (1) inhalation Inhalation twice a day. 4. Lovenox ___ mg/mL Syringe Sig: One (1) injection Subcutaneous once a day. Disp:*10 injections* Refills:*0* 5. diltiazem HCl 120 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:*0* 6. Outpatient Lab Work Please check INR. Please send the results to Dr ___ at ___ ___ Fax: ___ 7. warfarin 2.5 mg Tablet Sig: One (1) Tablet PO once a day: Please take one tablet with dinner daily. You will be notified for dose changes. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: - atrial flutter Secondary diagnosis: - Chronic obstructive pulmonary disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You came to our hospital for rapid heart rate, and was found to have a heart rhythm called atrial flutter. We gave you medication to slow down your heart rate, which you responded very well. You also underwent an ultrasound of your heart (aka ECHO), which did not show evidence of structural heart disease. The blood work did not reveal reversible cause of your atrial flutter either. This condition most likely occurred from your COPD. . Please note the following changes to your medication: - Please STOP taking aspirin - Please START to administer lovenox ___ mg (one injection) subcutaneously daily. You will need to continue doing that until your INR > 2.0 for at least 24 hours - Please START to take warfarin 2.5 mg tablet by mouth daily with your dinner - Please START to take diltiazem ER 120 mg tablet by mouth daily - Please continue to take the rest of your medication . We have made the following arrangements: - There will be a visiting nursing coming to your home to make sure everything is well. - Please go to the ___ at ___ for blood draw on ___. - We have also arranged an NP appointment in your PCP's office on ___. - You will be notified for the cardiology appointment. . It has been a pleasure taking care of you here at ___. We wish you a speedy recovery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN pain 2. Docusate Sodium 100 mg PO BID 3. LeVETiracetam 500 mg PO BID Duration: 7 Days RX *levetiracetam [Keppra] 500 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*25 Tablet Refills:*0 5. Senna 1 TAB PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: - Left small subarachnoid hemorrhage - Left proximal humoral head 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 ___ on ___ after you sustained a fall at work. On further evaluation, you were found to have the following injuries: - Left small subarachnoid hemorrhage - Left proximal humoral head fracture You were seen by the Neurosurgery service. There was nothing to do for your subarachnoid hemorrhage. You should follow up with their office in one month (see appointment below). Because you had a small amount of blood in your head, you are taking Keppra, which will prevent potential seizures in this situation. Take all medication until it is finished. For your left arm (humoral head) fracture, you were seen the the Orthopedic Surgery team. They recommend that you wear a sling at all times (other than for hygiene), do not bear weight using that arm, and follow up with their service in two weeks (appointment below). Lastly, you were seen by Physical and Occupational therapy. Both services felt you were safe to be discharged home. There is no further follow-up needed. Please continue to take any medications you were taking prior to this admission. You are being give a prescription for pain medication. Take as needed. Do not drive or operate heavy machinery while taking those narcotics. If you become constipated, you may take colace (stool softener) daily and a laxative as needed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Lisinopril 10 mg PO DAILY 3. Warfarin 3 mg PO DAILY16 4. Acetaminophen 1000 mg PO TID max dose 3g daily 5. Calcium Carbonate 500 mg PO TID 6. Vitamin D 800 UNIT PO DAILY 7. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 8. Docusate Sodium 100 mg PO BID 9. Enoxaparin Sodium 30 mg SC Q24H use as bridge until INR therapeutic (2.0-3.0) 10. Multivitamins 1 TAB PO DAILY 11. OxycoDONE (Immediate Release) 2.5 mg PO TID:PRN Pain 12. Senna 2 TAB PO HS 13. Potassium Chloride 20 mEq PO DAILY Hold for K > Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Femur Fracture blood loss anemia Discharge Condition: Patient was alert and interactive. Out of bed with assistance. With minimal pain adequately controled by PO medication. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. You came in following a fall and broke your femur. You had some bleeding so you were given several blood transfusions. You had surgery and there were no complications with the procedure. Your blood counts stabilized so you were discharged to rehab. While you were here we discontinued your coumadin because you needed surgery. You were restarted on your coumadin at discharge. Your INR needs to be followed up.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Bisacodyl 10 mg PR QHS:PRN constipation 3. Docusate Sodium 100 mg PO BID 4. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN wheezing 5. Lithium Oral Solution 150 mg PO BID 6. Morphine Sulfate (Oral Solution) 2 mg/mL 2.5 mg PO Q6H:PRN pain or dyspnea RX *morphine 10 mg/5 mL 2.5 mg by mouth every 4 hours Disp #*45 Milliliter Milliliter Refills:*0 7. Pantoprazole (Granules for ___ ___ 40 mg PO DAILY 8. Polyethylene Glycol 17 g PO DAILY 9. Senna 8.6 mg PO BID 10. Simethicone 40 mg PO TID:PRN distension 11. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 12. amLODIPine 5 mg PO DAILY 13. Calcium Carbonate 500 mg PO DAILY 14. FLUoxetine 40 mg PO DAILY 15. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 16. Levothyroxine Sodium 100 mcg PO 6X/WEEK (___) 17. Levothyroxine Sodium 50 mcg PO 1X/WEEK (___) 18. Loratadine 10 mg PO DAILY:PRN allergies 19. OLANZapine 5 mg PO DAILY 20. Timolol Maleate 0.5% 1 DROP BOTH EYES BID Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: PRIMARY DIAGNOSIS ================= - Paraesophageal hernia - Recurrent aspiration pneumonia c/b hypoxic respiratory failure - Severe Malnutrition SECONDARY DIAGNOSIS =================== - Right breast cancer s/p lumpectomy, XRT, arimidex - Radiation pneumonitis/BOOP - Bipolar disorder - Hypertension - Hypothyroidism 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 taking care of you at ___ ___. You were admitted for abdominal pain related to your stomach hernia. You had surgery on that hernia, but unfortunately it did not improve your symptoms. We had a feeding tube that bypasses the stomach placed which also did not help, and the feeds actually seemed to make your symptoms a lot worse. Therefore, we continued to feed you through your PICC instead. After talking with you and your family, it was decided that it would be best to transition to hospice in order to shift the focus of your care to maximize your comfort and quality of life. We wish you the best of health, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Docusate Sodium 100 mg PO DAILY 3. Furosemide 40 mg PO DAILY 4. Omeprazole 40 mg PO DAILY 5. Oxybutynin 2.5 mg PO BID 6. Acetaminophen 650 mg PO TID 7. Senna 8.6 mg PO BID constipation 8. Metoprolol Tartrate 25 mg PO BID 9. Potassium Chloride 20 mEq PO DAILY 10. Fluticasone Propionate 110mcg 2 PUFF IH BID 11. Bisacodyl 10 mg PR QHS:PRN constipation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Trauma: fall right ___ rib fractures Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after a fall in which he sustained right sided rib fracutures. Because you were on coumadin, there was concern for bleeding. You were admitted to the intensive care unit for monitoring. Your rib pain has been controlled in pain medication. Your vital signs have been stable and you are preparing for discharge home with the following instructions: 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. Acyclovir 400 mg PO Q8H 2. Budesonide 3 mg PO TID 3. Citalopram 20 mg PO DAILY 4. Cyanocobalamin ___ mcg PO DAILY 5. Docusate Sodium 100 mg PO BID:PRN constipation 6. Dronabinol 5 mg PO BID:PRN nausea 7. FoLIC Acid 1 mg PO DAILY 8. Isoniazid ___ mg PO DAILY 9. Lorazepam 1 mg PO Q8H:PRN Anxiety 10. Multivitamins 1 TAB PO DAILY 11. PredniSONE 10 mg PO DAILY Start: After last tapered dose completes This is the maintenance dose to follow the last tapered dose 12. Pyridoxine 50 mg PO DAILY 13. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 14. Tacrolimus 2 mg PO Q12H 15. Vitamin D 1000 UNIT PO BID 16. DASatinib 100 mg PO QHS 17. Magnesium Oxide 400 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Dehydration 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 take care of you at ___. You were admitted with 1 day of nausea, diarrhea, and difficulty eating food and taking medications. We treated you with IV fluids and monitored you closely. You did well during your hospitalization and were able to eat regular foods the next day. You were discharged on ___ in improved condition. Please continue taking all of your medications as prescribed, and attend all follow-up appointments. Again, it was a please participating in your care. We wish you the best. Sincerely, Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>-You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month; this may be related to the passage of stone fragments or the indwelling ureteral stent (if there is one). -The kidney stone may or may not have been removed AND/or there may fragments/others still in the process of passing. -You may experience some pain associated with spasm of your ureter.; This is normal. Take the narcotic pain medication as prescribed if additional pain relief is needed. -Ureteral stents MUST be removed or exchanged and therefore it is IMPERATIVE that you follow-up as directed. -Do not lift anything heavier than a phone book (10 pounds) -You may continue to periodically see small amounts of blood in your urine--this is normal and will gradually improve -Resume all of your pre-admission medications, except HOLD aspirin until you see your urologist in follow-up -You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month; this may be related to the passage of stone fragments or the indwelling ureteral stent. -The kidney stone may or may not have been removed AND/or there may fragments/others still in the process of passing. -You may experience some pain associated with spasm of your ureter.; This is normal. Take the narcotic pain medication as prescribed if additional pain relief is needed. -Ureteral stents MUST be removed or exchanged and therefore it is IMPERATIVE that you follow-up as directed. -Do not lift anything heavier than a phone book (10 pounds) -You may continue to periodically see small amounts of blood in your urine--this is normal and will gradually improve -Resume all of your pre-admission medications, except HOLD aspirin until you see your urologist in follow-up -IBUPROFEN (the ingredient of Advil, Motrin, etc.) may be taken even though you may also be taking Tylenol/Acetaminophen. You may alternate these medications for pain control. For pain control, try TYLENOL FIRST, then ibuprofen, and then take the narcotic pain medication as prescribed if additional pain relief is needed. -Ibuprofen should always be taken with food. Please discontinue taking and notify your doctor should you develop blood in your stool (dark, tarry stools) -You MAY be discharged home with a medication called PYRIDIUM that will help with the "burning" pain you may experience when voiding. This medication may turn your urine bright orange. -Colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. Discontinue if loose stool or diarrhea develops. Colace is a stool softener, NOT a laxative, and available over the counter. The generic name is DOCUSATE SODIUM. It is recommended that you use this medication. -Do not eat constipating foods for ___ weeks, drink plenty of fluids to keep hydrated -No vigorous physical activity or sports for 4 weeks and while Foley catheter is in place.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ALPRAZolam 0.25 mg PO BID:PRN anxiety 2. Aspirin 325 mg PO DAILY 3. Calcitriol 0.25 mcg PO DAILY 4. Carvedilol 6.25 mg PO BID 5. Clopidogrel 75 mg PO DAILY 6. Docusate Sodium 100 mg PO TID 7. Ferrous Sulfate 325 mg PO DAILY 8. FoLIC Acid 1 mg PO DAILY 9. glimepiride *NF* 4 mg ORAL DAILY 10. Omeprazole 40 mg PO DAILY 11. Rosuvastatin Calcium 40 mg PO DAILY 12. Senna 1 TAB PO BID:PRN constipation 13. Valsartan 320 mg PO DAILY 14. Epoetin Alfa 8000 UNIT SC QMOWEFR Start: ___ 30,000units SC every two weeks. Next injection due ___ 15. Hydrochlorothiazide 25 mg PO DAILY 16. Torsemide 60 mg PO DAILY 17. NIFEdipine CR 90 mg PO DAILY please hold for SBP < 100 18. Vancomycin 1000 mg IV Q48H next doses are ___ and ___ for wound drainage/infection. End date ___. 19. Outpatient Lab Work ICD-9 280.0 (anemia, iron deficient), please check CBC and chemistry 7 on ___. - If Hgb < 7 , please consider transfusion vs. ER evaluation at ___ - If K > 5, (non-hemolyzed), Cr > 4.5, or urine output is sluggish, consider ER evaluation at ___ 20. NPH 12 Units Bedtime Insulin SC Sliding Scale using HUM Insulin Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Anemia Chronic kidney Disease ___ cellulitis Type II Diabetes Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires some assistance Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a great pleasure taking care of you. As you know you were most recently discharged from ___ after your left lower extremity bypass, and returned from your facility because of fatigue and slight interval decrease in your hematocrit. You received one unit of blood during your admission and your hemoglobin has remained stable: Hgb ___ It will be important to discuss with your primary care physician regarding having ___ colonscopy done since it might provide an additional explanation for your low blood levels. Discharge Instructions: Division of Vascular and Endovascular Surgery Lower Extremity Bypass Surgery Discharge Instructions What to expect when you go home: 1. It is normal to feel tired, this will last for ___ weeks •You should get up out of bed every day and gradually increase your activity each day •Unless you were told not to bear any weight on operative foot: you may walk and you may go up and down stairs •Increase your activities as you can tolerate- do not do too much right away! 2. It is normal to have swelling of the leg you were operated on: •Elevate your leg above the level of your heart (use ___ pillows or a recliner) every ___ hours throughout the day and at night •Avoid prolonged periods of standing or sitting without your legs elevated 3. It is normal to have a decreased appetite, your appetite will return with time •You will probably lose your taste for food and lose some weight •Eat small frequent meals •It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing •To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication What activities you can and cannot do: •No driving until post-op visit and you are no longer taking pain medications •Unless you were told not to bear any weight on operative foot: •You should get up every day, get dressed and walk •You should gradually increase your activity •You may up and down stairs, go outside and/or ride in a car •Increase your activities as you can tolerate- do not do too much right away! •No heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit •You may shower (unless you have stitches or foot incisions) no direct spray on incision, let the soapy water run over incision, rinse and pat dry •Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area that is draining, as needed •Take all the medications you were taking before surgery, unless otherwise directed •Take one full strength (325mg) enteric coated aspirin daily, unless otherwise directed What to report to office: •Redness that extends away from your incision •A sudden increase in pain that is not controlled with pain medication •A sudden change in the ability to move or use your leg or the ability to feel your leg •Temperature greater than 100.5F for 24 hours •Bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions We did the following changes in your medication list: - Please START PLAVIX as anti-platelet agent for your bypass graft (1 month through ___ - Please START VANCOMYCIN every 48 hours (next doses are ___ and ___ for wound drainage/infection - Please DECREASE NPH at bed time to 14 units. You can increase this 2 units every 3 days or as directed by your physician as ___ based on your fingerstick blood sugar levels - Please INCREASE your nifedipine from 60 mg to 90 mg due to high blood pressure in the hospital. Please continue taking the rest of your home medications the way you were taking at home prior to admission. Please follow up with your appointments as illustrated below. You will also have a repeat blood count and chemistry panel on ___ at your rehab.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Metoprolol Tartrate 6.25 mg PO BID Hold for SBP <90, HR<55 2. Atorvastatin 20 mg PO QPM 3. QUEtiapine Fumarate 6.25 mg PO QHS 4. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever 5. Allopurinol ___ mg PO DAILY 6. Ampicillin 2 g IV Q6H 7. CefTRIAXone 2 gm IV Q12H 8. Digoxin 0.125 mg PO DAILY 9. Ferrous Sulfate 325 mg PO DAILY 10. Finasteride 5 mg PO DAILY 11. Heparin Flush (10 units/ml) 2 mL IV PRN and PRN, line flush 12. Levothyroxine Sodium 75 mcg PO DAILY 13. multiv-min-FA-lycopene-lutein 1.25-2.5-7 mg oral DAILY 14. Pantoprazole 40 mg PO Q24H 15. Potassium Chloride 20 mEq PO DAILY 16. Potassium Chloride 20 mEq PO PRN WITH METOLAZONE with metolazone Hold for K > 17. Tamsulosin 0.4 mg PO QHS 18. Tranylcypromine Sulfate 10 mg PO BID 19. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP TID:PRN itch 20. HELD- MetOLazone 2.5 mg PO EVREY OTHER DAY This medication was held. Do not restart MetOLazone until your doctor tells you to 21. HELD- Metoprolol Succinate XL 12.5 mg PO DAILY This medication was held. Do not restart Metoprolol Succinate XL until your doctor tells you to Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Hemorrhagic shock, likely UGIB from stomach erosions Atrial fibrillation ___ Delirium Acute kidney injury History of Enterococcal Bacteremia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were hospitalized at ___. The following is a summary of your hospital visit and instructions for hospitalizations. Reason for hospitalization: gastrointestinal bleed Treatment: Blood transfusions, EGD Instructions for after hospitalization: 1) Stop aspirin. 2) Stop eliqius. 4) Follow up with Palliative Care at ___. 5) Continue antibiotics for infection. While you were here with us, you had indicated that you were very sad and frustrated with repeated hospitalizations, and you were no longer interested in further invasive procedures or repeated hospitalizations. Your goal was to stay at ___ for as long as possible, surrounded by your ___ community, but at the same time, you were still interested in your current medications as well as your antibiotics. We believe that the palliative care team will be able to help you best achieve these goals, and encourage you to continue to engage with them. Your weight on discharge was 123.9 lbs, and you are on torsemide 120 mg daily. If you have further dyspnea or painful edema this can be uptitrated to twice daily if needed and add metolazone if needed as well. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever Do not exceed 4GM acetaminophen in 24 hours. 2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 3. Docusate Sodium 100 mg PO BID 4. Famotidine 20 mg PO BID 5. Glycopyrrolate 1 mg PO BID 6. Heparin 5000 UNIT SC BID 7. LevETIRAcetam 1250 mg PO BID 8. Metoprolol Tartrate 50 mg PO Q6H 9. Multivitamins W/minerals Liquid 15 mL PO DAILY 10. Nystatin Oral Suspension 5 mL PO QID 11. Senna 8.6 mg PO BID constipation 12. Thiamine 100 mg PO DAILY 13. Vitamin D 1000 UNIT PO DAILY 14. FoLIC Acid 1 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Intraparenchymal Hemorrhage Seizure Nonocclusive Pulmonary Embolism Multiple Embolic Strokes Venous Sinus Thrombosis Tachycardia Hypertension Pneumonia, H. Flu Thrombocytopenia Respiratory Failure Transaminitis Discharge Condition: Mental Status: Nonverbal Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Hemorrhage with Surgery Surgery •You underwent a surgery called a craniectomy. A portion of your skull was removed to allow your brain to swell. You must wear a helmet when out of bed at all times. •It is best to keep your incision open to air but it is ok to cover it when outside. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •If you experienced a seizure while admitted, you are NOT allowed to drive by law. •No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications •Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •You may have difficulty paying attention, concentrating, and remembering new information. •Emotional and/or behavioral difficulties are common. •Feeling more tired, restlessness, irritability, and mood swings are also common. •You may 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. Ciprofloxacin HCl 500 mg PO Q24H Duration: 12 Days 2. Ramelteon 8 mg PO QHS:PRN Insomia 3. Metoprolol Tartrate 37.5 mg PO BID 4. amLODIPine 10 mg PO DAILY 5. Atorvastatin 10 mg PO QPM 6. Docusate Sodium 100 mg PO BID 7. NutriSure Plus (food supplemt, lactose-reduced) 0.05-1.5 gram-kcal/mL oral 3X/WEEK 8. Oxybutynin 5 mg PO QHS 9. sevelamer CARBONATE 1600 mg PO TID W/MEALS 10. Tamsulosin 0.4 mg PO QHS 11. Vitamin B Complex w/C 1 TAB PO DAILY 12. Vitamin D ___ UNIT PO EVERY 4 WEEKS (___) Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: Klebsiella oxytoca bacteremia HD line infection End State Renal Disease secondary to Focal Segmental Glomerular Sclerosis Macrocytic anemia SECONDARY DIAGNOSES: History of myocardial infarction related to cocaine Hypertension Benign prostatic hyperplasia Obstructive sleep apnea Consipation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___! WHY WAS I IN THE HOSPITAL? ========================== - You were admitted because you had a fever and bacteria growing in your blood WHAT HAPPENED IN THE HOSPITAL? ============================== - You were treated with IV antibiotics and had your tunneled dialysis catheter removed because we suspected that was the site that caused bacteria to grow in your blood - You had dialysis performed on the fistula in your right arm WHAT SHOULD I DO WHEN I GO HOME? ================================ - Be sure to take all your medications and attend all of your appointments listed below. Thank you for allowing us to be involved in your care, we wish you all the best! Your ___ Healthcare 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 - Mild RX *acetaminophen 500 mg 1 tablet(s) by mouth every 6 hours as needed Disp #*100 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:*12 3. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*12 4. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*12 Discharge Disposition: Home Discharge Diagnosis: # acute pancreatitis # liver cirrhosis # hypertensive gastropathy 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 at ___! Why was I in the hospital? - because you had belly pain, nausea, and dark stools. - you were found to have an inflammation of you pancreas, likely secondary to your alcohol consumption - you were also found to have liver cirrhosis and bleeding from your stomach, likely also secondary to your alcohol consumption as well as a viral infection of your liver (hepatitis C) - you were treated with fluids and pain medication What should I do after discharge? - you should follow up with your new PCP as well as hepatology as below - you should take all your medications as prescribed - you should abstain from alcohol 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 RX *acetaminophen 325 mg 2 tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 2. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*10 Tablet Refills:*0 3. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram 17 g by mouth once a day Disp #*14 Packet Refills:*0 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 40 mg PO QPM 6. Dexilant (dexlansoprazole) 60 mg oral DAILY 7. Metoprolol Succinate XL 50 mg PO DAILY 8. Triamterene-HCTZ (37.5/25) 1 CAP PO DAILY Discharge Disposition: Home Discharge Diagnosis: Acute cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with acute cholecystitis. You were taken to the operating room and had your gallbladder removed laparoscopically. You tolerated the procedure well and are now being discharged home to continue your recovery with the following instructions. Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol-Ipratropium ___ PUFF IH Q6H:PRN sob 2. Acyclovir 800 mg PO DAILY 3. BuPROPion 75 mg PO BID 4. Duloxetine 20 mg PO DAILY 5. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 6. Lactulose ___ mL PO TID 7. Metoclopramide 5 mg PO BID 8. Pantoprazole 40 mg PO Q24H 9. Rifaximin 550 mg PO BID 10. Senna ___ TAB PO BID:PRN constipation 11. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 12. Raltegravir 400 mg PO BID 13. Spironolactone 50 mg PO BID RX *spironolactone 50 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*3 14. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth once a day Disp #*60 Tablet Refills:*3 15. Nadolol 60 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: 1) Ascites Secondary diagnoses: 1) Hepatitis C cirrhosis 2) Hepatic encephalopathy 3) HIV on HAART medications Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Dr. ___, ___ was our pleasure to take care of you here at ___ ___. You were admitted to the hospital because of ascites. We treated you with a diagnostic and therapeutic paracentesis to remove 3.8L of ascitic fluid. There was no infection in this fluid. We increased your spironolactone from 50mg daily to 50mg twice a day. We also added furosemide 40mg daily. These two medications are for treatment of ascites. 1) Please maintain a low sodium diet. 2) Please take spironolactone 50mg twice a day and furosemide 40mg daily. 3) Please see below for your upcoming appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY 2. Tamsulosin 0.4 mg PO QHS 3. Acetaminophen 325-650 mg PO Q6H:PRN pain RX *acetaminophen 325 mg ___ tablet(s) by mouth every 6 hours Disp #*40 Tablet Refills:*0 4. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth every 12 hours Disp #*19 Tablet Refills:*0 5. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*28 Tablet Refills:*0 6. Ondansetron 4 mg PO Q8H:PRN nausea/vomiting Duration: 5 Days RX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*15 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Uncomplicated diverticulitis Cholelithiasis without evidence of acute cholecystitis Secondary: Hypertension Benign prostatic hypertrophy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because of lower abdominal pain. You were found to have a condition called diverticulitis that is caused by inflammation in the outpouchings in the large intestine. You were given antibiotics for this that you will continue for a full 10 day treatment course. Please continue with a clear liquid diet within the next ___ days and transition to a normal diet if you are tolerating fluids without difficulty. It was a pleasure being involved in your care. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Chlorthalidone 12.5 mg PO DAILY RX *chlorthalidone 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 3. ___ 22 Units Breakfast ___ 4 Units Dinner Insulin SC Sliding Scale using REG Insulin 4. Acetaminophen 650 mg PO BID:PRN Pain - Mild/Fever 5. Albuterol 0.083% Neb Soln 1 NEB IH Q8H:PRN shortness of breath 6. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO BID:PRN gas 7. amLODIPine 10 mg PO DAILY 8. Aranesp (in polysorbate) (darbepoetin alfa in polysorbat) 40 mcg/mL injection 1X/WEEK 9. Arnuity Ellipta (fluticasone furoate) 100 mcg/actuation inhalation DAILY 10. Aspirin 81 mg PO DAILY 11. Bisacodyl 10 mg PO DAILY:PRN Constipation - Second Line 12. Gabapentin 100 mg PO BID 13. Omeprazole 20 mg PO DAILY 14. Polyethylene Glycol 17 g PO DAILY 15. PredniSONE 7 mg PO DAILY 16. Senna 17.2 mg PO BID 17. HELD- Potassium Chloride 10 mEq PO DAILY This medication was held. Do not restart Potassium Chloride until your electrolytes are checked. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES ================= HYPOXIC RESPIRATORY FAILURE COPD EXACERBATION PNEUMONIA SECONDARY DIAGNOSES =================== Altered Mental status Lower gastrointestinal bleed Hypernatremia Type II Diabetes Mellitus Hypertension Chronic Kidney Disease Heart failure with preserved ejection fraction Elevated troponin Chronic pain Bullous pemphigoid Coronary Artery Disease Hyperkalemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___. Why did you come to the hospital? - You were having trouble breathing - You were having blood in your bowel movements What did you receive in the hospital? - You received medications for your COPD and your breathing improved - You received antibiotics for pneumonia and your cough and breathing improved - You received 1 blood transfusion - You stopped having blood in your bowel movements. What should you do once you leave the hospital? - Please take all your medications as prescribed and attend all of your follow-up appointments as scheduled. We wish you all the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. BuPROPion (Sustained Release) 150 mg PO QAM 3. BuPROPion (Sustained Release) 150 mg PO QPM 4. Calcium Carbonate 1250 mg PO DAILY 5. Ferrous Sulfate 325 mg PO DAILY 6. Gabapentin 400 mg PO TID 7. Lorazepam 0.5 mg PO DAILY:PRN anxiety 8. Multivitamins 1 CAP PO DAILY 9. Thiamine 100 mg PO DAILY 10. Vitamin D 400 UNIT PO DAILY 11. Bismuth Subsalicylate 30 mL PO QID Duration: 14 Days RX *bismuth subsalicylate [Bismuth] 262 mg 2 Tablets by mouth four times a day Disp #*112 Tablet Refills:*0 12. Doxycycline Hyclate 100 mg PO Q12H Duration: 14 Days RX *doxycycline hyclate 100 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 13. MetRONIDAZOLE (FLagyl) 250 mg PO Q6H Duration: 14 Days RX *metronidazole [Flagyl] 250 mg 1 tablet(s) by mouth every six (6) hours Disp #*112 Tablet Refills:*0 14. Nicotine Patch 14 mg TD DAILY:PRN Tobacco withdrawal RX *nicotine 14 mg/24 hour 1 patch Daily Disp #*30 Each Refills:*0 15. Omeprazole 40 mg PO BID RX *omeprazole 40 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 16. Sucralfate 1 gm PO QID RX *sucralfate 1 gram 1 tablet(s) by mouth four times a day Disp #*120 Tablet Refills:*0 17. ZOFRAN ODT *NF* (ondansetron) 4 mg Oral q8h prn nausea RX *ondansetron [ZOFRAN ODT] 4 mg 1 tablet(s) by mouth every 6 to 8 hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Marginal ulcer H. pylori infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital due to abdominal pain and three episodes of vomiting, one of which contained blood. Your blood count and vital signs remained stable and treatment for your known H. pylori/ anastamotic ulcer was resumed. Also, your abdominal CT scan was reassuring. You may continue your recovery at home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Dorzolamide 2% Ophth. Soln. 1 DROP RIGHT EYE BID 3. Ferrous Sulfate 325 mg PO BID RX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 4. Levothyroxine Sodium 75 mcg PO DAILY 5. Multivitamins 1 TAB PO DAILY 6. Rifaximin 550 mg PO BID 7. Lactulose 30 mL PO Q4H hepatic encephalopathy RX *lactulose 10 gram/15 mL 15 mL by mouth three times a day Disp #*1000 Milliliter Refills:*1 8. Furosemide 40 mg PO DAILY 9. Nadolol 20 mg PO DAILY 10. Omeprazole 20 mg PO DAILY 11. Spironolactone 50 mg PO DAILY 12. Outpatient Lab Work Please draw blood for CBC, electrolytes, BUN/Cr, ALT, AST, AP, and TBili on ___ with PCP. ICD 571.5 Cirrhosis. Please fax results to Dr. ___ at ___ Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: - ___ varices - Acute blood loss anemia Secondary diagnoses: - Pulmonary embolism - Contrast-induced nephropathy - HCV cirrhosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you while you were a patient at ___. You came to us with bleeding in your colostomy bag. You were treated with a procedure called TIPS which you tolerated well. After this procedure your kidneys were functioning slightly worse than normally. We treated you with IV fluids which resulted in improvement in your kidney function. You were also found to have a small blood clot in your lung. We could not treat you with blood thinners since your were bleeding, so you had filters placed in a vein in your abdomen to prevent more clots from traveling to your lungs. Please be sure to take all of your medications as listed below. Please keep all of your ___ appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth Twice a day Disp #*50 Capsule Refills:*0 3. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*30 Tablet Refills:*0 4. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H pain RX *oxycodone 5 mg 1 tablet(s) by mouth every ___ hours Disp #*50 Tablet Refills:*0 5. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 by mouth Twice a day Disp #*50 Capsule Refills:*0 6. Polyethylene Glycol 17 g PO DAILY 7. Atenolol 50 mg PO DAILY 8. Cyproheptadine 4 mg PO DAILY 9. Sertraline 100 mg PO DAILY 10. ciprofloxacin 500 mg/5 mL oral BID Duration: 10 Days RX *ciprofloxacin 500 mg/5 mL 5 ml by mouth twice a day Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Perforated appendicitis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with appendicitis. You were taken to the operating room and had your appendix removed. You tolerated the procedure well and are now being discharged home with the following instructions: Please follow up at the appointment in clinic listed below. We also generally recommend that patients follow up with their primary care provider after having surgery. We have scheduled an appointment for you listed below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for ___ weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: You may feel weak or "washed out" a couple weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You could have a poor appetite for a couple days. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Tomorrow you may shower and remove the gauzes over your incisions. Under these dressings you have small plastic bandages called steristrips. 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. Your incisions may be slightly red around the stitches. This is normal. You may gently wash away dried material around your incision. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Do not drink alcohol or drive while taking narcotic pain medication. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ascorbic Acid ___ mg PO DAILY RX *ascorbic acid ___ mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Finasteride 5 mg PO DAILY RX *finasteride 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Gabapentin 100 mg PO QHS RX *gabapentin 100 mg 1 capsule(s) by mouth at night Disp #*30 Capsule Refills:*0 6. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine 5 % (700 mg/patch) apply to affected area once a day Disp #*30 Patch Refills:*0 7. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 8. Rosuvastatin Calcium 10 mg PO QPM RX *rosuvastatin [Crestor] 10 mg 1 tablet(s) by mouth every evening Disp #*30 Tablet Refills:*0 9. Tamsulosin 0.4 mg PO QHS RX *tamsulosin 0.4 mg 1 capsule(s) by mouth at night Disp #*30 Capsule Refills:*0 10. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 11. TraMADOL (Ultram) 25 mg PO TID TID:PRN pain 12. TraZODone 150 mg PO QHS RX *trazodone 150 mg 1 tablet(s) by mouth every night Disp #*30 Tablet Refills:*0 13. Albuterol Inhaler ___ PUFF IH Q4H:PRN dyspnea RX *albuterol sulfate [ProAir HFA] 90 mcg 2 puff IH every 4 hours Disp #*1 Inhaler Refills:*0 14. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -400 unit oral DAILY RX *calcium carbonate-vitamin D3 [Calcium 500 + D] 500 mg calcium (1,250 mg)-400 unit 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 15. esomeprazole magnesium 40 mg oral BID RX *esomeprazole magnesium 40 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 16. Tiotropium Bromide 1 CAP IH DAILY RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 capsule IH daily Disp #*30 Capsule Refills:*0 17. Docusate Sodium 200 mg PO BID Hold if having diarrhea RX *docusate sodium 100 mg 2 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 18. Polyethylene Glycol 17 g PO DAILY Hold if having diarrhea RX *polyethylene glycol 3350 17 gram 1 powder(s) by mouth once a day Disp #*60 Packet Refills:*1 19. Levothyroxine Sodium 150 mcg PO DAILY take in the morning, ___ min apart from all other medicines RX *levothyroxine 150 mcg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 20. Sodium Chloride 1 gm PO TID RX *sodium chloride 1 gram 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 21. Outpatient Lab Work CHEM 10 twice a week ___ and ___ and fax results to Dr. ___ at ___ ICD10: ___.1 22. Maalox/Diphenhydramine/Lidocaine ___ mL PO QID:PRN heartburn RX *alum-mag hydroxide-simeth 200 mg-200 mg-20 mg/5 mL 15 mL by mouth four times a day Refills:*0 23. Magnesium Oxide 400 mg PO BID Do not take at same time as levothyroxine RX *magnesium oxide 400 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Community acquired pneumonia Chronic alcohol abuse Constipation Gastric ulceration and edema of the pylorus. Poor nutritional status Hyponatremia Recurrent aspirations SECONDARY DIAGNOSIS: Anemia Atrial fibrillation COPD BPH Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Mental Status: Confused - sometimes. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of ___ at ___. ___ came to the hospital because ___ had fevers, cough and some chest pain. For your fevers and cough, we thought that these were likely due to a pneumonia so we started ___ on antibiotics, which ___ finished while ___ were in the hospital. For your chest pain, we determined that this was not likely a heart problem. Please continue to monitor your pain and notify a nurse or call ___ if ___ have different or worse pain, or sudden shortness of breath. ___ also had abdominal pain, which we determined to primarily be due to constipation given that it changed a little bit every day. However, on CT scan, ___ had a swelling at the end of your stomach where it meets your small intestines and so ___ had camera sent into your stomach (endoscopy) to look at the inside of your stomach. ___ were found to have one ulcer as well as the swelling at the end of your stomach which was biopsies. ___ can learn about the results of this biopsy at your follow-up appointments with Dr. ___ should keep taking your reflux medication, esomeprazole magnesium, at home. While ___ were in the hospital, we learned that ___ were not eating well at home, and ___ levels of some nutrients in your blood (phosphorus, potassium, magnesium) were low. ___ were also monitored because your sodium was very low, but it improved., There was also concern that ___ were aspirating (swallowing your food into your lungs), which caused occasional fevers and puts ___ at risk for pneumonia. ___ should only drink thickened liquids and soft food. Drink 3 Ensures with Protein each day. INSTRUCTIONS FOR EATING: nectar-thick liquids and soft solids Take pills with whole with nectar-thick liquids or at least in pureed solids if drinking thin liquids Do not lay down after eating Eat sitting up. Please follow-up with appointments with your primary care doctor, your gastroenterologist and your vascular surgeon. Thank ___ for choosing ___. We wish ___ the very best. Your ___ team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 14 Days RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*28 Tablet Refills:*0 2. Atorvastatin 10 mg PO QPM 3. Budesonide 9 mg PO DAILY 4. Lisinopril 10 mg PO DAILY 5. Mesalamine ___ 1200 mg PO QAM 6. Mesalamine Enema 4 gm PR QHS Discharge Disposition: Home Discharge Diagnosis: pneumoperitoneum 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 after undergoing a colonoscopy. You underwent imaging and there was concern that you had a bowel perforation. You were placed on bowel rest and started on intravenous antibiotics. Your abdominal pain has decreased and you have been tolerating a regular diet. You are being discharged with the following instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness, abdominal pain *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.</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 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. Donepezil 10 mg PO HS 4. Duloxetine 60 mg PO DAILY 5. Mirtazapine 7.5 mg PO QHS 6. Multivitamins 1 TAB PO DAILY 7. OxycoDONE (Immediate Release) 2.5 mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth Q4H PRN Disp #*30 Tablet Refills:*0 8. Polyethylene Glycol 17 g PO DAILY:PRN constipation 9. Senna 8.6 mg PO BID:PRN constipation 10. Simvastatin 20 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Fall Rib fractures Left scapular fracture T1 retropulsion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>* Your injury caused left rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. * You should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. If the pain medication is too sedating take half the dose and notify your physician. * Pneumonia is a complication of rib fractures. In order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. This will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. * You will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. * Symptomatic relief with ice packs or heating pads for short periods may ease the pain. * Narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. * Do NOT smoke * If your doctor allows, non-steroidal ___ drugs are very effective in controlling pain ( ie, Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. * Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs (crepitus).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY 2. moxifloxacin *NF* 400 mg Oral qd Duration: 9 Days Reason for Ordering: per ID recommendation RX *moxifloxacin [Avelox] 400 mg 1 tablet(s) by mouth once a day Disp #*10 Tablet Refills:*0 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp #*15 Tablet Refills:*0 4. Docusate Sodium 100 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Pancreaticocutaneous fistula Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the surgery service at ___ for treatment of your pancreaticocutaneous fistula. You have done well ___ the post operative period and are now safe to return home to complete your recovery with the following instructions: . Please call Dr. ___ office ___ if you have ant questions or concerns. During off hours: call Operator at ___ and ask to ___ service.</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. LORazepam 0.5 mg PO Q6H:PRN nausea/anxiety 3. Multivitamins 1 TAB PO DAILY 4. Ondansetron 8 mg PO Q8H:PRN Nausea/Vomiting - First Line 5. Prochlorperazine 10 mg PO Q6H:PRN Nausea/Vomiting - Second Line 6. Calcium Carbonate Dose is Unknown PO Frequency is Unknown Discharge Disposition: Home Discharge Diagnosis: # Fatigue secondary to recent chemotherapy and # stage IVB Ovarian Adenocarcinoma 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 priviliege to care for you at the ___ ___. You were admitted for weakness/fatigue. We performed several tests and the most likely cause of your symptoms is side effects from your recent chemotherapy. You were given IV fluids for dehydration and it is now safe to be discharged home. Please follow up with your appointment to see Dr. ___ week. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to ___ from ___ due to an infection in your prosthetic knee. You were started on antibiotics for your infection. You eventually had the liner replaced in your knee by Orthopedic surgeons. You improved on the antibiotics and were discharged home with physical therapy and home antibiotics. Your transplanted kidney was also not working properly on admission, though it improved throughout your stay. It was a pleasure taking care of you this admission! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. esomeprazole magnesium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 4. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO BID (2 times a day). 6. ranolazine 500 mg Tablet Extended Release 12 hr Sig: One (1) Tablet Extended Release 12 hr PO BID (2 times a day). 7. valsartan 160 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO twice a day. 9. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) PO once a day as needed for constipation. Discharge Disposition: Home Discharge Diagnosis: Mitochondrial Myopathy Coronary Artery Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital because you were having chest pain. We monitored your heart enzymes and EKGs which were normal. We notified your cardiologist who suggested that you have a stress test which was completed and normal. Your pain likely occurred because you were dehydrated. After IV fluid you felt better and were discharged home. No changes were made to your medications. Please be sure to take them as directed</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN fever/pain 2. Albuterol Inhaler ___ PUFF IH Q4H:PRN wheezing 3. Bisacodyl 10 mg PO/PR DAILY 4. Docusate Sodium 100 mg PO BID 5. Heparin 5000 UNIT SC TID 6. HydrALAzine ___ mg IV Q6H:PRN SBP>160 7. HYDROmorphone (Dilaudid) ___ mg PO Q8H:PRN headache 8. LeVETiracetam 500 mg PO BID 9. Methadone 40 mg PO DAILY 10. Nicotine Patch 14 mg TD DAILY 11. Senna 1 TAB PO BID 12. Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Subdural hematoma Methadone for withdrawal Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance. Followup Instructions: ___ [/INST] </s><s>Craniotomy for Hemorrhage •Have a friend/family member check your incision daily for signs of infection. •Take your pain medicine as prescribed. •Exercise should be limited to walking; no lifting, straining, or excessive bending. •Your wound was closed with staples. You may wash your hair only after staples have been removed. •You may shower before this time using a shower cap to cover your head. •Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. •If you were on a medication such as Coumadin (Warfarin), or Plavix (clopidogrel), or Aspirin, prior to your injury, you may safely resume taking this on follow up. •You have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. •Clearance to drive and return to work will be addressed at your post-operative office visit. •Make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING •New onset of tremors or seizures. •Any confusion or change in mental status. •Any numbness, tingling, weakness in your extremities. •Pain or headache that is continually increasing, or not relieved by pain medication. •Any signs of infection at the wound site: redness, swelling, tenderness, or drainage. •Fever greater than or equal to 101.5° F.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Calcium Carbonate 500 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Ferrous Sulfate 325 mg PO BID 5. meloxicam 15 mg oral DAILY 6. Pantoprazole 40 mg PO Q24H 7. Phenytoin Sodium Extended 200 mg PO BID 8. Senna 8.6 mg PO BID:PRN constipation 9. Simvastatin 20 mg PO DAILY 10. Tizanidine 8 mg PO BID 11. Zonisamide 500 mg PO DAILY 12. Acetaminophen 650 mg PO Q4H:PRN pain, HA, fever 13. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO QID:PRN upset stomach 14. Lorazepam 1 mg PO DAILY:PRN seizure 15. Guaifenesin ER 600 mg PO Q12H:PRN cough 16. Oxcarbazepine 600 mg PO QAM RX *oxcarbazepine 300 mg As directed tablet(s) by mouth 2 tabs (600 mg) every morning and 3 tab (900 mg) every evening Disp #*150 Tablet Refills:*11 17. Oxcarbazepine 900 mg PO QPM 18. Amoxicillin ___ mg PO PRN dental procedure Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: epilepsy 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 Mr. ___, You came to the hospital with breakthrough seizures. We monitored you on EEG and made medication adjustments. Your keppra has been stopped and you are taking a new medication called oxcarbazepine. You will continue to take your previous medications dilantin and zonisamide as well. Please follow up in neurology clinic. Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You were evaluated at ___ for your increase in seizure frequency which is in the setting of antibiotic treatment. It is possible that your use of a cephalosporin antibiotic, Rocephin(ceftriaxone), which was administered intramuscularly may have transiently decreased your seizure threshold resulting in your breakthrough seizures. We recommended no changes to your anti-epileptic regimen; you were given an additional dose of medication to increase your blood level of the Phenytoin to theraputic.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 50 mg PO DAILY 2. Carbidopa-Levodopa (___) 2 TAB PO TID 3. Docusate Sodium 100 mg PO BID 4. Lactulose 15 mL PO BID 5. Omeprazole 40 mg PO DAILY 6. Paroxetine 20 mg PO DAILY 7. Simvastatin 40 mg PO QHS 8. Azithromycin 250 mg PO Q24H Duration: 4 Doses Please take until ___ RX *azithromycin 250 mg 1 tablet(s) by mouth daily Disp #*4 Tablet Refills:*0 9. Space Chamber Plus (inhalational spacing device) 1 miscellaneous Q6H:PRN Please use with albuterol MDI as needed RX *inhalational spacing device Please use spacer with inhaler every 6 hours Disp #*1 Inhaler Refills:*0 10. Albuterol Inhaler ___ PUFF IH Q6H:PRN shortness of breath Duration: 1 Dose Please dispense ___ MDI. Please use as needed for shortness of breath/wheezing RX *albuterol ___ puff IH every 6 hours Disp #*1 Inhaler Refills:*0 11. Wheelchair ICD9 Code: 332.0 ___ Disease Sig: Please dispense 1 wheelchair for patient. Duration: Lifetime. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: 1. Viral Upper Respiratory Illness SECONDARY DIAGNOSES: 1. ___ Disease 2. Alzheimer's Disease Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your hospital stay at ___. You were admitted to the hospital after having a cough at home, and you underwent chest imaging which did not show a pneumonia. We were concerned that you likely have a viral upper respiratory illness, and started azithromycin to help with inflammation and infection. Please continue to take this medication as prescribed. We were also concerned about your ability to swallow and your risk of aspiration in the future. Please follow up with your primary care physician and discuss this risk in the future. Please continue to take your other home medications as prescribed. Script for wheelchair provided, and this can be obtained at any medical supply store. Take Care, 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 2. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN sob 3. Allopurinol ___ mg PO TID 4. Amlodipine 5 mg PO DAILY 5. Bumetanide 1 mg PO DAILY 6. BuPROPion 75 mg PO BID 7. Docusate Sodium 100 mg PO BID 8. Fluticasone Propionate NASAL 1 SPRY NU DAILY 9. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 10. FoLIC Acid 1 mg PO DAILY 11. Gabapentin 300 mg PO BID 12. Levothyroxine Sodium 25 mcg PO DAILY 13. Multivitamins 1 TAB PO DAILY 14. Omeprazole 40 mg PO BID 15. Lactulose 15 mL PO Q8H:PRN constipation 16. OxycoDONE (Immediate Release) ___ mg PO Q6H:PRN pain 17. Senna 3 TAB PO HS 18. Simethicone 40-80 mg PO QID:PRN gas, indigestion 19. Metoprolol Succinate XL 50 mg PO DAILY 20. Erythromycin 0.5% Ophth Oint 0.5 in RIGHT EYE QID Duration: 7 Days 21. Vitamin D 50,000 UNIT PO QMONTH ___ 22. Ramipril 1.25 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Obstructive Sleep Apnea Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, Thank you for choosing us for your care. You were admitted to the ICU for respiratory distress which resolved without intervention. We monitored your breathing overnight and you did not have any problems breathing. You also reported nausea which we treated with medication. We have prescribed your erythromycin eye drops for eye irritation. We are setting you up for followup with outpatient pulmonology and sleep medicine.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Escitalopram Oxalate 10 mg PO DAILY 3. Atenolol 25 mg PO DAILY 4. Diovan HCT (valsartan-hydrochlorothiazide) 320-25 mg oral DAILY 5. Evista (raloxifene) 60 mg oral DAILY 6. Verapamil 120 mg PO Q12H 7. Ciprofloxacin HCl 500 mg PO Q12H Duration: 5 Days RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth twice a day Disp #*8 Tablet Refills:*0 8. Outpatient Lab Work please draw labs for cbc, ast, alt, alp, total bilirubin, pt, ptt, BUN and creatinin, sodium, potassium, chloride and bicarbonate Fax to: Attn: ___, MD Phone: ___ Fax: ___ Dx: Cirrhosis Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: 1. Obstructive jaundice SECONDARY DIAGNOSIS: 1. Alcoholic/NASH cirrhosis 2. Internal hemorrhoids 3. Acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___. Why was I here? You were admitted to the hospital for jaundice (yellow skin and eyes)due to a mass in your pancreas causing obstruction of bile outflow from the liver. What was done while I was here? - You underwent ERCP (endoscopic retrograde cholangiopancreatography), a procedure in which a camera (endoscope) is inserted in your esophagus and passed down your digestive tract to place a stent to restore bile duct flow. - You were started on oral antibiotics (Ciprofloxacin) to prevent infection. - You had an imaging study which showed a mass in the pancreas enlarged since ___. - You had an ultrasound and fine needle biopsy of the pancreatic mass on ___. - You had bloody stools, so underwent a flexible sigmoidoscopy (camera study of the left half of your colon) which showed internal hemorrhoids. You received intravenous fluids and blood transfusion with improvement in your blood pressure. What should I do when I get home? - Please continue taking all medications as prescribed. - Please get labs done at your primary doctor's office and fax to Dr. ___ liver doctor. - Please ___ with your PCP and specialists as an outpatient. We wish you a speedy recovery, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH ___ wheeze, SOB 2. Amitriptyline 75 mg PO QHS 3. Citalopram 40 mg PO QAM 4. Gabapentin 600 mg PO BID 5. Gabapentin 1600 mg PO QHS 6. Ibuprofen 600 mg PO Q8H:PRN hip pain, migraine 7. Acetaminophen 650 mg PO Q6H:PRN pain 8. Cyanocobalamin 100 mcg PO DAILY RX *cyanocobalamin (vitamin ___ 100 mcg 1 tab by mouth once a day Disp #*30 Tablet Refills:*0 9. Multivitamins 1 TAB PO DAILY 10. Vitamin D 800 UNIT PO DAILY 11. ALPRAZolam 0.5 mg PO QD:PRN anxiety No more than 10 pills per month. 12. ___ mg oral TID:PRN migraine No more than 15 pills per month. 6 per day. 13. Lactaid (lactase) 3,000 unit oral QID:PRN dairy 14. Miconazole 2% Cream 1 Appl TP BID To the irritated areas under your breasts and stomach. RX *miconazole nitrate 2 % 1 finger tip amount twice a day Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: - Borderline hypoglycemia post gastric bypass - Morbid obesity - Candidal dermatitis Secondary: - Depression - Anxiety - Chronic pain - Migraine headaches Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mrs. ___, ___ was our pleasure caring for you at ___ ___. You were admitted with concerns for low blood sugar. Your blood sugars were within normal limits while you were in the hospital. It is possible that changes in your body since your gastric bypass are causing some of your symptoms. You need to follow up with bariatric surgery along with a nutritionist and your primary care physician to create ___ lifestyle plan that will work for you. Your second urine sample returned clear without signs of infection and you do not need antibiotics. If you feel lightheaded or shaky, please eat something with sugar immediately or drink orange juice or cola. Take your blood sugar by finger prick, if less than 70 then consume juice or cola and let your regular outpatient doctor know. ___ wishes, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LORazepam 0.5 mg PO Q6H:PRN nausea, anxiety Duration: 3 Days Do not drive or operate heavy machinery while taking this medication RX *lorazepam [Ativan] 0.5 mg 0.5 (One half) mg by mouth every six (6) hours Disp #*10 Tablet Refills:*0 2. Ondansetron 4 mg PO Q8H:PRN nausea Duration: 5 Days RX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*30 Tablet Refills:*2 3. Omeprazole 40 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY ======= Cyclic vomiting syndrome Acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, It was a pleasure taking care of you at ___ ___. You were in the hospital because you were having nausea and vomiting at home. We think this was due to a condition called Cyclic Vomiting Syndrome. We gave you medicines for nausea and IV fluids. When you leave the hospital, we will give you medicines to help control your nausea. It will be important for you to establish care with your primary care doctor. If you have any further nausea/vomiting and are not able to tolerate food or drink by mouth, you should call your doctor or return to the Emergency Department. Best wishes, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluoxetine 20 mg PO DAILY 2. Magnesium Oxide 400 mg PO DAILY 3. Indomethacin 25 mg PO TID Duration: 2 Weeks RX *indomethacin 25 mg 3 capsule(s) by mouth Every 8 hours Disp #*36 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Costochondritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital for chest pain and shortness of breath. We investigated the cause with a cardiac MRI, and echocardiogram and a cardiac catheterization. None of these showed any active inflammation around your heart (pericarditis) or any other potential heart causes for your chest pain, which was reassuring. We believe that your current pain is likely coming from your chest wall and may be related to an injury. You were started on an anti-inflammatory medicine (indomethacin) with improvement in your symptoms. Please follow up with your doctor. The details of your follow up appointments are given below. It was a pleasure taking care of you. Sincerely, Your ___ Cardiology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CefTRIAXone 2 gm IV Q24H RX *ceftriaxone ___ dextrose,iso-os 2 gram/50 mL 2 g IV q24hours Disp #*19 Intravenous Bag Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth Twice daily Disp #*20 Tablet Refills:*0 3. Ibuprofen 600 mg PO Q6H:PRN Pain - Mild NOT relieved by Acetaminophen RX *ibuprofen 600 mg 1 tablet(s) by mouth Every 6 hours Disp #*30 Tablet Refills:*0 4. MetroNIDAZOLE 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth Three times a day Disp #*54 Tablet Refills:*0 RX *metronidazole 500 mg 1 tablet(s) by mouth Three times a day Disp #*57 Tablet Refills:*0 5. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth Every 6 hours Disp #*15 Tablet Refills:*0 6. Senna 8.6 mg PO BID:PRN Constipation - First Line RX *sennosides [senna] 8.6 mg 1 Tablet by mouth Twice daily Disp #*20 Tablet Refills:*0 7. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild/Fever RX *acetaminophen 500 mg ___ tablet(s) by mouth Every 6 hours Disp #*30 Tablet Refills:*0 8. Lisinopril 20 mg PO DAILY 9. MetFORMIN (Glucophage) 850 mg PO BID Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Left Foot Necrotizing Infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you at ___. You were admitted to the Podiatric Surgery service after your left foot surgery. You were given IV antibiotics while here and had a PICC line placed for easier long-term IV antibiotics. You are being discharged home with the following instructions: ACTIVITY: There are restrictions on activity. Please remain non weight bearing to your left foot until your follow up appointment. You should keep this site elevated when ever possible (above the level of the heart!) No driving until cleared by your Surgeon. PLEASE CALL US IMMEDIATELY FOR ANY OF THE FOLLOWING PROBLEMS: Redness ___ or drainage from your leg wound(s). New pain, numbness or discoloration of your foot or toes. Watch for signs and symptoms of infection. These are: a fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site. If you experience any of these or bleeding at the incision site, CALL THE DOCTOR. Exercise: Limit strenuous activity for 6 weeks. No heavy lifting greater than 20 pounds for the next ___ days. Try to keep leg elevated when able. BATHING/SHOWERING: You may shower immediately upon coming home, but you must keep your dressing CLEAN, DRY and INTACT. You can use a shower bag taped around your ankle/leg or hang your foot/leg outside of the bathtub. Avoid taking a tub bath, swimming, or soaking ___ a hot tub for 4 weeks after surgery or until cleared by your physician. MEDICATIONS: Unless told otherwise you should resume taking all of the medications you were taking before surgery. Remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods ___ your diet. (Check with your physician if you have fluid restrictions.) If you feel that you are constipated, do not strain at the toilet. You may use over the counter Metamucil or Milk of Magnesia. Appetite suppression may occur; this will improve with time. Eat small balanced meals throughout the day. DIET: There are no special restrictions on your diet postoperatively. Poor appetite is not unusual for several weeks and small, frequent meals may be preferred. FOLLOW-UP APPOINTMENT: Be sure to keep your medical appointments. If a follow up appointment was not made prior to your discharge, please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit. This should be scheduled on the calendar for seven to fourteen days after discharge. Normal office hours are ___ through ___. PLEASE FEEL FREE TO CALL THE OFFICE WITH ANY OTHER CONCERNS OR QUESTIONS THAT MIGHT ARISE. FOLLOW UP: Please follow up with your Podiatric Surgeon, Dr. ___. You will have follow up ___ the Podiatric Surgery Clinic ___ ___ days post-operation for evaluation. Call ___ to schedule appointment upon discharge if it is not listed below. Please follow up with your primary care doctor regarding this admission within ___ weeks and for and any new medications/refills.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you. You were admitted to ___ ___ for altered mental status and swelling in your legs. While you were here, you were treated with IV antibiotics for a leg infection called cellulitis. Your pessary was removed due to concern that this could be contributing to your infection. You were also treated with Lasix to improve the swelling in your legs. You were evaluated by physical therapy, and you will need 24-hour care as you recover from this hospitalization. It is very important that you attend all of your follow up appointments, listed below. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. 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. Ciprofloxacin HCl 250 mg PO Q12H END: ___ 2. Acetaminophen 650 mg PO Q6H 3. Alendronate Sodium 70 mg PO QTHUR 4. amLODIPine 2.5 mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. Calcium 500 With D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -400 unit oral DAILY 8. diclofenac sodium 1 % topical DAILY 9. Docusate Sodium 100 mg PO BID 10. DULoxetine 20 mg PO DAILY 11. Gabapentin 400 mg PO BID 12. Gabapentin 200 mg PO NOON 13. Lidocaine 5% Patch 1 PTCH TD QAM 14. Multivitamins 1 TAB PO DAILY 15. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 16. Polyethylene Glycol 17 g PO DAILY 17. Senna 17.2 mg PO BID 18. Sucralfate 1 gm PO BID 19. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: #Acute on chronic back pain #Lumbar radiculopathy #UTI #HTN Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted to ___ for back pain. WHILE YOU WERE HERE: - We did images which ruled out dangerous causes of your pain - Your pain improved WHEN YOU GO HOME: - Please take all medications as directed and follow-up with the below doctors ___ the best, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ALPRAZolam 0.5 mg PO QHS 2. Desmopressin Acetate 0.2 mg PO QHS 3. Donepezil 5 mg PO QHS 4. LORazepam 0.5 mg PO QAM 5. Metoprolol Succinate XL 25 mg PO DAILY 6. QUEtiapine Fumarate 100 mg PO BID 7. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Urinary tract infection Aspiration PNA Fall Advanced dementia Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert but non-verbal Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted after a fall with weakness and were found to have a urinary tract infection in addition to possible Aspiration Pneumonia. You have been treated with antibiotics for a 5day course and will need ongoing rehab at the skilled nursing facility. Best wishes from your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth every 12 hours Disp #*30 Capsule Refills:*0 3. Gabapentin 100 mg PO TID RX *gabapentin 100 mg 1 capsule(s) by mouth every 8 hours Disp #*84 Capsule Refills:*0 4. Senna 8.6 mg PO BID constipation 5. Sodium Chloride 1 gm PO DAILY RX *sodium chloride 1 gram 1 tablet(s) by mouth daily Disp #*14 Tablet Refills:*0 6. Tizanidine 2 mg PO TID RX *tizanidine 2 mg 1 capsule(s) by mouth every 8 hours Disp #*40 Capsule Refills:*0 7. Albuterol 0.083% Neb Soln 1 NEB IH DAILY 8. Atenolol 50 mg PO DAILY 9. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 10. Simvastatin 40 mg PO DAILY 11. Tiotropium Bromide 1 CAP IH DAILY 12. Warfarin 3 mg PO 4X/WEEK (MO,WE,TH,SA) 13. Warfarin 4 mg PO 3X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: C1/C2 fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Activity • We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. • You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. • No driving while taking any narcotic or sedating medication. • No contact sports until cleared by your neurosurgeon. Medications • You are cleared to resume your home blood thinning medication (Aspirin, Coumadin) by the neurosurgeon. • You may take Ibuprofen/ Motrin for pain. • You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. • It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: • Severe pain or swelling. • Fever greater than 101.5 degrees Fahrenheit • New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Glycerin Supps 1 SUPP PR PRN constipation RX *glycerin (adult) Adult 1 suppository(s) rectally Daily PRN Disp #*30 Suppository Refills:*0 2. Senna 8.6 mg PO BID Constipation - First Line RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 3. Simethicone 120 mg PO QID:PRN gas, distention RX *simethicone [Gas Relief] 125 mg 1 capsule by mouth QID PRN Disp #*30 Capsule Refills:*0 4. Allopurinol ___ mg PO DAILY RX *allopurinol ___ mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 6. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB 7. Atorvastatin 10 mg PO QPM 8. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 9. Calcitriol 0.25 mcg PO DAILY 10. Finasteride 5 mg PO DAILY 11. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 12. Lactulose 30 mL PO BID 13. Lidocaine 5% Patch 1 PTCH TD QPM 14. Linzess (linaclotide) 145 mcg oral DAILY 15. Omeprazole 40 mg PO DAILY 16. Polyethylene Glycol 17 g PO BID 17. sevelamer CARBONATE 800 mg PO TID W/MEALS 18. Sodium Bicarbonate 1300 mg PO BID 19. Tamsulosin 0.4 mg PO QHS 20. Torsemide 140 mg PO DAILY 21. Verapamil SR 180 mg PO Q24H Discharge Disposition: Home Discharge Diagnosis: PRIMARY: Flank Pain Constipation Polycystic Kidney Disease Chronic Kidney Disease Stage V SECONDARY: Benign Prostate Hyperterophy Chronic obstructive sleep disease Hyperlipidemia Gout Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you at the ___ ___. Why did you come to the hospital? - You were having left sided abdominal pain and constipation What did you receive in the hospital? - We did imaging of your kidneys and your abdomen, and it did not show an obstruction. - We think your abdominal pain is likely from your enlarged kidneys and constipation. You may also be having some muscle pain. - We think your nausea, vomiting, and constipation is from your bowels slowing down and not moving food through as well as it should What should you do once you leave the hospital? - We are working on scheduling an appointment with Dr. ___. Please call your PCP's office if you have not heard back by ___. - An appointment was scheduled with Dr. ___ to discuss your gastroparesis and chronic constipation on ___ at 1:30pm - New medications: Simethicone 120 mg PO/NG QID:PRN gas - Changed medications: Allopurinol to 100mg PO daily (given kidney function) 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: None Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: 1. Neurocardiogenic (vasovagal) syncope . Secondary Diagnoses: None Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Patient Discharge Instructions: . You were admitted to the Internal Medicine service at ___ ___ on CC7 regarding management of your syncope episode. You were evaluated by the Medicine team and had reassuring telemetry monitoring and reassuring EKG findings. Your cardiac biomarkers were negative (two-sets). You did have evidence of an elevated serum glucose and this should be rechecked as an outpatient. . Please call your doctor or go to the emergency department if: * You experience new chest pain, pressure, squeezing or tightness. * You develop new or worsening cough, shortness of breath, or wheezing. * You are vomiting and cannot keep down fluids, or your medications. * If 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 an unusual discharge. * You have pain that is not improving within 12 hours or is not under control within 24 hours. * Your pain worsens or changes location. * You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. * You develop any other concerning symptoms. . CHANGES IN YOUR MEDICATION RECONCILIATION: . * Upon admission, we ADDED: NONE . * This admission, we CHANGED: NONE . * The following medications were DISCONTINUED on admission and you should NOT resume: NONE . * You should continue all of your other home medications as prescribed, unless otherwise directed above.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 162 mg PO DAILY 2. Atenolol 50 mg PO BID 3. Levothyroxine Sodium 50 mcg PO DAILY 4. Losartan Potassium 100 mg PO DAILY 5. Omeprazole 40 mg PO DAILY 6. Vitamin D 1000 UNIT PO DAILY 7. LeVETiracetam 500 mg PO BID 8. Acetaminophen 325-650 mg PO Q6H:PRN fever, HA 9. Ferrex ___ (polysaccharide iron complex) 150 mg iron oral Q24H 10. LOPERamide 2 mg PO QID:PRN Loose BM 11. Zenpep (lipase-protease-amylase) ___ capsules oral TID W/MEALS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Seizures Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (___ or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted with three seizures. We think these seizures came from the area of old stroke in your brain. You were started on a medication called Keppra 500mg BID to prevent future seizures from happening. You were evaluated by physical therapy, and they felt that you needed rehabilitation. You will go to rehab at ___. It was a pleasure meeting you! Dr. ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 3. Aspirin 162 mg PO DAILY 4. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*100 Capsule Refills:*0 5. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth Every ___ hours Disp #*60 Tablet Refills:*0 6. Tamsulosin 0.4 mg PO HS 7. Simvastatin 40 mg PO DAILY 8. Lisinopril 2.5 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Acute Cholecystitis s/p Laparoscopic Cholecystectomy 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 acute cholecystitis. You were taken to the operating room and had your gallbladder removed laparoscopically. You tolerated the procedure well and are now being discharged home to continue your recovery with the following instructions. During your stay, you received lasix for fluid overload, as you had edema in your extremities and groin. Please f/u with your PCP for further diuretic management. Your platelets were trending down so we got a HIT panel which is still pending. Your blood cultures grew Ecoli at admission so we started you on Unasyn while you were here. You are being discharged on Augmentin for 7days. Please follow up in the Acute Care Surgery clinic. You need to call ___ 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. allopurinol ___ mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. enalapril maleate 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) 80mg Subcutaneous Q12H (every 12 hours). 4. insulin asp prt-insulin aspart 100 unit/mL (70-30) Solution Sig: One (1) 50 units Subcutaneous twice a day. 5. FIRST-Mouthwash BLM 200-25-400-40 mg/30 mL Mouthwash Sig: One (1) teaspoon Mucous membrane four times a day as needed for mouth pain: swish and spit. 6. metoclopramide 10 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for nausea. 7. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 8. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1) Tablet PO DAYS (___). 9. pravastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 10. tacrolimus 1 mg Capsule Sig: Three (3) Capsule PO Q12H (every 12 hours). 11. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 12. Biotene Oralbalance Liquid Sig: One (1) Mucous membrane four times a day. Discharge Disposition: Home Discharge Diagnosis: atypical chest pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, you were admitted to the hospital because you had shortness of breath and chest pressure. You also had some night sweats. You had a workup in the hospital, which showed that you did not have a heart attack. You also had no signs of pneumonia or other infections. You were briefly treated with antibiotics, which were not continued on discharge. You had a scan of your lungs, which showed no significant blood clot. We have not made any changes to your medications. Please continue to take them as previously prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Bisacodyl 10 mg PO DAILY:PRN constipation 3. Calcium Carbonate 500 mg PO DAILY 4. Ferrous Sulfate 325 mg PO DAILY 5. Fluvoxamine Maleate 50 mg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. Senna 8.6 mg PO DAILY 8. TraZODone 25 mg PO HS 9. Cyanocobalamin 1000 mcg IM/SC MONTHLY 10. Milk of Magnesia 30 mL PO Q6H:PRN constipation 11. Mylanta 1 unknown ORAL QD 12. Vitamin D 50,000 UNIT PO 1X/WEEK (___) 13. Outpatient Lab Work ___ CBC to assess for stability of anemia and digoxin level to assess for toxicity 14. Digoxin 0.125 mg PO DAILY 15. Aspirin 325 mg PO DAILY 16. Metoprolol Tartrate 25 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY Anemia Atrial fibrillation with rapid ventricular response Hypotension SECONDARY Schizophrenia Dementia 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 to take care of you during this hospitalization. You were admitted to ___ ___ for low blood count (anemia) and fast heart rate. Your blood count was monitored and stable when we discharged you. It is likely that multiple factors are contributing to your anemia and you should follow up with GI and hematology oncology as an outpatient. For your atrial fibrillation with a rapid heart rate, we restarted you on 2 medications (metoprolol and digoxin) to help control/decrease your heart rate. You will need to follow up with your regular doctor. You are now safe to leave the hospital. Please follow-up with your doctors and take ___ your medications as prescribed.</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. LevETIRAcetam 1000 mg PO Q12H RX *levetiracetam [Keppra] 1,000 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*60 Tablet Refills:*0 3. Anastrozole 1 mg PO DAILY 4. Levothyroxine Sodium 100 mcg PO DAILY 5. HELD- Lisinopril 5 mg PO DAILY This medication was held. Do not restart Lisinopril until you follow up with your PCP and have your blood pressure monitored. Discharge Disposition: Home Discharge Diagnosis: Recurrent Focal Seizures Post-Obstructive Pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - You were admitted for three episodes of uncontrolled left hand movements that were concerning for seizures. WHAT HAPPENED TO ME IN THE HOSPITAL? - Your anti-epileptic drugs were changed and you were started on Keppra. - Your pneumonia treatment was continued with antibiotics. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Please take all of your medications as prescribed and go to all of your follow up appointments as listed below. - Please call Dr. ___ office to schedule a follow up appointment. Thank you for allowing us to take part in your care. 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. Albuterol Inhaler 2 PUFF IH Q6H:PRN Wheeze/Cough 2. Diazepam 5 mg PO Q12H:PRN Anxiety 3. Hydrochlorothiazide 25 mg PO DAILY 4. Losartan Potassium 100 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Simvastatin 40 mg PO QPM 7. Acetaminophen 650 mg PO Q6H:PRN Pain 8. Amoxicillin-Clavulanic Acid ___ mg PO Q12H 9. Bisacodyl 10 mg PO/PR DAILY constipation 10. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN Pain 11. Polyethylene Glycol 17 g PO DAILY 12. Docusate Sodium 100 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Perirectal abscess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You returned to the hospital perianal discomfort and inability to void after undergoing a recent incision and drainage of a perirectal abscess. You were given Augmentin and have not had any fevers for the last 24 hours. Your white blood cell count is also decreasing to normal. During this admission, you underwent exam under anesthesia, abscess drainage, and ___ placement. You have recovered from this procedure well and you are now ready to return home. You have tolerated a regular diet and your pain is controlled with pain medications by mouth. You may return home to finish your recovery. You will need to take your oral antibiotics for 12 more days after returning home, stopping them after ___. You have small incisions next to your anus, with a drain and two setons. Your incision is healing well however it is important that you monitor the area for signs and symptoms of infection including: increasing redness of the incision line, white/green/yellow/malodorous drainage, increased pain at the incision, increased warmth of the skin at the incision, or swelling of the area. Please call the office if you develop any of these symptoms or a fever. You may go to the emergency room if your symptoms are severe. You may shower; pat the incisions dry with a towel, do not rub. The small incision may be left open to the air. You have recently been prescribed narcotic pain medication oxycodone. This medication should be taken when you have pain and as needed as written on the bottle. This is not a standing medication. You should continue to take Tylenol for pain around the clock and you can also take Advil. Please do not take more than 4000mg of Tylenol in 24 hours. Do not drink alcohol while taking narcotic pain medication or Tylenol. Please do not drive a car while taking narcotic pain medication. Thank you for allowing us to participate in your care! Our hope is that you will have a quick return to your life and usual activities</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, It was a pleasure to care for you at ___. You were admitted for shortness of breath, fever and chest pain and found to have fluid in your lungs (a pleural effusion) and signs of pneumonia. You were treated with antibiotics and this improved. Please follow-up with your outpatient primary care physicians to ensure that this resolves. Best wishes, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) syringe Subcutaneous Q12H (every 12 hours). Disp:*60 syringe* Refills:*2* 2. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia. 4. Zofran 4 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for nausea. 5. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours) as needed for pain. 7. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) Powder in Packet PO DAILY (Daily) as needed for constipation. Disp:*30 Powder in Packet(s)* Refills:*0* 10. ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). 11. methadone 40 mg Tablet, Soluble Sig: One (1) Tablet, Soluble PO TID (3 times a day): Do not drive or drink alcohol while taking this medication. . Disp:*90 Tablet, Soluble(s)* Refills:*0* 12. gabapentin 300 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*0* 13. tizanidine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): Do not drive or drink alcohol while taking this medication. . Disp:*60 Tablet(s)* Refills:*0* 14. dexamethasone 4 mg Tablet Sig: One (1) Tablet PO QAM (once a day (in the morning)): please refer to your oncologist for dosing of this medication. Disp:*30 Tablet(s)* Refills:*0* 15. hydromorphone 4 mg Tablet Sig: ___ Tablets PO Q3H (every 3 hours) as needed for breakthrough pain: Do not drive or drink alcohol while taking this medication. . Disp:*30 Tablet(s)* Refills:*0* 16. bupivacaine (PF) 0.25 % (2.5 mg/mL) Solution Sig: ___ mL Injection continuous: Infuse via peripheral nerve catheter continuous infusion x10d. Continuous infusion at ___ ml/hr; titrate to pain control. Please mix 2.5mg/ml in 500ml cartridge . Disp:*4 cartridges* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Left humerus pathological fracture Secondary: ___ Bilateral DVTs 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 ___. You were admitted because of increasing left shoulder/arm pain and were found to have a non-displaced fracture of your left humerus. You were given 5 treatments of palliative radiation to the site as well as conservative management with a sling and pain control. You were also found to have new clots in the veins of you legs bilaterally. You were started on a therapeutic dose of Lovenox (Enoxaparin) to treat these. We used a number of different modalities to attempt to effectively treat your pain. Ultimately, we came to the conclusion that the best treatment for your pain would be to do a regional nerve blockade to the affected area. Please make the following changes to your medications: START Enoxaparin Sodium 80 mg, subcutaneous injection twice a day START Miralax one packet every day, as needed, for constipation CHANGE gabapentin to 300mg twice per day CHANGE dilaudid to ___, by mouth, every three hours, as needed for pain CHANGE dexamethasone from 2mg to 4mg every morning CHANGE methadone to 40mg three times per day START tizanidine 2mg twice per day Please take the rest of your home medications as previously prescribed. Below are some important information regarding your infusion pump: You or the infusion company should not change the dressing on your pump. Nobody should change the dressing on your pump. If you have any numbness around the eyes, ringing of the ears, palpitations, or seizures, this may be toxicity from the medication in the pump. You should go to the closest emergency department. If you have any fevers, chills, swelling, redness or significant pain around the insertion site of the pump, you should call your doctor or have it evaluated at the closest emergency department. You will be re-admitted to the hospital (___ on ___. You should arrive to ___ approximately at 9am. Ideally, the pump will be shut off before you leave your home that morning. You should STOP taking your LOVENOX on the morning of ___. If you have any problems or questions with the pump, you should call your infusion company, or you should call the Anesthesia nurse ___ (cell ___. If you are having pain, you should notify your infusion company, and they will contact ___ for a prescription to go up on the pump's parameters. You should continue to take your lovenox twice per day. Know that lovenox leads to thinner blood, and you are at increased risk for bleeding. You had a small amount of bleeding from your hemorrhoids this hospital stay. If you have increased bleeding, or are feeling unwell such as lightheaded, chest pain, or dizzy, you should be evaluated by your local emergency department.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Prenatal Vitamins 1 TAB PO DAILY Discharge Disposition: Home Discharge Diagnosis: pregnancy at 31w6d flank pain Discharge Condition: stable Followup Instructions: ___ [/INST] </s><s>You were admitted to the antepartum service for observation due to flank pain, concerning for a possible kidney stone. Your pain improved and it was felt it was safe for you to be discharged home. Fetal testing was reassuring while you were here. You have no activity restrictions at home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO QPM 2. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES BID 3. Fenofibrate 160 mg PO QHS 4. Fish Oil (Omega 3) 1000 mg PO BID 5. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 6. Metoprolol Succinate XL 200 mg PO DAILY 7. Vitamin D ___ UNIT PO DAILY 8. Lisinopril 10 mg PO DAILY 9. NPH 10 Units Breakfast NPH 20 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 10. PredniSONE 4 mg PO DAILY RX *prednisone 1 mg 4 tablet(s) by mouth daily Disp #*120 Tablet Refills:*0 11. Sirolimus 1.5 mg PO DAILY RX *sirolimus 0.5 mg 3 tablets by mouth once daily Disp #*90 Tablet Refills:*0 12. Amlodipine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 13. Outpatient Lab Work Please draw on ___. Chem10 and serum Osms ICD10 B97.89 and ___ Fax results to ___ Attn Dr. ___ ___ Disposition: Home Discharge Diagnosis: Primary Diagnosis: Acute kidney injury - BK nephropathy Hyponatremia Secondary Diagnosis: Diabetes mellitus, insulin dependent 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 the ___ ___. You were recently admitted for worsening kidney function. You were evaluated with laboratory testing and a kidney biopsy which showed BK virus nephropathy. You were treated with IVIG and we decreased your immunosuppression and your kidney function improved. You developed low sodium levels which are improving with fluid restriction. You should get repeat labwork on ___ and continue your 1.5L fluid restriction.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. biotin unknown oral DAILY 2. Calcium Carbonate 1000 mg PO DAILY 3. Glucosamine (glucosamine sulfate) unknown oral DAILY 4. Potassium Iodide unknown PO ASDIR 5. Vitamin B Complex 1 CAP PO DAILY 6. Vitamin D UNKNOWN PO DAILY 7. Vitamin E UNKNOWN PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: vasovagal syncope Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ to determine why you lost consciousness at dinner on ___. Based on testing that you received here, we think that you fainted due to a phenomenon called vasovagal syncope. We know that you have had previous episodes of vasovagal syncope. Here are some ways that you can prevent loss of consciousness/passing out in the future when you start to feel lightheaded: +Leg-crossing - cross one leg over the other and squeeze the muscles in your legs, abdomen and buttocks. Hold this position as long as you can or until your symptoms disappear. +Arm-tensing - grip one hand with the other and pull them against each other without letting go. Hold this grip as long as you can or until your symptoms disappear. +Water ingestion - drink water when you feel as though you are going to faint. It is also possible that you fainted due to an issue with your heart, although we think that this is less likely given that your stress test and echo were normal when you were hospitalized at Mount ___ in ___. However, we still think that it would be beneficial to do some additional testing as an outpatient (another stress test and potentially a 24-hour cardiac monitor). We have scheduled a follow up appointment. Please see below. 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 Q8H:PRN pain 2. Magnesium Oxide 400 mg PO BID 3. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 4. Simethicone 40-80 mg PO QID:PRN gas 5. Spironolactone 12.5 mg PO DAILY 6. Thiamine 100 mg PO DAILY 7. FoLIC Acid 1 mg PO DAILY 8. Ibuprofen 400 mg PO Q8H:PRN pain 9. Multivitamins 1 TAB PO DAILY 10. Vitamin D ___ UNIT PO DAILY 11. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: - Alcoholic induced pancreatitis - Alcohol withdrawal - Accelerated hypertension Secondary: - Long QT syndrome c/b TdP/VT cardiac arrest; s/p single lead ICD (Biotonik Ilesto VR-T) ___ - Alcohol abuse - Discoid lupus - GERD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please take all of you medications as prescribed, keep your follow-up appointments, and abstain from all drug and alcohol use.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Metoprolol Succinate XL 50 mg PO BID 2. ___ MD to order daily dose IV HD PROTOCOL 3. Glargine 7 Units Breakfast Insulin SC Sliding Scale using REG Insulin 4. Warfarin 5 mg PO DAILY16 5. Atorvastatin 40 mg PO QPM 6. melatonin 3 mg oral QHS 7. Mirtazapine 15 mg PO QHS 8. Nephrocaps 1 CAP PO DAILY 9. Pantoprazole 40 mg PO Q12H 10. Sertraline 25 mg PO DAILY 11. sevelamer CARBONATE 800 mg PO TID W/MEALS 12. Sucralfate 1 gm PO QID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Multifocal Pneumonia MRSA Bacteremia Dysphagia Atrial Fibrillation History of multiple DVTs Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>You were admitted with DKA in the setting of a pneumonia as well as blood infection. You were admitted to the ICU initially. You were treated with antibiotics you will need to continue vancomycin for 6 weeks. You also had a feeding tube placed that you will use for your nutrition.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Azithromycin 250 mg PO DAILY Duration: 4 Doses 2. Cefpodoxime Proxetil 400 mg PO Q24H Duration: 3 Days 3. Docusate Sodium 100 mg PO BID 4. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 5. Carvedilol 6.25 mg PO BID 6. Finasteride 5 mg PO DAILY 7. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 8. Losartan Potassium 12.5 mg PO DAILY 9. Simvastatin 40 mg PO QPM 10. Timolol Maleate 0.5% 1 DROP BOTH EYES BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Community Acquired Pneumonia Discharge Condition: Mental Status: Alert and oriented to name, not to place or time. Able to follow directions, but is very hard of hearing. Ambulatory Status: Limited. Able to sit up in chair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking part in your care here at ___! Why was I admitted to the hospital? You were admitted because we suspected you might have pneumonia given your recent cough and fever. What was done for me while I was in the hospital? You received antibiotics and medications that can help you breathe easier. What should I do when I leave the hospital? Follow-up with your primary care doctor within the next week to ensure your breathing has improved. Continue taking your antibiotics. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Divalproex (DELayed Release) 1000 mg PO DAILY 2. Divalproex (DELayed Release) 500 mg PO QPM 3. Lisinopril 40 mg PO DAILY 4. Aspirin EC 325 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 5. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 6. melatonin *NF* 5 mg Oral QHS:PRN insomnia 7. Simvastatin 20 mg PO DAILY RX *simvastatin 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 8. Tiotropium Bromide 1 CAP IH DAILY 9. Chlorthalidone 25 mg PO DAILY 10. Quetiapine Fumarate ___ mg PO QHS:PRN insomnia 11. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 12. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheeze Discharge Disposition: Home Discharge Diagnosis: Left cerebellar stroke. Left vertebral artery occlusion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted with a cerbellar stroke. You were started on a new medication to prevent new strokes. These are Apirin 81 mg daily and Plavix (Clopidogrel) 75mg daily. You should follow up with your primary care provider to schedule an echo of your heart.</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 Reason for PRN duplicate override: Alternating agents for similar severity Discharge Disposition: Home Discharge Diagnosis: fevers that resolved Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for fevers. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Weight bearing as tolerated MEDICATIONS: 1) Take Tylenol ___ every 6 hours as needed for your pain.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. cabergoline 1 mg oral 2X/WEEK 2. Enoxaparin Sodium 60 mg SC Q12H Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 60 mg/0.6 mL 60 mg SC every twelve (12) hours Disp #*10 Syringe Refills:*0 3. Fluticasone Propionate NASAL 2 SPRY NU DAILY 4. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 5. Ledipasvir/Sofosbuvir 1 TAB PO DAILY 6. OxyCODONE SR (OxyconTIN) 20 mg PO Q8H 7. Pregabalin 150 mg PO TID 8. Warfarin 5 mg PO DAILY16 RX *warfarin [Coumadin] 5 mg 1 tablet(s) by mouth daily Disp #*14 Tablet Refills:*0 9. Famotidine 20 mg PO Q12H RX *famotidine [Acid Controller] 20 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*30 Tablet Refills:*0 10. 1 mg Other 2X/WEEK 11. Furosemide 20 mg PO DAILY:PRN leg swelling 12. melatonin 3 mg oral QHS 13. oxyCODONE-acetaminophen 7.5-500 mg ORAL TID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Abdominal pain SECONDARY DIAGNOSIS: Recent Gallstone Pancreatitis Recent pulmonary embolism Hepatitis C Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you at ___ ___. You came back to the hospital because you had worsening abdominal pain and nausea. You had an endoscopic ultrasound that found no cause of your abdominal pain. They took biopsies during that procedure that are still pending. We found no abnormalities causing your abdominal pain. You were able to eat a regular diet and were discharged home safely. You should follow up with the surgeons on ___ to have your gallbladder removed. We are starting you back on your coumadin with lovenox injections until your coumadin is therapeutic. Please talk to your primary care doctor to determine when you can stop the lovenox. You should have your next INR drawn on ___. Please follow up at the appointments below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. cilostazol *NF* 100 mg ORAL BID 3. Clopidogrel 75 mg PO DAILY 4. Furosemide 20 mg PO DAILY 5. Labetalol 400 mg PO BID 6. Losartan Potassium 100 mg PO DAILY 7. Pantoprazole 40 mg PO Q24H 8. Sertraline 50 mg PO DAILY 9. Simvastatin 40 mg PO DAILY 10. Glycopyrrolate 2 mg PO TID:PRN gas bloating Discharge Disposition: Home Discharge Diagnosis: Atypical chest pain 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 for chest pain. Your labwork showed you did not have a heart attack. You had a nuclear stress test that showed no concerning signs. Please follow-up with your cardiologist in the next 2 weeks. Please also find a new primary care doctor to discuss your symptoms.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. CeFAZolin 2 g IV Q8H 3. Docusate Sodium 100 mg PO BID 4. Vancomycin 1000 mg IV Q 8H LLE cellulitis 5. Rivaroxaban 10 mg PO BID Duration: 12 Days Discharge Disposition: Extended Care Discharge Diagnosis: ___ cellulitis 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 TO ___ Physical Therapy: NWB in ___ Treatments Frequency: Continued care for infection</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Linezolid ___ mg PO Q12H RX *linezolid ___ mg 1 tablet(s) by mouth twice a day Disp #*42 Tablet Refills:*0 2. Chlorthalidone 25 mg PO DAILY 3. Cyanocobalamin 2500 mcg PO DAILY 4. Levothyroxine Sodium 75 mcg PO DAILY 5. Potassium Chloride 20 mEq PO DAILY 6. Pravastatin 40 mg PO QPM 7.Outpatient Lab Work Please check CBC with differential, CHM:Na, BUN, Creatinine, AST, ALT, TB, ALK PHOS, CRP on ___, and ___. Fax results to: ___ CLINIC - FAX: ___ AND ___ ___ - FAX: ___ ICD-10 code: ___ Discharge Disposition: Home Discharge Diagnosis: Primary Diagnoses: Right Thigh Hematoma/Abscess, Coagulopathy- Unspecified Secondary Diagnoses: Myelodysplastic Syndrome, Hypertension, Hypothyroidism 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 ___. WHY WERE YOU ___ THE HOSPITAL? ============================== - You had fevers due to a collection of blood (hematoma) ___ your right leg that was infected. WHAT WAS DONE WHILE YOU WERE ___ THE HOSPITAL? ============================================== - You had the infected fluid drained and a drain was placed ___ your right thigh. - You were given antibiotics. - An IV catheter was placed ___ your right arm, which caused a lot of bleeding. It was eventually removed. - A number of studies were done to determine why you had the bleeding ___ your thigh and from the IV. WHAT YOU NEED TO DO WHEN YOU GO HOME? ====================================== - Please continue to take all of your medicines as prescribed. - Follow up with the Infectious Disease doctors ___ ___ to determine how long to continue antibiotic therapy. - Follow up with the Hematology doctors ___ ___ to complete the evaluation of your bleeding disorder. It was a pleasure taking care of you! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H RX *acetaminophen [Pain Reliever] 500 mg 2 tablet(s) by mouth every 8 hours as needed Disp #*100 Tablet Refills:*1 2. Diazepam 5 mg PO BID:PRN pain Discontinue when no longer needed. Don't take before or while driving or operating machinery. RX *diazepam 2 mg 1 by mouth two times daily as needed for spasms Disp #*14 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 2 capsule(s) by mouth two times daily Disp #*60 Capsule Refills:*1 4. Gabapentin 100 mg PO Q8H Discontinue when no longer needed for pain control. RX *gabapentin 100 mg 1 capsule(s) by mouth every 8 hours Disp #*60 Capsule Refills:*1 5. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity Take for moderate to severe pain. Don't take before driving or operating machinery. RX *oxycodone 5 mg 1 tablet(s) by mouth every 6 hours as needed Disp #*30 Tablet Refills:*0 6. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 by mouth twice daily Disp #*30 Tablet Refills:*1 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Cervical myelopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory with walker assistance. Followup Instructions: ___ [/INST] </s><s>Surgery •Your dressing may come off on the second day after surgery. •Your incision is closed with dissolvable sutures underneath the skin and steri strips. You do not need suture removal. Do not remove your steri strips, let them fall off. •Please keep your incision dry for 72 hours after surgery. •Please avoid swimming for two weeks. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •No contact sports until cleared by your neurosurgeon. •Do NOT smoke. Smoking can affect your healing and fusion. Medications •***Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •Do not take any anti-inflammatory medications such as Motrin, Advil, Aspirin, and Ibuprofen etc… for 2 weeks. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. •It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO TID 2. Apixaban 5 mg PO BID RX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Aspirin 81 mg PO DAILY 4. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation - First Line 5. Docusate Sodium 100 mg PO BID 6. Doxazosin 1 mg PO HS RX *doxazosin [Cardura] 1 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 7. Fleet Enema (Saline) ___AILY:PRN constipation 8. Fosfomycin Tromethamine 3 g PO 1X/WEEK (MO) RX *fosfomycin tromethamine [Monurol] 3 gram 1 packet(s) by mouth On ___ Disp #*30 Packet Refills:*0 9. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine 5 % 1 patch to affected area of pain Daily in morning Disp #*30 Patch Refills:*1 10. Phenazopyridine 200 mg PO TID RX *phenazopyridine 200 mg 1 tablet(s) by mouth TID PRN Disp #*90 Tablet Refills:*0 11. Polyethylene Glycol 17 g PO DAILY 12. Sotalol 40 mg PO BID RX *sotalol 80 mg 0.5 (One half) tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 13.___ lift Rx: ___ lift Dx: Deconditioning (___.81), stroke (___.9) Duration: ___ years Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Urinary tract infection Moderate sleep apnea Constipation Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>You came to the hospital after an episode of unresponsiveness. You were found to have a urinary tract infection. You were treated with antibiotics, which finished on ___. While in the hospital, you were observed to stop breathing while you were asleep for brief periods of time. This is called sleep apnea. You would benefit from sleeping on your side and not taking sedating medications prior to sleep. You will need to follow-up with the sleep medicine doctors after ___ leave the hospital. Your PCP can make arrangements for you to see a sleep medicine doctor as an outpatient.</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. Amlodipine 5 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 5 mg PO QPM 5. Benzonatate 100 mg PO TID 6. BuPROPion (Sustained Release) 300 mg PO DAILY 7. Codeine Sulfate ___ mg PO Q12H:PRN cough 8. Docusate Sodium 100 mg PO BID 9. Fentanyl Patch 25 mcg/h TD Q72H 10. Gabapentin 300 mg PO QAM 11. Gabapentin 600 mg PO QPM 12. Hydrochlorothiazide 25 mg PO DAILY 13. 70/30 26 Units Breakfast 70/30 26 Units Dinner 14. Lisinopril 40 mg PO DAILY 15. Mirtazapine 30 mg PO QHS 16. Omeprazole 40 mg PO DAILY 17. Tiotropium Bromide 1 CAP IH DAILY 18. Azithromycin 250 mg PO Q24H Duration: 3 Doses RX *azithromycin 250 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 19. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB 20. budesonide-formoterol 80-4.5 mcg/actuation INHALATION BID 21. ciclopirox 0.77 % topical DAILY 22. Clotrimazole Cream 1 Appl TP BID 23. DiphenhydrAMINE 25 mg PO Q12H:PRN itching 24. Fluticasone Propionate 110mcg 2 PUFF IH BID 25. Ibuprofen 600 mg PO Q12H 26. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 27. Vitamin D 50,000 UNIT PO ONCE A MONTH 28. PredniSONE 40 mg PO DAILY Duration: 3 Doses RX *prednisone 20 mg 2 tablet(s) by mouth daily Disp #*6 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis COPD exacerbation Secondary diagnosis Chronic kidney disease Hypertension Type 2 diabetes mellitis Anxiety Chronic pain 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>Dear Mr. ___, You were admitted to the hospital for difficulty breatjing. This was related to your COPD and was similar to your episodes in the past. We treated you with steroids and an antibiotic called azithromycin. You should continue taking the steroid called prednisone and azithromycin for 3 more days after discharge. You should also continue taking your home inhalers to help with your breathing. It will be important to see your primary care doctor to help determine what is caused this episode and if there is anything to be done to prevent future episodes. It was a pleasure taking care of you. Best of luck, Your ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain or fever 2. cilostazol *NF* 50 mg Oral bid Reason for Ordering: Wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. 3. Fluticasone Propionate NASAL 1 SPRY NU DAILY 4. Metoprolol Tartrate 100 mg PO BID 5. Nystatin Oral Suspension 5 mL PO QID:PRN thrush 6. Pravastatin 40 mg PO DAILY 7. PredniSONE 3 mg PO DAILY 8. Sulfameth/Trimethoprim SS 1 TAB PO 3X/WEEK (___) 9. Tacrolimus 5 mg PO QPM 10. Tacrolimus 6 mg PO QAM 11. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 12. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice daily Disp #*60 Capsule Refills:*0 13. Senna 1 TAB PO BID:PRN constipatoin RX *sennosides [___] 8.6 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*0 14. Colchicine 0.6 mg PO DAILY RX *colchicine [Colcrys] 0.6 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 15. TraMADOL (Ultram) 50 mg PO Q12H:PRN pain 16. NIFEdipine CR 60 mg PO DAILY 17. Hydrocodone-Acetaminophen (5mg-500mg) ___ TAB PO Q4H:PRN pain 18. Outpatient Lab Work Please check labs ___: CBC, chemistry panel, tacrolimus level. Fax results to transplant cener ___ ICD-9 V42.0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Urinary retention Constipation Acute on chronic kidney injury in the setting of ESRD s/p transplant Hyponatremia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, As you know, you were admitted for urinary retention and abdominal distention and found to have some reduction in your kidney function and low sodium. A Foley catheter was placed, allowing you to urinate comfortably, and abdominal distention likely reflected constipation due to pain medication use after surgery. Your kidney function and low sodium improved with fluids. You also were treated for a gout flare in your right great toe. Please do not restart your chlorthalidone (diuretic) until your kidney function is checked on labs on ___ and your PCP advises you to do so.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q8H:PRN pain 2. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet,delayed release (___) by mouth daily Disp #*15 Tablet Refills:*0 3. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*15 Tablet Refills:*0 4. Levofloxacin 750 mg PO Q24H Duration: 2 Days RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 5. Multivitamins W/minerals 1 TAB PO DAILY 6. PredniSONE 40 mg PO DAILY Duration: 3 Days RX *prednisone 20 mg 2 tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 7. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*15 Tablet Refills:*0 8. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain RX *tramadol 50 mg 1 tablet(s) by mouth every six (6) hours Disp #*20 Tablet Refills:*0 9. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet extended release 24 hr(s) by mouth daily Disp #*15 Tablet Refills:*0 10. Lisinopril 2.5 mg PO DAILY RX *lisinopril 2.5 mg 1 tablet(s) by mouth daily Disp #*15 Tablet Refills:*0 11. Outpatient Lab Work At follow-up PCP appointment, please check Chem10 to evaluate response to lisinopril and sodium level 12. Albuterol Inhaler ___ PUFF IH Q6H:PRN dyspnea, wheezing RX *albuterol sulfate 90 mcg ___ puff IH every six (6) hours Disp #*1 Inhaler Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Hyponatremia, likely from poor nutrition and SIADH Alcohol withdrawal Cardiomyopathy, likely alcoholic Troponin elevation Community-acquired vs. aspiration pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at the ___. You came for further evaluation of alcohol withdrawal and low sodium levels. Your low sodium levels were probably from inadequate diet and possibly pain and pneumonia causing excessive hormone release. This level improved with restriction of fluid and nutrition. You should not take in more than 2 liters of fluid a day at home for now. It is very important that you follow up to get your sodium rechecked and focus on eating a balanced diet upon discharge. You had fallen when you came in likely due to alcohol intoxication, and you were treated for alcohol withdrawal during your admission. IT IS VERY IMPORTANT TO STOP DRINKING ALCOHOL, AS IT IS EXTREMELY DANGEROUS FOR YOUR HEALTH. If you feel that you are in danger of beginning to drink again, please call your PCP for further support. You were also found to have new heart failure, which is likely due to your alcohol use, and may have had a heart attack during your admission. You are scheduled to follow up with a cardiologist upon discharge. Please be sure to make this appointment. Please also be sure to take all of your medications as prescribed and follow up with all appointments listed below. Good luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Rivaroxaban 15 mg PO BID Duration: 21 Days RX *rivaroxaban [___] 15 mg 1 tablet(s) by mouth twice a day Disp #*42 Tablet Refills:*0 2. Rivaroxaban 20 mg PO DAILY Do not begin taking this medication until you complete the 21 day course of rivaroxaban 15 mg PO BID RX *rivaroxaban [___] 20 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Class I pulmonary embolism Secondary diagnosis: Normocytic 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 at the ___ ___. Why did you come to the hospital? - You were feeling short of breath and had chest pain, and were found to have blood clots in your lungs What did you receive in the hospital? - You were treated with a blood thinner - You had a CAT scan that showed your heart function was normal - You had an ultrasound of your legs which did not show any blood clots - We performed blood work and did not find any obvious abnormalities What should you do once you leave the hospital? - Continue to take rivaroxaban 15 mg PO two times per day for 3 weeks total (21 days). After this, you should take rivaroxaban 20 mg PO one time per day, until your outpatient doctor tells you to stop. (You will likely be on this medicine for ___ months.) - Take your medications as prescribed and attend your follow up appointments We wish you all the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Bisacodyl 10 mg PO DAILY:PRN Constipation - Second Line 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 30 mg SC QHS Continue 30 days after surgery ___ - ___ 5. GuaiFENesin ___ mL PO Q6H:PRN cough 6. Metoprolol Succinate XL 25 mg PO DAILY 7. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Third Line 8. Senna 8.6 mg PO BID Constipation second line Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Periprosthetic hip fracture Secondary: Pancytopenia Acute anemia likely secondary to multiple myeloma Transaminitis Syncope History of SVT Hyponatremia Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were admitted to the hospital after falling and fracturing your leg. ___ had surgery to fix this. ___ were found to have low blood counts and a hurt liver, but this was improving by discharge. ___ were also found to have likely new multiple myeloma, which the Hematologists are planning on seeing ___ in clinic for. INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - ___ 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: -Touchdown weightbearing right lower extremity, range of motion as tolerated MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add Tramadol as needed for increased pain (of note, this did make the patient more tired than usual). 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 ___ are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If ___ require more, ___ 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 ___ 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: - ___ 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, ___ may apply a gauze dressing secured with paper tape. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if ___ experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever >101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE <30 DAYS OF REHAB Please follow up with your Orthopaedic Surgeon, Dr. ___. ___ will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for any new medications/refills.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Hydrochlorothiazide 25 mg PO DAILY RX *hydrochlorothiazide 25 mg 1 tablet(s) by mouth ONCE DAILY Disp #*30 Tablet Refills:*1 2. Lisinopril 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY RX *aspirin [Adult Low Dose Aspirin] 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. NIFEdipine CR 30 mg PO DAILY hold for SBP<90 RX *nifedipine [Afeditab CR] 30 mg 1 tablet(s) by mouth ONCY DAILY Disp #*30 Tablet Refills:*1 5. Blood pressure cuff Discharge Disposition: Home Discharge Diagnosis: Primary: 1. Hypertensive urgency Secondary: 1. Hypertension 2. Hepatitis C Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___. You were admitted for a dangerously high blood pressure. We treated you with blood pressure-lowering medications, and your symptoms improved. We did an echocardiogram of your heart, which showed changes consistent with high blood pressure. In the future, if these symptoms return, notify your PCP ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Metoprolol Tartrate 25 mg PO BID 2. GlipiZIDE 10 mg PO DAILY 3. Omeprazole 20 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS #Acute on chronic renal failure SECONDARY DIAGNOSES #Chronic kidney disease, stage III #Hypothyroidism #Papillary thyroid carcinoma #Gastroesophageal reflux disease #Obstructive sleep apnea #Type 2 diabetes mellitus Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to care for ___ at ___. ___ were admitted for decreased kidney function, with a rise in a blood value called 'creatinine'. We believe that your kidneys had lower blood flow than they normally do because of two things: ___ have not been on thyroid medication for a few weeks and ___ were taking blood pressure medication. Thyroid hormone helps regulate blood flow to the kidney, without it in your system they were not able to filter the blood as well. The medications ___ take for high blood pressure can also lower blood flow to your kidneys. Fortunately, there did not appear to be any death of the kidney cells when we looked at your urine under a microscope. The lab value (creatinine) improved over 24 hours after we gave ___ intravenous (IV) fluids. Because of the rapid improvement with IV fluids we do not think that any of the medications ___ take were causing kidney inflammation. Most of your hypertension (high blood pressure) medications were stopped in the hospital and your blood pressures were 100-120 systolic. We continued your beta-blocker (metoprolol) and ___ should continue this at your regular dose. Your primary care doctor can restart your blood pressure medications when your thyroid has been treated. The following medication changes were made: STOP amlodipine (This is temporary. Please follow up with Dr. ___ to discuss when to restart this) STOP lisinopril (This is temporary. Please follow up with Dr. ___ to discuss when to restart this) STOP</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. HydrOXYzine ___ mg PO Q4H:PRN Itching RX *hydroxyzine HCl 25 mg ___ tablets by mouth every four (4) hours Disp #*120 Tablet Refills:*0 3. LORazepam 0.25 mg PO BID insomnia RX *lorazepam 0.5 mg 1 by mouth twice a day Disp #*6 Tablet Refills:*0 4. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 5. OxyCODONE (Immediate Release) 5 mg PO Q8H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth three times a day Disp #*10 Tablet Refills:*0 6. Rifaximin 550 mg PO BID RX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 7. Sodium Bicarbonate 1300 mg PO BID RX *sodium bicarbonate 650 mg 2 tablet(s) by mouth twice daily Disp #*120 Tablet Refills:*0 8. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 9. TraZODone 50 mg PO QHS RX *trazodone 50 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 10. Ursodiol 600 mg PO BID RX *ursodiol 300 mg 2 capsule(s) by mouth twice a day Disp #*120 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: ================== Alcohol Hepatitis Alcohol Cirrhosis complicated by: -Ascites -Coagulopathy SECONDARY DIAGNOSIS: ===================== #Spontaneous Bacterial Peritonitis #Acute Kidney Injury #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 admitted to the hospital because acute on chronic liver failure WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - We did two paracenteses, on of which found an infection in your abdomen, this is known as spontaneous bacterial peritonitis - We had palliative care speak with you and help optimize your medications to treat your symptoms WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Take all of your medications as prescribed (listed below) - Please follow up with your ___ services. You will also be seen by the hospice team at your home - We set up appointments with your primary care physician and the liver team. Thank you for involving us in your care. -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. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO DAILY 4. cilostazol 100 mg ORAL BID 5. Docusate Sodium 100 mg PO BID 6. Isosorbide Mononitrate (Extended Release) 120 mg PO DAILY 7. Levothyroxine Sodium 75 mcg PO DAILY 8. Losartan Potassium 25 mg PO DAILY 9. Metoprolol Succinate XL 25 mg PO DAILY 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation 11. Senna 1 TAB PO BID:PRN constipation 12. Tamsulosin 0.4 mg PO HS 13. Warfarin 5 mg PO 4X/WEEK (___) 14. Warfarin 4 mg PO 3X/WEEK (___) 15. Enoxaparin Sodium 150 mg SC DAILY Start: ___, First Dose: First Routine Administration Time until INR above 2.0 RX *enoxaparin 150 mg/mL 150 mg sc once daily Disp #*3 Syringe Refills:*1 16. Albuterol Inhaler 1 PUFF IH PRN SOB, wheezing 17. Bisacodyl 5 mg PO DAILY:PRN constipation 18. Diphenoxylate-Atropine 1 TAB PO DAILY:PRN diarrhea 19. Fish Oil (Omega 3) 1000 mg PO DAILY 20. GlyBURIDE 5 mg PO BID 21. LOPERamide 2 mg PO BID:PRN diarrhea 22. Multivitamins 1 TAB PO DAILY 23. Ocuvite (vit C-vit E-lutein-min-om-3) 150-30-6-150 mg-unit-mg-mg Oral Daily 24. Omeprazole 20 mg PO BID:PRN heartburn 25. travoprost 0.004 % OS QHS 26. Vitamin D ___ UNIT PO DAILY 27. Outpatient Lab Work INR Fax results to: ___ ___ Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Afib with RVR, Lightheadedness Secondary diagnosis: CAD HTN HLD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to the hospital because you felt lightheaded and had chest discomfort. When you were admitted to the hospital you were found to be in atrial fibrillation with a fast heart rate, which means that your heart was not pumping normally. We think that this is what caused your symptoms. Your heart returned into its normal rhythm, and you did not have your symptoms. You were originally scheduled to have a cardiac catheterization ___. However, after touching base with your primary cardiologist Dr. ___ was decided that your symptoms were more likely due to your rhythm and that you would not need a cath at this point. Because you were off of your warfarin for a few days, we will start you on a medication called Lovenox (Enoxaparin) that well prevent you from having a clot. You will need to take this medication along with the warfarin until you follow up in your ___ clinic next week. You will also be sent home with a device called the ___ of hearts" to see if your rhythm coincides with when you have symptoms. You will follow up with Dr. ___ with this. Continue to take all of your other medications as previously prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sulfameth/Trimethoprim DS 1 TAB PO BID RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth Twice daily Disp #*7 Tablet Refills:*0 2. ARIPiprazole 20 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -200 unit oral DAILY 5. Divalproex (EXTended Release) 1500 mg PO DAILY 6. Divalproex (EXTended Release) 1000 mg PO QHS 7. Gabapentin 300 mg PO QHS 8. Lidocaine 5% Patch 1 PTCH TD QAM 9. Midodrine 5 mg PO DAILY 10. Multivitamins 1 TAB PO DAILY 11. Omeprazole 20 mg PO DAILY 12. Ondansetron 8 mg PO Q8H:PRN nausea 13. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation DAILY:PRN 14. RisperiDONE 2 mg PO QHS 15. Sertraline 200 mg PO DAILY 16. Terbinafine 1% Cream 1 Appl TP DAILY 17.Rolling walker Rolling walker Dx: R56.9 Px: Good ___: 13 mos Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Urinary tract infection Secondary Diagnosis: Delirium Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ because you became confused and sleepy. You were found to have a urinary tract infection. Your confusion improved with treatment of your infection. You should continue to take Bactrim twice daily (end on ___. You were not taking your seizure medication (Depakote) before you came into the hospital. Make sure you take all of your medications as prescribed with the help of your ___. Please make sure you follow up with your Neurologist to monitor the level of this medication. You were evaluated by our physical therapists and occupational therapists during your hospitalization. You will receive physical and occupational therapy at home. You were given a walker to help with your mobility. 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. Ferrous Sulfate 325 mg PO DAILY ___ cause dark stools RX *ferrous sulfate [iron] 325 mg (65 mg iron) 1 capsule(s) by mouth Daily Disp #*60 Capsule Refills:*0 2. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 3. Ascorbic Acid ___ mg PO DAILY 4. DiphenhydrAMINE 50 mg PO Q6H:PRN allergy 5. Mirtazapine 7.5 mg PO QHS 6. Tylenol-Codeine #3 (acetaminophen-codeine) 300-30 mg oral Q8H:PRN 7. Vitamin D 1000 UNIT PO DAILY 8. HELD- amLODIPine 10 mg PO DAILY This medication was held. Do not restart amLODIPine until your PCP tells you to do so. Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: ==================== lower gastrointestinal bleed Secondary diagnoses: ==================== hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure caring for you at the ___ ___! Why were you hospitalized? -You were hospitalized because you were having dark stools and we were worried about a bleed from the GI tract. What was done in the hospital? -You were given blood to replete the blood you lost from your GI bleed -You had a colonoscopy to find the cause of your bleeding, which was negative. Your blood counts then leveled off so we think that the bleeding stopped on its own. What should you do when you get home? -Keep track of your stools. If you have red bloody stools or dark black, tarry stools at home please call your doctor or come back to the ER. Your stools may be dark from iron supplements, but they should not come out like tar. -Continue to take your medications as prescribed. -Please be sure to go to your follow up appointment on ___ with ___ and Dr. ___. She will check your blood counts and make sure that you are not having more GI bleeding. We wish you all the best! Sincerely, Your ___ Team</s>