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. ertapenem 1 gram intramuscular DAILY Duration: 6 Days ___ through ___ for full ___onsider treating for 14 days if UA still positive or if pt is symptomatic. 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 3. Atorvastatin 80 mg PO QPM 4. Bisacodyl 10 mg PR QHS:PRN constipation 5. Docusate Sodium 100 mg PO BID 6. Finasteride 5 mg PO DAILY 7. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 8. Lactulose 30 mL PO BID 9. Metoprolol Succinate XL 25 mg PO DAILY 10. Milk of Magnesia 30 mL PO Q6H:PRN constipation 11. Omeprazole 20 mg PO DAILY 12. Phenytoin Sodium Extended 400 mg PO 4X/WEEK (___) 13. Phenytoin Sodium Extended 300 mg PO 3X/WEEK (___) 14. Senna 17.2 mg PO BID 15. Tamsulosin 0.8 mg PO QHS 16. Vitamin D ___ UNIT PO 1X/WEEK (WE) 17. HELD- Aspirin 81 mg PO DAILY This medication was held. Do not restart Aspirin until You meet with Dr. ___ ___ Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Chronic stable Subdural hematoma, urinary tract infection Secondary: CAD s/p CABG in ___, NSTEMI, systolic CHF (EF 35-40%), PVD s/p bypass, CKD stage III, history of LLE DVT s/p IVC filter, chronic SDH, 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 Mr. ___, It was a pleasure taking care of you. Why you were admitted? -You were admitted to the hospital because you fell. What was done for you? -You had a CT scan of your head which showed a bleed in your head that was stable from your previous CT scan. Nothing needed to be done. Your asprin was held while you were here. -You were found to have urinary tract infection. What should you do when you leave the hospital? -You should continue taking the antibiotic Ertapenem (last day ___ to complete a 7 day course. 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. QUEtiapine Fumarate 25 mg PO BID 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 3. amLODIPine 10 mg PO DAILY 4. Bisacodyl ___AILY:PRN Constipation - Second Line 5. Bisacodyl 10 mg PO DAILY 6. Carbidopa-Levodopa (___) 1 TAB PO TID 7. Docusate Sodium 200 mg PO BID 8. Melatin (melatonin) 3 mg oral QHS 9. Milk of Magnesia 30 mL PO DAILY:PRN Constipation - First Line 10. Multivitamins W/minerals 1 TAB PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Hypernatremia Malnutrition Failure to thrive Advanced dementia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>You admitted to ___. The follow is a summary of your hospitalization and instructions for after discharge from the hospital. Reasons for hospitalization: 1) Dehydration 2) High sodium levels 3) Poor appetite 4) Malnutrition</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 RX *oxycodone 5 mg ___ tablet(s) by mouth q4-6h Disp #*30 Tablet Refills:*0 2. Ciprofloxacin HCl 750 mg PO Q12H RX *ciprofloxacin 750 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*20 Tablet Refills:*0 3. Clindamycin 300 mg PO Q8H RX *clindamycin HCl 300 mg 1 capsule(s) by mouth every six (6) hours Disp #*40 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: right foot infection Discharge Condition: Activity Status: Ambulatory - Independent. Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>These are the discharge instructions for post-operative discharge instructions. Discharge Instructions: Please call your surgeon or return to the emergency department if you develop a fever greater than 101.5, severe increase ___ pain to operative site or pain unrelieved by your pain medication, nausea, vomiting, chills, foul smelling or colorful drainage from your incisions/wounds, redness or swelling around your incisions, or any other symptoms which are concerning to you. Diet: regular diet Medication Instructions: Resume your home medications. You will be starting some new medications: 1. You are being discharged on medications to treat the pain from your operation. These medications will make you drowsy and impair your ability to drive a motor vehicle or operate machinery safely. You MUST refrain from such activities while taking these medications. 2. If you were prescribed antibiotics, it is critical for you to take them as prescribed and for the full course of the regimen. Activity: Please, remain nonweightbearing to your right foot. This is crucial to increase healing potential. Wound Care: You may shower but please keep dressings clean, dry, and intact. Do not submerge your foot/leg ___ water. Please call the doctor or page the ___ pager, if you have increased pain, swelling, redness, or drainage to the operative sites.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. abacavir 300 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 3. citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. Tricor 145 mg Tablet Sig: One (1) Tablet PO once a day. 5. gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q48H (every 48 hours). 6. labetalol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 times a day). 8. lamivudine 10 mg/mL Solution Sig: ___ (25) mg PO DAILY (Daily). 9. lopinavir-ritonavir 200-50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 10. methadone 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. mycophenolate mofetil 250 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 12. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 13. rifaximin 550 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 14. sirolimus 1 mg Tablet Sig: One (1) Tablet PO Every ___. 15. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 16. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 17. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 18. simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for gas. 19. sevelamer carbonate 800 mg Tablet Sig: One (1) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). Disp:*90 Tablet(s)* Refills:*2* 20. Zofran 4 mg Tablet Sig: One (1) Tablet PO three times a day as needed for nausea. 21. Lantus 100 unit/mL Solution Sig: Ten (10) u Subcutaneous at bedtime. 22. Humalog 100 unit/mL Solution Sig: as per home sliding scale Subcutaneous four times a day. 23. vancomycin in 0.9% sodium Cl 1 gram/250 mL Solution Sig: One (1) Intravenous with HD for 7 days. 24. Outpatient Lab Work Please obtain CBC, Chem 7 and Rapamycin level on ___ in AM before taking your dose of Rapamycin. Please fax resutls to your Dr. ___ ___, Fax: ___. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Graft cellulitis AND seroma of graft Secondary: End stage renal disease, HIV, liver transplatation. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ after having been found a falsely abnormal lab value and worsening left arm pain at site of your graft. You were treated with antibiotics for suspected infection in your arm. You were found to have enlarging fluid collections at your arm which were felt to be seromas. Aspiration of fluid from the collection closest to your arm pit did not show infection. You were treated for cellulitis (infection of the skin) over your graft. In addition, you had worsening fluid swelling and low sodium due to having taken too much fluid by mouth. In addition, there was scrotal and penile swelling. This resolved with dialisys and fluid restriction. Please do not drink more than 1.5 liters of fluids daily. The following changes were made to your medications: STARTED: - Sevelamer CHANGED: Sirolimus 1mg every ___ STOPPED: None You were discharged home. Should you develop any symptoms concerning to you, please call your liver doctor, primary care doctor or go to the emergency room. You underwent hemodialisis during your hospital stay.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q12H 2. Aspirin 325 mg PO DAILY 3. Diltiazem Extended-Release 120 mg PO DAILY 4. Gabapentin 100 mg PO QAM 5. Gabapentin 200 mg PO HS 6. Metoprolol Succinate XL 25 mg PO DAILY 7. Multivitamins 1 TAB PO DAILY 8. Tamsulosin 0.4 mg PO HS 9. Vitamin D 800 UNIT PO DAILY 10. Dexamethasone 10 mg PO 1X/WEEK (___) 11. Levofloxacin 750 mg PO Q48H Duration: 5 Days RX *levofloxacin 750 mg 1 tablet(s) by mouth Q48H Disp #*3 Tablet Refills:*0 12. Lenalidomide 10 mg PO DAILY 13. OxycoDONE (Immediate Release) ___ mg PO QHS:PRN pain do not take if sedated, do not take if driving RX *oxycodone 5 mg ___ capsule(s) by mouth at bedtime Disp #*20 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: pneumonia Secondary: multiple myeloma 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 for right sided chest pain. This was likely due to your resolving pneumonia. You were treated with antibiotics and were feeling better. Please see below for changes to your medications and 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. Amlodipine 5 mg PO DAILY 3. BuPROPion (Sustained Release) 200 mg PO QAM 4. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth Twice daily as needed for constipation Disp #*20 Capsule Refills:*0 5. Loratadine 10 mg PO DAILY 6. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth Every 4 hours as needed for pain control Disp #*60 Tablet Refills:*0 7. Pantoprazole 40 mg PO Q24H 8. Vitamin D 400 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: L greater troch fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. WOUND CARE: - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. -Splint must be left on until follow up appointment unless otherwise instructed ACTIVITY AND WEIGHT BEARING: - weight bearing as tolerated left lower extremity with minimal abduction of the leg until follow up. Physical Therapy: Weight bearing as tolerated in left lower extremity with restrictions on abduction of the leg until follow up due to greater troch fracture Treatments Frequency: None</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 200 mg PO Q12H pneumonia RX *cefpodoxime 200 mg 1 tablet(s) by mouth twice a day Disp #*4 Tablet Refills:*0 2. LevETIRAcetam 1000 mg PO BID RX *levetiracetam 1,000 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*5 3. Aspirin 81 mg PO DAILY 4. Donepezil 10 mg PO QHS 5. Levothyroxine Sodium 100 mcg PO DAILY 6. Omeprazole 40 mg PO DAILY 7. Simvastatin 40 mg PO QPM Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: seizure Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, You were admitted for seizure. You were started on a new anti-seizure medication called Keppra. You should continue taking this everyday to help prevent seizure. You were also found to have a pneumonia while you were in the hospital. You will take 2 more days of antibiotics at home to complete your treatment course. Memantine was stopped during this hospitalization due to ineffectiveness. There were no other changes to your medications. You should follow up with your neurologist, Dr. ___. It was a pleasure caring for you. Sincerely, ___ Neurology</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 10 mg PO DAILY 2. Levothyroxine Sodium 75 mcg PO DAILY 3. Lidocaine 5% Patch 1 PTCH TD DAILY 4. Lisinopril 7.5 mg PO DAILY 5. NiMODipine 60 mg PO Q4H Last dose on ___. 6. Nystatin Oral Suspension 5 mL PO TID:PRN thrush 7. Ondansetron 4 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Reversible cerebral vasoconstriction syndrome Intracranial Hemorrhage 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 hospitalized due to symptoms of headaches and resulting from an acute brain hemorrhage likely due to a syndrome called reversible cerebral vasoconstriction syndrome. Reversible cerebral vasoconstriction syndromes (RCVS) are a group of conditions characterized by reversible narrowing and dilatation of the cerebral arteries. The cause of this syndrome is unknown, though the reversible nature of the vasoconstriction suggests an abnormality in the control of cerebrovascular tone. RCVS can cause brain hemorrhages and cerebral edema. You have received supportive therapy directed towards managing your intracranial pressure, blood pressure and headaches. We have started you on oral calcium channel blockers to treat vasoconstriction. Recurrence of an episode of RCVS is rare. You require rehabilitation with physical-, occupational and speech therapy to recover from your neurological deficits. Please continue taking nimodipine, the last dose is on ___. Please continue taking amlodipine and lisinopril Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q4-6H:PRN pain RX *acetaminophen 500 mg 2 tablet(s) by mouth q4-6h Disp #*60 Tablet Refills:*0 2. Donepezil 10 mg PO QHS RX *donepezil 10 mg 1 tablet(s) by mouth at bedtime 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. Bumetanide 1 mg PO DAILY Increase to 1mg twice a day if more short of breath. Decrease to 1mg if breathing improves RX *bumetanide 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Carvedilol 12.5 mg PO BID RX *carvedilol 12.5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 6. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN SOB RX *ipratropium bromide [Atrovent HFA] 17 mcg/actuation 17 mcg HFA every six hours as needed Disp #*1 Inhaler Refills:*0 7. Levofloxacin 500 mg PO Q48H RX *levofloxacin 500 mg 1 tablet(s) by mouth every 48 hours Disp #*2 Tablet Refills:*0 8. Potassium Chloride 20 mEq PO DAILY RX *potassium chloride [Klor-Con] 20 mEq 1 packet(s) by mouth daily Disp #*30 Packet Refills:*0 9. ValACYclovir 1000 mg PO Q12H RX *valacyclovir 1,000 mg 1 tablet(s) by mouth every 12 hours Disp #*14 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Dyspnea Secondary Diagnoses: Atrial Fibrillation Hypertension Coronary Artery Disease Dysphagia Urinary Retention Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, it was our pleasure caring for you during your admission to ___ ___ ___. You were admitted for shortness of breath. We think this was due to extra fluid that collected in your lungs from your heart disease. We treated you with a water pill and this resulted in an improvement in your symptoms. Your discharge weight was 95.2 kg. You should weigh yourself daily. If you notice weight gain of 3 lbs in 2 to 3 days you should call your doctor. We also noticed a rash on your buttocks that was concerning for shingles. We sent a few tests to confirm this diagnosis. We are giving you a prescription to treat shingles called valacyclovir. We will have the results of the tests we sent in the next ___ to 48 hours and we will call you with the results. You should take this medication as prescribed until we call you with the results. We wish you the best. - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID RX *apixaban [Eliquis] 5 mg one tablet(s) by mouth twice daily Disp #*30 Tablet Refills:*2 2. Atorvastatin 40 mg PO QPM 3. Centrum (multivit-iron-min-folic acid;<br>multivit-mins-ferrous gluconat) 3,500-18-0.4 unit-mg-mg oral DAILY 4. Nicotine Patch 21 mg TD DAILY RX *nicotine 21 mg/24 hour 1 patch daily Disp #*30 Patch Refills:*0 5. Tamsulosin 0.4 mg PO QHS RX *tamsulosin 0.4 mg 1 capsule(s) by mouth at night Disp #*30 Capsule Refills:*0 6. QUEtiapine Fumarate 25 mg PO QHS RX *quetiapine 25 mg 1 tablet(s) by mouth at night Disp #*30 Tablet Refills:*0 7. NexIUM (esomeprazole magnesium) 40 mg oral BID 8. Tudorza Pressair (aclidinium bromide) 400 mcg/actuation inhalation BID 9. Incruse Ellipta (umeclidinium) 62.5 mcg/actuation inhalation DAILY 10. Breo Ellipta (fluticasone-vilanterol) 100-25 mcg/dose inhalation DAILY 11. glimepiride unknown ORAL Frequency is Unknown Please resume the dose you were previously taking. 12. Metoprolol Tartrate 75 mg PO TID RX *metoprolol tartrate 75 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Encephalopathy Central Sleep Apnea Atrial Fibrillation Benign Prostatic Hyperplasia Chronic Obstructive Pulmonary Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You presented to the hospital with poor sleep and agitation. You were treated initially with Haldol and then transitioned to Seroquel. You were seen by the neurologists and the psychiatrists. Many of your sedating medications, including Xanax and Ambien, were stopped. You were also seen by the sleep specialists for your central sleep apnea and will follow up with them as an outpatient. You were also found to have new atrial fibrillation, for which you were started on metoprolol with improvement in your heart rates. You were started on a blood thinner, called Apixaban, to help prevent strokes. Your aspirin and Plavix were stopped to decrease the risk of bleeding. You had an ultrasound of your heart which showed no concerning findings. You were also started on Flomax for symptoms of urinary urgency. You were seen by our physical therapists. Your oxygen levels were noted to decrease significantly with walking; however, you reported that this is not very different from your baseline. We recommended that you be discharged to rehab; however, you insisted to be discharged home. It is very important that you follow up with your physicians as instructed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 650 mg PO TID RX *aspirin 650 mg 1 tablet(s) by mouth three times a day Disp #*36 Tablet Refills:*0 2. Desipramine 250 mg PO DAILY 3. FoLIC Acid 1 mg PO DAILY 4. Methocarbamol 750 mg PO BID:PRN pain 5. Omeprazole 20 mg PO DAILY 6. Outpatient Lab Work Please check CBC, chem-7, and LFTs including: Na, K, Cl, HCO3, BUN, Cr, Glc, AST, ALT, ALP, tbili Fax results to: ___. fax #: ___ 7. Colchicine 0.6 mg PO BID Duration: 48 Hours RX *colchicine [Colcrys] 0.6 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: viral pericarditis Secondary diagnosis: rheumatoid arthritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during your stay at ___. You were admitted for an expedited workup of multiple issues, including your shortness of breath, elevated ALP, and for fluid around your heart. You underwent several diagnostic tests, including a liver ultrasound, an MRI of your liver, an echocardiogram, and x-rays of your foot. These showed that you do not have any life-threatening conditions that we can identify. You were also evaluated by our rheumatology team, who did not believe your symptoms were related to your underlying rheumatoid arthritis. We sent a number of studies that are pending at discharge. Please follow-up with your PCP within the next week to continue monitoring your symptoms. Please continue to take your aspirin three times a day for 2 weeks and colchicine twice a day for 3 months to help with the chest pain. Please have your labs drawn on ___ next week so your PCP can closely monitor your progress. We recommended iron supplementation to help with your anemia but understand you do not wish to take it. Please re-consider this decision as treating your anemia may make you feel better and less tired. It was a pleasure taking care of you. Best wishes, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 2. Docusate Sodium 100 mg PO BID 3. Sodium Chloride Nasal ___ SPRY NU DAILY:PRN dry nasal mucosa 4. Furosemide 20 mg PO DAILY 5. Metoprolol Succinate XL 100 mg PO DAILY 6. Omeprazole 20 mg PO DAILY 7. Oxazepam 10 mg PO QHS:PRN imnsonia 8. Verapamil 20 mg PO Q8H 9. Warfarin 2.5 mg PO ONCE Duration: 1 Dose follow-up with PCP for repeat ___ and dosing of coumadin 10. ___ MD to order daily dose PO DAILY16 Discharge Disposition: Home Discharge Diagnosis: Hemoperitoneum status post laparoscopic cholecystectomy. 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 Acute Care Surgery Service on ___ with abdominal pain after a recent laparoscopic procedure. You were found to have a bleed in your abdomen. Initially we attempted to monitor the bleed and slowly restart your anticoagulation medication. Unfortunately you continued to bleed and therefore you were taken back to the operating room and an arterial bleed was found and stopped. After surgery your blood levels were closely monitored and remained stable. Your anticoagulation was again restarted which you tolerated well. You are now doing better, tolerating a regular diet, and ready to be discharged to home to continue your recovery. Please note the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery. Please follow-up with your PCP ___ 24 hours after discharge to review Coumadin dosing If you have any questions about your recovery, please call the Acute Care clinic at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluoxetine 20 mg PO DAILY 2. Lorazepam 0.5 mg PO Q4H:PRN nausea RX *lorazepam 0.5 mg 1 tab(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 3. Multivitamins 1 TAB PO DAILY 4. Omeprazole 20 mg PO BID 5. Acetaminophen 1000 mg PO TID RX *acetaminophen 500 mg 2 tablet(s) by mouth three times a day Disp #*60 Tablet Refills:*0 6. Acidophilus *NF* (L.acidoph & ___ acidophilus) 1 capsule ORAL DAILY As directed 7. Ondansetron 8 mg PO Q8H:PRN nausea RX *ondansetron 8 mg 1 tablet(s) by mouth every eight (8) hours Disp #*45 Tablet Refills:*0 8. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Abdominal pain, nausea, vomiting 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 ___ ___. As you know, you were hospitalized for nausea and abdominal pain. We consulted our gastroenterology team who recommended we checked a barium swallow with small bowel follow through as well as a gastric emptying study. Both of these were normal, and did not provide an explanation for your nausea and abdominal pain. Our gastroeneterology team's recommendation is that you follow up as an outpatient for continued investigation and management of your nausea and abdominal pain. At the time of discharge we have controlled your symptoms adequately with oral medications. You should follow up with your GI doctor as directed. Our GI team will attempt schedule you an appointment with one of our GI specialists, here at ___ who may be able to evaluate your symptoms better. They will also contact you to set up an appointment in our GI Clinic with one of our Gastroenterology Fellows in the next ___ weeks to check up on your symptoms. We have made the following changes in your medications: START Ondansetron (Zofran) lorazepam (Ativan) Oxycodone Acetaminophen STOP hydromorphone (Dilaudid)</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q8H:PRN Pain - Mild 2. Docusate Sodium 100 mg PO BID Hold for loose stool 3. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity Wean as tolerated. Patient may request partial fill. RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*10 Tablet Refills:*0 4. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: Acute appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ with acute appendicitis. You were taken to the operating room and had your appendix removed laparoscopically. This procedure went well. You are now tolerating a regular diet and your pain is better controlled. You are now ready to be discharged home to continue your recovery. Please note the following discharge instructions: Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o You have Dermabond adhesive applied to your incisions and this will dissolve on its own over the next couple of weeks. 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. Simvastatin 40 mg PO QPM 2. Metoprolol Succinate XL 125 mg PO DAILY 3. Lisinopril 10 mg PO DAILY 4. Eplerenone 25 mg PO DAILY 5. Eliquis (apixaban) 2.5 mg oral BID 6. Acetaminophen 500 mg PO Frequency is Unknown 7. Furosemide 20 mg PO DAILY 8. ProAir HFA (albuterol sulfate) 108 mcg inhalation prn 9. Fluticasone Propionate 110mcg 1 PUFF IH BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS ================= Acute on chronic heart failure with reduced ejection fraction Exacerbation Dyspnea Atrial Fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___. You were admitted because you had extra fluid in your body related to your heart disease. We gave you medicines through your IV to take that fluid off. It is very important that you take all of your medicines as prescribed and go to all of your follow up appointments. 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. Acetaminophen 650 mg PO Q6H:PRN pain 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO QPM 4. Docusate Sodium 100 mg PO BID please hold for loose stool 5. Finasteride 5 mg PO DAILY 6. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 7. Glucose Gel 15 g PO PRN hypoglycemia protocol 8. Insulin SC Sliding Scale Fingerstick q6h Insulin SC Sliding Scale using REG Insulin 9. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain, fever do NOT drink alcohol or drive while taking this medication RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation 11. Senna 8.6 mg PO BID:PRN constipation 12. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Closed loop bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You presented to the ___ on ___ after with abdominal pain and were found to have a small bowel obstruction. You were admitted to the Acute Care Surgery team for further medical care. You were taken to the Operating Room and underwent surgical repair of your bowel obstruction. You tolerated this procedure well and were transferred to the surgical floor for pain control and to await the return of your bowel function. You are now tolerating a regular diet, you pain is well controlled and you have worked with Physical Therapy. The Physical Therapy team evaluated you and recommended that you continue your recovery at a rehabilitation facility. You were also evaluated by the Medicine team given that you reported fainting and losing consciousness at home prior to being admitted to the hospital. There are no acute concerns and it is recommended you follow-up with your outpatient Cardiologist and have an outpatient ECHO. You are now medically cleared to be discharged. Please note the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *Your staples will be removed at your follow-up appointment.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Diazepam 10 mg PO HS 2. Divalproex (EXTended Release) 1500 mg PO DAILY 3. Doxepin HCl 20 mg PO HS 4. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 5. Hydrochlorothiazide 25 mg PO DAILY 6. Ibuprofen 800 mg PO Q8H:PRN arthritis pain 7. Lisinopril 40 mg PO DAILY 8. Lithium Carbonate CR (Eskalith) 900 mg PO DAILY Eskalith CR 9. Lorazepam 1 mg PO DAILY:PRN anxiety 10. lurasidone 80 mg oral DAILY 11. QUEtiapine Fumarate 400 mg PO QAM 12. QUEtiapine Fumarate 800 mg PO QPM 13. Tiotropium Bromide 1 CAP IH DAILY 14. Enoxaparin Sodium 110 mg SC Q12H Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 120 mg/0.8 mL 120 mg SQ Two (2) times a day Disp #*20 Syringe Refills:*0 15. Warfarin 5 mg PO DAILY16 Take as directed by the ___ clinic. RX *warfarin 5 mg 1 tablet(s) by mouth daily as directed by your ___ clinic Disp #*30 Tablet Refills:*0 16. esomeprazole magnesium 40 mg oral DAILY 17. ipratropium-albuterol ___ mcg/actuation inhalation Q6H:PRN sob, wheeze 18. MetFORMIN (Glucophage) 500 mg PO BID 19. Warfarin 2 mg PO DAILY16 Take as directed by the ___ clinic RX *warfarin 2 mg 1 tablet(s) by mouth daily as directed by the anticoagulation clinc Disp #*30 Tablet Refills:*0 20. Outpatient Lab Work Pulmonary Embolism ICD-9 415.19 ___ to be drawn on ___ Discharge Disposition: Home Discharge Diagnosis: Primary: lobar and segmental pulmonary emboli Secondary: hepatitis C, schizophrenia, seizure disorder 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 ___ with worsening chest pain and shortness of breath. You were found to have blood clots in your lungs. You were started on a medication called warfarin to thin your blood and prevent the blood clots from getting worse. It takes at least ___ days for this medication to work properly, so you need to take an additional injectible medication called enoxaparin (Lovenox) until your blood levels of warfarin are appropriate. You will take 5mg of warfarin daily. You need to have your bloodwork done on ___ to see if the warfarin levels become therapeutic. At that time, the ___ clinic nurses ___ advise you if you need to change this regimen. You should not get your tooth pulled for at least the next month while your blood thinner dose is being adjusted. Overall, you will need to take the warfarin for ___ months.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO DAILY 2. Amlodipine 2.5 mg PO DAILY 3. Artificial Tears 2 DROP BOTH EYES Q6H:PRN dry eyes 4. Aspirin 81 mg PO DAILY 5. BuPROPion 100 mg PO BID 6. Cyanocobalamin 1000 mcg PO DAILY 7. Docusate Sodium 100 mg PO BID 8. Gabapentin 100 mg PO BID 9. Lactulose 15 mL PO TID 10. Lorazepam 0.5 mg PO Q6H:PRN anxiety 11. Multivitamins 1 TAB PO DAILY 12. Polyethylene Glycol 17 g PO Q12H 13. Sertraline 100 mg PO DAILY 14. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain 15. Vitamin D 1000 UNIT PO DAILY 16. Bisacodyl 5 mg PO DAILY:PRN constipation 17. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 18. Ondansetron 4 mg PO Q6H:PRN nausea 19. Reguloid (psyllium husk;<br>psyllium seed (sugar)) 0.52 gram oral BID 20. Atorvastatin 10 mg PO QPM RX *atorvastatin 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnoses: Viral gastroenteritis Acute kidney injury Constipation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___. You were admitted with a gastrointestinal infection. You were treated with IV fluids and nausea medications. Your kidney function was decreased on admission, but improved with IV fluids. We are glad you are feeling better. Best wishes, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. Aspirin 81 mg PO DAILY 3. Amlodipine 10 mg PO EVERY ___ AFTER DIALYSIS 4. Nephrocaps 1 CAP PO DAILY 5. Senna 8.6 mg PO QHS:PRN constipation 6. HydrOXYzine 10 mg PO BID:PRN Itch 7. Vitamin D 1000 UNIT PO BID 8. Ciprofloxacin HCl 500 mg PO Q24H 9. Labetalol 200 mg PO TID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Multifactorial hypertensive and toxic/metabolic encephalopathy ESRD on HD 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 for evaluation of a brief episode of unresponsiveness you had during dialysis. We performed extensive evaluation and found that you likely had a urinary tract infection. Your blood pressure was also high, likely as a result of stopping your clonidine patch recently. We think the combination of these factors was the likely cause of your episode, and we treated you with antibiotic medications and high blood pressure medications. You should continue dialysis (___) at rehab, and continue to adjust BP medications in conjunction with the Renal team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clobetasol Propionate 0.05% Ointment 1 Appl TP DAILY RX *clobetasol 0.05 % Apply to erythematous lesions twice a day Refills:*0 2. Enoxaparin Sodium 80 mg SC Q12H 3. FoLIC Acid 5 mg PO DAILY RX *folic acid 1 mg 5 tablet(s) by mouth once a day Disp #*150 Tablet Refills:*0 4. LevoFLOXacin 750 mg PO DAILY RX *levofloxacin 750 mg 1 tablet(s) by mouth once a day Disp #*5 Tablet Refills:*0 5. PredniSONE 60 mg PO DAILY RX *prednisone 20 mg 3 tablet(s) by mouth once a day Disp #*90 Tablet Refills:*0 6. Tacrolimus 0.5 mg PO QPM RX *tacrolimus 0.5 mg 1 capsule(s) by mouth at bedtime Disp #*30 Capsule Refills:*0 7. Tacrolimus 1 mg PO QAM RX *tacrolimus 0.5 mg 2 capsule(s) by mouth QAM Disp #*60 Capsule Refills:*0 8. Acyclovir 400 mg PO Q8H 9. Atovaquone Suspension 1500 mg PO DAILY 10. BuPROPion XL (Once Daily) 450 mg PO DAILY 11. Cyanocobalamin 250 mcg PO DAILY 12. Docusate Sodium 100 mg PO BID:PRN constipation 13. Fluconazole 400 mg PO Q24H 14. FLUoxetine 80 mg PO DAILY 15. LORazepam 0.5-1 mg PO Q8H:PRN anxiety 16. Magnesium Oxide 400 mg PO BID 17. Multivitamins W/minerals 1 TAB PO DAILY 18. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate 19. Prochlorperazine ___ mg PO Q6H:PRN nausea/vomiting 20. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: PRIMARY ======= - Superior vena cava syndrome - Pulmonary emboli SECONDARY ========= - DLBCL s/p allogenic SCT - Neutropenia - Erythema nodosum Discharge Condition: . Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You came into the hospital because you were having flushing of your face and a sensation of fullness in your chest, as well as difficulty breathing. You were found to have a clot in the main vein near your heart and in the vessels in your lungs. You had this clot and your port removed and were started on blood thinners. Additionally, you had low white blood cell counts ***. You had some rashes on your legs that suggest an inflammatory condition. Therefore, you were started on corticosteroids (anti-inflammatory medication). When you leave the hospital you should: - Take all of your medications as prescribed. - Attend all scheduled clinic appointments. - Clean biopsy site with soap, water, then pad dry every day for 2 weeks. Cover with a thin layer of vaseline and perform dressing change every day for 2 weeks. Sutures can be removed on ___. It was a pleasure taking care of you, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q6H:PRN pain do not exceed 4000 mg in 24 hours RX *acetaminophen [Acetaminophen Extra Strength] 500 mg ___ tablet(s) by mouth every 6 hours Disp #*40 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID take while using oxycodone for pain RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*40 Capsule Refills:*0 3. Ibuprofen 400 mg PO Q8H:PRN Pain RX *ibuprofen 400 mg 1 tablet(s) by mouth every 8 hours Disp #*20 Tablet Refills:*0 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain do not drive while taking, use with a stool softener RX *oxycodone [Oxecta] 5 mg ___ tablet(s) by mouth every 4 hours Disp #*35 Tablet Refills:*0 5. LaMOTrigine 200 mg PO QHS 6. Levothyroxine Sodium 100 mcg PO DAILY 7. Lithium Carbonate SR (Lithobid) 900 mg PO QHS Lithobid SR Discharge Disposition: Home Discharge Diagnosis: Mesosalpinx inclusion cyst Final pathology pending Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, . You were admitted to the gynecologic oncology service after undergoing the procedures listed below. You have recovered well after your operation, and the team feels that you are safe to be discharged home. Please follow these instructions: . * Take your medications as prescribed. * Do not drive while taking narcotics. * Do not combine narcotic and sedative medications or alcohol. * Do not take more than 4000mg acetaminophen (APAP) in 24 hrs. * No strenuous activity until your post-op appointment. * Nothing in the vagina (no tampons, no douching, no sex) for 12 weeks. * No heavy lifting of objects >10 lbs for 6 weeks. * You may eat a regular diet. * It is safe to walk up stairs. . Incision care: * You may shower and allow soapy water to run over incision; no scrubbing of incision. No bath tubs for 6 weeks. * If you have steri-strips, leave them on. If they are still on after ___ days from surgery, you may remove them. . To reach medical records to get the records from this hospitalization sent to your doctor at home, call ___. . Call your doctor at ___ for: * fever > 100.4 * severe abdominal pain * difficulty urinating * vaginal bleeding requiring >1 pad/hr * abnormal vaginal discharge * redness or drainage from incision * nausea/vomiting where you are unable to keep down fluids/food or your medication * chest pain or difficulty breathing * onset of any concerning symptoms</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 200 mg PO Q12H Duration: 2 Doses RX *cefpodoxime 200 mg 1 tablet(s) by mouth twice a day Disp #*2 Tablet Refills:*0 2. OSELTAMivir 75 mg PO BID Duration: 9 Doses RX *oseltamivir [Tamiflu] 75 mg 1 capsule(s) by mouth twice a day Disp #*2 Capsule Refills:*0 3. Acetaminophen 1000 mg PO Q8H 4. Aspirin 81 mg PO DAILY 5. Carvedilol 6.25 mg PO BID 6. Citalopram 40 mg PO DAILY 7. Docusate Sodium 100 mg PO BID 8. dulaglutide 1.5 mg/0.5 mL subcutaneous q week 9. Ferrous Sulfate 325 mg PO BID 10. Furosemide 40 mg PO BID 11. linaGLIPtin 5 mg oral daily 12. Lisinopril 40 mg PO DAILY 13. MetFORMIN (Glucophage) 1000 mg PO BID 14. Omeprazole 40 mg PO DAILY 15. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Third Line 16. Pregabalin 200 mg PO BID 17. Rosuvastatin Calcium 20 mg PO QPM 18. Tamsulosin 0.4 mg PO QHS 19. TraZODone 100 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: #Pneumonia #Influenza #Hypoxia #Diarrhea #Nausea #HFrEF #Elevated Troponin #Elevated Pro-BNP #Acute kidney injury #Insomnia #DMII #Microscopic Hematuria 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 admitted to the hospital? =================================== - You were admitted because you had 2 days of cough, fevers/chills, malaise, worsening fatigue as well as chest pain and worsening shortness of breath. What happened while I was in the hospital? ========================================== - We did blood work and imaging to figure out what might be causing this and found out you had the flu as well as a lung infection. - You were initially admitted to the intensive care unit for close monitoring in the setting of infection but improved and were on the regular hospital floor. - We started you on antibiotic and antiviral and monitored your heart. - We manged your lack of sleep and nausea with medication. What should I do after leaving the hospital? ============================================ - Please take your medications as listed in discharge summary and follow up at the listed appointments. Thank you for allowing us to be involved in your care, we wish you all the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth every 6 hours as needed Disp #*10 Tablet Refills:*0 2. Acetaminophen 500 mg PO Q6H:PRN pain 3. Amitriptyline 10 mg PO QHS 4. Omeprazole 20 mg PO DAILY 5. Pravastatin 40 mg PO QPM 6. Venofer (iron sucrose) 200 mg/10 mL iron INJECTION Q4WEEK 7. Lidocaine 5% Patch 1 PTCH TD QPM knee pain 8. Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN stomach discomfort Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: Congestive Heart Failure Polyvalvular Heart Disease Acute on Chronic Kidney Disease Chronic Anemia Mechanical Left Knee Pain Neck Muscle Stiffness SECONDARY DIAGNOSES: Hypertension Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. You were admitted for shortness of breath. We believe your shortness of breath was due to your heart not working as efficiently as it used to. This caused fluid to back up into your lungs, making it difficult for you to breathe. We gave you a water pill to help remove this extra fluid in your lungs. However, because your kidney function worsened, we stopped giving you the water pill. Your breathing improved and you did not need any extra oxygen by the time you were ready to leave the hospital. We put in a catheter to help empty your bladder and monitor your urine output. You developed a fever on a few occasions. Because of your loose stools, we thought your fevers were due to a infection in your bowels but we did not find one. We initially treated you with antibiotics but stopped them since we did not find an infection. Your left knee pain and neck pain improved with pain medications and were not concerning for any infection. Due to your chronic anemia, we gave you two units of blood. Once your kidney function returned to normal and your left knee and neck pain improved, we discharged you to rehab. It will be important to see your primary care doctor within ___ weeks of leaving the hospital. You should also ask your primary care doctor about seeing a cardiologist to better manage your heart conditions. Please remember to weigh yourself at home everyday and let your primary care doctor know if you have unexpected weight gain. Thank you for letting us take part in your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CeftriaXONE 2 gm IV Q 12H 2. Tizanidine 4 mg PO TID 3. traZODONE 50 mg PO HS:PRN insomnia 4. LeVETiracetam 1000 mg PO BID 5. Nicotine Patch 14 mg TD DAILY 6. Ibuprofen 600 mg PO Q6H:PRN pain 7. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain if not responding to ibuprofen or tizanidine Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1) Streptococcus pneumoniae bacterial meningitis, 2) Status epilepticus Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neuro Exam: MS notable for disinhibition, Mild UMN weakness in UE and ___ L > R. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ on ___ after you developed fever and headache at home and subsequently developed seizures. You were found to have bacterial meningitis, an infection in the membranes surrounding your brain. You were admitted to our ICU for close monitoring and improved with antibiotics and anti-seizure medications. We made the following changes to your medications: Keprra 1000 mg twice daily to continue for 6 months. Trazadone was also added as needed for sleep. You may not need this outside of the hospital. You have been treated for back, leg pain and headache with muscle relaxants (tizanidine) and ibuprofen. You were given tylenol, but had an increase in your liver function tests, therefore you should avoid taking tylenol for the time being. Instructions for Rehab: 1. Please treat headache, back and leg pain with tizanidine 4 mg three times daily as needed or ibuprofen 600 mg every 6 hours as needed. 2. Please avoid tylenol. 3. Reserve oxycodone for severe pain only and avoid if possible. 4. Please continue Ceftriaxone 2 grams twice daily through ___, to complete a 14 day course. The PICC line may be pulled following the last dose of ceftriaxone.</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 #*25 Tablet Refills:*0 2. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp #*5 Tablet Refills:*0 3. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram/dose 17 g by mouth once a day Refills:*0 4. Acyclovir 400 mg PO Q12H 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. MetFORMIN (Glucophage) 500 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Left incarcerated inguinal hernia 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. CT scan revealed a left inguinal hernia. You were taken to the operating room and had a left inguinal hernia repair with mesh. 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 Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Diazepam 5 mg PO Q8H:PRN muslce spasm 3. Docusate Sodium 100 mg PO BID 4. Gabapentin 300 mg PO TID 5. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Moderate 6. Senna 8.6 mg PO BID:PRN constiaption 7. Allopurinol ___ mg PO DAILY 8. Famotidine 20 mg PO BID Discharge Disposition: Home Discharge Diagnosis: L1 superior wedge fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Activity - Please wear your TLSO brace at all times when at edge of bed or out of bed, Please ___ your brace at your bedside. - Ok to take TLSO brace off when lying in bed - Please shower while wearing your TLSO brace - 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. Pain Control · 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, 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. Enoxaparin Sodium 110 mg SC Q12H Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 100 mg/mL ___very twelve (12) hours Disp #*60 Syringe Refills:*5 2. Outpatient Physical Therapy please evaluate and treat 3. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB 4. Aspirin 81 mg PO DAILY 5. Docusate Sodium 100 mg PO BID:PRN constipation 6. exemestane 25 mg Oral daily 7. Fluticasone Propionate NASAL 2 SPRY NU DAILY 8. Gabapentin 600 mg PO TID 9. Guaifenesin-CODEINE Phosphate 5 mL PO Q8H:PRN cough 10. Lorazepam 2 mg PO QHS:PRN insomnia 11. Omeprazole 20 mg PO DAILY 12. Ranitidine 300 mg PO QHS 13. Senna 8.6 mg PO BID:PRN constipation 14. Hydrocodone-Acetaminophen (5mg-325mg) ___ TAB PO Q6H:PRN pain RX *hydrocodone-acetaminophen 5 mg-325 mg ___ tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 15. Ibuprofen 400 mg PO Q8H:PRN knee pain Duration: 3 Days Please use sparingly 16. Symbicort (budesonide-formoterol) 80-4.5 mcg/actuation inhalation BID Discharge Disposition: Home Discharge Diagnosis: Acute pulmonary embolism Left lateral meniscus tear Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>It was a pleasure looking after you, Ms. ___. As you know, you were admitted with shortness of breath and was found to have an acute pulmonary embolus (clot in the lung). You were treated with lovenox to help thin the blood and prevent progression of old clot or development of new clot. To identify a reason for why this clot developed, a lower extremity ultrasound and abdominal CT scan was performed. It did not show a clot in the legs - moreover, there was no sign of recurrence of cancer which would potentially increase the risk of developing a pulmonary embolus. You did not require oxygen during this hospitalization. You also had left knee pain. MRI of the knee revealed a tear in the lateral meniscus - and this will be managed conservatively (physical therapy). Please continue with home physical therapy. You can continue to take ibuprofen as needed for pain, but please use this sparingly as this can cause stomach ulcers which would put you at risk of bleeding while you are on Lovenox. You can also take vicodin as needed for pain.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB RX *albuterol sulfate 2.5 mg/3 mL (0.083 %) 1 neb IH every six (6) hours Disp #*1 Unit Refills:*1 2. Citalopram 40 mg PO QAM 3. Docusate Sodium 100 mg PO BID:PRN constipation 4. Ferrous Sulfate 325 mg PO QAM 5. Gabapentin 1200 mg PO TID 6. HydrOXYzine 25 mg PO Q6H:PRN itch 7. Glargine 50 Units Bedtime 8. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 9. Lisinopril 30 mg PO DAILY 10. Multivitamins 1 TAB PO DAILY 11. Omeprazole 20 mg PO BID 12. Polyethylene Glycol 17 g PO DAILY:PRN constipation 13. Promethazine 25 mg PO BID:PRN nausea 14. RISperidone 1 mg PO QAM 15. RISperidone 4 mg PO HS 16. Rosuvastatin Calcium 10 mg PO HS 17. Tizanidine 4 mg PO TID 18. TraZODone 150 mg PO HS:PRN insomnia 19. Azithromycin 500 mg PO Q24H Duration: 3 Days RX *azithromycin 500 mg 1 tablet(s) by mouth Q24H Disp #*3 Tablet Refills:*0 20. PredniSONE 60 mg PO DAILY Duration: 3 Days RX *prednisone 20 mg 2 tablet(s) by mouth daily Disp #*6 Tablet Refills:*0 21. ammonium lactate *NF* 12 % Topical BID 22. Clindamycin 1 Appl TP BID 23. Fluticasone Propionate 110mcg 2 PUFF IH BID 24. glimepiride *NF* 2 mg Oral QAM 25. MetFORMIN (Glucophage) 1000 mg PO BID 26. Victoza 2-Pak *NF* (liraglutide) 1.2 mg Subcutaneous QPM 27. Nebulizer Please provide patient with 1 nebulizer. 28. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB Only use if albuterol nebulizer is not working. RX *albuterol 2 puffs IH every six (6) hours Disp #*1 Inhaler Refills:*1 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: COPD exacerbation Secondary: Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you while you were a patient at ___. You came in because of shortness of breath and cough. We performed a CT scan of your lungs to make sure there was no pneumonia or blood clot. We didn't find anything concerning on the CT scan. This suggests that your symptoms were due to temporary worsening of your COPD. We treated you with steroids, antibiotics, and breathing treatments which significantly improved your symptoms. At home, please remember to take your fluticasone inhaler twice a day. You are being discharged with a prescription for more albuterol which you should use when you are short of breath. In terms of follow-up, please be sure to keep your appointment with Dr. ___ on ___. We are working on getting you an appointment in the Pulmonary Clinic. It is very important that you follow-up with Dr. ___ in the next few weeks about your breathing.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H 2. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO Q4H:PRN indigestion 3. Artificial Tears 1 DROP BOTH EYES QAM 4. Aspirin 162 mg PO DAILY 5. Cyanocobalamin 500 mcg PO DAILY 6. FoLIC Acid 1 mg PO DAILY 7. Furosemide 20 mg PO DAILY 8. Guaifenesin 15 mL PO Q4H:PRN cough 9. Levothyroxine Sodium 25 mcg PO DAILY 10. Loratadine 10 mg PO DAILY:PRN itch 11. Magnesium Oxide 400 mg PO DAILY 12. Milk of Magnesia 30 mL PO Q6H:PRN constipation 13. Mirtazapine 37.5 mg PO HS 14. OLANZapine 2.5 mg PO DAILY:PRN agitation 15. OLANZapine (Disintegrating Tablet) 5 mg PO DAILY 16. Omeprazole 20 mg PO DAILY 17. Oxcarbazepine 300 mg PO BID 18. Senna 17.2 mg PO HS 19. Vitamin D 400 UNIT PO DAILY 20. Nitroglycerin SL 0.3 mg SL PRN PAIN Q5MIN chest pain 21. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 2 Doses RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*2 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Urinary tract infection Secondary: Dementia Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were transferred to ___ from ___ Hospital after you fell at your nursing facility. There was concern that you had bleeding inside your brain, for which you were worked up with a CT scan. The scan showed no acute bleeding. You were however found to have a urinary tract infection for which you were treated with antibiotics.</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 the ___ for shortness of breath. You were treated for fluid overload and underwent a cardiac catheterization which you tolerated well. You were also seen by the lung doctors who ___ and ___ continue to follow you as an outpatient. You will be visited at home by nurses who will come to draw blood to monitor your comadin levels, and they will ensure that you received your lovenox injections as prescribed until the shots are no longer needed. Weigh yourself every morning, call your primary care doctor if your weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 2. Docusate Sodium 100 mg PO BID:PRN constipation RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. Nicotine Patch 21 mg TD DAILY RX *nicotine 21 mg/24 hour 1 patch daily Disp #*30 Patch Refills:*0 4. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ capsule(s) by mouth every four (4) hours Disp #*30 Capsule Refills:*0 5. Alendronate Sodium 70 mg PO QMON 6. ARIPiprazole 15 mg PO QHS 7. Atorvastatin 20 mg PO QPM 8. Furosemide 20 mg PO DAILY:PRN swelling 9. HumaLOG (insulin lispro) 100 unit/mL SC 20 units TID 10. insulin glargine 100 unit/mL subcutaneous 15 units BID 11. LamoTRIgine 100 mg PO BID 12. Levothyroxine Sodium 137 mcg PO DAILY 13. Lisinopril 2.5 mg PO DAILY 14. LORazepam 0.5 mg PO BID 15. TraZODone 100 mg PO QHS 16. Zolpidem Tartrate 5 mg PO QHS:PRN insomnia Discharge Disposition: Home With Service Facility: ___ 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 admitted to the Acute Care Surgery Service on ___ with a small bowel obstruction. You had an exploratory laparotomy with lysis of adhesions. You are have recovered in the hospital, are now tolerating a regular diet, and ready to be 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. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Bisacodyl 10 mg PR HS:PRN constipation 4. Calcium Acetate 1334 mg PO TID W/MEALS 5. Epoetin Alfa 10,000 UNIT IV 3X/WEEK (___) 6. Gabapentin 300 mg PO Q48H 7. Fluoxetine 10 mg PO DAILY 8. Milk of Magnesia 30 mL PO Q6H:PRN constipation 9. Nephrocaps 1 CAP PO DAILY 10. Omeprazole 20 mg PO BID 11. OxycoDONE (Immediate Release) 10 mg PO Q8H:PRN pain 12. Benzonatate 100 mg PO TID cough RX *benzonatate 100 mg 1 capsule(s) by mouth three times a day Disp #*21 Capsule Refills:*0 13. Guaifenesin ___ mL PO Q6H:PRN cough 14. Albuterol-Ipratropium 2 PUFF IH Q6H:PRN shortness of breath 15. Acetaminophen 325-650 mg PO Q6H:PRN pain 16. DiphenhydrAMINE 25 mg PO BID:PRN itch Discharge Disposition: Home Discharge Diagnosis: Cough Viral bronchitis End stage renal disease Type 2 diabetes mellitus Discharge Condition: Mental Status: Clear and coherent. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital with cough, muscle pains and low grade fevers. We gave you cough medications and your symptoms improved. These symptoms are likely due to a virus and should continue to improve. You do not need antibiotics at this time. At home, you can use the following medications to manage your cough: -Tessalon pearls three times daily -Guaifenesin cough syrup as needed -You can also use your Combivent inhaler (previously prescribed by your primary care doctor) if you feel short of breath or wheezy It was a pleasure taking care of you during your hospitalization and we wish you a speedy recovery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*0* 3. vancomycin 125 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 12 days. Disp:*48 Capsule(s)* Refills:*0* 4. nifedipine 10 mg Capsule Sig: One (1) Capsule PO Q8H (every 8 hours). Disp:*90 Capsule(s)* Refills:*0* 5. ondansetron HCl 4 mg Tablet Sig: One (1) Tablet PO three times a day as needed for nausea. Disp:*10 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Clostridium difficile colitis Rectal bleeding Hemorrhoids Acute on chronic renal failure Anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted with bleeding from your rectum. During your hospitalization, we checked your blood counts multiple times found them to be low, so we gave you a blood transfusion. A GI consultation felt the bleeding was related to hemorrhoids. Furthermore, we found that you were suffering from an infection in your intestines called C. Diff. We are treating you with oral antibiotics for this infection. It is very important that you complete the course of antibiotics in order to eliminate the infection. Additionally, the ulcers on your finger tips were evaluated by our rheumatology department, and it was felt that the cause of the painful ulcers was related to a chemotherapy drug you have been receiving called gemcitabine. One of your blood tests, the anti-nuclear antibody, was positive and may provide additional information as to the cause of these ulcers. We have set you up with a rheumatology appointment for follow-up, and we have started you on a medication which may diminish these effects, nifedipine. Finally, we noted that your kidney function was abnormal. A renal ultrasound was done, which only showed two simple cysts, which do not explain the cause of the kidney dysfunction. We recommend that you see a nephrologist as an outpatient and have made an appointment for you with Dr. ___ below). We also recommend you see a rheumatologist and have made this appointment as well. Please note the following changes to your medications: Start baby aspirin (for your finger ulcers) Start Nifedipine (for your finger ulcers) Start Vancomycin (for your C diff infection) - for 12 more days Start Zofran for Nausea (as needed)</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q8H:PRN Pain - Mild 2. Albuterol Inhaler ___ PUFF IH Q6H:PRN SOB/Wheeze 3. amLODIPine 10 mg PO DAILY 4. Calcitriol 0.25 mcg PO 3X/WEEK (___) 5. Calcium Carbonate 750 mg PO TID 6. Furosemide 20 mg PO EVERY OTHER DAY 7. imiglucerase 3200 units injection EVERY 2 WEEKS 8. Labetalol 200 mg PO TID 9. Losartan Potassium 100 mg PO DAILY 10. Mycophenolate Mofetil 250 mg PO BID 11. PredniSONE 5 mg PO DAILY 12. raloxifene 60 mg oral DAILY 13. Sertraline 125 mg PO DAILY 14. Simvastatin 40 mg PO QPM 15. Sodium Bicarbonate 650 mg PO BID 16. Tacrolimus 1 mg PO Q12H 17. Vancomycin Oral Liquid ___ mg PO Q6H RX *vancomycin 125 mg 1 capsule(s) by mouth four times a day Disp #*12 Capsule Refills:*0 18. Vitamin D 1000 UNIT PO 4X/WEEK (___) 19. Zolpidem Tartrate 5 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Acute Issues: #Diarrhea Chronic Issues: #History of recurrent C. diff #Hypertension #Normocytic anemia #S/P LLRT ___ #Depression #Insomnia #Mineral metabolism 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. ___, WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted because you were fatigued and had abdominal pain as well as diarrhea WHAT WAS DONE WHILE I WAS IN THE HOSPITAL? - We ran tests which showed you did not have an infection. WHAT DO I NEED TO DO AFTER DISCHARGE? - Please have close follow-up with your transplant doctors - Please stop taking any form of laxatives, and discuss this with your PCP. Thank you for choosing ___ for your care. We wish you luck for the future.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Cyanocobalamin 50 mcg PO DAILY 3. Duloxetine 60 mg PO DAILY 4. FoLIC Acid 1 mg PO DAILY 5. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 6. Metoprolol Succinate XL 25 mg PO DAILY 7. Multivitamins 1 TAB PO DAILY 8. RISperidone 1 mg PO QHS 9. Simvastatin 40 mg PO QPM 10. Thiamine 100 mg PO DAILY 11. Vitamin D 1000 UNIT PO DAILY 12. MetFORMIN XR (Glucophage XR) 1000 mg PO BID 13. Lorazepam 0.5 mg PO BID:PRN anxiety 14. GlipiZIDE XL 2.5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Depression, Confusion/Altered Mental Status, s/p mechanical fall Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, Thank you for allowing us to participate in your care at ___. You were admitted to the hospital because of your fall and because of confusion. We evaluated you with a CT scan of your head and xrays of your chest and spine which showed no acute changes. We also evaluated your electrolytes and your blood counts which were normal. We also checked your B12 level and your thyroid function. The results of these tests are still pending. We also evaluated you with urine culture. These results are still pending as well. We believe your fall and your confusion may have happened because of the medications you are taking. We stopped your mirtazapine and your busiprone and we decreased your duloxetine. After discharge, you should follow up with your primary care physician for further management of your medical conditions. You should follow up with your psychiatrist for further management of your psychiatric medications and for further management of your confusion. We wish you the best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Simethicone 40-80 mg PO QID:PRN gas pan 2. Vitamin D 1000 UNIT PO DAILY 3. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 4. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB 5. Escitalopram Oxalate 20 mg PO DAILY 6. Famotidine 20 mg PO BID 7. Fluticasone Propionate NASAL 1 SPRY NU DAILY 8. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 9. ketotifen fumarate 0.025 % (0.035 %) ophthalmic (eye) Q12H:PRN itchy eyes 10. Loratadine 10 mg PO DAILY 11. LORazepam 0.5 mg PO QHS:PRN insomnia 12. MethylPHENIDATE (Ritalin) 5 mg PO BID 13. Montelukast 10 mg PO DAILY 14. Ondansetron ODT 8 mg PO Q8H:PRN Nausea/Vomiting - First Line 15. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Moderate 16. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 17. Prochlorperazine 10 mg PO Q6H:PRN Nausea/Vomiting - Second Line 18. Rivaroxaban 20 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Partial SBO, loculated ascites Secondary: Metastatic mixed carcinosarcoma/serous endometrial cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ because you were having abdominal pain, adn you were found to have a partial blockage and increasing fluid. You had a procedure known as a paracentesis to remove the excess fluid in your abdomen. You initially needed an tube in your nose to help relieve the blockage in your bowels. This was removed and you tolerated eating solid food and then had bowel movements. If you develop this issue in the future, you should discuss with your palliative care doctors having something called a venting g-tube placed to help relieve the pressure. Please follow up with all appointments and take all medications as prescribed. If you develop any of the danger symptoms below, please seek medical evaluation immediately. We wish you the best. Sincerely, Your care team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Azithromycin 250 mg PO Q24H continue until you ___ with your pulmonologist 2. GuaiFENesin ER 600 mg PO Q12H 3. ___ Neb 1 NEB NEB Q6H:PRN wheezing take PRN for wheezing or shortness of breath 4. Nicotine Patch 14 mg TD DAILY 5. PNEUMOcoccal ___ polysaccharide vaccine 0.5 ml IM NOW X1 6. PredniSONE 10 mg PO DAILY Duration: 3 Days 7. Torsemide 10 mg PO DAILY 8. Aspirin 81 mg PO DAILY 9. Benztropine Mesylate 0.5 mg PO DAILY 10. ClonazePAM 1 mg PO QHS 11. ClonazePAM 0.25 mg PO DAILY 2PM 12. ClonazePAM 0.5 mg PO DAILY 13. Docusate Sodium 100 mg PO DAILY 14. Fluticasone Propionate NASAL 1 SPRY NU DAILY 15. Levothyroxine Sodium 50 mcg PO DAILY 8pm 16. Linzess (linaclotide) 290 mcg oral daily 17. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN CP for up to 3 doses 18. Omeprazole 20 mg PO BID WIHT LUNCH AND DINNER 19. Oxybutynin 5 mg PO BID 20. RisperiDONE 1 mg PO DAILY 21. Senna 8.6 mg PO QHS:PRN constipation 22. Sertraline 150 mg PO DAILY 23. Simvastatin 20 mg PO QPM 24. Symbicort ___ mcg/actuation inhalation BID 25. Systane Gel (artificial tears(hypromellose);<br>peg ___ glycol) ___ % ophthalmic TID 26. TraMADol 50 mg PO TID 27. Warfarin 3 mg PO DAILY16 28. HELD- Loxapine Succinate 30 mg PO DAILY This medication was held. Do not restart Loxapine Succinate until you discuss with PCP 29. HELD- Nitroglycerin Patch 0.1 mg/hr TD Q24H This medication was held. Do not restart Nitroglycerin Patch until discuss with PCP - soft BPs on discharge Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Pneumonia COPD exacerbation Right heart failure, RV Strain 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. ___, It was a pleasure taking care of you during your recent admission to ___. You were admitted with shortness of breath which was likely due to a combination of pneumonia, COPD exacerbation and fluid in your lungs. You were treated with Antibiotics, steroids and diuretics and you improved. You were started on an oral diuretic which you should continue on discharge. It is important that you follow up with your cardiologist and pulmonologist after discharge We wish you the best, Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild Reason for PRN duplicate override: Alternating agents for similar severity Do not exceed 4000 mg daily. 2. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*20 Tablet Refills:*0 3. MetroNIDAZOLE 500 mg PO Q8H Do not drink alcohol while taking this medication. RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: acute appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ with acute appendicitis. You were managed non-operatively with IV antibiotics and bowel rest. You have recovered well and are now ready for discharge home. Please follow the instructions below to ensure a speedy recovery. ACTIVITY: -no restrictions -resume your normal activity as tolerated DIET: -no restrictions -resume your normal diet as tolerated MEDICATIONS: -you may continue to take Tylenol as needed for abdominal pain (do not take more than 4000 mg daily) -You are being discharged with a prescription for antibiotics (Ciprofloxacin and Flagyl). You should take these for 10 days. It is important that you finish taking these as prescribed. FOLLOW-UP: -Please follow up in the Acute Care Surgery clinic at the appointment listed below. -At follow-up appointment, can discuss scheduling of laparoscopic appendectomy 6 weeks from date of diagnosis. Contact your surgeon or present to the ED if you experience any of the following: - 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 Thank you for allowing us to participate in your care. Sincerely, Your ___ Surgery Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 2.5 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Gabapentin 600 mg PO HS 4. Levothyroxine Sodium 150 mcg PO DAILY 5. Amiodarone 200 mg PO BID 6. Digoxin 0.125 mg PO DAILY 7. Metoprolol Tartrate 12.5 mg PO TID 8. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*40 Tablet Refills:*0 9. Acetaminophen 325 mg PO Q8H:PRN pain 10. acidophilus-B.bifidum-B.longum (L.acidoph & ___ acidophilus) 150 mg (3 billion cell) oral BID 11. Aspirin 81 mg PO DAILY 12. Calcium Carbonate 500 mg PO DAILY 13. Enoxaparin Sodium 40 mg SC Q12H Start: Today - ___, First Dose: Next Routine Administration Time 14. Guaifenesin ER 600 mg PO Q12H 15. Guaifenesin-CODEINE Phosphate 5 mL PO HS:PRN cough 16. LOPERamide 2 mg PO QID:PRN diarrhea 17. Mesalamine (Rectal) ___ID 18. Multivitamins 1 TAB PO DAILY 19. Omeprazole 20 mg PO BID 20. saccharomyces boulardii 250 mg oral BID 21. Tolterodine 4 mg PO DAILY 22. Vitamin D 1000 UNIT PO DAILY 23. Amoxicillin-Clavulanic Acid ___ mg PO Q8H Duration: 5 Days Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, you were admitted to ___ with cholecystitis. You underwent percutaneous cholecystostomy tube placement. Please, follow up these instructions -the drain will stain ___ weeks. Please, follow these drain care instruction General Drain Care: *Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *If the drain is connected to a collection container, please note color, consistency, and amount of fluid in the drain. Call the doctor, ___, or ___ nurse if the amount increases significantly or changes in character. Be sure to empty the drain frequently. Record the output, if instructed to do so. *Wash the area gently with warm, soapy water. *Keep the insertion site clean and dry otherwise. *Avoid swimming, baths, hot tubs; do not submerge yourself in water. *Make sure to keep the drain attached securely to your body to prevent pulling or dislocation. Please, follow these general instructions Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications , unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN pain Discharge Disposition: Home Discharge Diagnosis: Appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for what was likely early appendicitis. You infection has cleared and you are cleared to be discharged home Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You were admitted to the hospital with a flare of your ulcerative colitis. This improved with use of two doses of infliximab. you are also on steroids at discharge with prednisone. If you have new GI symptoms you can contact the GI on call ___ such as new abdominal pain, fever, chills, bloody stools, worse diarrhea. We wish you the best in your recovery, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth once a day Disp #*7 Capsule Refills:*0 2. ALPRAZolam 0.25 mg PO TID:PRN anxiety 3. dimethyl fumarate 120 mg (14)- 240 mg (46) oral BID 4. Ketoconazole 2% 1 Appl TP BID 5. Metoclopramide 5 mg PO BID:PRN with tecfidara 6. norgestimate-ethinyl estradiol 0.18/0.215/0.25 mg-25 mcg oral DAILY 7. Vitamin D 5000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Relapsing Remitting Multiple sclerosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You came into the hospital because you were having double vision, dizziness, and sensory changes. You are admitted to the hospital to have a lumbar puncture and additional imaging. You received 2 doses of steroids. When you leave the hospital you should: - Take all of your medications as prescribed. You should complete your steroid course as an outpatient. - Attend all scheduled clinic appointments. It was a pleasure taking care of you, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you in the hospital. You were admitted for evaluation of shortness of breath and had a catheterization - you were found to have a blockage in of the arteries in your heart. You had a stent placed to open the blockage. You were started on plavix. It is VERY important that you DO NOT stop this medication unless you are told do so by your cardiologist. Please be sure to consult your cardiologist before stopping plavix. This helped your breathing. You were also given lasix to get extra fluid off of you and help your breathing. Your oxygen levels improved. You were also found to have a urinary tract infection and you were given antibiotics. You worked with physical therapy who felt that you would benefit from rehab to improve your strength. Your kidney function worsened a little bit while you were in the hospital. Please try to drink fluids at home to keep hydrated (no more than 1.5 liters) Please weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO QPM 2. GlipiZIDE XL 5 mg PO QAM 3. GlipiZIDE XL 10 mg PO QHS 4. Metoprolol Tartrate 50 mg PO BID 5. Acetaminophen 1000 mg PO Q8H 6. Docusate Sodium 100 mg PO BID please hold for loose stool 7. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 8. Glucose Gel 15 g PO PRN hypoglycemia protocol 9. Heparin 5000 UNIT SC BID 10. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain do NOT drink alcohol or drive while taking this medication RX *hydromorphone 2 mg ___ tablet(s) by mouth Q3H Disp #*30 Tablet Refills:*0 11. Insulin SC Sliding Scale Fingerstick Q6H Insulin SC Sliding Scale using HUM Insulin 12. MetFORMIN XR (Glucophage XR) 1000 mg PO BID 13. Senna 8.6 mg PO BID please hold for loose stool 14. Timolol Maleate 0.5% 1 DROP BOTH EYES BID 15. MetFORMIN (Glucophage) 1000 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: L rib fx ___, sternal fx, T8 vertebral body fracture, R lateral malleolus fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital after suffering a motor vehicle accident. You were found to have multiple left rib fractures, a sternal fracture, T8 vertebral body (spine) fracture and a right lateral malleolus (ankle) fracture. You were admitted to the Trauma/Acute Care Surgery service and transferred to the Intensive Care Unit (ICU) to help manage your pain and monitor your breathing. When medically stable, you were transferred to the surgical floor. You worked with the Physical Therapy team who recommended your discharge to a rehabilitation center to continue your recovery. You are now medically cleared for discharge. Please note the following discharge instructions: Rib Fractures: * Your injury caused left-sided rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. * You should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. If the pain medication is too sedating take half the dose and notify your physician. * Pneumonia is a complication of rib fractures. In order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. This will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. * You will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. * Symptomatic relief with ice packs or heating pads for short periods may ease the pain. * Narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. * Do NOT smoke * If your doctor allows, non-steroidal ___ drugs are very effective in controlling pain (ie, Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. * Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs (crepitus). Spine Injury Instructions: Please wear your TLSO brace while out of bed Instructions for your Right Ankle Fracture: Please wear air cast boot on right foot when out of bed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN pain 2. Docusate Sodium 100 mg PO DAILY 3. Polyethylene Glycol 17 g PO DAILY:PRN constipation 4. Timolol Maleate 0.5% 1 DROP BOTH EYES BID 5. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600-800 mg-IU oral DAILY 6. Vitamin D3 (cholecalciferol (vitamin D3)) 2,000 unit oral DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: - Alzheimer's dementia - Delirium and lethargy due to acute UTI - Urinary tract infection Secondary: - Carotid artery stenosis NOS - Vertebral compression Fractures - Glaucoma - Vaginal Prolapse Discharge Condition: Somnolent, minimally responsive. Withdraws and says 'ouch' to pain. Mental Status: Confused - always. Level of Consciousness: Lethargic and not arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure participating in your care during your recent stay at ___. You were hospitalized for lethargy after a fall. CT and MRI scans of your ___ were taken to look at the structure of your ___ and showed ___ atrophy with enlarged ventricles but no acute abnormalities. EEG (electroencephalogram) testing was performed to look for evidence of seizures and showed diffuse encephalopathy; your clinical picture is not consistent with seizures, and you will not be on anti-seizure medication. You had a lumbar puncture to evaluate for normal pressure hydrocephalus, and the procedure was not consistent with that diagnosis. Your final diagnosis is Alzheimer's Disease, and your increased lethargy is due to UTI, which has been treated with antibiotics. It will take time to recover your mental status from this infection, and you may only experience a partial recovery. You were also evaluated by physical therapy who felt that it would be best if you were to go to rehabilitation to help build up your strength again. Once again, thank you for the opportunity to participate in your care. We wish you the best! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Citalopram 20 mg PO DAILY 3. Omeprazole 20 mg PO DAILY 4. Simvastatin 20 mg PO DAILY 5. Amlodipine 5 mg PO DAILY 6. Lisinopril 20 mg PO DAILY 7. Metoprolol Succinate XL 100 mg PO DAILY RX *metoprolol succinate [Toprol XL] 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. Amoxicillin 500 mg PO Q8H Duration: 10 Days RX *amoxicillin 500 mg 1 tablet(s) by mouth three times daily Disp #*29 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: - Acute complicated cystitis - Sepsis Secondary diagnoses: - Atrial fibrillation with rapid ventricular response - Metastatic bladder carcinoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, ___ was a a privilege to care for you here at ___. You were admitted to ___ due to fevers. Your evaluation revealed concern for a bladder infection. You were treated with IV antibiotics (vancomycin) for an enterococcal UTI and then were transitioned to oral amoxicillin to complete for 10-days. Your fevers resolved at discharge. Please keep all your doctors' appointments. We wish you all the best!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aripiprazole (ARIPiprazole) 30 mg ORAL QHS 2. Aspirin 81 mg PO DAILY 3. Glargine 46 Units Breakfast Glargine 6 Units Bedtime Humalog 12 Units Breakfast Humalog 10 Units Lunch Humalog 15 Units Dinner 4. LaMOTrigine (lamoTRIgine) 300 mg ORAL DAILY 5. Multivitamins 1 TAB PO DAILY 6. Vitamin D 800 UNIT PO DAILY 7. Acetaminophen 1000 mg PO Q8H Maximum 6 of the 500 mg tablets daily RX *acetaminophen 500 mg 2 tablet(s) by mouth every 8 hours Disp #*24 Tablet Refills:*0 8. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice daily Disp #*40 Capsule Refills:*0 9. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain No driving if taking this medication. Taper as tolerated RX *oxycodone 5 mg 1 capsule(s) by mouth every ___ hours Disp #*35 Tablet Refills:*0 10. Senna 8.6 mg PO DAILY RX *sennosides [___] 8.6 mg 1 tablet by mouth daily Disp #*40 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Acute cholecystitis 8 cm hepatic adenoma in the right lobe Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please call Dr ___ office at ___ for fever > 101, chills, nausea, vomiting, diarrhea, constipation, increased abdominal pain, pain not controlled by your pain medication, swelling of the abdomen or ankles, yellowing of the skin or eyes, inability to tolerate food, fluids or medications, incisional redness, drainage or bleeding, or any other concerning symptoms. You may shower. Allow water to run over the incision. Pat the area dry, do not apply lotions or powders to the incision area. No lifting more than 10 pounds No driving if taking narcotic pain medication</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain 2. Docusate Sodium 100 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Motor Vehicle Collision Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>* You are advised to stay home from work for at least 2 weeks. * You are advised to avoid any contact sports or any activity that may involve impact to your abdomen, for at least ___ weeks. * 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. * You will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. * Symptomatic relief with ice packs or heating pads for short periods may ease the pain. * Narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. * Do NOT smoke * If your doctor allows, non steroidal antiinflammatory drugs are very effective in controlling pain ( ie, Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. * Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs ( crepitus).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 10 mg PO QPM 3. Dulera (mometasone-formoterol) 200-5 mcg/actuation inhalation X2 PRN 4. Levothyroxine Sodium 25 mcg PO DAILY 5. Lisinopril 10 mg PO BID 6. Metoprolol Tartrate 100 mg PO BID 7. Omeprazole 20 mg PO DAILY 8. ProAir HFA (albuterol sulfate) 108 mcg inhalation X2 PRN 9. Tiotropium Bromide 1 CAP IH 2 INHALATIONS DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Gastrointestinal Bleed Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for evaluation of rectal bleeding and were found to have a gastrointestinal bleed which required many blood transfusions. You were evaluated by the interventional radiology and gastroenterology teams and were closely monitored in the intensive care unit. Your blood counts (hematocrit and hemoglobin) have been stable and you are recovering well. You are now ready for discharge. Please follow the instructions below to continue your recovery: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *You are dizzy, overly fatigued or weak. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 40 mg SC QPM RX *enoxaparin 40 mg/0.4 mL 1 syringe subcutaneous once a day Disp #*30 Syringe Refills:*0 5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 6. Senna 8.6 mg PO QHS 7. Vitamin D 1000 UNIT PO DAILY 8. BusPIRone 5 mg PO DAILY 9. BusPIRone 10 mg PO QHS 10. Calcium Carbonate 500 mg PO TID 11. Ferrous Sulfate 325 mg PO DAILY 12. Venlafaxine XR 300 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right femoral fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (crutches). Followup Instructions: ___ [/INST] </s><s>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: -Right lower extremity 50% partial weightbearing MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 3 hours as needed x 1 day, then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take Lovenox daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. TREATMENT/FREQUENCY: Any staples or superficial sutures you have are to remain in place for at least 2 weeks postoperatively. Incision may be left open to air unless actively draining after POD3. If draining, you may apply a gauze dressing secured with paper tape. You may shower and allow water to run over the wound, but please refrain from bathing for at least 4 weeks postoperatively. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever greater than 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to the Acute Care Surgery Service with right upper quadrant pain. You had a CT scan and ultrasound of your abdomen that showed acute cholecystitis and a gallstones causing an obstruction. You had an ERCP procedure and had three stones removed. You were given antibiotics and taken to Interventional radiology for placement of a tube to help drain the infection from your gallbladder. You tolerated the procedure well and are now ready to be discharged to home to continue your recovery. Please note the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Drain Care: *Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *If the drain is connected to a collection container, please note color, consistency, and amount of fluid in the drain. Call the doctor, ___, or ___ nurse if the amount increases significantly or changes in character. Be sure to empty the drain frequently. Record the output. *Wash the area gently with warm, soapy water. *Keep the insertion site clean and dry otherwise. *Avoid swimming, baths, hot tubs; do not submerge yourself in water. *Make sure to keep the drain attached securely to your body to prevent pulling or dislocation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Augmentin 500-125 mg Tablet Sig: One (1) Tablet PO three times a day for 7 days. Disp:*21 Tablet(s)* Refills:*0* 2. levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO once a day. 3. NPH insulin sc 10 units daily 4. humalog sliding scale: ___ units morning, 4 units sc at lunch, ___ units at dinner 5. oxycodone 5 mg Tablet Sig: ___ Tablets PO every ___ hours as needed for pain for 5 days: please do not drive while taking this medication. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: right flank abscess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You wee admitted to the hospital with an abscess on your right flank. You were started on intravenous antibiotics. You underwent a cat scan of the pelvis and the abscess was found to have a localized collection which was drained. Your vital signs have been stable and your white blood cell count normal. You are being discharged home on 7 days of antibiotics. So your last day of antibiotics will be on ___. Please resume all regular home medications, unless specifically advised not to take a particular medication. Please take any new medications as prescribed. Please take the prescribed analgesic medications as needed. You may not drive or heavy machinery while taking narcotic analgesic medications. You may also take acetaminophen (Tylenol) as directed, but do not exceed 4000 mg in one day. Narcotic medication can make you constipated so take over the counter colace as instructed on the bottle if you do take the narcotic pain medication. The packing in your wound will need to be changed once a day. You will be set up with a visiting nurse to help with this.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your hospitalization at ___. Briefly, you were hospitalized with fever. You were started on antibiotics. Blood and urine cultures did not show any bacteria. A chest x ray and ultrasound of your liver/gall bladder were also negative for signs of infection. Antibiotics were discontinued and you will follow up with Dr. ___ as an outpatient in the liver clinic. Sincerely, Your ___ Treatment 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 2. Aspirin 81 mg PO DAILY 3. Calcium Carbonate 1250 mg PO BID 4. Ferrous Sulfate 325 mg PO DAILY 5. Fluticasone Propionate NASAL 2 SPRY NU BID 6. Furosemide 80 mg PO DAILY RX *furosemide 80 mg 1 tablet(s) by mouth every morning Disp #*30 Tablet Refills:*0 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Montelukast 10 mg PO DAILY 9. Senna 8.6 mg PO BID:PRN constipation 10. Sertraline 100 mg PO DAILY 11. Vitamin D 1000 UNIT PO DAILY 12. TraMADOL (Ultram) ___ mg PO Q4H:PRN pain 13. Simvastatin 20 mg PO DAILY 14. Cyanocobalamin 1000 mcg IM/SC MONTHLY 15. Myrbetriq (mirabegron) 25 mg oral daily 16. Polyethylene Glycol 17 g PO DAILY:PRN constipation 17. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP TID:PRN arm rash RX *triamcinolone acetonide 0.1 % apply 4 times per day Refills:*0 18. Morphine Sulfate (Oral Soln.) 5 mg PO Q4H:PRN dyspnea RX *morphine 10 mg/5 mL 0.5 (One half) teaspoon by mouth every 4 hours Refills:*0 19. Levothyroxine Sodium 175 mcg PO DAILY 20. Rivaroxaban 20 mg PO DAILY 21. Docusate Sodium 100 mg PO DAILY:PRN constipation 22. Sarna Lotion 1 Appl TP QID:PRN itchy skin 23. Estrogens Conjugated 0.625 gm VG DAILY 24. Lidocaine 5% Patch 1 PTCH TD QAM Discharge Disposition: Home with Service Facility: ___ Discharge Diagnosis: Atypical healthcare associated pneumonia Hypoxia acute diastolic CHF exacerbation Contact dermatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking part in your care at ___. You were admitted because you had difficulty breathing and low oxygen. We treated you with IV antibiotics for several days and gave you water pills to help you urinate. After several discussions, you stated to us that you would not want to be re-hospitalized under any circumstances, would not want to return to the hospital for antibiotics, IV lines, or diuretics, and that you would rather stay at home and focus on being made comfortable. We are sending you home to continue this transition towards being comfortable. Your ___ and case manage will continue to work with you to make sure your care is within your goals. 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. Ciprofloxacin HCl 250 mg PO Q12H 2. Clotrimazole 1 TROC PO QID:PRN Thrush 3. Dexamethasone 0.5 mg PO EVERY OTHER DAY 4. Docusate Sodium 100 mg PO BID:PRN Constipation 5. Glargine 20 Units Bedtime 6. LevETIRAcetam 250 mg PO BID 7. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 8. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 9. Tolterodine 4 mg PO BID 10. Enoxaparin Sodium 100 mg SC Q12H Start: Today - ___, First Dose: Next Routine Administration Time 11. Metoprolol Succinate XL 50 mg PO DAILY 12. Mirtazapine 15 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Bilateral ___ DVTs, Bilateral PE's 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 for low blood pressure and found to have blood clots in your legs and in your lungs. You were started on a medication to treat these blood clots, called lovenox. You should continue taking these injections until your outpatient doctor tells you to stop. You are now safe for discharge with close follow up. For your blood pressure we are decreasing your home metoprolol. It was a pleasure caring for you - we wish you all the best! Sincerely, Your ___ Oncology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever 2. Clindamycin 300 mg PO Q6H Duration: 10 Days RX *clindamycin HCl 300 mg 1 capsule(s) by mouth every six (6) hours Disp #*40 Capsule Refills:*0 3. Glargine 10 Units Breakfast Insulin SC Sliding Scale using NOVOLOG Insulin RX *blood sugar diagnostic [FreeStyle Lite Strips] check blood glucose four times a day Disp #*100 Strip Refills:*2 RX *insulin glargine [Basaglar KwikPen U-100 Insulin] 100 unit/mL (3 mL) AS DIR 10 Units before BKFT; Disp #*1 Syringe Refills:*2 RX *lancets [FreeStyle Lancets] 28 gauge check blood glucose four times a day Disp #*100 Each Refills:*2 RX *insulin lispro [Admelog SoloStar U-100 Insulin] 100 unit/mL AS DIR Up to 10 Units QID per sliding scale Disp #*1 Syringe Refills:*2 4. Linezolid ___ mg PO Q12H Duration: 10 Days RX *linezolid ___ mg 1 tablet(s) by mouth twice a day Disp #*20 Tablet Refills:*0 5. Zolpidem Tartrate 5 mg PO QHS insomnia Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1) Right breast cellulitis and abscess 2) Type II diabetes (initiated on insulin this admission) Discharge Condition: x Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please follow these discharge instructions: -Continue to monitor your right breast area for continued improvement. If the redness and swelling increase, please call the doctor's office to report this. -Should you have fevers and chills, please call the doctor's office immediately to report. -Continue your antibiotics until they are finished. -You may consider eating a probiotic yogurt daily to replace the 'good' bacteria in your intestinal tract. If you cannot tolerate yogurt then you may buy 'acidophilus' over the counter as a supplement choice. Acidophilus is a 'friendly' bacteria for your gut. -If you start to experience excessive diarrhea, please call the doctor's office to report this. -Do not overexert yourself and no strenuous exercise for now. -You may take either tylenol or advil (ibuprofen) for your discomfort. Take as directed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 10 days: To be taken for 10 additional days until ___. Disp:*20 Tablet(s)* Refills:*0* 2. triamterene-hydrochlorothiazid 37.5-25 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 3. Calcium-Vitamin D 600 mg calcium- 400 unit Tablet Sig: One (1) Tablet PO twice a day. 4. omega-3 fatty acids-vitamin E Oral 5. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig: ___ puff Inhalation every six (6) hours as needed for shortness of breath or wheezing. Discharge Disposition: Home Discharge Diagnosis: Pyelonephritis Elevated liver function tests Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital for burning on urination, fevers, and feeling unwell. You were found to have a kidney and urinary tract infection, called pyelonephritis. An ultrasound of your kidneys showed no evidence of a complicated infection, and antibiotics were started with improvement of your symptoms. You also had a low blood count and concern for blood in your stool, and underwent an endoscopy which showed no abnormalities in the upper gastrointestinal tract. However, you will need to have a colonoscopy as an outpatient to assess your lower gastrointestinal tract. Please also follow up with your primary care physician regarding your low blood counts. Your liver function tests were abnormal, and you had pain in the right upper abdomen on exam, which you did not experience when you were not being examined. An ultrasound of your gallbladder showed no evidence of gallstones, and your liver function tests were trending back towards the normal range. Please follow up with your primary care physician regarding these findings. The following changes were made to your home medications: - Ciprofloxacin was STARTED, to be taken for 10 additional days until ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID Do not take if loose stools RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Polyethylene Glycol 17 g PO DAILY:PRN constipation Hold if loose stools RX *polyethylene glycol 3350 [Miralax] 17 gram 1 powder(s) by mouth daily Disp #*30 Packet Refills:*3 3. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 4. Acetaminophen 1000 mg PO Q6H RX *acetaminophen 500 mg 2 tablet(s) by mouth every six (6) hours Disp #*240 Tablet Refills:*0 5. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Severe Do not take if sedated RX *oxycodone 5 mg ___ tablet(s) by mouth q4h prn pain Disp #*30 Tablet Refills:*0 6. ammonium lactate 12 % topical apply to legs BID PRN dryness 7. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 8. LORazepam 0.5 mg PO BID RX *lorazepam 0.5 mg 1 tablet by mouth twice a day Disp #*30 Tablet Refills:*0 9. magnesium hydroxide unknown oral DAILY 10. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Ruptured abdominal aortic aneurysm Right lower leg critical limb ischemia status post ruptured abdominal aortic aneurysm Type II Diabetes Mellitus Chronic Obstructive Pulmonary Disease Hypertension Fibromyalgia Discharge Condition: Mental Status: Clear and coherent, intermittently anxious. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for a ruptured abdominal aortic aneurysm. You underwent an endovascular repair to fix this major blood vessel in your abdomen. WHAT TO EXPECT: 1. It is normal to feel weak and tired, this will last for ___ weeks • You should get up out of bed every day and gradually increase your activity each day • You may walk and you may go up and down stairs • Increase your activities as you can tolerate, do not do too much right away! 2. It is normal to have incisional and leg swelling: • Wear loose fitting pants/clothing (this will be less irritating to incision) • Elevate your legs above the level of your heart with ___ pillows every ___ hours throughout the day and at night • Avoid prolonged periods of standing or sitting without your legs elevated 3. It is normal to have a decreased appetite, your appetite will return with time • You will probably lose your taste for food and lose some weight • Eat small frequent meals • It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing • To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication • Take all the medications you were taking before surgery, unless otherwise directed • Take one aspirin daily, unless otherwise directed ACTIVITIES: • No driving until postop visit and you are no longer taking pain medications • You should get up every day, get dressed and walk, gradually increasing your activity • You may up and down stairs, go outside and/or ride in a car • Increase your activities as you can tolerate, do not do too much right away! • No heavy lifting, pushing or pulling (greater than 5 pounds) until your post op visit • You may shower (let the soapy water run over incision, rinse and pat dry) • Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area CALL THE OFFICE FOR : ___ • Redness that extends away from your incision • Purulent or foul smelling drainage from your incision We wish you the best in your health, 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 Q4H:PRN pain 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 60 mg PO DAILY 4. Levothyroxine Sodium 112 mcg PO DAILY 5. Multivitamins 1 TAB PO DAILY 6. Mycophenolate Mofetil 500 mg PO BID 7. PredniSONE 3 mg PO DAILY 8. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 9. Tamoxifen Citrate 20 mg PO DAILY 10. Atenolol 6.25 mg PO DAILY 11. cilostazol 50 mg oral BID 12. Citracal Regular (calcium citrate-vitamin D3) 315/250 mg oral daily 13. Furosemide 20 mg PO QHS:PRN edema please take this daily at least until your renal appointment next week 14. Lubiprostone 8 mcg PO BID 15. Nitroglycerin SL 0.3 mg SL PRN chest pain 16. Vitamin D ___ UNIT PO DAILY 17. CycloSPORINE (Neoral) MODIFIED 75 mg PO Q12H 18. Phosphorus 250 mg PO BID RX *sod phos,di & mono-K phos mono [K-Phos-Neutral] 250 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 19. Ciprofloxacin HCl 500 mg PO Q12H Duration: 14 Days RX *ciprofloxacin 500 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 20. Insulin Pump SC (Self Administering Medication)Insulin Aspart (Novolog) (non-formulary) Basal rate minimum: 0.1 units/hr Basal rate maximum: 0.3 units/hr Target glucose: ___ Fingersticks: QAC and HS Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: #Gastroenteritis #Pyelonephritis #Acute kidney injury #Hypophosphatemia Secondary diagnoses: # S/p renal transplant Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___. You were admitted with nausea, vomiting, and diarrhea likely from gastroenteritis. You also developed a urinary tract infection. We treated you with fluids and antibiotics and your symptoms improved. You will need to continue ciprofloxacin for a two week course (starts ___. We also treated you for low phosphorous in your blood and decreased your cyclosporine level. Your electrolytes and phosphorus will need to be checked in the next week or so, at your appointment with Dr. ___. If you have questions about your blood sugars, you can call the ___ Nurse on Call at ___. Take care, and we wish you the best. Sincerely, Your ___ medicine team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lactulose 30 mL PO TID 2. Methadone 65 mg PO DAILY 3. Gabapentin 800 mg PO TID 4. Rifaximin 550 mg PO BID RX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 5. U500 insulin as advised by your outpatient endocrinologist Discharge Disposition: Home Discharge Diagnosis: Primary: Hepatic Encephalopathy Secondary: Uncontrolled diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___. You were admitted after you went to the Emergency Department with shakiness and confusion (due to your liver) and were also found to have high blood sugar. Your shakiness and confusion improved with extra doses of lactulose and does not appear to be due to infection. To prevent this in the future, we have added a medication called Rifaximin to be taken twice daily in addition to your Lactulose. Also, if you feel that your hands are jerking in a similar fashion and you feel confused, you should take an extra dose of lactulose to help with this and then call the liver doctors if not improving. Your high blood sugars were have been a chronic issue and it is important to follow the new regimen that your outpatient diabetes doctor prescribed for you. You also mentioned you have shoulder pain in both shoulders. You should follow up with your orthopaedist that you have seen previously because it seems to have gotten worse. Also, it is important that you follow up with your PCP about the fall you experienced 10 days prior. Your CAT scan didn't show any blood in your head but it is important that we try to prevent this from happening again. If you get dizzy in the future, try to sit down as quickly and safely as possible. It has been a pleasure taking care of you and 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 650 mg PO Q6H:PRN Pain - Mild 2. amLODIPine 2.5 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Oxybutynin 5 mg PO Q8H:PRN bladder spasms 5. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Severe 6. Phenazopyridine 200 mg PO Q8H:PRN bladder discomfort 7. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: bilateral ureteral stones Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/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 your pre-admission/home medications EXCEPT as noted. You should ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor. HOLD ASPIRIN and aspirin containing products for one week unless otherwise advised. -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. Calcium Carbonate 500 mg PO BID 2. FoLIC Acid 1 mg PO DAILY 3. Furosemide 60 mg PO DAILY 4. Mirtazapine 15 mg PO HS 5. Multivitamins 1 TAB PO DAILY 6. Omeprazole 20 mg PO DAILY 7. Spironolactone 100 mg PO DAILY 8. Vitamin D 800 UNIT PO DAILY 9. Ciprofloxacin HCl 500 mg PO Q12H Continue until ___ to complete a two week antibiotic course. RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth Twice daily Disp #*14 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Klebsiella Bacteremia Secondary: Cirrhosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a true pleasure caring for you at ___! You were admitted due to bacteria in your bloodstream that caused a severe illness. In the intensive care unit you were stabilized and given strong antibiotics which cleared your infection. We did an MRI and an ERCP procedure to look for the source of these bloodstream bacteria but found none. You are now ready for discharge with close outpatient follow-up. Please continue Cipro (oral antibiotic) for another week. Please call the Liver clinic to set up an appointment next week for follow-up as noted below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO BID:PRN pain 2. Docusate Sodium 100 mg PO BID 3. Hydroxychloroquine Sulfate 200 mg PO BID 4. Polyethylene Glycol 17 g PO DAILY:PRN constipation 5. Simethicone 120 mg PO QID:PRN gas 6. Ursodiol 600 mg PO BID 7. Vitamin D ___ UNIT PO DAILY 8. Ciprofloxacin HCl 500 mg PO Q12H Duration: 3 Days RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every 12 hours Disp #*5 Tablet Refills:*0 9. Calcium Citrate + D (calcium citrate-vitamin D3) 315-200 mg-unit oral TID 10. Ferrous Sulfate 325 mg PO DAILY 11. Furosemide 20 mg PO DAILY 12. Pantoprazole 40 mg PO Q12H 13. Bethanechol 10 mg PO TID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Complicated urinary tract infection GAVE s/p thermal therapy Secondary: Autoimmune cirrhosis Rheumatoid arthritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You came to the hospital with burning with urination and were found to have a urinary tract infection. We treated you with intravenous antibiotics and transitioned you to the pill form of antibiotics to complete a full 7 day course of antibiotics. You also had lower blood counts so we had a procedure called an endoscopy and procedure to stop bleeding. We also gave you blood transfusion with stabilization of your blood counts. You developed some diarrhea before leaving the hospital so we sent of a stool test to check you for an infection called c. difficile colitis that was negative and showed no infection which is great news. Your antibiotic will be delivered to your home later today. Please follow up with your appointments below. It was a pleasure being involved in your care. Your, ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Labetalol 200 mg PO TID 2. Lisinopril 40 mg PO DAILY 3. Phenazopyridine 100 mg PO TID Duration: 3 Days you should take it for 3 days 4. amLODIPine 10 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Intraparenchymal hemorrhage Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of dizziness, nausea and emesis resulting from an ACUTE HEMORRHAGIC STROKE. We think this happened due to high blood pressure. In order to prevent another hemorrhagic stroke we encourage you to take your medication as prescribed. We are changing your medications as follows: -Start Lisinopril 40mg daily -Start Amlodipine 10mg daily -Start Labetalol 200mg three times daily -STOP Aspirin Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BuPROPion (Sustained Release) 300 mg PO QAM 2. Lorazepam 0.5-1 mg PO BID:PRN anxiety, insomnia 3. MethylPHENIDATE (Ritalin) 5 mg PO BID 4. Sertraline 200 mg PO DAILY 5. Dexamethasone 4 mg PO Q6H RX *dexamethasone 4 mg 1 tablet(s) by mouth every six (6) hours Disp #*120 Tablet Refills:*0 6. Cetirizine *NF* 10 mg Oral daily 7. OxycoDONE (Immediate Release) ___ mg PO Q6H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: spinal tumor with concern for cord compression metastatic renal cell carcinoma 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 participating in your care at ___. You were admitted with back pain, weakness, and numbness, and were found to have a tumor in your spinal canal. You have received two days of radiation and should return on ___ for the remainder of your radiation therapy, and for MRIs of your head and the rest of your spine. You should also continue taking oral steroids to relieve the swelling around your tumor.</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. Mirtazapine 15 mg PO QHS 4. Ondansetron 8 mg PO Q8H:PRN nausea 5. Polyethylene Glycol 17 g PO DAILY:PRN constipation 6. Prochlorperazine 10 mg PO Q6H:PRN nausea 7. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: Rectal Cancer 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 shortness of breath and worsening liver function tests. This was thought to be due to your metastatic rectal cancer. You were given chemotherapy which you will continue as an outpatient tomorrow.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Docusate Sodium 100 mg PO BID 3. Fluticasone Propionate NASAL 1 SPRY NU DAILY one spray each nostril 4. Lisinopril 2.5 mg PO DAILY 5. Spironolactone 25 mg PO DAILY 6. Mirtazapine 15 mg PO HS 7. Quetiapine Fumarate 12.5 mg PO BID 8. Senna 2 TAB PO HS 9. Simvastatin 20 mg PO DAILY 10. Megestrol Acetate 200 mg PO DAILY liquid form; plan for 2 week course per ___ home records 11. MetFORMIN (Glucophage) 250 mg PO DAILY 12. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 13. Outpatient Lab Work Please draw chem 7, Ca, Mg, Phos on ___ and fax to Dr. ___ at ___. 14. Outpatient Lab Work Please draw chem 7, Ca, Mg, Phos on ___ and fax to Dr. ___ at ___. 15. Aspirin EC 325 mg PO DAILY 16. Levothyroxine Sodium 150 mcg PO HS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute on Chronic Systolic Heart Failure exacerbation Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, Thank you for choosing us for your care. You were admitted for difficulty breathing. We treated you for a heart failure exacerbation with diuretics (medicines to increase your urination). We also monitored your heart rate and blood oxygen levels in the hospital and they have been stable. We also noticed that your thyroid function continues to be decreased despite treatment. Please make sure the thyroid replacement medicine Levothyroxine is taken on an empty stomach, as food can impair its absorption. Going forward, the nursing home should weigh you every morning. If you gain more than 3lbs in a day, your cardiologist Dr. ___ be notified. Please START Furosemide 40mg Daily Please CONTINUE Megase Please STOP Torsemide</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth QAM Disp #*30 Tablet Refills:*0 2. NovoLIN ___ FlexPen U-100 (insulin NPH and regular human) 12 units subcutaneous DAILY RX *insulin NPH and regular human [Novolin ___ FlexPen U-100] 100 unit/mL (70-30) 12 units SC once a day Disp #*15 Syringe Refills:*0 3. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB, wheezing 4. Ascorbic Acid ___ mg PO BID 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 20 mg PO QPM 7. CARVedilol 12.5 mg PO BID 8. Diltiazem Extended-Release 180 mg PO DAILY 9. Docusate Sodium 100 mg PO BID 10. Ferrous Sulfate 325 mg PO DAILY 11. Fluticasone Propionate NASAL 2 SPRY NU BID 12. Fosfomycin Tromethamine 3 g PO 1X/WEEK (___) 13. HydrALAZINE 10 mg PO TID 14. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H:PRN wheeze/sob 15. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 16. LevETIRAcetam 500 mg PO BID 17. Loratadine 10 mg PO EVERY OTHER DAY 18. Mycophenolate Mofetil 250 mg PO BID 19. Omeprazole 20 mg PO DAILY 20. PredniSONE 5 mg PO DAILY 21. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q6H:PRN shortness of breath 22. Repaglinide 1 mg PO TIDAC 23. Sodium Bicarbonate 650 mg PO BID 24. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 25. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation BID:PRN sob 26. Tiotropium Bromide 1 CAP IH DAILY 27. TraZODone 25 mg PO QHS:PRN insomnia 28. ValACYclovir 500 mg PO Q24H 29. Vitamin D ___ UNIT PO 1X/WEEK (WE) 30.Equipment Please provide portable home nebulizer ICD code: ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES ================= Acute Kidney Injury ___ hypovolemia CHRONIC DIAGNOSES ================= ESRD ___ HTN and DM s/p DDRT c/b CKD of renal allograft Heart Failure with Preserved Ejection Fraction Type II diabetes Chronic Obstructive Pulmonary Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You were feeling dizzy and weak at home WHAT HAPPENED TO ME IN THE HOSPITAL? - You were found to have a kidney injury, likely because you were not drinking enough fluids at home. - You received intravenous fluids. - You had imaging of your kidney and lungs. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? -Please continue to take all of your medications and follow-up with your appointments as listed below. - Please weight yourself every day, if your weight increases by 3 pounds or more, please call your healthcare provider. - Your dose of diuretic medication called Furosemide was decreased from twice daily to once daily. - Weigh yourself daily and call your doctor if your weight increases by more than 3 lbs in 2 days or 5 lbs in 1 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: 1. CeFAZolin 2 g IV Q8H RX *cefazolin in dextrose (iso-os) 2 gram/50 mL 2 gm IV q8hr Disp #*125 Intravenous Bag Refills:*0 2. Aspirin 81 mg PO DAILY 3. Chlorthalidone 25 mg PO DAILY 4. Vitamin D 1000 UNIT PO DAILY 5. Zomig (ZOLMitriptan) 2.5 mg oral PRN Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: MSSA bacteremia with cavitary penumonia Elevated ALT HTN 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 MSSA bacteremia and found to have a cavitary pneumonia. You improved on IV Antibiotics and these were tapered per sensitivity testing. You were seen by infectious disease consult service and will followed by them over the next ___ months. You underwent transthoracic and transesophageal echocardiography without evidence of heart valve infection. The ID team will establish and contact you with follow appointment information. You will need weekly labs with results faxed to ID team ___ clinic) as per paperwork. You are may not drive yourself home tonight.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO DAILY 2. bromfenac 0.07 % ophthalmic Qhs 3. Calcium Carbonate 500 mg PO DAILY 4. Docusate Sodium 100 mg PO BID:PRN constipation 5. Guaifenesin 10 mL PO Q6H:PRN cough 6. Lidocaine 5% Patch 1 PTCH TD QAM right knee 7. Metoprolol Succinate XL 25 mg PO HS Hold for systolic blood pressure < 100 or HR < 60 8. Multivitamins 1 TAB PO DAILY 9. Nystatin Cream 1 Appl TP BID breasts 10. Pantoprazole 40 mg PO Q24H 11. Polyethylene Glycol 17 g PO DAILY:PRN constipation 12. Senna 8.6 mg PO DAILY:PRN constipation 13. Torsemide 40 mg PO DAILY Hold for systolic blood pressure < 100 or HR < 60. 14. Vitamin D 1000 UNIT PO DAILY 15. Cepastat (Phenol) Lozenge 1 LOZ PO Q2H:PRN cough or sore throat RX *phenol [Cepastat] 14.5 mg Take 1 lozenge Up to every 2 hours Disp #*90 Lozenge Refills:*0 16. Ciprofloxacin HCl 500 mg PO Q12H Last dose is on ___ RX *ciprofloxacin 500 mg 1 tablet(s) by mouth Every 12 hours Disp #*5 Tablet Refills:*0 17. ___ (cranberry extract) 500 mg oral BID 18. Nitroglycerin SL 0.3 mg SL ASDIR 19. Amoxicillin 500 mg PO Q8H last day = ___ RX *amoxicillin 500 mg 1 capsule(s) by mouth Every 8 hours Disp #*30 Capsule Refills:*0 20. NPH 14 Units Breakfast NPH 4 Units Dinner Insulin SC Sliding Scale using HUM Insulin Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: ------------------ PRIMARY DIAGNOSES ------------------ Urinary tract infection Sepsis Hypotension Shock liver ------------------ SECONDARY DIAGNOSES ------------------ Chronic systolic congestive heart failure Coronary artery disease Acute renal failure Chronic kidney disease, stage III Diabetes mellitus type II, insulin dependent Anemia 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 to take care of you during your hospital stay. You were admitted to the hospital because you had fever, rigors, and pain upon urination. You were found to have a urinary tract infection. At first this was treated with IV antibiotics. After a few days, you no longer had fevers, your blood pressures became stable, and you no longer had nighttime sweats or chills. At this point, your blood cultures were negative, so we felt it was safe to switch you from IV to PO antibiotics. You will be discharged with 2 antibiotics: ciprofloxacin and amoxicillin. Your last day of ciprofloxacin will be ___ for 10 total days, and your last day of amoxicillin will be ___ for 14 total days. You were restarted on your blood pressure and heart medications (lisinopril and metoprolol) before discharge and your blood pressure was stable. When you are at home, you can continue to check your blood pressure. If your systolic blood pressure is less than 100 (the top number) or your heart rate is less than 60, please call your primary care physician to ask if you should continue taking lisinopril and/or metoprolol. We also stopped Tylenol while your were in the hospital because your liver enzymes were high. You should discuss with your PCP ___ you can restart Tylenol. Please continue to follow up with your primary care physician. You are now being discharged to home with ___ and ___ services. Your ___ 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. Lisinopril 20 mg PO DAILY 3. Metoprolol Succinate XL 100 mg PO DAILY 4. Omeprazole 40 mg PO BID 5. Simvastatin 20 mg PO QPM 6. Vitamin E 400 UNIT PO DAILY 7. Warfarin 6 mg PO DAILY16 8. Oxybutynin 5 mg PO Q8H:PRN Bladder pain 9. saw ___ Dose is Unknown ORAL Frequency is Unknown 10. Calcitriol 1 mcg PO 3X/WEEK (___) 11. Placebo #00 (cellulose (bulk)) unknown ORAL DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES: Atypical chest pain Hematuria SECONDARY DIAGNOSES: End-stage renal disease Gastritis Anemia Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You came to the hospital because you were experiencing chest pain. Tests did not show any evidence of heart attack. Your chest pain seemed to be related to change in position and could be musculoskeletal in nature. You were also found to have blood in the urine, which is related to your recent bladder procedure. You also experienced some injury from the urinary catheter, which was also contributing to the blood in the urine. We removed the catheter before your discharge and treated your bladder spasm with pain medications. Please remember that you might continue having blood in the urine because you are on the blood thinner warfarin. Please make sure to follow up with your doctors as ___ and take all your medications on time. Best regards, ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Mrs. ___, you were admitted for anastomotic leak. However, this is a contained leak, and you appeared very well throughout this hospital admission. We attempted at interventional radiology drainage, but there is no drainable collection. Thus you will be discharged with follow-up with Dr. ___. Warning signs: If you experience fever, chills, nausea/vomiting, inability to tolerate oral intake, please call the office or come to the emergency room. Diet: No restrictions Medications: You may resume all your home medications. We will continue oral antibiotics for the next ___ days. Lastly, we will send you home on Lovenox (therapeutic lovenox) and you can follow-up with your PCP for bridging to Coumadin. It is extremely important, for you to follow-up with your PCP for ___ bridging, as you are at high risk for clotting, and other thromboembolic events.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Atorvastatin 40 mg PO DAILY RX *atorvastatin 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES BID RX *brimonidine 0.15 % 1 drop optho twice a day Refills:*0 4. Dorzolamide 2% Ophth. Soln. 1 DROP BOTH EYES TID RX *dorzolamide 2 % 1 drop eye three times a day Refills:*0 5. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Timolol Maleate 0.5% 1 DROP BOTH EYES BID RX *timolol [Betimol] 0.5 % 1 drop eye twice a day Refills:*0 7. bimatoprost 0.01 % ophthalmic QHS RX *bimatoprost [Lumigan] 0.01 % 1 drop eye at night Refills:*0 8. glipiZIDE-metformin 2.5-500 mg oral BID RX *glipizide-metformin 2.5 mg-500 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: left hand weakness SECONDARY DIAGNOSIS: hypertension type 2 diabetes glaucoma hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking care of you at the ___. You were admitted in the hospital because of weakness in your left arm and leg which improved on their own. You underwent a CAT scan and MRI of the head which did not showed a new stroke. We were concerned that you had not been taking your home medications and we restarted these during your stay. It is important to take these medications even while you feel well as we think these medications will KEEP you feeling well. Please make sure to take your medications regularly and keep you follow up appointments with your PCP and neurologist. It was a pleasure taking care of you at the ___. We wish you all the best, Your ___ team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 20 mg PO DAILY 3. Furosemide 20 mg PO DAILY 4. Levothyroxine Sodium 112 mcg PO DAILY 5. Metoprolol Tartrate 75 mg PO BID 6. Mirtazapine 30 mg PO HS 7. Omeprazole 20 mg PO DAILY 8. Senna 1 TAB PO BID:PRN constipation 9. Vitamin D 1000 UNIT PO DAILY 10. Warfarin 1 mg PO DAILY16 Do not give on ___. Give 2mg instead 11. azelastine *NF* 0.05 % ___ BID PRN 1 drop to affected eye 12. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 13. Hydroxyurea 500 mg PO 2X/WEEK (___) ___ 14. Loratadine *NF* 10 mg Oral daily 15. Nitroglycerin SL 0.3 mg SL PRN chest pain 1 tab under tongue every 5 min as needed for chest pain, up to 3 doses 16. Proctosol HC *NF* (hydrocorTISone) 2.5 % Rectal BID 17. tetrahydrozoline *NF* 0.05 % ___ prn conjunctivitis 18. Warfarin 2 mg PO ___ 2mg on ___ Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Orthostasis secondary Afib and volume depletion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your stay at ___. You came in due to lightheadedness and dizziness. A CT scan of your head showed no bleeding or strokes. An EKG showed that you were in atrial fibrillation, which is a heart arrhythmia you have a history of. Your blood pressure dropped significantly when you stood up which is most likely why you felt dizzy. We also gave you intravenous fluids because we felt you were dehydrated. Your atrial fibrillation stopped and you now feel less dizzy and lightheaded. Please continue to take all of your home medications as directed. We also met with you and your family about your care for the future. Please follow-up with your outpatient providers with any questions that may come up later regarding medications and further care. 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. Oxybutynin 5 mg PO TID:PRN bladder spasms RX *oxybutynin chloride 5 mg 1 tablet(s) by mouth three times daily as needed for bladder spasms Disp #*20 Tablet Refills:*0 2. Phenazopyridine 100 mg PO TID PRN dysuria Duration: 3 Days RX *phenazopyridine 100 mg 1 tablet(s) by mouth three times daily as needed for urinary pain Disp #*20 Tablet Refills:*0 3. Sulfameth/Trimethoprim DS 1 TAB PO BID urinary tract infection Duration: 14 Days RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth every 12 hours Disp #*28 Tablet Refills:*0 4. Tamsulosin 0.4 mg PO QHS Pain related to stent RX *tamsulosin 0.4 mg 1 capsule(s) by mouth once daily Disp #*30 Capsule Refills:*1 Discharge Disposition: Home Discharge Diagnosis: Obstructing ureteral stone Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/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 your pre-admission/home medications EXCEPT as noted. You should ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor. HOLD ASPIRIN and aspirin containing products for one week unless otherwise advised. -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. -You may be given “prescriptions” for a stool softener and/or a gentle laxative. These are over-the-counter medications that may be “health care spending account reimbursable.” -Colace (docusate sodium) may have been prescribed to avoid post-surgical constipation or constipation related to use of narcotic pain medications. Discontinue if loose stool or diarrhea develops. Colace is a stool-softener, NOT a laxative. -Senokot (or any gentle laxative) may have been prescribed to further minimize your risk of constipation. -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. Docusate Sodium (Liquid) 100 mg PO BID:PRN constipation 2. Levothyroxine Sodium 50 mcg PO DAILY 3. Senna 17.2 mg PO BID:PRN constipation 4. Diltiazem 30 mg PO Q6H RX *diltiazem HCl [Cardizem] 30 mg 1 tablet(s) by mouth every six (6) hours Disp #*120 Tablet Refills:*0 5. FoLIC Acid 1 mg PO DAILY 6. Ibuprofen 600 mg PO Q8H:PRN pain 7. Metoprolol Tartrate 37.5 mg PO Q6H RX *metoprolol tartrate 37.5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 8. QUEtiapine Fumarate 50 mg PO QHS Insomnia RX *quetiapine 50 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 9. Thiamine 100 mg PO DAILY 10. Warfarin 2.5 mg PO ONCE Duration: 1 Dose RX *warfarin [Coumadin] 2.5 mg 1 tablet(s) by mouth once a day Disp #*10 Tablet Refills:*0 11. Acetaminophen (Liquid) 650 mg PO Q6H:PRN pain RX *acetaminophen 500 mg/5 mL 10 mL by mouth every six (6) hours Refills:*2 12. Albuterol Inhaler 2 PUFF IH Q6H:PRN cough/wheezing 13. amLODIPine 5 mg PO DAILY 14. fluticasone 50 mcg/actuation inhalation BID:PRN allergy symptoms 15. Hydrochlorothiazide 25 mg PO DAILY 16. Lisinopril 40 mg PO DAILY 17. Lotrimin AF Powder (miconazole nitrate) 2 % topical TID:PRN itching/rash 18. Ondansetron ___ mg PO Q8H:PRN nausea 19. OxycoDONE Liquid ___ mg PO Q4H:PRN moderate to severe pain RX *oxycodone 5 mg/5 mL 5 mL by mouth every six (6) hours Refills:*0 20. TraZODone 50 mg PO QHS:PRN insomnia Discharge Disposition: Home Discharge Diagnosis: Alcohol withdrawal Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mrs. ___, ___ were admitted to the hospital with confusion and mental status changes following a recent surgery. ___ were treated for alcohol withdrawal syndrome and are now ready to be discharged home to complete your recovery there. Please make sure to follow these instructions after your discharge to assure timely recovery. DIET: ___ may continue a FULL LIQUID DIET until ___ are seen by Dr. ___ in clinic and are instructed to advance your diet. All medications and pills must be crushed in apple sauce, yogurt or other soft creamy foods. There is a risk they will get stuck in your esophagus if taken whole. The only pill ___ may take whole is your levothyroxine (synthroid). ACTIVITY: ___ may resume regular activity without restrictions. FOLLOW-UP: ___ should follow up with Dr. ___ as instructed. ___ have an appointment set up for ___. MEDICATIONS: ___ are being discharged on your home medications plus several new ones. ___ no longer need to take acid reflux medications like omeprazole or nexxium. Because ___ had atrial fibrillation or afib in the hospital, and ___ cannot take pradaxa for now (it cannot be crushed and ___ are not allowed to take pills for the next two weeks), ___ are leaving with a prescription for Coumadin. This is a blood thinner similar to pradaxa, but requires monitoring, which your primary care physician ___ provide. It is imperative that ___ call and set up an appointment with your primary care doctor within 2 days of your discharge from the hospital. ALCOHOL: ___ should refrain from alcohol at all costs. A medication ___ were given to treat alcohol withdrawal (phenobarbital) will remain in your system for a week after ___ stop taking it. When mixed with alcohol, it causes a high risk of respiratory suppression which can be life-threatening. Make sure ___ report any urge to drink to a physician or relative who can help ___. We recommend social work and withdrawal counseling services. Thank ___ for letting us participate in your care! Good luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB or wheeze 2. Aspirin 325 mg PO DAILY 3. Disopyramide CR 300 mg PO Q12H 4. Furosemide 20 mg PO DAILY 5. Metoprolol Succinate XL 100 mg PO DAILY 6. Pantoprazole 40 mg PO Q12H 7. fluticasone *NF* 220 mcg/actuation Inhalation DAILY:PRN allergy season 8. Montelukast Sodium 10 mg PO DAILY:PRN during allergy season Discharge Disposition: Home Discharge Diagnosis: Acid reflux Esophageal spasm Secondary: Hypertrophic cardiomyopathy 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 positive stress test. After discussion with your cardiologist, we determined that the stress test result was probably a false-positive. You had cardiac catheterization in ___ that demonstrated no angiographically apparent coronary artery disease, and it is unlikely that you developed coronary disease that needs intervention in the meantime. Your pain was likely either A) acid reflux from possible recurrence of H.pylori or B) esophageal spasm. We are recommending you see a gastroenterologist for further evaluation. You can call our GI department ___ and make an appointment. In addition, please call Dr ___ office at ___ and make an appointment to be seen this week for follow-up.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to ___ due to recurrent chest pain. Your EKG was reassuring and your cardiac enzymes were normal. This reassured us that the pain was unlikely to be related to cardiac ischemia. You underwent a CT scan of your chest that showed evidence of a small blood clot in the lungs. This may be contributing to your pain. You were started on anticoagulation (blood thinner) for the clot and will need to continue on this for the next few months at least, and follow up with the clinic in ___. We do suspect that there may be another source for your pain, so it is important that you ___ with the gastroenterologists for an upper endoscopy. We have started you on the medication sucralfate to help with your abdominal pain. It was a pleasure taking care of you. We wish you all the best.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ondansetron 4 mg PO TID RX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*24 Tablet Refills:*0 2. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever Discharge Disposition: Home Discharge Diagnosis: Peutz-Jehgers syndrome, nausea and vomiting Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, Please call ___ to schedule an appointment with dr. ___ ___. I know you still don't feel at best and anxious that those symptoms will be back, but I trust Dr. ___ will take care of you and come up with plan to address your disease in the best way available. Warmest wishes from ___ Medicine team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Gabapentin 600 mg PO QHS:PRN fibromyalgia 3. Losartan Potassium 100 mg PO DAILY 4. Topiramate (Topamax) 30 mg PO QHS:PRN migraine 5. Xopenex Neb ___ puffs inhalation every ___ hours Discharge Disposition: Home Discharge Diagnosis: Polycythemia ___ ___ Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Hello Ms. ___, It was a pleasure taking care of you here at ___. You presented to us ___ night with a one-day history of throbbing right-sided headache, blurry vision, and left hand weakness. Your hematocrit count was 57.6 - consistent with your diagnosis of polycythemia ___. An extensive MRI of the tissue/arteries/veins in head and neck was normal. To relieve your symptoms, you were given a therapeutic phlebotomy, which relieved your right-sided headache, and brought your hematocrit down to 50.9. We wish you all the best! Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation RX *bisacodyl 5 mg 2 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Enoxaparin Sodium 40 mg SC QHS Duration: 14 Days Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 1 at bedtime Disp #*14 Syringe Refills:*0 5. Metoprolol Succinate XL 25 mg PO DAILY 6. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 7. RISperidone 0.25 mg PO HS 8. Lorazepam 0.5 mg PO HS:PRN anxiety Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left trimalleolar ankle fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet ACTIVITY AND WEIGHT BEARING: - Non weight-bearing, left lower extremity</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Warfarin 10 mg PO DAILY16 2. Atorvastatin 10 mg PO DAILY 3. Digoxin 0.375 mg PO 4X/WEEK (___) 4. Digoxin 0.5 mg PO 3X/WEEK (___) 5. Glargine 60 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 6. Lisinopril 5 mg PO DAILY HOLD FOR BP<100 7. CefePIME 2 g IV Q12H RX *cefepime 2 gram 1 infusion every 12 hours Disp #*17 Unit Refills:*0 8. Miconazole 2% Cream 1 Appl TP BID RX *miconazole nitrate 2 % apply to both tops and bottoms of feet and to toe webspaces twice a day Disp #*1 Tube Refills:*1 9. Vancomycin 1250 mg IV Q 8H RX *vancomycin 500 mg 1500mg dose every 8 hours Disp #*25 Unit Refills:*0 10. Outpatient Lab Work Please check CBC, CHEM 10, INR and vancomycin trough (1 hour prior to next dose of vancomycin) on ___ and fax results to Dr ___ platelet monitoring, Creatinine monitoring, vancomycin dose adjustment, goal vancomycin level ___ and coumadin dose adjustment, goal INR ___ Dr ___: ___ Fax: ___ 11. Metoprolol Succinate XL 100 mg PO DAILY 12. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight hours Disp #*25 Tablet Refills:*0 13. Nicotine Polacrilex 2 mg PO Q1H:PRN smoking urge RX *nicotine (polacrilex) [Nicorette] 2 mg 1 gum every hour as needed to curb the urge to smoke Disp #*100 Gum Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Osteomyelitis Secondary Diabetes Atrial Fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital because you had a left foot infection. You were found to have osteomyelitis of the left ___ toe, and underwent surgical ray resection. You were also treated with the intravenous antibiotics. You will continue to take antibiotics for another 8 days. Please note that you CANNOT drink alcohol while taking the antibiotics as you can have a very severe reaction. Weight bearing instructions left foot: Weight bearing to heel ___ a surgical shoe</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Azithromycin 250 mg PO Q24H 3. Gabapentin 800 mg PO TID 4. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 5. Lorazepam 0.5 mg PO BID:PRN nausea 6. Metoprolol Tartrate 25 mg PO BID 7. Multivitamins W/minerals 1 TAB PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Ondansetron 8 mg PO Q8H:PRN nausea 10. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 11. PredniSONE 40 mg PO DAILY Duration: 4 Weeks 40 mg daily and decrease as per taper RX *prednisone 10 mg 4 tablet(s) by mouth once a day Disp #*50 Tablet Refills:*0 12. Sertraline 100 mg PO DAILY 13. Tiotropium Bromide 1 CAP IH DAILY 14. TraZODone 50 mg PO QHS 15. Maalox/Diphenhydramine/Lidocaine ___ mL PO QID:PRN mouth pain RX *alum-mag hydroxide-simeth [Antacid M] 200 mg-200 mg-20 mg/5 mL ___ ml by mouth qid prn Refills:*3 16. albuterol sulfate 2.5 mg /3 mL (0.083 %) inhalation Q4H:PRN shortness of breath/wheezing 17. budesonide-formoterol 160-4.5 INHALATION BID 18. Diphedryl (diphenhydrAMINE HCl) 12.5 mg/5 mL ORAL QID 19. Guaifenesin-CODEINE Phosphate ___ mL PO Q6H:PRN cough 20. Mag-Al Plus (alum-mag hydroxide-simeth) 200 mg/5 mL ORAL QID 21. Prochlorperazine 5 mg PO Q6H:PRN nausea 22. Ertapenem Sodium 1 g IV DAILY Duration: 13 Doses last day ___ RX *ertapenem [Invanz] 1 gram 1 gram IV Q24H Disp #*13 Vial Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Enterobacter bacteremia COPD exacerbation SECONDARY DIAGNOSES: ___ CAD GERD Depression Insomnia Neuropathy ___ Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to participate in your care at ___. You were admitted for shortness of breath initially to the ICU. You were found to have a bacterial infection of your bloodstream, which you will need to complete a course of antibiotics for at home through a special catheter in your arm, and your port was removed. You also underwent your radiation treatments while you were here, and we decided that chemotherapy at this point would probably do more harm than good. We treated your COPD while you were here, and you should complete a tapered course of steroids as instructed. Please follow-up with your outpatient providers as listed below. We wish you all the best! Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Docusate Sodium 100 mg PO BID 3. TraMADOL (Ultram) 50 mg PO Q4H:PRN pain RX *tramadol 50 mg 1 Tablet(s) by mouth every four (4) hours Disp #*50 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: s/p MVC with +LOC Left distal clavicle fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after a motor vehicle accident. You lossed consciousness at the scene but your injury is a broken collar bone (clavicle). You were evaluated by orthopedics for this who determined your injury to be nonoperative. You should remain in a sling and not bear weight on your left arm for 2 weeks until you follow up in ___ clinic. You remove your arm from the sling from time to time and perform range of motion exercises. You will receive a prescription for pain medication to take by mouth. Take the medication as prescribed as needed. Narcotic pain medication can cause constipation so it is generally recommended that you take an over-the-counter stool softener such as colace or milk of magnesia to prevent this. Narcotics also cause sedation so do not drink alcohol or drive/operate heavy machinery while taking narcotic pain medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H Do not take more than 8 extra strength tablets per day RX *acetaminophen 500 mg 2 tablet(s) by mouth three times a day Disp #*180 Tablet Refills:*0 2. Bisacodyl 10 mg PR QHS:PRN constipation RX *bisacodyl 10 mg 1 suppository(s) rectally Daily Disp #*30 Suppository Refills:*0 3. Fentanyl Patch 75 mcg/h TD Q72H RX *fentanyl 75 mcg/hour Apply as directed Q72Hr Disp #*10 Patch Refills:*0 4. Docusate Sodium 100 mg PO BID 5. LORazepam 0.5 mg PO Q8H:PRN anxiety 6. Ondansetron 8 mg PO Q8H:PRN nausea 7. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate 8. Polyethylene Glycol 17 g PO DAILY:PRN constipation 9. Prochlorperazine 10 mg PO Q6H:PRN nausea 10. Senna 8.6 mg PO BID:PRN constipation 11. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Leg Pain Metastatic Colon Cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms ___, You were admitted to the hospital with leg pain. You were evaluated for a cause for the pain but unfortunately we could not find one despite many different images including MRIs and CT scans. You were treated with pain medication and your pain was better controlled. Please take your medications as directed and follow up as directed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Acyclovir 400 mg PO Q8H 3. Aspirin 81 mg PO DAILY 4. Bisacodyl 10 mg PR QHS:PRN Constipation - First Line 5. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q8H 6. CefTRIAXone 1 gm IV Q24H 7. Cyanocobalamin 100 mcg PO DAILY 8. Docusate Sodium 100 mg PO DAILY 9. Enoxaparin Sodium 40 mg SC DAILY 10. Fleet Enema (Saline) ___AILY:PRN constipaton 11. HydrALAZINE 10 mg PO Q6H:PRN SBP >160 12. LamoTRIgine 125 mg PO QHS 13. LOPERamide 2 mg PO QID:PRN diarrhea 14. Milk of Magnesia 30 mL PO DAILY:PRN Constipation - Third Line 15. Mirtazapine 15 mg PO QHS 16. Multivitamins W/minerals 1 TAB PO DAILY 17. Ondansetron ODT 4 mg PO Q8H:PRN nausea 18. OxyCODONE (Immediate Release) 5 mg PO DAILY:PRN rib discomfort 19. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 20. Pravastatin 40 mg PO QPM 21. Prochlorperazine 10 mg PO BID:PRN for nausea before the car ride to ___ 22. Ranitidine 150 mg PO BID 23. Senna 8.6 mg PO DAILY:PRN Constipation - First Line 24. Sodium Chloride 2 gm PO QID 25. TraMADol 50 mg PO Q8H:PRN Pain - Moderate Discharge Disposition: Extended Care Discharge Diagnosis: # Hyponatremia # Urinary Tract Infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure to participate in your care. You were admitted for low sodium. You received IV fluids and your condition improved. You were also treated for a urinary tract infection. Best Regards, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amitriptyline 100 mg PO QHS 2. ARIPiprazole 5 mg PO DAILY 3. ClonazePAM 0.5 mg PO TID 4. Gabapentin 400 mg PO BID 5. Hydrochlorothiazide 12.5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Primary Diagnosis: Community acquired pneumonia Secondary Diagnosis: Chronic pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted to ___ due to symptoms of fever and confusion in the context of a several day history of productive cough. Based on these symptoms and clinical findings, you were diagnosed with pneumonia. We treated your pneumonia with levofloxacin for 5 days. You completed this treatment on ___. You tolerated this treatment well and your symptoms improved. You will be discharged to a rehab facility to continue your recovery. During your hospitalization your blood pressure was often high. To address this we restarted the medication (hydrochlorothiazide) that you had been taking last year. You tolerated this medication well and it helped control your blood pressure. You should follow up with your primary care physician about your high blood pressure, and the best possible treatment. It was a pleasure caring for you during this hospitalization and we wish you the best of health. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Dilaudid ___ PO q6 hours prn pain Discharge Disposition: Home Discharge Diagnosis: symptomatic cholelithiasis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were treated at the hospital for symptomatic cholelithiasis with a laparascopic cholecystectomy. Please call your doctor or nurse practitioner if you experience the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain is not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse, changes location, or moves to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID:PRN constipation 2. Lactulose 15 mL PO TID:PRN constipation 3. Ondansetron 8 mg PO Q8H:PRN nausea/vomiting 4. Polyethylene Glycol 17 g PO DAILY:PRN constipation 5. Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting 6. Senna 8.6 mg PO BID:PRN constipation 7. Zolpidem Tartrate 5 mg PO QHS:PRN insomnia Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis -Superficial thrombophlebitis Secondary Diagnosis -Gallbladder cancer 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 ___. You came to our hospital for right arm redness and pain. We evaluated your arm for a blood clot and it did show a superficial vein blood clot, but no deep vein clots. This is likely the cause for the pain and redness and it is likely related to your recent chemotherapy treatments. There is no need to treat the blood clot with blood thinners at this time. Please make sure to call your doctors ___ present to the emergency room if you have worsening pain, swelling, or redness, of if you have fevers, chills, or sweats. Please continue to use hot compresses to your arm, and you can use Motrin/ibuprofen 600mg up to every 8 hours as needed for pain. Always take this with food.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 2. Phenytoin Sodium Extended 200 mg PO BID RX *phenytoin sodium extended 100 mg 2 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*2 3. Zonisamide 200 mg PO BID RX *zonisamide 100 mg 2 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*2 4. Albuterol Inhaler ___ PUFF IH Q4H:PRN Wheezing 5. Gabapentin 300 mg PO QHS 6. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 7. LevETIRAcetam 1000 mg PO QAM 8. LevETIRAcetam ___ mg PO QPM 9. Simvastatin 20 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: Seizure Discharge Condition: Mental Status: Clear and coherent. Mildly inattentive Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized at ___ after being found confused with slurred speech. Your doctors think that this was most likely due to a seizure. You were admitted to the Neurology Service and monitored for seizures. While in the hospital, an MRI was done. Your AVM was stable (no new change or bleed) compared to prior imaging. You were monitored on EEG. Though no convulsive or clinical seizures were detected, multiple seizures without clinical correlate (non-convulsive electrographic seizures) were detected. You had no symptoms from these. While your anti-seizure medications were optimized, new agents were not started because these events were not interfering with your life. After talking with your daughter, you were felt to be your normal self and were safe for discharge. Given the change in your phenytoin dosing however, your doctors request that ___ get a phenytoin level drawn on an outpatient basis. This should be a "trough" level, drawn roughly ___ minutes prior to your morning dose. This was ordered for you and may be done at any ___ lab in ___ weeks. If you have any questions following discharge, please feel free to contact ___ 11 or Dr. ___ office. It was a pleasure taking care of you, Your ___ Care Team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H RX *acetaminophen 500 mg 2 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 2. Bisacodyl 10 mg PO/PR DAILY RX *bisacodyl 10 mg 1 suppository(s) rectally daily Disp #*12 Suppository Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Ibuprofen 400 mg PO Q8H:PRN Pain - Moderate RX *ibuprofen 200 mg 2 tablet(s) by mouth q8 Disp #*90 Tablet Refills:*0 5. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine [Lidoderm] 5 % 1 patch daily Disp #*30 Patch Refills:*0 6. Morphine SR (MS ___ 15 mg PO Q8H RX *morphine 15 mg 1 tablet(s) by mouth every eight (8) hours Disp #*25 Tablet Refills:*0 7. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 8. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 17gram powder(s) by mouth ___ times daily Refills:*0 9. Polyethylene Glycol 17 g PO QID:PRN Constipation - Third Line 10. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a day Disp #*60 Tablet Refills:*0 11. Vitamin D ___ UNIT PO 1X/WEEK (FR) Duration: 8 Weeks RX *ergocalciferol (vitamin D2) [Vitamin D2] 50,000 unit 1 capsule(s) by mouth weekly (every ___ Disp #*8 Capsule Refills:*0 12.Outpatient Physical Therapy evaluate and treat as needed metastatic breast cancer to spine Discharge Disposition: Home Discharge Diagnosis: pathologic L3 vertebral fracture metastatic malignancy to bone breast cancer 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 ___ with severe back pain. Unfortunately you were found to have a fracture in your back as well as lesions that were concerning for cancer. You underwent further workup and testing for these lesions while you were in the hospital. You were also started on pain medications to help with your pain. Please do not drink alcohol or drive while taking oxycodone or MS ___. Please take your medication as prescribed involved with doctors as recommended below. We found breast cancer on biopsy that we think has spread to the spine bone. You will see cancer specialists in follow up. It has been a pleasure taking care of you and we wish you the best.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth Q6H:PRN Disp #*21 Tablet Refills:*0 2. Diphenoxylate-Atropine 2 TAB PO Q8H:PRN lose stool 3. Gabapentin 300 mg PO TID 4. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 5. Omeprazole 20 mg PO DAILY 6. Opium Tincture (morphine 10 mg/mL) 6 mg PO Q6H:PRN lose stool RX *opium tincture 10 mg/mL (morphine) 6 mg by mouth every six (6) hours Disp ___ Milliliter Milliliter Refills:*0 7. Rifaximin 550 mg PO TID 8. Simvastatin 20 mg PO QPM 9. Acetaminophen 1000 mg PO Q6H:PRN pain 10. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Choledocholithiasis SECONDARY DIAGNOSIS: - Afib (not on anticoagulation), - Perforated infectious colitis requiring emergent subtotal colectomy with ileostomy - GERD - HLD - Open subtotal colectomy with ileostomy (___) Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ came to ___ for abdominal pain and were found to have a stone obstructing one of your bile ducts. ___ had a procedure to remove the stone, along with symptomatic treatment for pain. Your liver enzymes were elevated, which is expected when ___ have an obstruction of your bile ducts. Thankfully these liver enzymes have slowly decreased. Please follow up with your primary care doctor and also with your gastrointestinal doctor once ___ have been discharged. ___ and your GI doctor can consider a cholecystectomy to prevent future episodes of stone pain after discussing the benefits and risks of each option. Continue ciprofloxacin antibiotic for five days. We wish ___ a speedy recovery. It was a pleasure taking care of ___! Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q12H RX *acyclovir 400 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*60 Tablet Refills:*0 2. Allopurinol ___ mg PO DAILY RX *allopurinol ___ mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 3. DASatinib 70 mg PO Q12H ) ( ) RX *dasatinib [Sprycel] 70 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*60 Tablet Refills:*2 4. PredniSONE 10 mg PO DAILY Duration: 11 Doses Take 30 mg (3 pills) ___. Take 20 mg (2 pills) ___. Take 10 mg (1 pill) ___. RX *prednisone 10 mg 1 tablet(s) by mouth Daily Disp #*11 Tablet Refills:*0 5. Sulfameth/Trimethoprim SS 1 TAB PO DAILY RX *sulfamethoxazole-trimethoprim 400 mg-80 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 6. Metoprolol Succinate XL 50 mg PO DAILY 7. Sertraline 100 mg PO QAM 8. Sertraline 50 mg PO QPM 9. HELD- Aspirin 81 mg PO BID This medication was held. Do not restart Aspirin until you have discussed with your PCP. Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: Ph+ ALL Pancytopenia Secondary diagnoses: Anxiety Depression Hypertension Discharge Condition: Activity Status: Ambulatory - Independent. Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during your admission to ___. Below you will find information regarding your stay. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted because you had Acute Lymphoblastic Leukemia. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? - You had a bone marrow biopsy that showed acute lymphoid leukemia. - You were treated with Prednisone and Dasatinib. - You had a lumbar puncture and received methotrexate. WHAT SHOULD I DO WHEN I GO HOME? -Take your medications as prescribed -Keep your follow up appointments with your team of doctors Thank ___ for letting us be a part of your care! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. OLANZapine (Disintegrating Tablet) 2.5 mg PO QID: PRN anxiety, agitation RX *olanzapine 2.5 mg 1 tablet(s) by mouth QID:PRN Disp #*20 Tablet Refills:*0 3. Piperacillin-Tazobactam 4.5 g IV Q8H RX *piperacillin-tazobactam 4.5 gram 4.5 g IV every eight (8) hours Disp #*63 Vial Refills:*0 4. PredniSONE 30 mg PO DAILY See instructions on discharge worksheet, taper by 5mg weekly with plan to maintain on 10mg daily Tapered dose - DOWN RX *prednisone 5 mg 6 tablet(s) by mouth once a day Disp #*80 Tablet Refills:*1 5. Pyridostigmine Bromide 15 mg PO Q8H:PRN myasthenic sx 6. Aspirin 81 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: #Myasthenic crisis #Diverticulitis #Pelvic abscess s/p ___ drain replacement ___ #R gluteal abscess #Leukocytosis #Diarrhea #Hypokalemia #Hypomagnesemia #Hypophosphatemia #Hypernatremia #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 presented to ___ with abdominal pain, somnolence, emesis, and respiratory distress. You were found to have an infection and myasthenia crisis. You were treated with plasmapheresis, IVIG, and antibiotics. Your potassium and magnesium were found to be low. You were seen by the surgery, interventional radiology, neurology, medicine, nephrology, and infectious disease specialists. You received a CT scan which showed a new abscess. Interventional radiology performed a procedure and you expressed strong wishes to go home the next day. We set up ___ services for you after leaving the hospital. Additionally, you should follow up with your primary care doctor and your neurologist as an outpatient. We also recommend follow up with surgery and a gastroenterologist. You will need regular lab checks after leaving the hospital to monitor your potassium, magnesium, and other electrolytes as well as your blood count. We wish you the best, Your ___ team Instructions for Drain Care: You will be going home with your surgical drain. Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). Maintain suction of the bulb. Please flush drainage catheter with 10 cc of sterile saline twice daily. Note color, consistency, and amount of fluid in the drain. Call the doctor, ___, or ___ nurse if the amount increases significantly or changes in character. Be sure to empty the drain as needed and record output. You may shower; wash the area gently with warm, soapy water. Keep the insertion site clean and dry otherwise. Avoid swimming, baths, hot tubs; do not submerge yourself in water. Make sure to keep the drain attached securely to your body to prevent pulling or dislocation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO QPM 2. Clopidogrel 75 mg PO DAILY 3. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain RX *nitroglycerin 0.3 mg 1 tablet(s) sublingually Every 5 minutes Disp #*10 Tablet Refills:*0 4. Aspirin 81 mg PO DAILY 5. Calcium 600 with Vitamin D3 (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral DAILY 6. CARVedilol 6.25 mg PO BID 7. Glargine 20 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 8. Isosorbide Mononitrate (Extended Release) 120 mg PO DAILY 9. Losartan Potassium 100 mg PO DAILY 10. Multivitamins 1 TAB PO DAILY 11. Torsemide 20 mg PO DAILY 12. Vitamin D 1000 UNIT PO DAILY 13. HELD- amLODIPine 2.5 mg PO DAILY This medication was held. Do not restart amLODIPine until you are told to do so by your primary care doctor 14. HELD- HydrALAZINE 100 mg PO TID This medication was held. Do not restart HydrALAZINE until you are told to do so by your primary care doctor Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: NSTEMI 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 ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because of chest pain WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? - You were found to have a heart attack. - You had a procedure to assess the arteries around the heart. There were two blockages found that were stented. You were started on medications to prevent further blockages in your heart. - You were found to have fluid in your lungs after the procedure and were given medications to help remove the fluid. - An ultrasound of your heart showed mildly reduced heart function. - A physical therapist evaluated you and found that you were safe to go home independently. - When your chest pain improved, you were discharged home. WHAT SHOULD I DO WHEN I GO HOME? - You should continue to take your medications as prescribed. - You should attend the appointments listed below. - If you experience severe chest pain, worsening shortness of breath, or loss of consciousness, please return to the Emergency Department. We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild 2. Senna 17.2 mg PO QHS 3. Aspirin 81 mg PO DAILY 4. Chlorthalidone 25 mg PO DAILY 5. dutasteride 0.5 mg oral QPM 6. Lisinopril 40 mg PO DAILY 7. Metoprolol Tartrate 12.5 mg PO BID 8. Rosuvastatin Calcium 20 mg PO QPM 9. Vitamin B Complex 1 CAP PO DAILY 10. Vitamin D 400 UNIT PO DAILY 11. Warfarin 10 mg PO 2X/WEEK (___) 12. Warfarin 7.5 mg PO 5X/WEEK (___) Discharge Disposition: Home Discharge Diagnosis: Bleeding and clot retention after TURP Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>-drink plenty of water -minimize constipation -no heavy lifting These steps can help you recover after your procedure. •DO drink plenty of water to flush out the bladder. •DO avoid straining during a bowel movement. Eat fiber-containing foods and avoid foods that can cause constipation. Ask your doctor if you should take a laxative if you do become constipated. •Don't take blood-thinning medications until your doctor says it's OK. •Don't do any strenuous activity, such as heavy lifting, for four to six weeks or until your doctor says it's OK. •Don't have sex. You'll likely be able to resume sexual activity in about four to six weeks. •Don't drive until your doctor says it's OK. ___, you can drive once your catheter is removed and you're no longer taking prescription pain medications. •You may continue to periodically see small amounts of blood in your urine--this is normal and will gradually improve. You may have clear or yellow urine that periodically turns pink/red throughout the healing process. Generally, the discoloration of the urine is “OK” unless it transitions from ___, ___ Aid to a very dark, thick or “like tomato juice” color •Resume your pre-admission/home medications EXCEPT as noted. You should ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care team. •Unless otherwise advised, blood thinning medications like ASPIRIN should be held until the urine has been clear/yellow for at least three days. Your medication reconciliation will note if you may resume aspirin or prescription blood thinners (like Coumadin (warfarin), Xarelto, Lovenox, etc.) •If needed, you will be prescribed an antibiotic to continue after discharge or save until your Foley catheter is removed (called a “trial of void” or “void trial”). •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 it is available over-the-counter •AVOID STRAINING for bowel movements as this may stir up bleeding. Avoid constipating foods for ___ weeks, and drink plenty of fluids to keep hydrated •No vigorous physical activity or sports for 4 weeks or until otherwise advised •Do not lift anything heavier than a phone book (10 pounds) or participate in high intensity physical activity (which includes intercourse) for a minimum of four weeks or until you are cleared by your Urologist in follow-up •Acetaminophen (Tylenol) should be your first-line pain medication. A narcotic pain medication may also be prescribed for breakthrough or moderate pain. •The maximum daily Tylenol/Acetaminophen dose is 3 grams from ALL sources. •Do not drive or drink alcohol while taking narcotics and do not operate dangerous machinery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 2. Alendronate Sodium 70 mg PO 1X/WEEK (MO) 3. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg calcium- 200 unit oral DAILY 4. Docusate Sodium 100 mg PO BID 5. Donepezil 5 mg PO QHS 6. Fluticasone Propionate NASAL 1 SPRY NU DAILY 7. guaiFENesin 200 mg oral DAILY 8. lactulose 20 gram oral DAILY 9. Meladox (melatonin) 3 mg oral DAILY 10. PARoxetine 30 mg PO DAILY 11. Senna 17.2 mg PO QHS 12. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Aspiration Pneumonia Acute Hypoxemic Respiratory Failure Hypotension Secondary: Alzheimer's Downs syndrome Constipation Osteoporosis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, It was a pleasure to care for you at the ___ ___. Why did you come to the hospital? - You came in for fevers What did you receive in the hospital? - You were found to have pneumonia What should you do once you leave the hospital? - Continue to take the medications we prescribe you - Follow up with all your doctors ___ as below - Be sure to have someone help you eat, and follow a careful puree'd and thickened diet (see diet section) We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. glimepiride 4 mg Tablet Sig: One (1) Tablet PO twice a day. 2. metformin 500 mg Tablet Sig: 0.5 Tablet PO twice a day. 3. simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 5. Januvia 100 mg Tablet Sig: One (1) Tablet PO once a day. 6. Levemir 100 unit/mL Solution Sig: ___ (55) units Subcutaneous once a day. 7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 8. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) packet PO DAILY (Daily). Disp:*30 packet* Refills:*2* 9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 10. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain: Do not exceed 4gm a day. Disp:*100 Tablet(s)* Refills:*0* 11. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Disp:*80 Tablet(s)* Refills:*0* 12. ceftriaxone ___ dextrose,iso-os 2 gram/50 mL Piggyback Sig: Two (2) grams Intravenous Q24H (every 24 hours): Continue until the Infectious Disease specialists tell you to stop. Disp:*84 grams* Refills:*0* 13. heparin, porcine (PF) 10 unit/mL Syringe Sig: One (1) ML Intravenous PRN (as needed) as needed for line flush. Disp:*20 syringes* Refills:*1* 14. enoxaparin 30 mg/0.3 mL Syringe Sig: Thirty (30) mg Subcutaneous Q12H (every 12 hours) for 2 weeks. Disp:*28 syringes* Refills:*0* 15. Outpatient Lab Work Weekly labs while on Ceftriaxone: Please draw CBC with differential, Basic Metabolic Panel, Liver Function Tests, ESR, CRP and fax results to Infectious Disease at ___. 16. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: Septic knee Secondary Diagnosis: Type II diabetes, hypertension, high cholesterol, obesity, mild renal insufficiency, and a previous history of asthma. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. You were admitted for an infection ___ your knee which required a surgical procedure to remove the infected material. The plastic liner ___ your knee was replaced during the procedure. You were treated with antibiotics and are doing better, although you will need to continue intravenous antibiotics as an outpatient to fully treat the infection and you will need to go to a rehabilitation facility to get your mobility back. You should follow up with the infectious disease specialists (see appointment below) and with your original orthopedic surgeon at ___. The following medications were ADDED: CONTINUE Ceftriaxone 2gm intravenously one time daily - course will be decided by Infectious disease physicians. TAKE tylenol ___ every 4 hours as needed for pain. Do not exceed 4gms per day. TAKE oxycodone 5mg by mouth every 6hours as needed for pain. CONTINUE lovenox 30mg 1 syringe twice daily, continue for 2 weeks TAKE Lisinopril 10mg (you used to take 20mg) by mouth daily. While on all these pain medications you are at risk risk for constipation. Please take the following medications regularly to keep your bowel movements soft. TAKE senna 1 tablet by mouth twice daily. TAKE docusate sodium 1 tablet twice a day by mouth. TAKE Miralax 1 packet by mouth daily. Please continue your other medications as prescribed. No other changes have been made.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen-Caff-Butalbital ___ TAB PO Q6H:PRN Headache 2. Bisacodyl 10 mg PO DAILY:PRN Constipation 3. Docusate Sodium 100 mg PO BID 4. Ibuprofen 600 mg PO Q8H:PRN Pain - Mild 5. Meclizine 25 mg PO TID 6. Senna 17.2 mg PO BID:PRN Constipation 7. Diazepam 10 mg PO Q8H:PRN muscle spasm 8. LevETIRAcetam 1000 mg PO BID 9. Lidocaine 5% Patch 1 PTCH TD DAILY:PRN local back pain 10. OxyCODONE (Immediate Release) 30 mg PO Q4H:PRN BREAKTHROUGH PAIN 11. OxyCODONE SR (OxyconTIN) 60 mg PO Q8H 12. Topiramate (Topamax) 25 mg PO BID 13. TraMADol 25 mg PO Q6H:PRN Pain - Moderate 14.Walker with attachment and with wheels Walker with attachment and with wheels Customer ID # ___ 15.Wheelchair standard with no attachment Wheelchair standard with no attachment Customer ID # ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Non-epileptic seizures Pseudoseizure Chronic progressive distal myopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ for evaluation of lower extremity weakness and spells of altered consciousness; you were evaluated by neurology and psychiatry, who determined that these spells are likely non-epileptic in nature. Activity: - You should take safety precautions because of these spells. Use caution when swimming and bathing. You may drown or become seriously injured if you have a spell while in water. - Avoid climbing ladders or performing activities involving heights unattended. - Take all medications as directed - Do not drive. You are not allowed to drive by law if you experience an episode of altered consciousness. - Please use your wheelchair at all times for mobility. - Physical therapy will work with you to help you regain your strength. They will advise you when you may return to using your cane/walker, and will further advise you on your activity level.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth once daily at night Disp #*30 Tablet Refills:*0 3. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 4. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 5. Prasugrel 10 mg PO DAILY RX *prasugrel 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS ================= NSTEMI HLD HTN 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 to the hospital because you had a heart attack, which happens when the blood supply to your heart gets blocked WHAT HAPPENED IN THE HOSPITAL? ============================== - You underwent a procedure that showed that one of your arteries that supplies blood to your heart was almost closed off. We opened it during the procedure with a metal tube called a stent, which stays in the artery. - We started you on a lot of medicines to help prevent a heart attack from happening in the future and prevent your stent from clotting and giving you another heart attack WHAT SHOULD I DO WHEN I GO HOME? ================================ - Be sure to take all your medications and attend all of your appointments listed below. - It is very important to take your aspirin and prasugrel every day. - These two medicines keep the stent in the artery open and help reduce your risk of having a future heart attack. - If you stop these medications or miss ___ dose, you risk causing a blood clot forming in your heart stents and having another heart attack - Please do not stop taking either medication without taking to your heart doctor. - You are also on other new medications to help your heart, including metoprolol and lisinopril. These medicines help to reduce your blood pressure and keep your heart healthier after the heart attack. Please take these as directed. Thank you for allowing us to be involved in your care, we wish you all the best! Your ___ Healthcare Team</s>