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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Citalopram 20 mg PO DAILY 2. Gabapentin 300 mg PO TID 3. Lorazepam 1 mg PO TID:PRN anxiety 4. OxycoDONE (Immediate Release) 5 mg PO BID:PRN hip pain 5. Pravastatin 20 mg PO HS 6. Rifampin 600 mg PO Q24H 7. RISperidone 3 mg PO DAILY 8. Sulfameth/Trimethoprim DS 1 TAB PO BID 9. Atenolol 12.5 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ ___: Primary diagnosis: Panic attack Secondary diagnosis: HTN, depression/panic disorder, osteoarthritis, hypokalemia 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 may know, you were admitted to the hospital for chest pain and shortness of breath. We feel that your symptoms were likely due to a panic attack. Your EKG and other labwork was normal so we do not believe you had a heart attack or other heart problem. You received fluids and pain medication and your symptoms resolved. We also noticed an area of redness on your right thigh. You were initially started on antibiotics, but we stopped these because we did not think this was a skin infection. You can continue to follow up with your orthopedic doctors at ___, your appointment details are below. Lastly, your body's potassium levels are on the lower side so we recommend that you try to eat some foods that are high in potassium (see the list we gave you). Please see your PCP at the appointment below. Again, it was a pleasure taking care of you, 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. Atorvastatin 20 mg PO QPM 2. CarBAMazepine 400 mg PO BID 3. Lisinopril 20 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Neuropathic pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted with a sensation of tightness in the abdomen and some paresthesias on the skin. You had an MRI of your brain and spinal cord which did not show any evidence of lesions. You also had a lumbar puncture which did not have any concerning findings. We feel the cause of your symptoms is possibly secondary to neuropathic pain. You should follow-up with Dr. ___ at the appointment below for further management. It was a pleasure taking care of you, Your ___ Neurologists</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Warfarin 5 mg PO DAILY16 4. Metoprolol Tartrate 25 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis Acute Kidney Injury Bradycardia Digoxin Toxicity Secondary Diagnosis CHF Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because you were found to have an abnormality in your kidney labwork pre-operative evaluation by your vascular surgeon, a slowed heart rate, and a concern regarding a chronic cough. After evaluating you with blood work, electrocardiogram, and imaging it was determined that you most likely had a slowed heart rate due to a combination of your medications. We discontinued your metoprolol and digoxin and monitored your heart rhythm. We recommend that you follow up with your vascular surgeon prior to your planned surgery. *** You will be discharged with a special wearable device to monitor your heart rate. Please wear this device at all times. If you become dizzy or lighthead, experience chest pain or shortness of breath please activate the device as you have been instructed *** ** You will need to see your PCP to check your blood work before you have your surgery. Additionally, you should have an echocardiogram performed as well. The vascular teams and your PCP ___ contact you about scheduling these tests. *** Please take all medications as prescribed and keep all scheduled appointments. Should you develop a severe worsening of symptoms, experience any of the warning signs listed below, or have any any other symptoms that concern you please seek medical attention. It was a pleasure taking care of you! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 1 PUFF IH TID:PRN shortness of breath or wheezing 2. Calcium Carbonate 500 mg PO BID 3. Fluticasone Propionate NASAL 2 SPRY NU DAILY 4. Glargine 30 Units Bedtime Insulin SC Sliding Scale using Insulin 5. Multivitamins 1 TAB PO DAILY 6. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every six (6) hours Disp #*12 Tablet Refills:*0 7. Vitamin D 1000 UNIT PO DAILY 8. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 9. Docusate Sodium 100 mg PO BID 10. Senna 1 TAB PO BID:PRN Constipation 11. Sulfameth/Trimethoprim DS 1 TAB PO BID RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 12. Loratadine *NF* 10 mg Oral daily 13. Zolpidem Tartrate 6.25 mg PO HS:PRN insomnia Discharge Disposition: Home Discharge Diagnosis: foot cellulitis diabetes type 2 complicated, controlled chronic HCV Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>you were hospitalized with an infection of your skin on your foot, called cellulitis. this is likely related to your recent surgery and scab on the top of the foot. this is being treated with antibiotics, which you should continue for the next 7 days. please wrap your foot with a clean dressing daily. monitor the foot for worsening redness, swelling, pus, drainage, or if you develop fever. for any of those sympotms please call your doctor.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild/Fever RX *acetaminophen 325 mg ___ tablet(s) by mouth every eight (8) hours Disp #*24 Tablet Refills:*0 2. Ciprofloxacin HCl 500 mg PO Q12H Duration: 7 Days RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 3. rifAXIMin 550 mg PO BID RX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 4. albuterol sulfate 90 mcg/actuation inhalation DAILY:PRN asthma 5. Ascorbic Acid ___ mg PO DAILY 6. Creon 12 4 CAP PO TID W/MEALS 7. FoLIC Acid 1 mg PO DAILY 8. Furosemide 40 mg PO DAILY 9. 70/30 15 Units Breakfast 70/30 15 Units Dinner 10. Lactulose 15 mL PO TID RX *lactulose 10 gram/15 mL (15 mL) 15 ml by mouth three times a day Disp #*90 Container Refills:*0 11. Magnesium Oxide 400 mg PO BID RX *magnesium oxide 400 mg (241.3 mg magnesium) 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 12. Multivitamins 1 TAB PO DAILY 13. Omeprazole 40 mg PO DAILY 14. Phosphorus 500 mg PO TID RX *sod phos di, mono-K phos mono [Phosphorous] 250 mg 2 tablet(s) by mouth twice a day Disp #*120 Tablet Refills:*0 15. Spironolactone 100 mg PO DAILY 16. Thiamine 100 mg PO DAILY 17. Vitamin D ___ UNIT PO DAILY 18. Zinc Sulfate 220 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnoses: Fall Pyelonephritis Gram-negative bacteremia Alcoholic hepatitis Encephalopathy Secondary Diagnoses: IDDM Pancreatitis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___. Why did you come to the hospital? - You fell and were found to have an infection in your kidneys and blood. Your liver tests were also very bad What did you receive in the hospital? - You were seen by the medicine service, as well as social work, physical therapy and nutrition. You received IV fluids, IV antibiotics to treat your infections, and medications (lactulose and rifaximin) to improve your liver function. You also received insulin to manage your diabetes and vitamins to improve your nutritional status. -We felt that you needed to stay in the hospital for a longer course of IV antibiotics and to continue to monitor your labs for a few days longer for your liver function. We discussed the risks of leaving the hospital and possibly having a worsening infection and worsening of your liver problems that could lead to you getting sicker and potentially dying. You understood the risks of leaving but still wanted to leave the hospital. What should you do once you leave the hospital? - Please avoid all alcohol and seek help from your PCP to get into a program to help to avoid alcohol use - Please come back to the hospital if you are feeling unwell - Please make sure you continue to eat 3 good meals per day and stay hydrated - Please take your medications as prescribed and go to your future appointments which are listed below. - Make sure to weigh yourself every day. If your weight goes up by 3 lb, please call your doctor. 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. Clopidogrel 75 mg PO DAILY to prevent stent thrombosis RX *clopidogrel 75 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Guaifenesin-Dextromethorphan 5 mL PO Q6H:PRN Cough, chest congestion RX *dextromethorphan-guaifenesin 100 mg-10 mg/5 mL ___ mL by mouth TID:PRN Refills:*0 3. Aspirin 81 mg PO DAILY 4. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN 5. Brimonidine Tartrate 0.15% Ophth. 1 DROP RIGHT EYE BID 6. Fluticasone Propionate NASAL 2 SPRY NU DAILY:PRN nasal congestion 7. Fluvastatin Sodium 80 mg oral DAILY 8. Hydrochlorothiazide 12.5 mg PO DAILY 9. Ketoconazole 2% 1 Appl TP DAILY 10. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 11. Levothyroxine Sodium 125 mcg PO DAILY 12. MetFORMIN XR (Glucophage XR) 500 mg PO BID 13. Metoprolol Succinate XL 50 mg PO DAILY 14. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 15. Valsartan 160 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Unstable angina Coronary artery disease Type 2 diabetes mellitus Hypothyroidism Glaucoma Asthma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, You were admitted to ___ after you had worsening chest pain at home after developing a likely upper respiratory viral illness. Your flu test was negative, and your EKG and cardiac enzymes were negative as well. However, your stress test showed some signs concerning for cardiac ischemia, and you went for a catheterization procedure which showed disease in your coronary arteries -- you had 2 stents placed in your "LAD" and they opened up your old stent in your "Left Circumflex" with a balloon. Please make sure to take aspirin and Plavix daily going forward for at least the next year. Please also make sure to weigh yourself every morning, and to call your doctor if your weight goes up more than 3 lbs. Your weight here was 205 lbs upon discharge. It was a pleasure taking care of you! Your ___ Cardiology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Patient eloped and no prescriptions were given including ceftriaxone or clonidine. Discharge Disposition: Home Discharge Diagnosis: #Complicated Group A strep Bacteremia #Presumed epidural abscess #Dilated CM with subsequent recovery of ejection fraction #Aspiration: #Dysphagia #Malnutrition: #Agitation: #Dystonic reaction to haldol #SI #Polysubstance Use: #Opiate dependence, withdrawal: #Chronic HCV infection: 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 ___. Please see below for information on your time in the hospital. WHY WAS I IN THE HOSPITAL? You were suicidal. You had a blood stream infection and were found to have a infection in your spine. WHAT HAPPENED IN THE HOSPITAL? -You were treated for your infection with intravenous antibiotics. You were seen by our infectious disease, spine specialists who felt this was the best way to treat your infection. -You had heart failure while you were very ill. Your heart function recovered. -You were intubated to help you breath. The breathing tube came out. You had difficulty swallowing after but recovered. -You were treated for withdrawal from opiates. You saw our addiction psychiatry team who offered suboxone which you declined at this time. WHAT SHOULD I DO WHEN I GO HOME? -Please report to your PCP, ___, or ___ 7 to have PICC line removed ASAP. -Do not use drugs. If you decide you want to support your sobriety with medication like suboxone ask your PCP. -Consider returning for treatment of this severe life-threatening infection. Unfortunately you choose to leave prior to completing your treatment. We had previously discussed risks of leaving without completing treatment including worsening infection, paralysis, and death. We explained that you are high risk for these complications. You expressed understanding and choose to leave anyway. We wish you the best! -Your Care Team at ___</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. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone [Oxaydo] 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Perianal abcess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ and underwent Exam under anesthesia and incision and drainage of your perianal abscess. You are recovering well and 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. *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 driving or operating heavy machinery while taking pain medications. You may have ___ baths 3 times a day for comfort. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 2. simethicone 80 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day) as needed for bloating. Disp:*qs Tablet, Chewable(s)* Refills:*0* 3. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain for 1 weeks. Disp:*qs Tablet(s)* Refills:*0* 4. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 5. losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*0* 7. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*0* 8. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0* 9. hydrocodone-acetaminophen ___ mg Capsule Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain for 1 weeks: Do not drive or operate heavy machinery while taking this medication. Disp:*qs Tablet(s)* Refills:*0* 10. calcium carbonate-vitamin D3 600 mg(1,500mg) -400 unit Capsule Sig: One (1) Capsule PO once a day. Discharge Disposition: Home Discharge Diagnosis: Coronary artery disease Retroperitoneal bleed causing bradycardia, hypotension, and brief cardiac arrest 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 blockages in your arteries putting you at high risk of a heart attack. You had a procedure to open up the blocked arteries, called a cardiac catheterization, and the placement of a stent which helps keep the arteries open. You will need to take multiple new medications and follow-up closely with your PCP and cardiologist to prevent complications. . You also had a low blood pressure and heart rate after the procedure, which was caused by bleeding into your belly. During this time we had to perform chest compressions to keep your heart pumping until we were able to give you medicines and fluids and help your heart start pumping sufficiently on its own. Because of this, you will have some chest discomfort for at least a week or so, and you should take the prescribed medications. Please return to the hospital immediately if you develop any bleeding, and light-headedness, pass out, or if you stop being able to urinate. . Please note the following medication changes: -Please START Asprin daily to help keep your stent open -Please START Plavix 75mg daily to help keep your stent open -Please START Simvastatin to lower your cholesterol -Please START metoprolol to help with your heart rate -Please START Pantoprazole to help with your reflux -Please START Simethicone as needed for bloating/gas pain -Please START Tramadol as needed for pain -Please START Vicodin as needed for pain . -Please STOP Omeprazole (replaced by pantoprazole) . -Please continue your other medications as previously prescribed</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 inpatient colorectal surgery service with fluid collections near the ostomy site. These were to small for any intervention. We have given you antibiotics and the pain and infection from the fluid collections have subsequently resolved after conservative management. You have tolerated a diet, You may return home to finish your recovery on the antibiotic ______ recommended by the infectious disease team. You should keep your appointment with Dr. ___ as listed below. You will continue the TPN and all other therapies at home but Dr. ___ will be restarting the Stelara and he will recommend when to restart this medication. You will need a CT scan of the abdomen on ___ to look at the collections and be sure it is safe to stop the antibiotics. Please arrive at ___ 4 radiology on the ___ of ___ at 12pm for a 1pm scan ___. If you have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, or any issues with ileostomy output. Thank you for allowing us to participate in your care! Our hope is that you will have a quick return to your life and usual activities. Good luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: N/A Discharge Disposition: Expired Facility: ___ Discharge Diagnosis: Diffuse large B cell lymphoma Enhancing lesion of R pons, midbrain and R posterio internal capsule Altered mental status leading to somnolence/coma Discharge Condition: Expired Followup Instructions: ___ [/INST] </s><s>Patient passed away ___ after being CMO >1week. Patient dx with relapsed refractory CNS lymphoma and presented with worsening neurological sx. Family meetings were arranged with the patients neuro-oncologist, primary oncologist, and all family members where the decision was made to make the patient CMO. Patient appeared comfortable and in no distress.</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. Metoprolol Tartrate 25 mg PO BID 4. Rosuvastatin Calcium 40 mg PO QPM 5. Valsartan 40 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ suffering small bowel obstruction and underwent conservative treatment. You are recovering well and 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. *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 driving or operating heavy machinery while taking opioid pain medications</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. Docusate Sodium 100 mg PO BID 3. FoLIC Acid 1 mg PO DAILY 4. Levothyroxine Sodium 88 mcg PO DAILY 5. Lorazepam 0.5 mg PO QHS:PRN insomnia 6. Multivitamins 1 TAB PO DAILY 7. Opium Tincture (morphine 10 mg/mL) 6 mg PO QID:PRN diarrhea 8. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 9. Prochlorperazine 10 mg PO Q6H:PRN nausea 10. Vitamin D 1000 UNIT PO DAILY 11. Ciprofloxacin HCl 500 mg PO Q12H Duration: 3 Days RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*2 Tablet Refills:*0 12. Oxybutynin 5 mg PO TID:PRN bladder spasm RX *oxybutynin chloride 5 mg 1 tablet(s) by mouth three times a day Disp #*30 Tablet Refills:*0 13. Simethicone 120 mg PO QID:PRN gas pain ___ may purchase over the counter 14. Senna 8.6 mg PO BID:PRN constipation ___ may purchase over the counter Discharge Disposition: Home Discharge Diagnosis: Gross hematuria with acute urinary obstruction DVT uterine cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>___ were admitted for blood in your urine. Urology was consulted and a three way foley catheter was placed to irrigate your bladder. Your hematuria resolved and the catheter was removed. The bleeding is likely related to irritation from radiation and tumor invasion into your bladder. For this, ___ will follow up with the urology doctors. ___ also were found to have a blood clot in your left calf (DVT), this will need to be followed with a repeat ultrasound of your leg next week at your oncologist's office. Your blood count can also be repeated at this time.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Albuterol Inhaler 6 PUFF IH Q4H:PRN wheezing, SOB 3. Artificial Tear Ointment 1 Appl BOTH EYES PRN dry eyes 4. Levothyroxine Sodium 75 mcg PO DAILY 5. Simvastatin 40 mg PO QPM 6. Milk of Magnesia 30 mL PO Q8H:PRN constipation 7. Sodium Chloride 3% Inhalation Soln 5 mL NEB TID 8. Senna 8.6 mg PO BID constipation 9. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 10. Nystatin Oral Suspension 5 mL PO QID:PRN prn thrush 11. Mirtazapine 15 mg PO QHS 12. Midodrine 10 mg PO TID 13. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 14. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID 15. Bisacodyl 10 mg PR QHS 16. Famotidine 20 mg PO DAILY 17. NPH 5 Units Breakfast NPH 5 Units Bedtime Insulin SC Sliding Scale using REG Insulin 18. Miconazole Powder 2% 1 Appl TP QID:PRN prn skin irritation 19. LACOSamide 100 mg PO BID 20. LeVETiracetam 500 mg PO BID 21. Docusate Sodium 100 mg PO BID constipation 22. Fleet Enema ___AILY:PRN constipation 23. Gabapentin 300 mg PO QHS 24. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 25. Glucose Gel 15 g PO PRN hypoglycemia protocol 26. Heparin 5000 UNIT SC TID 27. Clarithromycin 500 mg PO Q12H 28. Aquaphor Ointment 1 Appl TP TID:PRN rash or itchiness 29. Epoetin Alfa 5000 UNIT SC 3X/WEEK (___) 30. Erythromycin 0.5% Ophth Oint 0.5 in LEFT EYE QID 31. Lorazepam 0.5-2 mg IV Q6H:PRN anxiety 32. Triamcinolone Acetonide 0.1% Cream 1 Appl TP BID itching Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right SDH with 9mm midline shift Severely comminuted fracture-dislocation of C5 and C6 vertebral bodies with involvement of the transverse foramina of C5 and C6 C4 spinous process fracture T3 vertebral body fracture T7 transverse process fracture Bilateral vertebral artery dissection Right zygomatic arch and orbital wall fractures Bilateral hemopneumothoraces Community acquire pneumonia Ventilator acquire pneumonia Pulmonary norcardia SIADH/hyponatremia Axillary vein DVT Acute Kidney Injury Discharge Condition: Mental Status: Confused - sometimes. Clear sometimes, able to follow commands, nods yes or not to most basic questions. Opens eyes spontaneously. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital following a traumatic accident. You sustained a spinal fracture with subsequent paralysis. You also had a bleed in your head requiring surgery to relieve the pressure. You have had an extended hospital course with several infections that are inevitable with these types of injury and length of hospitalization however you are now stable and ready to be discharged from the hospital to rehab. Please continue to follow the recommendations we have sent your rehabilitation facility regarding your ongoing care. You will need follow up with your infectious disease specialists and your other doctors.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H pain 2. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 3. Labetalol 200 mg PO BID 4. Omeprazole 20 mg PO DAILY 5. Ondansetron 4 mg PO Q8H:PRN nausea Discharge Disposition: Home Discharge Diagnosis: small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after small bowel resections related to malignant adhesions. You have recovered from this procedure well and you are now ready to return home. Samples from your colon were taken and this tissue has been sent to the pathology department for analysis. You will receive these pathology results at your follow-up appointment. If there is an urgent need for the surgeon to contact you regarding these results they will contact you before this time. You have tolerated a regular diet, passing gas and your pain is controlled with pain medications by mouth. You may return home to finish your recovery. Please monitor yourself for signs of bleeding, you had some bleeding after surgery and it is important that you cal us if you develop any of the following symptoms: fast heart rate, low blood pressure, increased abdominal distension, increased adbominal pain, bleeding from your rectum, bleeding from your incision. Please monitor Movement prior to your discharge which is acceptable, however it is important that you have a bowel movement in the next ___ days. After anesthesia it is not uncommon for patient’s to have some decrease in bowel function but your should not have prolonged constipation. Some loose stool and passing of small amounts of dark, old appearing blood are expected however, if you notice that you are passing bright red blood with bowel your bowel function closely. If you are passing loose stool without improvement please call the office or go to the emergency room if the symptoms are severe. If you are taking narcotic pain medications there is a risk that you will have some constipation. Please take an over the counter stool softener such as Colace, and if the symptoms does not improve call the office. If you have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or constipation. You have a long vertical incision on your abdomen that is closed with staples. This incision can be left open to air or covered with a dry sterile gauze dressing if the staples become irritated from clothing. The staples will stay in place until your first post-operative visit at which time they can be removed in the clinic, most likely by the office nurse. Please monitor the incision for signs and symptoms of infection including: increasing redness at the incision, opening of the incision, increased pain at the incision line, draining of white/green/yellow/foul smelling drainage, or if you develop a fever. Please call the office if you develop these symptoms or go to the emergency room if the symptoms are severe. You may shower, let the warm water run over the incision line and pat the area dry with a towel, do not rub. No heavy lifting for at least 6 weeks after surgery unless instructed otherwise by Dr. ___ Dr. ___. You may gradually increase your activity as tolerated but clear heavy exercise with your surgeon. You will be prescribed a small amount of the pain medication Oxycodone. Please take this medication exactly as prescribed. You may take Tylenol as recommended for pain. Please do not take more than 3000mg of Tylenol daily. Do not drink alcohol while taking narcotic pain medication or Tylenol. Please do not drive a car while taking narcotic pain medication. Thank you for allowing us to participate in your care! Our hope is that you will have a quick return to your life and usual activities. Good luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ertapenem 1 gram Recon Soln Sig: One (1) ___ once a day for 6 days. Disp:*6 Recon Soln* Refills:*0* 2. allopurinol ___ mg Tablet Sig: One (1) Tablet PO once a day. 3. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 4. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 6. glipizide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 8. ferrous sulfate 300 mg (60 mg iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. amlodipine 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 11. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 12. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. enoxaparin 100 mg/mL Syringe Sig: One (1) syringe Subcutaneous BID (2 times a day) for 1 weeks. Disp:*14 syringe* Refills:*0* 14. warfarin 4 mg Tablet Sig: One (1) Tablet PO once a day: continue to monitor INR with ___ clinic. ___ PCP for any questions re; Coumadin. 15. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 16. Heparin Flush (10 units/ml) 2 mL IV PRN line flush PICC, heparin dependent: Flush with 10mL Normal Saline followed by Heparin as above daily and PRN per lumen. 17. multivitamin Tablet Sig: One (1) Tablet PO once a day. 18. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1. Pancreatic pseudocysts 2. Liver abscess 3. Sepsis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please ___ 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. ___ 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, 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. . PTBD 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. ___ 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 or ___ strength hydrogen peroxide followed by saline rinse, pat dry, and place a drain sponge. Change daily and as needed. *Keep the insertion site clean and dry otherwise. *Avoid swimming, baths, hot tubs; do not submerge yourself in water. *Make sure to keep the drain attached securely to your body to prevent pulling or dislocation. . PICC Line: *Please monitor the site regularly, and ___ your MD, nurse practitioner, or ___ Nurse if you notice redness, swelling, tenderness or pain, drainage or bleeding at the insertion site. * ___ your MD or proceed to the Emergency Room immediately if the PICC Line tubing becomes damaged or punctured, or if the line is pulled out partially or completely. DO NOT USE THE PICC LINE IN THESE CIRCUMSTANCES.Please keep the dressing clean and dry. Contact your ___ Nurse if the dressing comes undone or is significantly soiled for further instructions. . Liver 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. ___ 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 or ___ strength hydrogen peroxide followed by saline rinse, pat dry, and place a drain sponge. Change daily and as needed. *Keep the insertion site clean and dry otherwise. *Avoid swimming, baths, hot tubs; do not submerge yourself in water. *Make sure to keep the drain attached securely to your body to prevent pulling or dislocation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Metoprolol Succinate XL 100 mg PO BID 3. Omeprazole 20 mg PO DAILY 4. Simvastatin 10 mg PO DAILY 5. Vitamin D 1000 UNIT PO DAILY 6. Acetaminophen 1000 mg PO Q8H 7. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 6 hours Disp #*20 Tablet Refills:*0 8. ammonium lactate 12 % topical Daily Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Nephrolithiasis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted with left back pain and found to have a kidney stone in the left kidney. You pain has been treated with Tylenol and small doses of oxycodone as needed. Please follow-up with the Urologists, as below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. hydroxychloroquine 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 2. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff Inhalation BID (2 times a day). 3. Tylenol ___ mg Tablet Sig: ___ Tablets PO every ___ hours as needed for pain. 4. ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO Q8H (every 8 hours) as needed for nausea. Disp:*7 Tablet, Rapid Dissolve(s)* Refills:*1* Discharge Disposition: Home Discharge Diagnosis: Viral gastroenteritis 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 here at ___. You were admitted with abdominal/lower back pain, nausea, and vomiting. You were assessed for a possible flare of your lupus as you had flares with these symptoms in the past. Your symptoms were felt to be more consistant with a gastrointestinal viral illness and you were treated with IV fluids and IV pain and nausea medications. Your symptoms gradually improved and you were discharged once you were able to tolerate food. It is important that you continue to take your ___ twice daily as prescribed as this will help to prevent future lupus flares. The following changes have been made to your medications: - Zofran (ondansetron) as needed for nausea every 8 hours</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN pain/headache RX *acetaminophen 500 mg 2 tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 2. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*17 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*20 Capsule Refills:*0 4. Hydrochlorothiazide 25 mg PO DAILY 5. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every four (4) hours Disp #*25 Tablet Refills:*0 6. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*25 Tablet Refills:*0 7. Omeprazole 20 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Ruptured appendicitis with periappendical abscess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You presented to ___ with abdominal pain and were found to have ruptured appendicitis with periappendical abscess. You were admitted for bowel rest and IV antibiotics. A repeat CT scan showed the abscess was getting larger, so you were taken to Interventional Radiology and underwent drainage of the abscess. A drain was left in place. You are now tolerating a regular diet and your pain is well controlled. You are ready to be discharged home to continue your recovery. You will have a prescription to complete a course of antibiotics and will have a visiting nurse to help you with drain care. 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 drain site with a mild soap and warm water. Gently pat the area dry. JP 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). *Maintain suction of the bulb. *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. *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. *Flush drain three times a day</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Naltrexone 50 mg PO DAILY RX *naltrexone 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Warfarin 7.5 mg PO DAILY16 please take 7.5 mg of warfarin on ___, then get your INR checked on ___. 3. BuPROPion (Sustained Release) 150 mg PO BID 4. Cyanocobalamin 50 mcg PO DAILY 5. Enoxaparin Sodium 80 mg SC Q12H Start: Today - ___, First Dose: Next Routine Administration Time 6. Losartan Potassium 50 mg PO DAILY 7. Metoprolol Tartrate 25 mg PO BID 8. Multivitamins 1 TAB PO DAILY 9. Rosuvastatin Calcium 20 mg PO QPM 10. HELD- Aspirin 81 mg PO DAILY This medication was held. Do not restart Aspirin until ___ discuss it with your PCP ___: Home Discharge Diagnosis: ACUTE ISSUES ============= submandibular hematoma alcohol abuse Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Dr. ___, ___ were admitted to the hospital with swelling of the base of your tongue. Imaging (CT) showed a submandibular hematoma. ___ were found to have an INR higher than the therapeutic range, indicating that your blood had become very thin. This was likely due to recent heavy alcohol use increasing the effect of your warfarin. We treated ___ by reversing the effect of the warfarin (Coumadin) with Vitamin K and fresh frozen plasma. To bridge ___ back on to warfarin, we used a heparin drip and then Lovenox. ___ should continue to take the Lovenox at home until told to stop by the ___ clinic. Anticoagulation plan: - please take dose of lovenox at 2:15 AM on ___ (after receiving dose on 2:15 ___ of ___ - ___ can continue to make these doses slightly earlier to get them back on a normal schedule over time - please continue to take warfarin 7.5 mg on ___ (we will give ___ your dose in the hospital) and 7.5 mg on ___. - please get your INR checked on ___ and wait for instructions from the ___ on how much warfarin to take. It is very important to treat your alcohol abuse. ___ told us that ___ were interested in Vivitrol (naltrexone), and we commend ___ on taking this step forward. ___ received one dose before discharge. ___ should continue to take the Vivitrol at home: *** 50mg every day. Please keep the appointments that we made for ___ below, especially the appointment with Dr. ___. Sincerely, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Soft cervical collar Please provide patient 1 soft cervical collar 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO once a day. 4. cholecalciferol (vitamin D3) 1,000 unit Tablet Sig: One (1) Tablet PO once a day. 5. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. lovastatin 10 mg Tablet Sig: One (1) Tablet PO once a day: Home regimen. 8. glyburide 5 mg Tablet Sig: 1.5 Tablets PO once a day. 9. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. 10. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Acute gait disorder possibly secondary to cervical spondylosis (ruled out stroke) Secondary Diagnosis: Hypertension, Hyperlipidemia, Diabetes Mellitus, Chronic Kidney Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neurologic: Peripheral signs of cervical spondylosis and bilateral overshoot on cerebellar testing bilaterally and subtle proprioceptive signs in all 4 limbs. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of DIFFICULTY WALKING due to DYSEQUILIBRIUM, a feeling of imbalance while walking and standing. There was no vertigo (spinning sensation) or lightheadedness with this. We sought to exclude STROKE as a possible cause of this symptom, so we obtained an MRI and MRA of the BRAIN which fortunately did NOT show any evidence of a stroke. The most likely cause for your symptoms is cervical spondylosis (narrowing of the spinal canal at the neck) which can cause walking problems at times with awkward movements of the neck. We evaluated this with an ___ of the neck which showed no worrying changes. To treat your cervical spondylosis, you should wear a soft cervical collar at night. We have arranged neurology ___ as below. At this time, we will not change any of your medications. If you experience any of the following concerning symptoms below, please seek medical attention. It was a pleasure providing you with medical care during this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO BID Last dose in ___ of ___. MetroNIDAZOLE 500 mg PO TID Last dose in ___ of ___. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 40 mg PO QPM 6. Baclofen 10 mg PO QHS 7. Bisacodyl 10 mg PR QHS:PRN Constipation - Second Line 8. Clopidogrel 75 mg PO DAILY 9. Fluticasone Propionate NASAL 1 SPRY NU DAILY 10. Furosemide 20 mg PO DAILY 11. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 12. Lidocaine 5% Patch 1 PTCH TD QAM 13. Lisinopril 10 mg PO DAILY 14. Metoprolol Tartrate 25 mg PO DAILY 15. Milk of Magnesia 30 mL PO Q12H:PRN Constipation - First Line 16. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN cp 17. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Third Line 18. Senna 8.6 mg PO BID:PRN Constipation - First Line 19. TraMADol 25 mg PO Q4H:PRN Pain - Moderate Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute cholecystitis Chronic systolic CHF CAD prior DVA CKD III HTN 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>Patient was admitted for inflammation in his gallbladder (cholecystitis). He was started on antibiotics and he improved. The decision was made not to drain his gallbladder. He will need close monitoring for recurrence of symptoms. He will complete a 14 day course of antibiotics (Cipro/Flagyl) with his last dose on ___. He will need close follow up with his PCP to coordinate ___ repeat ultrasound of his gallbladder to monitor for ongoing inflammation. It was a pleasure taking care of you. Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H RX *acetaminophen 500 mg 2 tablet(s) by mouth every six (6) hours Disp #*20 Tablet Refills:*0 2. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*5 Tablet Refills:*0 3. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram 17 g by mouth once a day Disp #*10 Packet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Acute Cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital with acute cholecystitis. You were taken to the operating room and had your gallbladder removed laparoscopically. You tolerated the procedure well and are now being discharged home to continue your recovery with the following instructions. Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 20 mg PO BID 2. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild/Fever 3. Apixaban 5 mg PO BID 4. Baclofen 5 mg PO BID 5. Bimatoprost 0.03% Ophth (*NF*) 1 drop ___ 3X/WEEK 6. Cuvposa (glycopyrrolate) 1 mg/5 mL (0.2 mg/mL) oral TID 7. Glycopyrrolate 1 mg PO TID 8. GuaiFENesin 10 mL PO BID 9. Lactobacillus acidophilus 1 billion cell oral DAILY 10. Osmolite 1 Cal (nutritional supplements) 0.04 gram-1.06 kcal/mL oral 5X/DAY 11. PARoxetine 10 mg PO QHS 12. Simvastatin 20 mg PO QPM 13. Vitamin D 5000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Splenic artery aneurysm Discharge Condition: Stable, wheelchair-bound Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to the hospital due to a GI bleed. It is caused by a aneurysm in the arteries supplying the stomach and small intestines. Our interventional radiologist performed and angiogram and was successful in blocking the aneurysms to prevent further bleeding. You will need to follow up with one of our interventional radiologists after discharge. The only medication change is your Prilosec (omeprazole) for gastritis . You will need to take this two times a day for three months, and then go back to once a day. It was a pleasure taking care of you here in ___!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen (Liquid) 650 mg PO 5X/DAY while awake RX *acetaminophen 500 mg 2 tab by mouth three times a day Disp #*60 Tablet Refills:*0 2. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB, wheezing 3. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation RX *bisacodyl [Laxative (bisacodyl)] 5 mg 1 to 2 tablet(s) by mouth once a day Disp #*50 Tablet Refills:*0 4. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*50 Capsule Refills:*0 5. Enoxaparin Sodium 40 mg SC BID RX *enoxaparin 40 mg/0.4 mL 40 mg twice a day Disp #*56 Syringe Refills:*0 6. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 to 2 tablet(s) by mouth every four (4) hours Disp #*36 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY:PRN constipation Take daily as needed. RX *polyethylene glycol 3350 [ClearLax] 17 gram 1 powder(s) by mouth daily as needed Disp #*10 Packet Refills:*0 8. Psyllium Powder 1 PKT PO DAILY:PRN constip Take daily as needed. RX *psyllium husk (aspartame) [Fiber (with aspartame)] 3.4 gram/5.8 gram 1 powder(s) by mouth daily as needed Disp #*20 Packet Refills:*0 9. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a day Disp #*50 Tablet Refills:*0 10. Vitamin D 800 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 2 tablet(s) by mouth once a day Disp #*60 Tablet Refills:*0 11. Diltiazem Extended-Release 240 mg PO DAILY 12. Doxazosin 4 mg PO HS 13. Fluticasone Propionate 110mcg 2 PUFF IH BID 14. Furosemide 20 mg PO DAILY 15. Hydrochlorothiazide 12.5 mg PO DAILY 16. Losartan Potassium 100 mg PO DAILY 17. Metoprolol Succinate XL 100 mg PO DAILY 18. Omeprazole 20 mg PO DAILY 19. Tiotropium Bromide 1 CAP ___ DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: closed left intertrochanteric fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: -Weight Bearing as Tolerated to the Left lower extremity MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so 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 twice 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. - Please remain in your dressing and do not change unless it is visibly soaked or falling off. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE <30 DAYS OF REHAB FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___. You will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for and any new medications/refills. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Physical Therapy: Weight Bearing as Tolerated to the Right Lower Extremity Treatments Frequency: Any staples or superficial sutures you have are to remain in place for at least 2 weeks postoperatively. Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. You may shower and allow water to run over the wound, but please refrain from bathing for at least 4 weeks postoperatively. Please remain in the splint until follow-up appointment. Please keep your splint dry. If you have concerns regarding your splint, please call the clinic at the number provided.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*23 Tablet Refills:*0 2. Acyclovir 400 mg PO Q12H 3. LevETIRAcetam 500 mg PO TID 4. Multivitamins W/minerals 1 TAB PO DAILY 5. HELD- Posaconazole Delayed Release Tablet 300 mg PO DAILY This medication was held. Do not restart Posaconazole Delayed Release Tablet until until you further discuss with your doctors. Discharge Disposition: Home Discharge Diagnosis: Sepsis E.Coli Bacteremia MDS Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You presented with fevers and abdominal pain. You were found to have bacteria in your blood stream. The source of this bacteria was felt to either be your bile ducts or your urinary tract. You were initially treated with IV antibiotics, and you have been switched to oral antibiotics. You continue to feel well.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Enalapril Maleate 2.5 mg PO DAILY 3. Rosuvastatin Calcium 20 mg PO QPM 4. Zolpidem Tartrate ___ mg PO QHS Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES: Vasovagal episode Sinus bradycardia SECONDARY DIAGNOSES: CAD Insomnia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Dr. ___, ___ was a pleasure taking care of you at ___ ___. You came to the hospital because you experienced lightheadedness, nausea, and vomiting. Your heart rate was found to be low but you did not have any signs of heart attack. Your symptoms are likely related to a vasovagal episode. We advise you to stay hydrated during the day. We stopped your medication "Metoprolol" because it slows the heart rate. Make sure to take your medications as prescribed and follow up with your doctors as ___. Best regards, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H RX *acetaminophen 500 mg 2 tablet(s) by mouth every six (6) hours Disp #*40 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*20 Capsule Refills:*0 3. Senna 8.6 mg PO BID 4. Warfarin 2.5 mg PO 6X/WEEK (___) 5. Warfarin 1.25 mg PO 1X/WEEK (___) 6. Albuterol Inhaler ___ PUFF IH Q4-6H:PRN SOB or wheezing 7. Lisinopril 5 mg PO DAILY 8. Metoprolol Succinate XL 200 mg PO DAILY 9. Omeprazole 20 mg PO BID 10. Pravastatin 80 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: Gallstone ileus Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You came to the Emergency Department on ___ due to abdominal pain, no passing gas and constipation for 1 day. After examining you and doing a CT scan of your abdomen you were diagnosed with a gallstone ileus, which is an obstruction in your small intestine secondary to a stone from your gallbladder. You were admitted to the Acute Care Surgery Service and taken to surgery on ___ for removal of your stone. When you got out of the OR, you had elevation of your heart rate and blood pressure so you were taken to the TSICU for closer monitor of your condition and acute management. After 3 days in the TSICU you were properly conditioned to be transferred to the surgery floor, for management and observation. While in the floor your improvement was fast and as expected, and your vitals signs were controlled. Now, after 3 days of observation and treatment you are ready to go back home with your home medications. 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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 40 mg PO DAILY 2. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild/Fever 3. Apixaban 5 mg PO BID 4. Atorvastatin 40 mg PO QPM 5. Atovaquone Suspension 750 mg PO BID 6. Benzonatate 100 mg PO TID 7. Doxepin HCl 50 mg PO HS 8. Fluticasone Propionate 110mcg 2 PUFF IH BID 9. Furosemide 40 mg PO DAILY 10. GuaiFENesin ER 1200 mg PO Q12H 11. HYDROmorphone (Dilaudid) 24 mg PO Q3H:PRN Pain - Moderate 12. Levalbuterol Neb 0.63 mg NEB Q4H:PRN wheezing 13. levalbuterol tartrate 45 mcg/actuation inhalation Q4H:PRN Shortness of breath 14. Levofloxacin 750 mg PO Q24H Duration: 2 Days RX *levofloxacin 750 mg 1 tablet(s) by mouth once a day Disp #*1 Tablet Refills:*0 15. Lisinopril 20 mg PO DAILY 16. LORazepam ___ mg PO Q4H:PRN anxiety 17. Methylprednisolone ACETATE 12 mg IM DAILY 18. Metoprolol Succinate XL 50 mg PO BID 19. MetronidAZOLE Topical 1 % Gel 1 Appl TP BID:PRN rosacea 20. Montelukast 10 mg PO DAILY 21. Ondansetron 8 mg PO Q8H:PRN nausea 22. oxyMORphone 70 mg oral Q8H 23. Ranitidine 300 mg PO QHS 24. SITagliptin 100 mg oral DAILY 25. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation BID Discharge Disposition: Home Discharge Diagnosis: Aspiration pneumonia Laryngopharyngeal reflux Behcets Chronic pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital with aspiration pneumonia, likely due to recurrent aspiration episodes from reflux induced damage to your vocal cords. You were treated with antibiotics, and your pneumonia resolved. You are being discharged on levaquin to complete a course through ___. Will be important that you follow-up with your lung and ENT doctors after ___. ___ addition, please follow-up with your outpatient rheumatologist for ongoing treatment of your Behcets. With best wishes, ___ Medicine</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 Q6H:PRN Disp #*5 Vial Refills:*3 2. Amlodipine 5 mg PO DAILY 3. Aquaphor Ointment 1 Appl TP TID:PRN pruritis 4. Aspirin 325 mg PO DAILY 5. Lidocaine Jelly 2% 1 Appl TP PRN pain 6. Nicotine Polacrilex 2 mg PO Q4H:PRN nicotine craving RX *nicotine (polacrilex) 2 mg 1 lozenge Q4H:PRN Disp #*180 Lozenge Refills:*0 7. Pravastatin 40 mg PO QPM 8. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 9. Doxycycline Hyclate 100 mg PO Q12H RX *doxycycline hyclate 100 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*8 Tablet Refills:*0 10. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB RX *albuterol sulfate 90 mcg 2 PUFF IH Q4H:PRN Disp #*2 Inhaler Refills:*1 11. Ibuprofen 600 mg PO Q8H:PRN pain 12. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation BID RX *budesonide-formoterol [Symbicort] 160 mcg-4.5 mcg/actuation 1 PUFF IH twice a day Disp #*2 Inhaler Refills:*1 13. Tiotropium Bromide 1 CAP IH DAILY RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 CAP IH DAILY Disp #*30 Capsule Refills:*1 14. Triamcinolone Acetonide 0.025% Ointment 1 Appl TP BID:PRN pruritis 15. PredniSONE 40 mg PO DAILY Duration: 5 Doses RX *prednisone 20 mg 2 tablet(s) by mouth once a day Disp #*8 Tablet Refills:*0 16. nebulizers 1 nebulizer miscellaneous variable RX *nebulizers use daily variable Disp #*1 Each Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY: 1). Chronic obstructive pulmonary disease, acute on chronic 2). Alcohol intoxication SECONDARY: 1). 2). - EtOH abuse - h/o EtOH withdrawal, unclear character of withdrawal - tobacco dependence - COPD, followed by ___ (___) at ___ per pt - CAD - lung nodules on ___ CT scan (2 LLL noncalcified nodes) - chronic bronchitis - pt reports significant asbestos exposure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was our pleasure caring for you at ___ ___. You were admitted with a COPD exacerbation and treated with medications that improved your condition. You were also intoxicated with alcohol when you were admitted and were monitored for signs and symptoms of withdrawal. It is important you take your medications as prescribed and follow up with your doctors as ___ outpatient. In addition, avoiding smoking and not drinking alcohol will help you not get COPD flares and alcohol intoxication. LAST DAY OF DOXYCYCLINE AND PREDNISONE = ___ Best wishes, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 60 mg SC Q12H RX *enoxaparin 60 mg/0.6 mL 60 mg SC twice daily Disp #*60 Syringe Refills:*0 2. Acetaminophen 500 mg PO Q6H:PRN pain 3. Aspirin 325 mg PO DAILY 4. Docusate Sodium 100 mg PO BID 5. Gabapentin 600 mg PO TID 6. Lidocaine 5% Patch 2 PTCH TD QAM RX *lidocaine 5 % (700 mg/patch) Apply 1 patch to the affected area every morning Disp #*30 Patch Refills:*0 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Milk of Magnesia 15 mL PO PRN Heartburn 9. Ondansetron 8 mg PO Q8H:PRN nausea 10. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN breakthrough pain 11. OxyCODONE SR (OxyconTIN) 80 mg PO Q1600 RX *oxycodone 80 mg 1 tablet(s) by mouth at 4PM Disp #*30 Tablet Refills:*0 12. OxyCODONE SR (OxyconTIN) 100 mg PO TWICE DAILY, QAM & QHS RX *oxycodone [OxyContin] 40 mg 1 tablet(s) by mouth in the morning & at bedtime Disp #*60 Tablet Refills:*0 RX *oxycodone [OxyContin] 60 mg 1 tablet(s) by mouth in the morning & before bed Disp #*60 Tablet Refills:*0 RX *oxycodone 40 mg ___ tablet(s) by mouth three times daily Disp #*120 Tablet Refills:*0 13. Polyethylene Glycol 17 g PO DAILY:PRN constipation 14. Pyridoxine 50 mg PO DAILY 15. Senna 8.6 mg PO BID 16. Venlafaxine XR 150 mg PO DAILY RX *venlafaxine 150 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 17. Maalox Maximum Strength (alum-mag hydroxide-simeth) 400-400-40 mg/5 mL oral PRN heartburn Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: metastatic pancreatic cancer, splenic infarct, malnutrition Secondary diagnoses: atrial fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to ___ with increasing abdominal pain. You had a CAT scan again that showed no progression of your cancer, but a new "splenic infarction." Based on the imaging, the cause for this was most likely a blood clot. To treat this, we gave you a blood thinner called enoxaparin (Lovenox). We helped to get your pain under control with IV medications and made adjustments to your usual home regimen to address your pain and fatigue, which you'll see below. As we discussed, the reason for your pain was not typical for anything, but is most likely from your cancer and or the splenic infarct. It was a pleasure caring for you! We wish you the very best, Your Team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Propranolol 40 mg PO BID RX *propranolol 40 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 2. Calcium Carbonate 1000 mg PO DAILY RX *calcium carbonate [Antacid (calcium carbonate)] 215 mg calcium (500 mg) 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 3. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID RX *clobetasol 0.05 % apply to affected skin twice daily Refills:*0 4. Cyanocobalamin 1000 mcg PO DAILY RX *cyanocobalamin (vitamin B-12) 1,000 mcg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 5. Ferrous Sulfate 325 mg PO DAILY RX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Furosemide 20 mg PO DAILY RX *furosemide 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. HydrOXYzine 50 mg PO TID:PRN Anxiety, insomnia RX *hydroxyzine HCl 50 mg 1 tab by mouth three times daily Disp #*90 Tablet Refills:*0 9. Lactulose 30 mL PO BID RX *lactulose [Generlac] 10 gram/15 mL 30 ml by mouth twice daily Disp ___ Milliliter Refills:*0 10. LevETIRAcetam 500 mg PO BID RX *levetiracetam 500 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 11. Magnesium Oxide 800 mg PO QID RX *magnesium oxide 400 mg magnesium 2 tablet(s) by mouth four times daily Disp #*240 Tablet Refills:*0 12. Mirtazapine 30 mg PO QHS RX *mirtazapine 30 mg 1 tablet(s) by mouth daily at bedtime Disp #*30 Tablet Refills:*0 13. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 14. Naloxone 4 mg PO PRN Opioid overdose RX *naloxone [Narcan] 4 mg/actuation 1 spray nasal once Disp #*1 Spray Refills:*0 15. Omeprazole 40 mg PO BID RX *omeprazole 40 mg 1 capsule(s) by mouth twice daily Disp #*60 Capsule Refills:*0 16. Phosphorus 500 mg PO QID RX *sod phos di, mono-K phos mono [Phosphorous] 250 mg 2 tablet(s) by mouth four times daily Disp #*240 Tablet Refills:*0 17. Rifaximin 550 mg PO BID RX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 18. Spironolactone 25 mg PO DAILY RX *spironolactone 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 19. Sucralfate 1 gm PO QID RX *sucralfate [Carafate] 1 gram/10 mL 10 ml by mouth four times daily Refills:*0 20. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 21. TraZODone 100 mg PO QHS:PRN Insomnia RX *trazodone 100 mg 1 tablet(s) by mouth daily at bedtime Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS Hematemesis Alcoholic hepatitis Cirrhosis ETOH withdrawal Pneumonia SECONDARY DIAGNOSIS Right upper extremity trauma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you had bloody vomit at home. WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - You did not throw up any more blood. Your blood counts were monitored and they were stable. - You were treated for your alcohol withdrawal, and for your liver disease inflammation to alcohol . - You improved and were ready to leave the hospital. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Please take all of your medications as prescribed and go to your follow up appointments with your doctors ___ below) - Please pick up your prescription of rifaximin from the pharmacy in ___ days, because your insurance is currently working on the prior authorization for you to get this medication. - Please do not drink alcohol. It is injuring your liver. It was a pleasure participating in your care. We wish you the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for Pain for 2 weeks. Disp:*50 Tablet(s)* Refills:*0* 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*25 Capsule(s)* Refills:*2* 3. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. Disp:*25 Tablet(s)* Refills:*0* 4. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe Subcutaneous QPM (once a day (in the evening)) for 2 weeks: 40 mg daily for 2 weeks. Disp:*15 syringe* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: right tib-fib and tri-mal type 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>Wound Care: - Keep Incision clean and dry. - Keep pin sites clean and dry. - You can get the wound wet or take a shower starting from 7 days after surgery, but no baths or swimming for at least 4 weeks. - Dry sterile dresssing may be changed daily. No dressing is needed if wound continues to be non-draining. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. Activity: - Continue to be touch down weight bearing on your right leg - You should not lift anything greater than 5 pounds. - Elevate right leg to reduce swelling and pain. - Do not remove splint/brace. Keep splint/brace dry. Other Instructions - Resume your regular diet. - Avoid nicotine products to optimize healing. - Resume your home medications. Take all medications as instructed. - Continue taking the Lovenox to prevent blood clots. - You have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so plan ahead. You can either have them mailed to your home or pick them up at the clinic located on ___ 2. We are not allowed to call in narcotic (oxycontin, oxycodone, percocet) prescriptions to the pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - Narcotic pain medication may cause drowsiness. Do not drink alcohol while taking narcotic medications. Do not operate any motor vehicle or machinery while taking narcotic pain medications. Taking more than recommended may cause serious breathing problems. - If you have questions, concerns or experience any of the below danger signs then please call your doctor at ___ or go to your local emergency room.</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. Clobetasol Propionate 0.05% Cream 1 Appl TP BID psoriasis 4. Clobetasol Propionate 0.05% Soln 1 Appl TP BID psoriasis 5. Clopidogrel 75 mg PO DAILY 6. EPINEPHrine (EpiPEN) 0.3 mg IM ONCE MR1 Duration: 1 Dose 7. GlipiZIDE 10 mg PO BID 8. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 9. Lisinopril 2.5 mg PO DAILY 10. MetFORMIN (Glucophage) 1000 mg PO BID 11. Metoprolol Succinate XL 100 mg PO DAILY 12. Rosuvastatin Calcium 40 mg PO QPM 13.Outpatient Physical Therapy ICD 10: S83.419A Right MCL Sprain Discharge Disposition: Home Discharge Diagnosis: -Unstable Angina -Coronary artery disease -Coronary artery in-stent restenosis -Post-cardiac catheterization right forearm hematoma -Diabetes mellitus, type 2 -Right knee injury without radiographic evidence of fracture -Hyperlipidemia -Hypertension -Prior stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure to take care of you at ___ ___! Why Was I Admitted To The Hospital? - You were admitted to the hospital because you were having more chest pain both with activity and at rest which was concerning for worsening heart problems. What Was Done While I Was In The Hospital? - While in the hospital you were given medication for your chest pain - You had a procedure done called a cardiac catheterization with balloon angioplasty to help open up one of the major blood vessels in your heart - You were continued on your home heart medications - You were given a brace for your knee pain What Should I Do When I Go Home? - Make sure that you go to all of your follow up appointments including with your PCP and ___ (see below for appointment dates and times) - Take all of your medications as prescribed - Please weight yourself everyday and if your weight goes up by more than 3lbs call your PCP or ___ - You should eat a heart healthy diet (low salt-- less than 2 grams per day) - Please follow up with physical therapy as an outpatient for your knee and mobility - Please keep your right arm elevated. - Please do not lift anything heavier than a gallon of milk for the next week</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acarbose 50 mg PO BID 2. Amiodarone 200 mg PO DAILY 3. NIFEdipine CR 30 mg PO DAILY 4. Simvastatin 20 mg PO DAILY 5. Warfarin 2.5 mg PO DAYS (___) 6. GlipiZIDE 2.5 mg PO DAILY 7. Lisinopril 20 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: left extremity ischemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>This information is designed as a guideline to assist you in a speedy recovery from your surgery. Please follow these guidelines unless your physician has specifically instructed you otherwise. Please call our office nurse if you have any questions. Dial 911 if you have any medical emergency. . ACTIVITY: . No driving until cleared by your Surgeon. . Exercise: . Limit strenuous activity for 6 weeks. . Do not drive a car unless cleared by your Surgeon. . No heavy lifting greater than 20 pounds for the next ___ days. . BATHING/SHOWERING: . You may shower immediately upon coming home. No bathing. You may have sutures, which are usually removed in 4 weeks. This will be done by the Surgeon on your ___ appointment. . WOUND CARE: . Sutures / Staples may be removed before discharge. If they are not, an appointment will be made for you to return for staple removal. . When the sutures are removed the doctor may or may not place pieces of tape called steri-strips over the incision. These will stay on about a week and you may shower with them on. If these do not fall off after 10 days, you may peel them off with warm water and soap in the shower. . Avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery. . MEDICATIONS: . Unless told otherwise you should resume taking all of the medications you were taking before surgery. You will be given a new prescription for pain medication, which can be taken every three (3) to four (4) hours only if necessary. . Remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods in your diet. (Check with your physician if you have fluid restrictions.) If you feel that you are constipated, do not strain at the toilet. You may use over the counter Metamucil or Milk of Magnesia. Appetite suppression may occur; this will improve with time. Eat small balanced meals throughout the day. CAUTIONS: . NO SMOKING! We know you've heard this before, but it really is an important step to your recovery. Smoking causes narrowing of your blood vessels which in turn decreases circulation. If you smoke you will need to stop as soon as possible. Ask your nurse or doctor for information on smoking cessation. . No strenuous activity for 6 weeks after surgery. . DIET: . There are no special restrictions on your diet postoperatively. Poor appetite is expected for several weeks and small, frequent meals may be preferred. . For people with vascular problems we would recommend a cholesterol lowering diet: Follow a diet low in total fat and low in saturated fat and in cholesterol to improve lipid profile in your blood. Additionally, some people see a reduction in serum cholesterol by reducing dietary cholesterol. Since a reduction in dietary cholesterol is not harmful, we suggest that most people reduce dietary fat, saturated fat and cholesterol to decrease total cholesterol and LDL (Low Density Lipoprotein-the bad cholesterol). Exercise will increase your HDL (High Density Lipoprotein-the good cholesterol) and with your doctor's permission, is typically recommended. You may be self-referred or get a referral from your doctor. . If you are overweight, you need to think about starting a weight management program. Your health and its improvement depend on it. We know that making changes in your lifestyle will not be easy, and it will require a whole new set of habits and a new attitude. If interested you can may be self-referred or can get a referral from your doctor. . If you have diabetes and would like additional guidance, you may request a referral from your doctor. ___ APPOINTMENT: . Be sure to keep your medical appointments. The key to your improving health will be to keep a tight reign on any of the chronic medical conditions that you have. Things like high blood pressure, diabetes, and high cholesterol are major villains to the blood vessels. Don't let them go untreated! . Please call the office on the first working day after your discharge from the hospital to schedule a ___ visit. This should be scheduled on the calendar for seven to fourteen days after discharge. Normal office hours are ___ through ___. . PLEASE FEEL FREE TO CALL THE OFFICE WITH ANY OTHER CONCERNS OR QUESTIONS THAT MIGHT ARISE.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Bisacodyl 10 mg PO/PR DAILY 3. Bisacodyl ___AILY:PRN Constipation - First Line 4. CefTRIAXone 2 gm IV Q 24H Duration: 5 Weeks 5. Lidocaine 5% Patch 1 PTCH TD QAM 6. OxyCODONE (Immediate Release) 2.5 mg PO Q6H:PRN Pain - Severe RX *oxycodone 5 mg 0.5 (One half) tablet(s) by mouth Every 6 hours Disp #*14 Tablet Refills:*0 7. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 8. ___ MD to order daily dose PO DAILY16 9. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB 10. Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN indigestion or upset stomach 11. Atorvastatin 10 mg PO DAILY 12. Carbidopa-Levodopa (___) 1 TAB PO TID 13. Clopidogrel 75 mg PO DAILY 14. Diltiazem Extended-Release 120 mg PO DAILY 15. Docusate Sodium 200 mg PO DAILY 16. Fleet Enema (Mineral Oil) ___AILY:PRN Constipation 17. Fluticasone Propionate NASAL 2 SPRY NU DAILY 18. ___ (guaiFENesin) 100 mg/5 mL oral Q4H:PRN 19. Ipratropium Bromide MDI 2 PUFF IH Q6H:PRN SOB 20. Lactulose ___ mL PO QHS 21. Levothyroxine Sodium 50 mcg PO DAILY 22. melatonin 5 mg oral QHS 23. Mesalamine ___ 800 mg PO BID 24. Milk of Magnesia 30 mL PO Q6H:PRN Constipation - First Line 25. Multivitamins 1 TAB PO DAILY 26. Pantoprazole 40 mg PO Q12H 27. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 28. Senna 8.6 mg PO DAILY 29. Torsemide 100 mg PO QAM 30. Torsemide 80 mg PO QPM 31. Vitamin D 1000 UNIT PO DAILY 32.Outpatient Lab Work ICD 10: I33.0 Acute and subacute infective endocarditis CBC with diff, BUN/Cr, AST, ALT, Tbili, Alk Phos weekly Please fax results to: ATTN: ___ CLINIC ___ Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Primary Diagnosis ============== Acute on chronic heart failure Strep Gallolyticus bacteremia/endocarditis 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 ___ from ___. WHY WERE YOU ADMITTED? - You were admitted after sustaining a fall at your rehab facility and breaking your ribs. - You were found to have extra fluid in your body from an exacerbation of your congestive heart failure. WHAT HAPPENED WHILE YOU WERE HOSPITALIZED? - We gave you pain medications for your ribs. - We gave you medication to remove extra fluid from your body. - You were found to have a blood stream infection that requires IV antibiotics. WHAT SHOULD YOU DO AFTER YOU LEAVE THE HOSPITAL? - Take all of your medications as prescribed. - Follow up with you doctors as listed in this packet. It was a pleasure caring for you! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BusPIRone 5 mg PO BID 2. Fluoxetine 30 mg PO DAILY 3. Gabapentin 300 mg PO TID 4. HydrALAzine 50 mg PO QHS 5. Ibuprofen 600 mg PO Q6H:PRN Pain 6. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine [Lidoderm] 5 % apply daily to right side chest/abd. once a day Disp #*6 Patch Refills:*0 7. Levothyroxine Sodium 50 mcg PO DAILY 8. Acetaminophen 650 mg PO Q6H Do not exceed 3 grams daily 9. Ciprofloxacin HCl 500 mg PO Q12H last dose ___ RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*22 Tablet Refills:*0 10. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H last dose ___ RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*33 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Perihepatic abscess 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 ___ and underwent drainage of your infection. You are recovering well and are now ready for discharge. Please follow the instructions below to continue your recovery: 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. 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. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN pain 2. Ferrous Sulfate 150 mg PO BID 3. Albuterol Inhaler 2 PUFF IH Q8H:PRN SOB, wheezing 4. Calcium Carbonate 500 mg PO TID 5. Citalopram 10 mg PO DAILY 6. Docusate Sodium 100 mg PO BID 7. Fluticasone Propionate NASAL 2 SPRY NU DAILY 8. FoLIC Acid 1 mg PO DAILY 9. Hydroxychloroquine Sulfate 200 mg PO BID 10. Lovastatin *NF* 40 mg ORAL QHS 11. Methotrexate 15 mg PO 1X/WEEK (___) 12. Metoprolol Succinate XL 200 mg PO DAILY 13. Multivitamins 1 TAB PO DAILY 14. Nitroglycerin SL 0.4 mg SL PRN chest pain 15. Pantoprazole 40 mg PO Q12H 16. Psyllium 1 PKT PO TID:PRN constipation 17. Senna 1 TAB PO BID:PRN constipation 18. Valsartan 320 mg PO DAILY 19. Vitamin D 125 UNIT PO TID 20. Loratadine *NF* 10 mg Oral daily 21. melatonin *NF* 3 mg Oral qhs 22. Symbicort *NF* (budesonide-formoterol) 160-4.5 mcg/actuation INHALATION 2 PUFFS BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Chest pain Abdominal 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 for chest pain and abdominal pain, both of which resolved. If you have worsening of this pain, you should discuss with your primary care physician.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LaMOTrigine 100 mg PO QHS 2. OxycoDONE (Immediate Release) 10 mg PO Q6H:PRN pain RX *oxycodone 10 mg 1 tablet(s) by mouth every six (6) hours Disp #*10 Tablet Refills:*0 3. Acetaminophen 325 mg PO Q6H:PRN pain 4. Thiamine 100 mg PO DAILY 5. Multivitamins 1 TAB PO DAILY 6. Phosphorus 500 mg PO TID RX *sod phos,di & mono-K phos mono [Phospha 250 Neutral] 250 mg 2 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 7. Sucralfate 2 gm PO BID Duration: 14 Days RX *sucralfate 1 gram 2 tablet(s) by mouth twice a day Disp #*24 Tablet Refills:*0 8. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet,delayed release (___) by mouth q24h Disp #*30 Tablet Refills:*0 9. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron 4 mg 1 tablet,disintegrating(s) by mouth every eight (8) hours Disp #*10 Tablet Refills:*0 10. Linezolid ___ mg PO Q12H urinary tract infection Duration: 10 Days Take until ___ RX *linezolid [Zyvox] 600 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*10 Tablet Refills:*0 11. Albuterol-Ipratropium ___ PUFF IH Q6H:PRN shortness of breath 12. Spironolactone 150 mg PO DAILY RX *spironolactone 100 mg 1.5 tablet(s) by mouth daily Disp #*45 Tablet Refills:*0 13. Furosemide 60 mg PO DAILY RX *furosemide [Lasix] 40 mg 1.5 tablet(s) by mouth DAILY Disp #*45 Tablet Refills:*0 14. Outpatient Lab Work ICD-9: Alcoholic Cirrhosis (571.2) Check Chem10, LFTs, coags, CBC on ___ 15. Outpatient Lab Work Diagnosis: ___, ___.3 Obtain Right Upper Quadrant Ultrasound with Doppler the week of ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES ----------------- Alcoholic cirrhosis Hepatopulmonary syndrome Upper GI bleed Esophageal varices Rectal varices Abdominal hernia Community acquired pneumonia Urinary tract infection Hepatohydrothorax Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were transferred here from the ___ ___ for a GI bleed. Here, procedures were done to stop the bleeding in your esophagus and your rectum. Because you continued to bleed, a procedure called TIPS (transjugular intrahepatic portosystemic shunt) was done to reduce the risk of future bleeding. You also continued to have low oxygen levels here. You were treated for a pneumonia with antibiotics, which was part of the reason for your low oxygen. You have a condition called hepatopulmonary syndrome, which is a lung disease that is caused by cirrhosis. There is no treatment for this condition. You should wear oxygen only as needed to maintain oxygen levels greater than 92% You were also treated with antibiotics for a urinary tract infection. Finally, and most importantly, it is extremely important that you COMPLETELY abstain from alcoholic beverages. You were provided with resources for alcohol cessation. Alcohol consumption puts you at high risk for worsening liver failure, its numerous complications, and death. Social workers provided you with resources on alcohol cessation programs during your stay here. We highly recommend that you avail of these services.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO TID 2. Capsaicin 0.025% 1 Appl TP QID 3. Colchicine 0.6 mg PO DAILY continue to take until you follow up with your next doctor's appointment and he/she can reassess. 4. Minocycline 100 mg PO BID 5. Morphine SR (MS ___ 30 mg PO Q12H 6. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Severe 7. Polyethylene Glycol 17 g PO DAILY:PRN constipation 8. Senna 8.6 mg PO BID:PRN Constipation - First Line 9. ALPRAZolam 1 mg PO TID:PRN anxiety 10. Ascorbic Acid ___ mg PO BID 11. BuPROPion XL (Once Daily) 150 mg PO DAILY 12. carisoprodol (bulk) 350 mg PO TID 13. Docusate Sodium 100 mg PO BID 14. FLUoxetine 40 mg PO DAILY 15. Gabapentin 300 mg PO QID 16. Lidocaine 5% Patch 1 PTCH TD QAM 17. melatonin 5 mg oral QHS 18. Ondansetron ODT 4 mg PO Q8H:PRN Nausea - use first 19. Phenytoin Sodium Extended 150 mg PO BID 20. Phenytoin Sodium Extended 200 mg PO QHS 21. Promethazine 12.5 mg PO Q6H:PRN Nausea - use ___ 22. Warfarin 7.5 mg PO DAILY16 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right foot/ankle cellulitis Possible acute gout right ___ MTP DVT anxiety Epilepsy 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 with recurrent right ankle and foot pain with swelling and redness concerning for recurrent infection. We also considered gout and neuropathy as well. You were evaluated by our specialists and treatment recommended. We did not feel you had an acute infection but had acute gout and neuropathic pain. Please follow up with your outpatient doctors for ___.</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 migraine 2. Amitriptyline 100 mg PO HS 3. Cefpodoxime Proxetil 200 mg PO Q12H 4. Fentanyl Patch 12 mcg/h TD Q72H 5. Ferrous Sulfate 325 mg PO EVERY OTHER DAY 6. HYDROmorphone (Dilaudid) 4 mg PO Q4H:PRN pain 7. Lubiprostone 24 mcg PO BID 8. Metoclopramide 10 mg PO TID 9. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H 10. Midodrine 10 mg PO TID 11. Polyethylene Glycol 17 g PO DAILY 12. Senna 17.2 mg PO TID 13. Venlafaxine 150 mg PO DAILY 14. Venlafaxine 75 mg PO QPM 15. Zolpidem Tartrate 10 mg PO HS 16. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin 500 mg 1 tablet(s) by mouth Q12hours Disp #*60 Tablet Refills:*0 17. Miconazole Powder 2% 1 Appl TP QID RX *miconazole nitrate [Anti-Fungal] 2 % apply around Gtube site four times a day Refills:*1 18. Warfarin 10 mg PO DAILY16 19. Florastor (saccharomyces boulardii) 250 mg oral daily 20. Lactulose 15 mL PO Q8H:PRN constipation 21. Lidocaine 5% Patch 1 PTCH TD QAM 22. Lorazepam 0.5 mg PO HS:PRN sleep, anxiety 23. Cyanocobalamin 1000 mcg IM/SC EVERY 4 WEEKS (MO) DOSE IS UNCONFIRMED. PLEASE RESUME YOUR PREVIOUS DOSE. 24. NexIUM (esomeprazole magnesium) 40 mg oral daily Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: # small bowel bacterial overgrowth Secondary: # chemical dermatitis around G-tube site # Orthostatic hypotension # h/o DVT and PE # Chronic Protein Calorie malnutrition, on TPN # Chronic abdominal pain syndrome s/p recurrent small bowel obstructions # GERD # Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were hospitalized with abdominal pain. You were evaluated by the Surgery service, and your pain is likely due to bacterial overgrowth. You have been treated for this in the past, but your symptoms recurred because you were unable to take the Rifaximin as prescibed due to insurance issues. You were treated with Rifaximin, and your symptoms improved. Given the insurance limitations, we have started a trial of ciprofloxacin after discussion with GI team and your surgeon Dr ___. . You were noted to have increased drainage around your G-tube site, and it was determined that the tube is actually a Foley catheter. This was replaced by our largest G-tube per Interventional Radiology. Given the surrounding chemical dermatitis, you will need ongoing wound care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms. ___, You were admitted to the hospital for fevers, swelling around your eyes and a new rash. We first gave you antibiotics, and both rheumatology and dermatology came to see you. Your swelling and rash improved with antibiotics and topical steroids. There are many dermatologic and rheumatologic results still pending at the time of your discharge. These results will be discussed with you at your follow up appointment with Dr. ___ on ___ ___. You will get your stiches out on ___ at your PCP ___. It was a pleasure taking part in your care. Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen-Caff-Butalbital ___ TAB PO Q4H:PRN headache 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN dyspnea 3. ALPRAZolam 0.5 mg PO TID 4. Atazanavir 300 mg PO DAILY 5. Bisacodyl 10 mg PO DAILY 6. Cyclobenzaprine 10 mg PO TID:PRN pain/muscle spasms 7. Docusate Sodium 300 mg PO HS 8. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 9. Escitalopram Oxalate 15 mg PO DAILY 10. Fish Oil (Omega 3) ___ mg PO BID 11. Fleet Enema ___AILY:PRN constipation 12. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 13. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 14. Gabapentin 800 mg PO Q8H 15. Hydrocerin 1 Appl TP TID 16. HYDROmorphone (Dilaudid) 8 mg PO Q4H:PRN pain 17. Methadone 40 mg PO QAM 18. Methadone 30 mg PO NOON 19. Methadone 40 mg PO QPM 20. Miconazole Powder 2% 1 Appl TP BID 21. Nystatin Cream 1 Appl TP BID 22. Polyethylene Glycol 17 g PO DAILY constipation 23. Promethazine 25 mg PO BID:PRN nausea 24. Ranitidine 150 mg PO HS 25. RiTONAvir 100 mg PO DAILY 26. Senna 1 TAB PO BID 27. Spironolactone 25 mg PO DAILY 28. Sumatriptan Succinate 100 mg PO DAILY:PRN migraine 29. Warfarin 12.5 mg PO DAILY16 30. Guaifenesin-Dextromethorphan 5 mL PO Q6H:PRN Cough RX *dextromethorphan-guaifenesin 100 mg-10 mg/5 mL 5 ml by mouth Every 6 hours Disp #*1 Bottle Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Diarrhea Asthma Obesity Obstructive sleep apnea 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 diarrhea and abdominal pain. These symptoms have been chronic and your diarrhea did not recur while in the hospital. After discussing further work-up options, you decided to continue work-up as an outpatient. We provided you with follow-up contact information and stool sample collectors with instructions to bring the samples to microbiology at ___ if your diarrhea recurs. 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. Amlodipine 10 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Atenolol 25 mg PO DAILY 4. Chlorthalidone 25 mg PO DAILY 5. Losartan Potassium 100 mg PO DAILY 6. Lovastatin 40 mg oral daily 7. Multivitamins 1 TAB PO DAILY 8. Acetaminophen 650 mg PO Q6H:PRN pain 9. Levofloxacin 750 mg PO DAILY RX *levofloxacin [Levaquin] 750 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: pneumonia delirium Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted with confusion and you were found to have a pneumonia. You were started on antibiotics, with improvement in your confusion. Your last dose of antibiotics is tomorrow.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE-Acetaminophen Elixir ___ mL PO Q4H:PRN pain RX *oxycodone-acetaminophen [Roxicet] 5 mg-325 mg/5 mL ___ ml by mouth every 4 hours Disp ___ Milliliter Milliliter Refills:*0 2. Cyanocobalamin 500 mcg PO DAILY 3. Fluoxetine 60 mg PO QHS 4. Lorazepam 1 mg PO DAILY:PRN anxiety 5. Multivitamins 1 TAB PO DAILY 6. Sucralfate 1 gm PO QID 7. Omeprazole 40 mg PO BID RX *omeprazole 40 mg 1 capsule(s) by mouth two times a day Disp #*60 Capsule Refills:*0 8. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron [___] 4 mg 1 tablet(s) by mouth every 8 hours Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: jejeunal ulcer 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 inpatient bariatric surgery service at ___ for abdominal pain. We think this pain is due to your ulcer and it should continue to improve with Prilosec and carafate. * It is very important that you take these medications daily as prescribed. * It is also very important that you quit smoking. We had the addiction counselor reach out to you during this hospitalization and recommend that you follow her recommendations and encourage your to follow up on the resources she provided. * We will be discharging you with a prescription for pain medication. Please take as prescribed. Do NOT drink alcohol or drive or operate machinery while taking this medication. * Please seek immediate medical care if you experience worsening abdominal pain, inability to eat or drink any food, blood in your vomit or stool, fevers (temperature ___ chills. * Please see Dr. ___ in clinic in 2 weeks. Please continue the bariatric stage 5 diet until you see Dr. ___. It was a pleasure taking care of you!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Diphenoxylate-Atropine 1 TAB PO TID W/MEALS high ostomy output RX *diphenoxylate-atropine 2.5 mg-0.025 mg 1 tablet(s) by mouth TID with meals Disp #*90 Tablet Refills:*0 2. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Levofloxacin 750 mg PO DAILY Duration: 2 Days RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 4. LORazepam 1 mg SL Q4H 5. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Nicotine Patch 14 mg TD DAILY RX *nicotine 14 mg/24 hour Apply daily daily Disp #*14 Patch Refills:*0 7. Nicotine Polacrilex 2 mg PO Q1H:PRN nicotine cravings RX *nicotine (polacrilex) 2 mg Use as needed for cravings q2h Disp #*50 Gum Refills:*0 8. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 9. BuPROPion (Sustained Release) 200 mg PO QAM 10. Citalopram 40 mg PO QHS 11. Lithium Carbonate CR (Eskalith) 450 mg PO DAILY Eskalith CR 12. LOPERamide 4 mg PO TID W/MEALS diarrhea 13. Pantoprazole 40 mg PO Q24H 14. Psyllium Powder 1 PKT PO TID W/MEALS Discharge Disposition: Home Discharge Diagnosis: Catatonia Discharge Condition: Mental Status: Alert and not agitated on ativan Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to medicine with confusion and low sodium, as well as a pneumonia. You were appropriately treated; your sodium went back to normal as did your mental status. On the planned day of discharge, your psych meds were restarted and you had an episode of agitation followed by catatonia that took Ativan to break. Psych was consulted, who recommended treatment with Ativan. An EEG and MRI were both normal, ruling out seizure. A psychiatric hold was placed, and you will be transferred to a psychiatric facility for further treatment of your catatonia.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. PredniSONE 30 mg PO DAILY Duration: 5 Doses Start: ___, First Dose: Next Routine Administration Time Please start prednisone 30mg ___ This is dose # 1 of 3 tapered doses RX *prednisone 20 mg 1.5 tablet(s) by mouth once a day Disp #*8 Tablet Refills:*0 2. PredniSONE 20 mg PO DAILY Duration: 5 Doses Start: After 30 mg DAILY tapered dose Please start prednisone 30mg ___ This is dose # 2 of 3 tapered doses RX *prednisone 20 mg 1 tablet(s) by mouth once a day Disp #*5 Tablet Refills:*0 3. PredniSONE 10 mg PO DAILY Duration: 5 Doses Start: After 20 mg DAILY tapered dose Please start prednisone 30mg ___ This is dose # 3 of 3 tapered doses RX *prednisone 10 mg 1 tablet(s) by mouth once a day Disp #*5 Tablet Refills:*0 4. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN dyspnea RX *albuterol sulfate 2.5 mg/3 mL (0.083 %) 3 ml nebulized q6H PRN Disp #*30 Vial Refills:*0 5. Albuterol Inhaler 2 PUFF IH Q4H:PRN dyspnea RX *albuterol sulfate 90 mcg 2 puffs inhaled Q4H PRN Disp #*2 Inhaler Refills:*0 6. benralizumab 30 mg/mL subcutaneous EVERY 8 WEEKS 7. Cetirizine 10 mg PO DAILY 8. FLUoxetine 20 mg PO DAILY RX *fluoxetine 20 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*0 9. Fluticasone Propionate NASAL 2 SPRY NU BID RX *fluticasone propionate 50 mcg/actuation 2 Spray Nasal twice a day Disp #*1 Spray Refills:*0 10. Ipratropium-Albuterol Neb 1 NEB NEB Q6H RX *ipratropium-albuterol 0.5 mg-3 mg (2.5 mg base)/3 mL 3 ml sln every six (6) hours Disp #*30 Ampule Refills:*0 11. ketotifen fumarate 0.025 % (0.035 %) ophthalmic (eye) BID 12. Mirtazapine 30 mg PO QHS RX *mirtazapine 30 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 13. Montelukast 10 mg PO DAILY RX *montelukast 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 14. Ranitidine 150 mg PO BID RX *ranitidine HCl 150 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 15. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation DAILY RX *budesonide-formoterol [Symbicort] 160 mcg-4.5 mcg/actuation 1 Inhaled once a day Disp #*2 Inhaler Refills:*0 16.Other AeroChamber Spacer Use as directed with inhalder Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS =================== Asthma Exacerbation SECONDARY DIAGNOSIS =================== Viral gastroenteritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, Thank you for allowing us to participate n your care. WHY WAS I BROUGHT TO THE HOSPITAL? -You are having trouble breathing WHAT WAS DONE FOR ME WHILE I WAS AT THE HOSPITAL -We gave you steroids -You were given nebulizer treatments -We tested you for infection, which was negative -We continued all of your home asthma medications -You are on some oxygen which was weaned down before you left the hospital WHAT SHOULD I DO WHEN I GO HOME? - Please continue to take all your medications, especially your albuterol, symbicort, and montelukast - Please go to all your appointments - Call your primary doctor or go to the emergency room if you are having trouble breathing - Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. codeine-guaifenesin ___ mg/5 mL Syrup Sig: ___ MLs PO Q4H (every 4 hours) as needed for cough for 7 days. Disp:*qs ML(s)* Refills:*0* 2. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 8 days. Disp:*8 Tablet(s)* Refills:*0* 3. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) Powder in Packet PO DAILY (Daily). 8. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 9. benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*30 Capsule(s)* Refills:*2* 10. Citracal + D 250 mg calcium- 250 unit Tablet, Chewable Sig: One (1) Tablet, Chewable PO twice a day. Discharge Disposition: Home Discharge Diagnosis: Community acquired pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were hospitalized and found to have a right sided pneumonia. You were started on levofloxacin which you should take for a total of 10 days. You should follow up with Dr. ___ in ___ weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Amlodipine 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Omeprazole 20 mg PO DAILY 5. PredniSONE 5 mg PO DAILY 6. Sulfameth/Trimethoprim DS 1 TAB PO BID 7. Timolol Maleate 0.5% 1 DROP BOTH EYES BID 8. Furosemide 10 mg PO DAILY 9. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -200 unit oral DAILY 10. Acetaminophen w/Codeine 1 TAB PO Q6H:PRN pain 11. nystatin 100,000 unit/gram topical BID 12. Vitamin E 400 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: weakness urinary tract infection chronic gait instability Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You were admitted to the hospital because of worsening weakness. We felt that your weakness was likely due to your ongoing urinary tract infection. You had a CT scan of your brain which was stable. You were also evaluated by the neurology team who felt that your exam was reassuring. Please follow-up with your outpatient providers as instructed below. Thank you for allowing us to participate in your care. All ___ wishes for your recovery. Sincerely, Your ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms ___, You were admitted with an intra-abdominal abscess. To treat this, we started you on antibiotics and placed a drain; we also switched your G tube to a G-J tube and restarted tube feedings. You were tolerating this. You will need to complete an antibiotics course for 1 week (see prescriptions). The radiology team will contact you for a follow up appointment in 1 week to get the tube pulled.</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 TID 2. Guaifenesin ER 1200 mg PO Q12H 3. Losartan Potassium 50 mg PO DAILY 4. Tiotropium Bromide 1 CAP IH DAILY 5. Vitamin D 1000 UNIT PO DAILY 6. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron HCl 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*30 Tablet Refills:*0 7. Dexamethasone 2 mg PO Q12H Duration: 1 Day RX *dexamethasone 2 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*2 Tablet Refills:*0 8. Codeine Sulfate ___ mg PO Q6H:PRN cough RX *codeine sulfate 15 mg ___ tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 9. Cepastat (Phenol) Lozenge 2 LOZ PO Q2H:PRN sore throat RX *phenol [Cepastat] 14.5 mg 1 Lozenge up to every q2 Disp #*30 Lozenge Refills:*0 10. Benzonatate 100 mg PO TID:PRN cough RX *benzonatate 100 mg 1 capsule(s) by mouth up to every 8 hrs Disp #*30 Capsule Refills:*0 11. Acetylcysteine 20% ___ mL NEB BID stent RX *acetylcysteine 200 mg/mL (20 %) ___ mL twice a day Disp #*60 Cartridge Refills:*0 12. Sodium Chloride 3% Inhalation Soln 15 mL NEB Q6H stent RX *sodium chloride 3 % 15 mL INH every six (6) hours Disp #*100 Cartridge Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Small cell lung 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 for difficulty breathing secondary to growth of you lung tumor. You underwent a procedure to reduce the size of the tumor and place new stents in your airways. You were then transferred to the oncology service for initiation of chemotherapy which you tolerated well. Please continue to drink plenty of fluids at home given the recent chemotherapy. We wish you all the best and take good care, --Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Terazosin 10 mg PO HS 2. Simvastatin 20 mg PO DAILY 3. Omeprazole 20 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: Acute pancreatitis 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 participating in your care at ___ ___. You were admitted after you developed abdominal pain, nausea and vomiting. Your labs and imaging showed that you have acute pancreatitis, inflammation of the pancreas. You initially required care in the intensive care unit until you were stable enough to go to the regular medicine floor. You were given intravenous fluids while you were unable to eat as well as pain medications. The Gastroenterology team followed you during your admission and the Surgery team was consulted. They recommend that you have your gallbladder removed to try to prevent further episodes of pancreatitis. Your diet was slowly advanced and your abdominal pain improved. Please follow up with the appointments as listed below. 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. amLODIPine 5 mg PO DAILY 2. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID 3. Lidocaine 5% Patch 1 PTCH TD QAM 4. melatonin 5 mg oral QHS 5. Ranitidine 150 mg PO BID 6. Simethicone 40-80 mg PO QID bloating, gas 7. Vancomycin Oral Liquid ___ mg PO Q6H Duration: 4 Days Should continue through ___. 8. TraMADol 50 mg PO Q8H RX *tramadol 50 mg 1 tablet(s) by mouth EVERY 8 HOURS Disp #*20 Tablet Refills:*0 9. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath/wheezing. 10. Bisacodyl 10 mg PR QHS:PRN constipation. 11. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q8H 12. Carbidopa-Levodopa (___) 2.5 TAB PO QID 13. Docusate Sodium 100 mg PO BID 14. Fleet Enema ___ GM/118ML Enema PR DAILY 15. Levothyroxine Sodium 25 mcg PO DAILY 16. Lidocaine Viscous 2% 10 mL PO Q8H:PRN unknown 17. Lisinopril 5 mg PO DAILY 18. Mirtazapine 15 mg PO QHS 19. Omeprazole 20 mg PO DAILY 20. Polyethylene Glycol 17 g PO DAILY 21. QUEtiapine Fumarate 25 mg PO QHS 22. Senna 17.2 mg PO BID constipation 23. Travatan Z (travoprost) 0.004 % ophthalmic QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY ============== Acute pancreatitis C. difficile colitis Acute renal failure SECONDARY ============== ___ disease Anemia Chronic abdominal pain Malnutrition Hypertension Rotator cuff tendinopathy Acute toxic metabolic encephalopathy Hyponatremia Diastolic congestive heart failure, chronic Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you at ___ ___. Why was I in the hospital? You were in the hospital because you had belly pain. We believe this was due to your pancreas (a condition called pancreatitis). This improved while you were in the hospital. What happened to me in the hospital? You were first in the Intensive Care Unit, then were transferred to the medical floor once you were better. We also gave you antibiotics when you developed diarrhea (due to an infection called C. diff). What should I do when I leave the hospital? Weigh yourself every morning, call MD if weight goes up more than 3 pounds. Otherwise, continue to take your medicines and go to all your doctor's appointments. Best wishes, 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. Docusate Sodium 100 mg PO BID 3. Multivitamins 1 TAB PO DAILY 4. Vitamin B Complex 1 CAP PO DAILY 5. Vitamin D 1000 UNIT PO 2 TABS DAILY 6. Alendronate Sodium 70 mg PO 1X 7. Os-Cal 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -600 unit oral daily 8. Outpatient Physical Therapy Please arrange for ___ rehab given diagnosis of BPPV; 386.1 Discharge Disposition: Home Discharge Diagnosis: Pre-syncope Vertigo Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to participate in your care at ___. You were admitted for workup of your dizziness and lightheadedness. You were monitored on a heart monitor during your hospital stay, which did not reveal any cause for your symptoms. You were seen by the neurology team and we performed a scan of your head, which revealed no evidence of obstruction in the arteries in the back of your neck. We also sent of laboratory tests to determine if there is anything else that may be contributing to your neuropathy. Per the Neurology team, the cause of your symptoms was likely related to shifts in blood pressure (possibly related to low fluid intake) vs. possibly due to neuropathy. Please follow up with your primary care doctor. It was a pleasure to take care of you while you were with us! Your ___ treatment team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluoxetine 40 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Furosemide 40 mg PO DAILY 4. Multivitamins 1 TAB PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Pyridoxine 50 mg PO DAILY 7. Spironolactone 50 mg PO DAILY 8. Thiamine 100 mg PO DAILY 9. Lactulose 30 mL PO TID 10. Docusate Sodium 100 mg PO BID 11. Fexofenadine 60 mg PO DAILY 12. Senna 1 TAB PO BID 13. traZODONE 25 mg PO HS:PRN insomnia RX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth qhs:PRN Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ ___: Seizure, secondary to alcohol withdrawal Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, you were admitted to ___ ___ for seizures. We believe you had the seizures due to alcohol and benzodiazepine withdrawal. Your head was imaged with a CT scan which showed some blood, similar to your prior CT scan from ___. It is very important that you do not use any alcohol or benzodiazepines (xanax/alprazolam). Please follow up with ___ outpatient treatment as discussed which will start on ___.</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 Do not take more than 3 grams per day RX *acetaminophen 500 mg 1 tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID Do not take if having diarrhea RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Do not drive or use machinery when taking RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: acute appendicitis Discharge Condition: Activity Status: Ambulatory - Independent. Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to ___ and underwent laparoscopic appendectomy. You are recovering well and are now ready for discharge. Please follow the instructions below to continue your recovery: Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Calcium Carbonate 500 mg PO BID 3. Carvedilol 3.125 mg PO BID 4. Cinacalcet 90 mg PO DAILY 5. Isosorbide Mononitrate (Extended Release) 15 mg PO DAILY 6. Lisinopril 10 mg PO DAILY 7. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 8. sevelamer CARBONATE 3200 mg PO TID W/MEALS 9. Sorbitol 30 mL PO BID:PRN constipation 10. vitamin A and D small amount topical TOPICAL BID 11. Vitamin B Complex w/C 1 TAB PO DAILY 12. Vitamin D Dose is Unknown PO MONTHLY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Clotted right upper extremity fistula Secondary Diagnosis: - End stage renal disease - Hypertension - Anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were seen at ___ Why were you here? ============== - You were here because the fistula in your right arm was clotted. What did we do for you? ================== - We put in a temporary dialysis catheter to give you hemodialysis - You had a procedure (thrombectomy) to breakup the clot in your fistula What do you need to do? ================== - It is important that you follow up with your kidney doctor and continue your dialysis treatments as usual It was a pleasure taking care of you. 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. Amlodipine 2.5 mg PO DAILY 2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation RX *bisacodyl [Dulcolax] 5 mg 1 tablet,delayed release (___) by mouth once a day Disp #*14 Tablet Refills:*0 3. Cephalexin 500 mg PO Q8H RX *cephalexin 500 mg 1 capsule(s) by mouth three times a day Disp #*30 Capsule Refills:*0 4. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 5. Duloxetine 30 mg PO DAILY 6. Enoxaparin Sodium 40 mg SC DAILY Duration: 14 Days RX *enoxaparin 40 mg/0.4 mL 40 mg SQ once a day Disp #*14 Syringe Refills:*0 7. Fluconazole 200 mg PO Q24H 8. Furosemide 20 mg PO DAILY 9. Hydrocortisone Cream 1% 1 Appl TP QID rash 10. Hydroxychloroquine Sulfate 400 mg PO DAILY 11. Ipratropium Bromide MDI 2 PUFF IH BID 12. Levothyroxine Sodium 100 mcg PO DAILY 13. MethylPHENIDATE (Ritalin) 10 mg PO TID 14. Metoprolol Succinate XL 25 mg PO DAILY 15. Milk of Magnesia 30 mL PO Q6H:PRN constipation 16. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*100 Tablet Refills:*0 17. Pantoprazole 40 mg PO Q12H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: R distal femur periprosthetic fracture Discharge Condition: Stable Followup Instructions: ___ [/INST] </s><s>Take Keflex for a total of 10 days postoperatively (Last Day will be ___ MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - You can get the wound wet/take a shower starting 3 days after your surgery. You may wash gently with soap and water, and pat the incision dry after showering. - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. ACTIVITY AND WEIGHT BEARING: - TDWB ___ Physical Therapy: Range of motion as tolerated in unlocked ___ brace Toe-down weight bearing ___ Treatments Frequency: DSD as necessary to keep wound clean and dry</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. Aquaphor Ointment 1 Appl TP DAILY RX *white petrolatum [Aquaphor Original] 41 % Apply to skin graft donor sites once a day Refills:*0 3. Bisacodyl 10 mg PO DAILY:PRN constipation 4. Cyclobenzaprine 10 mg PO TID:PRN muscle spasm RX *cyclobenzaprine 10 mg 1 tablet(s) by mouth three times a day Disp #*30 Tablet Refills:*0 5. Daptomycin 850 mg IV Q24H RX *daptomycin 500 mg 850 mg IV Every 24 hours Disp #*100 Vial Refills:*0 6. Enoxaparin Sodium 40 mg SC DAILY Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 40 mg SC once a day Disp #*14 Syringe Refills:*1 7. Ertapenem Sodium 1 g IV 1X Once/day Duration: 1 Dose at least 4wks (___) or ongoing until definitive management of surgical flap RX *ertapenem [Invanz] 1 gram 1 gm IV Every 24 hours Disp #*40 Vial Refills:*0 8. Fluconazole 400 mg PO Q24H RX *fluconazole 200 mg 2 tablet(s) by mouth once a day Disp #*80 Tablet Refills:*0 9. LORazepam 0.5 mg PO Q4H:PRN anxiety RX *lorazepam 0.5 mg 1 tablet by mouth every six (6) hours Disp #*30 Tablet Refills:*0 10. TraZODone 50 mg PO QHS:PRN insomnia RX *trazodone 50 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 11. Aspirin 325 mg PO DAILY 12. Clopidogrel 75 mg PO DAILY 13. Docusate Sodium 100 mg PO BID 14. Ferrous Sulfate 325 mg PO DAILY 15. Hydrochlorothiazide 25 mg PO DAILY 16. Lisinopril 20 mg PO DAILY 17. Multivitamins 1 TAB PO DAILY 18. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*80 Tablet Refills:*0 19. Ranitidine 75 mg PO BID 20. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1) lower extremity flap color changes and fevers 2) ___ abscess LLE. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). ___ LLE Followup Instructions: ___ [/INST] </s><s>-You should keep your left lower extremity elevated when you are not standing to urinate and/or not standing and pivoting to chair and not walking around with crutches, to help with swelling and drainage. --You may not bear weight on your left lower extremity -Report any change in color of your flap area including increased redness and/or any dusky or darkened appearance to the office. -DAILY dressing changes to left knee flap: adaptic to flap/skin graft sites Wrap from toes to upper thigh in soft cottony WEBRIL wrap (multiple layers), wrap ACE bandages lightly over webril from toes to thigh. Please pad the heel well with at least 10 layers of webril. -You may shower once drain has been out for 48 hours and then re-wrap left leg. -apply aquaphor to skin graft donor sites daily . Diet/Activity: 1. You may resume your regular diet and continue your protein shakes 3x/day. . Medications: 1. You may take your prescribed pain medication for moderate to severe pain. You may switch to Tylenol or Extra Strength Tylenol for mild pain as directed on the packaging. 2. Take prescription pain medications for pain not relieved by tylenol. 3. Take Colace, 100 mg by mouth 2 times per day, while taking the prescription pain medication. . Call the office IMMEDIATELY if you have any of the following: 1. Signs of infection: fever with chills, increased redness, swelling, warmth or tenderness at the surgical site, or unusual drainage from the incision(s). 2. A large amount of bleeding from the incision(s). 3. Fever greater than 101.5 oF 4. Severe pain NOT relieved by your medication. . Return to the ER if: * If you are vomiting and cannot keep in fluids or your medications. * If you have shaking chills, fever greater than 101.5 (F) degrees or 38 (C) degrees, increased redness, swelling or discharge from incision, chest pain, shortness of breath, or anything else that is troubling you. * Any serious change in your symptoms, or any new symptoms that concern you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___. You came for evaluation of being found down at your home. You were found to have possible pneumonia, muscle breakdown causing hip and back pain, kidney failure, and new hepatitis C infection. You have gotten better and are now ready to go home. You will follow up with your primary care provider, psychiatrist and a new liver doctor, all next week (appointments listed below). It's very important that you follow up with these appointments and take all medications as prescribed. Above all, IT IS VERY IMPORTANT THAT YOU ABSTAIN FROM ALCOHOL AND ILLICIT DRUGS, AS THESE CAN NEGATIVELY AFFECT YOUR LIVER FUNCTION AND CAUSE MANY DIFFERENT HEALTH PROBLEMS.</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 QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right MCA ischemic stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were seen at an outside hospital with symptoms of left sided weakness and slurred speech resulting from an ACUTE ISCHEMIC STROKE, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. You were luckily seen at a hospital soon enough after your symptoms to get a medication that helps break up the clot. You were then transferred to ___ ___ a procedure called a thrombectomy to directly break up the clot. This was performed by passing a guide wide through your groin. After this procedure you had good blood flow through the blood vessels in your brain. Your examination improved back to baseline. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: <> smoking <> high cholesterol We are changing your medications as follows: <> please take an aspirin daily <> please start atorvastatin 40mg daily Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 80 mg PO QPM 3. Clopidogrel 75 mg PO DAILY to prevent stent thrombosis 4. Pantoprazole 20 mg PO Q24H 5. amLODIPine 10 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Coronary Artery Disease Angina Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. VS: T 98.1 BP 130/77 HR 59 RR 18 SpO2 95% RA PE: Gen: Patient is in no acute distress. HEENT: Face symmetrical, trachea midline. Neuro: A/Ox3. Speaking in complete, coherent sentences. No face, arm, or leg weakness. Pulm: Breathing unlabored. Breath sounds clear bilaterally. Cardiac: No JVD. No thrills or bruits heard on carotids bilaterally. S1, S2 RRR. No splitting of heart sounds, murmurs, S3, S4 or friction rubs heard. Vasc: No edema noted in bilateral upper or lower extremities. No pigmentation changes noted in bilateral upper or lower extremities. Skin dry, warm. Bilateral radial, ___ pulses palpable 2+. Access: Right radial access site soft, non-tender with no swelling, drainage or hematoma noted. +Radial pulse. Right femoral access site soft, non-tender with no swelling, drainage or hematoma noted. No bruit auscultated. Abd: Rounded, soft, non-tender. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___! WHY WAS I IN THE HOSPITAL? ========================== You were evaluated for chest pain (angina). WHAT HAPPENED IN THE HOSPITAL? ============================== You had a coronary angiogram which showed a blockage in your left anterior descending (LAD) artery. A drug coated stent was placed to reopen the blockage to restore or improve blood flow to the heart. After your procedure you felt nauseous and vomited. You had a scan of your heart that did not show any evidence of bleeding in your heart. Your wrist and groin access sites were stable. At this time your heart rate was slow. This was a vasovagal reaction (or nerve trigger) to your nausea and vomiting. We stopped your atenolol because it can further slow your heart rate. Because there was a small amount of blood when you vomited, the gastroenterology (GI) doctors saw ___. They recommended starting a medication called Pantoprazole for GERD. They recommend considering an EGD in the future once you are recovered from a cardiac perspective. We watched your blood counts which were stable, and your symptoms improved. Instructions regarding care of the right wrist and right groin access site are included with your discharge information. Please continue your current medications with the following changes: - Start Aspirin 81mg daily, lifelong. - Start Plavix 75mg daily, you should take this for a minimum of one year and ONLY stop when told by a cardiologist specifically. - Stop Pravastatin and start Atorvastatin 80mg daily. This medication is more effective at lowering cholesterol. - Start Pantoprazole 20mg daily. This is recommended by the GI doctors to help with your GERD. - Hold Atenolol for now because you had a slower heart rate after the procedure. When you follow up with Dr. ___ if it is ok for you to resume this medication. It is very important to take all of your heart healthy medications. In particular, Aspirin and Clopidogrel (Plavix) keep the stents in the vessels of the heart open and help reduce your risk of having a future heart attack. If you stop these medications or miss ___ dose, a blood clot could form in your heart stent which could cause a life threatening heart attack. Please do not stop taking either medication without taking to your heart doctor, even if another doctor tells you to stop the medications. It is strongly recommended that you attend a cardiac rehab program in the near future. A referral form was provided to you that lists the locations of these programs. Please bring this with you to your follow up visit with your cardiologist, and they will inform you when it is safe to begin a program. If you have any urgent questions that are related to your recovery from your hospitalization or are experiencing any symptoms that are concerning to you and you think you may need to return to the hospital, please call ___ Cardiology at ___ or your primary care doctor's office. It has been a pleasure to have participated in your care and we wish you the best with your health. -Your ___ Cardiac Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 40 mg PO DAILY 3. Hydroxychloroquine Sulfate 200 mg PO BID 4. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 5. Niacin SR 1500 mg PO DAILY 6. Warfarin 2.5 mg PO DAILY16 7. Acetaminophen 650 mg PO TID 8. Calcium Carbonate 500 mg PO QID:PRN heartburn/nausea 9. Docusate Sodium 100 mg PO BID 10. OxycoDONE (Immediate Release) 2.5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 0.5 (One half) tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 11. Metoprolol Succinate XL 50 mg PO DAILY 12. Senna 1 TAB PO BID:PRN Constipation 13. Enoxaparin Sodium 70 mg SC BID RX *enoxaparin [Lovenox] 80 mg/0.8 mL 70 mg twice a day Disp #*14 Syringe Refills:*0 14. Warfarin 5 mg PO ONCE Duration: 1 Doses please give ___ 15. PredniSONE 7.5 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Gallstone pancreatitis and chronic cholecystitis. 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 ___ on ___ with complaints of epigastric pain, nausea and vomiting. On further evaluation, you were found to have elevated liver enzymes and stones in your gallbladder. You had an endoscopic ultrasound (EUS) showing that you had a stone in your common bile duct. You subsequently underwent an ERCP to have the stone removed and faciliate drainage of bile from your gallbladder. Once your liver enzymes (labwork) improved and your pain was fairly resolved, you were taken to the operating room on ___ to have your gallbladder removed (cholecystectomy). This was initially done as a laparoscopic procedure, but due to surgical complexity, required that your abdomen be "opened" (via abdomina incision). You tolerated the procdure well. While recovering, you were found to have periods of rapid atrial fibrillation (AFIB) requiring an increase in the amount of beta blocker ("Lopressor") than what you normally take. Your cardiologist, Dr. ___, was informed and has made recommendation on the management of your afib. You have otherwise recovered well and are now being discharged with the following discharge instructions: ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for ___ weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. Heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. HOW YOU MAY FEEL: You may feel weak or "washed out" for 6 weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. You could have a poor appetite for a while. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Your incision may be slightly red around the staples. This is normal. You may gently wash away dried material around your incision. It is normal to feel a firm ridge along the incision. This will go away. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. Ove the next ___ months, your incision will fade and become less prominent. YOUR BOWELS: Constipation is a common side effect of medicine such as Percocet or codeine. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription from your surgeon for pain medicine to take by mouth. It is important to take this medicine as directied. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the folloiwng, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. In some cases you will have a prescription for antibiotics or other medication. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild 2. Bisacodyl 10 mg PO DAILY:PRN Constipation - Second Line 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 40 mg SC DAILY 5. Milk of Magnesia 30 mL PO Q6H:PRN Constipation - First Line Reason for PRN duplicate override: Alternating agents for similar severity 6. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate Duration: 7 Days Reason for PRN duplicate override: breakthrough RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*40 Tablet Refills:*0 7. Senna 8.6 mg PO BID:PRN Constipation - First Line 8. amLODIPine 5 mg PO DAILY 9. Atorvastatin 40 mg PO QPM 10. Chlorthalidone 25 mg PO DAILY 11. Ibuprofen 800 mg PO Q8H:PRN Pain - Moderate Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: multiple facial fractures, right APC 3 pelvic fracture, left medial malleolus fracture, left Achilles tendon rupture, and left ligamentous ankle injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>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: - non weight bearing in bilateral lower extremities MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 3 hours as needed x 1 day, then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take Lovenox 40mg SC daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - Splint must be left on until follow up appointment unless otherwise instructed. - Do NOT get splint wet. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE <30 DAYS OF REHAB Physical Therapy: non-weight bearing bilateral lower extremities Treatments Frequency: Any staples or superficial sutures you have are to remain in place for at least 2 weeks postoperatively. Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. You may shower and allow water to run over the wound, but please refrain from bathing for at least 4 weeks postoperatively. Please remain in the splint until follow-up appointment. Please keep your splint dry. If you have concerns regarding your splint, please call the clinic at the number provided.</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 Do not exceed 6 tablets/day. Do not exceed 4g/day of acetaminophen. 2. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild Do not exceed 4g/day. 3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 4. CeFAZolin 2 g IV Q8H Duration: 2 Doses End ___. 5. Docusate Sodium 100 mg PO BID 6. Doxazosin 2 mg PO HS 7. FoLIC Acid 1 mg PO DAILY 8. Heparin IV per Weight-Based Dosing Protocol Indication: Mechanical Heart Valve Continue existing infusion at last documented rate and adjust subsequent rate as per the heparin nomogram. Therapeutic/Target PTT Range: 60 - 99.9 seconds 9. LevETIRAcetam 1000 mg PO BID 10. Multivitamins W/minerals 1 TAB PO DAILY 11. Nicotine Patch 14 mg TD DAILY 12. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN BREAKTHROUGH PAIN ___ request partial fill. 13. Polyethylene Glycol 17 g PO DAILY:PRN constipation 14. QUEtiapine Fumarate 100 mg PO BID 15. QUEtiapine Fumarate 150 mg PO QHS 16. Senna 8.6 mg PO BID 17. Thiamine 100 mg PO DAILY 18. Warfarin 2.5 mg PO DAILY16 INR goal ___ 19. Digoxin 0.25 mg PO DAILY 20. Diltiazem Extended-Release 300 mg PO DAILY 21. FLUoxetine 40 mg PO DAILY 22. Furosemide 40 mg PO DAILY 23. glimepiride 1 mg oral DAILY 24. Lisinopril 5 mg PO DAILY 25. MetFORMIN (Glucophage) 500 mg PO BID 26. Metoprolol Succinate XL 100 mg PO DAILY 27. Simvastatin 20 mg PO QPM Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Right subdural hematoma with cerebral compression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Hemorrhage with Surgery Surgery •You underwent a surgery called a craniotomy to have blood removed from your brain. •Please keep your staples along your incision dry until they are removed. •It is best to keep your incision open to air but it is ok to cover it when outside. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •If you experienced a seizure while admitted, you are NOT allowed to drive by law. •No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications •You have been cleared for anticoagulation with Heparin drip (no bolus) and Coumadin. Please do NOT take any other blood thinning medications (Aspirin, Ibuprofen, Plavix) until cleared by the neurosurgeon. •You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •You may have difficulty paying attention, concentrating, and remembering new information. •Emotional and/or behavioral difficulties are common. •Feeling more tired, restlessness, irritability, and mood swings are also common. •You may also experience some post-operative swelling around your face and eyes. This is normal after surgery and most noticeable on the second and third day of surgery. You apply ice or a cool or warm washcloth to your eyes to help with the swelling. The swelling will be its worse in the morning after laying flat from sleeping but decrease when up. •You may experience soreness with chewing. This is normal from the surgery and will improve with time. Softer foods may be easier during this time. •Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Headaches: •Headache is one of the most common symptoms after a brain bleed. •Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. •Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. •There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •Nausea and/or vomiting •Extreme sleepiness and not being able to stay awake •Severe headaches not relieved by pain relievers •Seizures •Any new problems with your vision or ability to speak •Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: •Sudden numbness or weakness in the face, arm, or leg •Sudden confusion or trouble speaking or understanding •Sudden trouble walking, dizziness, or loss of balance or coordination •Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, . You were admitted to ___ for abdominal pain. While you were here, you were found to have decreased drainage from your percutaneous cholecystostomy tube. The top was changed. This resulted in good drainage. An ultrasound showed that it is in the correct place, draining the gallbladder. Your abdominal pain improved and you were able to eat without difficulty. . Weigh yourself every morning, call MD if weight goes up more than 3 lbs. If you continue to gain weight, dose may need uptitrated and should be managed by heart failure clinic (___). . You will be evaluated by surgery for consideration of removal of your gallbladder on ___. . You have COMPLETED your course of Augmentin. You should now stop it. While you were here none of your other medications were changed. You should continue to take all of your medications as prescribed previously.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Humalog 6 Units Breakfast Humalog 6 Units Dinner 2. Lactulose 60 mL PO QID Take extra dose(s) to achieve at least ___ bowel movements per day 3. Nortriptyline 50 mg PO DAILY 4. Omeprazole 20 mg PO DAILY 5. Ondansetron 4 mg PO Q12H:PRN n/v 6. Rifaximin 550 mg PO Q12H 7. traZODONE 150 mg PO HS:PRN insomnia 8. Docusate Sodium 100 mg PO BID 9. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 10. Polyethylene Glycol 17 g PO DAILY 11. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain hold for sedation, rr <10, change in mental status 12. Quetiapine extended-release 150 mg PO HS 13. Quetiapine extended-release 50 mg PO HS:PRN anxiety Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Constipation, hepatitis C cirrhosis, hepatic encephalopathy Secondary: depression Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted for confusion that developed because of your liver disease. When your liver is not working very well, it can't get rid of toxins that can cloud your thinking. The treatment of this is laxatives to keep your bowels regular, to get rid of these toxins. Please note that your medication list attached has been updated to reflect the medications you should receive at your facility. Of note, you do NOT need to continue taking spironolactone or nadolol which were started by the facility. Please take lactulose at least 4 times daily. This is a medicine to keep your bowels regular. You need at least ___ bowel movements per day to prevent confusion. If you are not moving your bowels ___ times per day, you should take extra doses of lactulose Please also STOP taking clonazepam and oxycodone. These medicines were not given to you in the hospital, and they will only make you more confused and cloud your thinking. For pain, you should START taking tramadol, which can effectively treat pain and will not make you as confused as oxycodone.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO QID 2. Atorvastatin 80 mg PO QPM 3. FoLIC Acid 1 mg PO DAILY 4. Metoprolol Succinate XL 25 mg PO DAILY 5. Multivitamins 1 TAB PO DAILY 6. QUEtiapine Fumarate ___ mg PO Q6H:PRN anxiety, agitation, insomnia 7. QUEtiapine Fumarate 200 mg PO QHS 8. QUEtiapine Fumarate 100 mg PO QAM AND 1200 9. Thiamine 250 mg PO DAILY 10. Torsemide 40 mg PO DAILY 11. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth q6hr Disp #*30 Tablet Refills:*0 12. Acetaminophen 650 mg PO Q8H Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Primary Diagnoses ===================== Encephalopathy Anion Gap Acidosis Hypotension Hyponatremia Systolic Heart Failure (EF 20%) Traumatic brain injury Unspecified mood disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you during your stay at ___. You were admitted to the hospital because of confusion and not thinking clearly. This was most likely from electrolyte abnormalities and alcohol intoxication. You had a CT scan of your head which did not reveal any abnormalities. You were treated with fluids and vitamins, and you improved throughout your hospital stay. You also had signs of fluid overload, and you were continued on your diuretic (water pill) but at a lower dose. A list of medications is included in your discharge paperwork. Your appointments are also listed below. It is very important that you continue to take your medications as prescribed, and that you bring a list of your medications to your follow up appointments. You should weigh yourself every morning, and call your doctor if your weight goes up by more than three pounds. 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. Aspirin 81 mg PO DAILY 2. Atorvastatin 40 mg PO DAILY 3. Hydroxychloroquine Sulfate 200 mg PO BID 4. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 5. Niacin SR 500 mg PO BID 6. Nitroglycerin SL 0.3 mg SL ASDIR for chest pain, every 5 mins x 3 doses then call ___ RX *nitroglycerin 0.4 mg 1 sublingually every 5 mins as needed Disp #*1 Bottle Refills:*0 7. PredniSONE 7.5 mg PO DAILY 8. Coumadin *NF* (warfarin) 2.5 mg Oral daily Please monitor ___ 9. Docusate Sodium 100 mg PO BID hold for diarrrhea 10. Senna 1 TAB PO BID:PRN constipation 11. Metoprolol Succinate XL 100 mg PO DAILY hold for bp <100, hr <60 RX *metoprolol succinate [Toprol XL] 100 mg 1 tablet(s) by mouth once a day Disp #*21 Tablet Refills:*0 12. Pantoprazole 40 mg PO Q24H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: hematoma right subcostal incision secondary diagnosis: chest pain tachycardia Discharge Condition: Mental Status: Clear and coherent. ( + HOH) Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were re-admitted to the hospital with bleeding from your incision after resuming your coumadin and starting lovenox. You required blood products to correct the elevated clotting studies. Your anti-coagulation was held and resumed after the coagulation studies normalized. Your vital signs and blood work have been stable. You are being discharged with the following instructions: Please watch and and report bleeding from your wound or bleeding from mouth, rectum, or skin. Your coumadin has been restarted and you will need careful monitoring of your ___. Your post-op instructions include: You were admitted to the hospital with acute cholecystitis. You were taken to the operating room and had your gallbladder removed laparoscopically. You tolerated the procedure well and are now being discharged home to continue your recovery with the following instructions. Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for 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. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. You could have a poor appetite for a while. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steristrips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). Your incisions may be slightly red around the stitches. This is normal. You may gently wash away dried material around your incision. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 3. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. cyanocobalamin (vitamin B-12) 500 mcg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. pilocarpine HCl 1 % Drops Sig: One (1) Drop Ophthalmic Q6H (every 6 hours). 7. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 9. meclizine 12.5 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for dizziness. 10. alum-mag hydroxide-simeth 200-200-20 mg/5 mL Suspension Sig: ___ MLs PO QID (4 times a day) as needed for indigestion. 11. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) unit PO DAILY (Daily) as needed for constipation. 12. Vitamin D-3 1,000 unit Tablet, Chewable Sig: One (1) Tablet, Chewable PO once a day. 13. Prosight Tablet Sig: One (1) Tablet PO twice a day. 14. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). Disp:*180 Tablet(s)* Refills:*2* 15. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 16. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO at bedtime. 17. brimonidine 0.15 % Drops Sig: One (1) Ophthalmic twice a day: to right eye. 18. timolol 0.5 % Drops Sig: One (1) drop Ophthalmic twice a day: to right eye. 19. travoprost 0.004 % Drops Sig: One (1) Ophthalmic at bedtime: to right eye. 20. Natural Tears (PF) 0.1-0.3 % Dropperette Sig: Two (2) Ophthalmic three times a day: to right eye. 21. Robitussin-DM ___ mg/5 mL Syrup Sig: Ten (10) mL PO every four (4) hours as needed for cough. 22. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*45 Tablet(s)* Refills:*0* 23. amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 24. cefpodoxime 100 mg Tablet Sig: One (1) Tablet PO twice a day for 3 days. Disp:*6 Tablet(s)* Refills:*0* Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: Left eye endophthalmitis Hypertension Bradycardia Secondary Diagnosis: AVNRT Glaucoma Urinary tract infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for a slow heart rate and painful eye. We had some difficulty controlling your heart rates and blood pressures, but we have found a regimen that hopefully will work well. To help your pain, we had eye doctors remove your ___. They expect you will still have some soreness at the site of the operation but this should improve with time. If you continue to have episodes of lightheadedness alternating with palpitations, you will need to consider whether a pacemaker is appropriate to help regulate your heart rate. The following medications were changed during this hospitalization: 1. Please START taking amlodipine 5mg daily for your high blood pressures 2. Please START taking oxycodone 5 to 7.5mg by mouth every four hours as needed for pain. 3. Please START taking 1g tylenol every eight hours to help reduce the pain and inflammation in your eye. 4. Please START taking cefpodoxime 100mg twice a day for your urinary tract infection for two more days. You will stop taking this medication on ___. Please continue to take all your other medications as previously prescribed.</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. Polyethylene Glycol 17 g PO DAILY Take for constipation as needed Discharge Disposition: Home Discharge Diagnosis: Peritoneal hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for evaluation of abdominal pain following a laparoscopic appendectomy on ___. Your blood counts were monitored closely and on ___ you were taken back to the operating room for a laparoscopic washout which you tolerated well. You are recovering well and 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. *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. Ranitidine 150 mg PO QHS RX *ranitidine HCl 150 mg one tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 RX *ranitidine HCl [Acid Control (ranitidine)] 150 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*2 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 3. Omeprazole 40 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Nausea with vomiting Gastritis 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>Why was I in the hospital? - you were admitted for nausea, vomiting, and pain What was done while I was in the hospital? - you were treated with anti-acid medications and anti-nausea medications - you were rehydrated - your diet was advanced back to a regular diet once you were better What will I need to do when I go home? - take your medications as prescribed - see your doctor next week as scheduled - see your GI doctor in ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID Please take while taking narcotics 2. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate Please do not operate heavy machinery, drink alcohol or drive 3. Exemestane 25 mg PO DAILY 4. FLUoxetine 10 mg PO DAILY 5. Fluticasone Propionate 110mcg 2 PUFF IH BID 6. Fluticasone Propionate NASAL 1 SPRY NU DAILY 7. FoLIC Acid 1 mg PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Propranolol 20 mg PO TID 10. Salmeterol Xinafoate Diskus (50 mcg) 2 INH IH QAM 11. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1. Retropharyngeal collection. 2. Progressive dysphagia. 3. Progressive shortness of breath, upper airway obstruction. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>I&D of Hematoma following your recent ACDF Surgery You have undergone the following operation:I&D of surgical site for hematoma from you recent Anterior Cervical Decompression and Fusion surgery at ___. Immediately after the operation: • Activity:You should not lift anything greater than 10 lbs for 2 weeks.You will be more comfortable if you do not sit in a car or chair for more than~45 minutes without getting up and walking around. • Rehabilitation/ Physical ___ times a day you should go for a walk for ___ minutes as part of your recovery.You can walk as much as you can tolerate. • Swallowing:Difficulty swallowing is not uncommon after this type of surgery.This should resolve over time.Please take small bites and eat slowly.Removing the collar while eating can be helpful–however,please limit your movement of your neck if you remove your collar while eating. • Cervical Collar / Neck Brace:If you have been given a soft collar for comfort, you may remove the collar to take a shower or eat.Limit your motion of your neck while the collar is off.You should wear the collar when walking,especially in public. • Wound Care:Remove the dressing in 2 days.If the incision is draining cover it with a new sterile dressing.If it is dry then you can leave the incision open to the air.Once the incision is completely dry (usually ___ days after the operation) you may take a shower.Do not soak the incision in a bath or pool.If the incision starts draining at anytime after surgery,do not get the incision wet.Call the office at that time. f you have an incision on your hip please follow the same instructions in terms of wound care. • You should resume taking your normal home medications. • You have also been given Additional Medications to control your pain.Please allow 72 hours for refill of narcotic prescriptions,so plan ahead.You can either have them mailed to your home or pick them up at the clinic located on ___ 2.We are not allowed to call in narcotic (oxycontin,oxycodone,percocet) prescriptions to the pharmacy.In addition,we are only allowed to write for pain medications for 90 days from the date of surgery. • Follow up: ___ Please Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. ___ At the 2-week visit we will check your incision,take baseline x rays and answer any questions. ___ We will then see you at 6 weeks from the day of the operation.At that time we will most likely obtain Flexion/Extension X-rays and often able to place you in a soft collar which you will wean out of over 1 week. Please call the office if you have a fever>101.5 degrees Fahrenheit, drainage from your wound,or have any questions. ***Also, Please follow up as scheduled with your primary surgeon. Physical Therapy: WBAT C-collar at all times except for hygiene Treatments Frequency: Remove the dressing in 2 days.If the incision is draining cover it with a new sterile dressing.If it is dry then you can leave the incision open to the air.Once the incision is completely dry (usually ___ days after the operation) you may take a shower.Do not soak the incision in a bath or pool.If the incision starts draining at anytime after surgery,do not get the incision wet.Call the office at that time. f you have an incision on your hip please follow the same instructions in terms of wound care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen (Liquid) 650 mg PO Q6H:PRN pain 2. Collagenase Ointment 1 Appl TP BID 3. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB/wheezing 4. Aspirin 81 mg PO DAILY 5. Budesonide *NF* 0.5 mg/2 mL INHALATION Q12H 6. Calcium Carbonate 1250 mg PO Q4H:PRN heart burn 7. ClonazePAM 0.5 mg PO BID 8. Docusate Sodium 100 mg PO BID 9. Glargine 10 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 10. Lansoprazole Oral Disintegrating Tab 30 mg PO BID 11. Levothyroxine Sodium 88 mcg PO DAILY 12. MethylPHENIDATE (Ritalin) 5 mg PO BID 13. Metoclopramide 10 mg PO QIDACHS 14. Montelukast Sodium 10 mg PO DAILY 15. Morphine Sulfate 0.5 mg IV Q6H:PRN pain 16. Neomycin-Polymyxin-Bacitracin 1 Appl TP BID:PRN redness 17. Ondansetron 4 mg IV Q8H:PRN nausea 18. Polyethylene Glycol 17 g PO DAILY:PRN constipation 19. PredniSONE 5 mg PO DAILY 20. Sarna Lotion 1 Appl TP QID:PRN itching 21. Senna 1 TAB PO BID 22. Simethicone 80 mg PO QID:PRN gas pain 23. Tacrolimus Suspension 2.5 mg PO Q12H 24. TraZODone 50 mg PO HS:PRN insomnia 25. Venlafaxine 50 mg PO BID 26. Zinc Sulfate 220 mg PO DAILY 27. Metoprolol Tartrate 12.5 mg PO BID 28. Heparin 5000 UNIT SC BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Septic shock Bacteremia End stage renal disease DM, type I Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was our pleasure to care for your at ___. You came in with septic shock. We treated you for your infection. You were dialyzed for your end-stage renal disease. You completed all required antibiotics needed to treat your infection during your hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levothyroxine Sodium 137 mcg PO DAILY 2. Multivitamins 1 TAB PO DAILY 3. Clopidogrel 75 mg PO DAILY 4. Sodium Chloride Nasal ___ SPRY NU BID:PRN nasal congestion 5. Acetaminophen 650 mg PO Q4H:PRN pain/temp 6. Bisacodyl ___AILY:PRN constipation 7. Atorvastatin 80 mg PO QPM 8. Divalproex Sod. Sprinkles 375 mg PO BID on ___ increase to 375mg qam and 500mg qpm until ___ and then increase to goal dose of 500mg BID 9. Fleet Enema ___AILY:PRN constipation Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute respiratory failure Sepsis aspiration pneumonia Chronic microvascular cerebral disease with old strokes metabolic encephalopathy Secondary: cognitive impairment schizoaffective disorder hypothyroidism hypertension Discharge Condition: Activity Status: Out of Bed with assistance to chair or wheelchair. Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Followup Instructions: ___ [/INST] </s><s>Ms. ___ was admitted in septic shock from aspiration pneumonia. She required intensive care, intubation and significant support. She ultimately improved and her encephalopathy is gradually improving, unfortunately she also suffered a seizure while in house which neuro recommended starting antiepileptic therapy. She was started on valproic acid with no further seizures. She also developed an MDR UTI with a catheter in place and was treated with meropenem with treatment completed in house.</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 Q4H:PRN dyspnea 2. Azathioprine 50 mg PO DAILY 3. Calcitonin Salmon 200 UNIT NAS DAILY 4. Calcium Carbonate 500 mg PO TID 5. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL DAILY 6. Enoxaparin Sodium 100 mg SC Q12H 7. Fentanyl Patch 100 mcg/h TP Q72H chronic pain 8. Ferrous Sulfate (Liquid) 300 mg PO DAILY 9. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 10. Gabapentin 300 mg PO TID 11. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN dyspnea 12. Levothyroxine Sodium 25 mcg PO DAILY 13. Lorazepam 0.5 mg PO Q8H:PRN anxiety 14. Morphine Sulfate (Concentrated Oral Soln) 15 mg PO Q4H:PRN pain 15. Pravastatin 40 mg PO DAILY 16. PredniSONE 7.5 mg PO DAILY 17. RISperidone 1 mg PO PRN agitation 18. Senna 2 TAB PO DAILY 19. Vitamin D 1000 UNIT PO DAILY 20. Heparin Flush (10 units/ml) 2 mL IV PRN line flush 21. Meropenem 1000 mg IV Q8H Please continue through ___. Please check CBC, Chem 7, and LFTs on ___ to ensure stability 22. Acetaminophen 1000 mg PO Q8H:PRN pain 23. Citalopram 10 mg PO DAILY 24. diclofenac epolamine *NF* 1.3 % Transdermal Q12H 25. Docusate Sodium 100 mg PO BID 26. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 27. Guaifenesin 15 mL PO Q6H:PRN cough Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: ## MDR E. coli Pneumonia, recurrent aspiration with Esophageal dysmotility and hiatal hernia with acid reflux ## Dypshagia - on modified diet (nectar thick liquids and soft solids) ## Chronic eosinophilic pneumonia on chronic prednisone and azathioprine ## Encephalopathy - improving, likely multifactorial ## Recent pulmonary embolism - acute right upper lobe pulmonary artery ## Enterocutaneous fistula s/p PEG tube removal ## COPD on home oxygen ## left hand pain NOS with abnormal x-ray with unclear significance - ? multiple myeloma, ? osteopenia, ? granulomatous process --> Recommend SPEP, and ? eval by Ortho ___ ___ ## Bipolar disorder ## Obstructive sleep apnea on BiPAP ## hyperlipidemia ## hypothyroidism ## Chronic back pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with pneumonia. You will need to complete an antibiotic course for this through ___. . You should have a follow up speech and swallow exam with fluoroscopy at the ___. . You should have a SPEP done to assess for the cause of some abnormalies seen in your hand bone.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ALPRAZolam 0.5 mg PO TID:PRN anxiety 2. Fluticasone Propionate NASAL 1 SPRY NU DAILY:PRN congestion 3. Levothyroxine Sodium 125 mcg PO DAILY 4. Vitamin D 400 UNIT PO DAILY 5. Hydrochlorothiazide 25 mg PO DAILY 6. Duloxetine 60 mg PO DAILY 7. Docusate Sodium 100 mg PO BID 8. Diclofenac Sodium ___ 50 mg PO BID 9. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth every four hours Disp #*60 Tablet Refills:*0 10. Fluconazole 100 mg PO Q24H Duration: 3 Days RX *fluconazole 100 mg 1 tablet(s) by mouth Daily Disp #*3 Tablet Refills:*0 11. Acetaminophen 650 mg PO Q6H:PRN pain 12. Senna 8.6 mg PO DAILY 13. VICOdin ES (HYDROcodone-acetaminophen) 7.5-300 mg ORAL Q6H:PRN pain Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hydronephrosis Discharge Condition: Discharge Condition: Good Mental Status: Coherent, Oriented, Alert Ambulatory Status: ambulating independently 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. -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. -DICLOFENAC SODIUM or 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. -DICLOFENAC SODIUM or 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. -You will be discharged home with the PERCUTANEOUS NEPHROSTOMY (PCN) or FOLEY -You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month -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. -PCNs/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 ___ see ___ team instructions and handout on PCN care, waste elimination, dressing changes. PERCUTANEOUS NEPHROSTOMY (PCN) TUBE INSTRUCTIONS FOR CARE---FOR FAMILY: Please leave PCN tube to external gravity drainage. Catheter flushing: If there are excessive blood clots or debris or thick urine within the connecting tubing, this can be gently flushed as needed to promote clearing. Use normal saline filled syringes provided by nursing. ***Catheter flushing: Aspirate/flush with 5 cc of sterile saline ONLY if debris/clots present*** Change every 3 days, if soiled/saturated, as needed: Gently cleanse around the skin entry site of the catheter with gentle soap w/ warm water. Dry and apply gauze dressing. Catheter security: a) EVERYDAY you must check to be sure the catheter, the connecting tubing and the drainage bag are securely attached to the patient and are not kinked. b) If the catheter appears to be pulling "out", please notify Interventional Radiology. c) If the catheter pulls out, please notify Interventional Radiology within 8 hours. SAVE THE CATHETER for inspection--DO NOT throw it away. Call Interventional Radiology/Angio for ANY catheter related questions or problems. ___ or Fellow/Resident (pager# ___</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/PR DAILY:PRN Constipation - First Line Reason for PRN duplicate override: Transfer order 3. Dexamethasone 3 mg PO Q6H Duration: 2 Doses Last dose ___ @0000. This is dose # 3 of 6 tapered doses Tapered dose - DOWN 4. Dexamethasone 3 mg PO Q8H Duration: 6 Doses ___ This is dose # 4 of 6 tapered doses Tapered dose - DOWN 5. Dexamethasone 2 mg PO Q6H Duration: 4 Doses ___ This is dose # 5 of 6 tapered doses Tapered dose - DOWN 6. Dexamethasone 2 mg PO Q8H Duration: 6 Doses ___ This is dose # 6 of 6 tapered doses 7. Dexamethasone 2 mg PO Q12H Start ___ This is the maintenance dose to follow the last tapered dose 8. Docusate Sodium 100 mg PO BID 9. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 10. Glucose Gel 15 g PO PRN hypoglycemia protocol 11. Heparin 5000 UNIT SC BID 12. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using HUM Insulin 13. LevETIRAcetam 1000 mg PO BID 14. Nicotine Patch 21 mg TD DAILY 15. OLANZapine (Disintegrating Tablet) 2.5-5 mg PO BID:PRN agitation and axiety 16. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Severe 17. Senna 17.2 mg PO HS 18. Ezetimibe 10 mg PO DAILY 19. FLUoxetine 40 mg PO DAILY 20. Lisinopril 10 mg PO DAILY 21. Omeprazole 20 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: ___ lesion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Surgery •You underwent a craniotomy for biopsy. A sample of tissue from the lesion in your ___ was sent to pathology for testing. •Please keep your incision dry until your staples are removed. •You may shower at this time but keep your incision dry. •It is best to keep your incision open to air but it is ok to cover it when outside. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •If you experienced a seizure while admitted, you are NOT allowed to drive by law. •No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications •Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •You may experience headaches and incisional pain. •You may also experience some post-operative swelling around your face and eyes. This is normal after surgery and most noticeable on the second and third day of surgery. You apply ice or a cool or warm washcloth to your eyes to help with the swelling. The swelling will be its worse in the morning after laying flat from sleeping but decrease when up. •You may experience soreness with chewing. This is normal from the surgery and will improve with time. Softer foods may be easier during this time. •Feeling more tired or restlessness is also common. •Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •Nausea and/or vomiting •Extreme sleepiness and not being able to stay awake •Severe headaches not relieved by pain relievers •Seizures •Any new problems with your vision or ability to speak •Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: •Sudden numbness or weakness in the face, arm, or leg •Sudden confusion or trouble speaking or understanding •Sudden trouble walking, dizziness, or loss of balance or coordination •Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Ferrous sulfate - 325mg PO daily Folic acid 1mg PO daily Lactulose 30ml PO as needed Levetiracetam 1500 mg PO 2 times a day Lisinopril 10mg PO daily Metoprolol Tartrate 100mg PO 3 times a day Omeprazole 20mg PO 2 times a day Rifaximin 550 mg PO 2 times a day Terazosin 2mg PO at bedtime Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis - Acute Gastrointestinal bleed - Anemia - Thrombocytopenia - Cirrhosis with ascites - Colonic mass (pathology pending) - Esophageal and Rectal varices - Upper GI ulcer (question of H.Pylori) Secondary diagnosis - Encephalopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Follow up on colonic mass pathology. Follow up on pathology for H.Pylori (patient was seropositive but has h/o H. Pylori) and if positive treat Follow up on Hep serologies Follow up with EGD in ___ weeks to reasses esophageal and rectal varices according to recommendations by GI Followup Instructions: ___ [/INST] </s><s>You were admitted for concern of Gastrointestinal bleed and black tarry stools. After endoscopy and colonoscopy, an upper GI ulcer, esophageal and rectal varices and a colonic mass were found. Biopsies were sent to pathology and we are awaiting a final read. You were also found to have cirrhosis on further imaging and lesions on the liver of which some are suspicious for hemangioma and others are nonspecific. You also had low blood counts, and low platelets concerning for malignancy or alcohol abuse. Please follow up with your PCP after discharge. You will also be scheduled to meet a colorectal surgeon, Dr ___. Expect to be contacted for an appointment in the next 2 weeks. You also have an appointment with a liver doctor scheduled for next week. If you feel confused, short of breath, further vomiting with blood or blood in your stools, please contact your doctor. Medication Changes Start Ferrous Sulfate 325mg daily Start Folic Acid 1mg daily Start Rifaximin 550mg twice a day Start Lactulose 30ml daily as needed for contipation Start Omeprazole 20mg twice ___ Medications stopped Stop Fluticasone Stop Vardenafil</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 7 Days RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tab by mouth twice a day Disp #*14 Tablet Refills:*0 2. Oxymetazoline 2 SPRY NU BID Duration: 4 Days RX *oxymetazoline [Afrin] 0.05 % 2 puffs nasal twice a day Disp ___ Milliliter Refills:*0 3. Pseudoephedrine 60 mg PO Q6H Duration: 4 Days RX *pseudoephedrine HCl 60 mg 1 tablet(s) by mouth every six (6) hours Disp #*20 Tablet Refills:*0 4. Amitriptyline 50 mg PO HS 5. Diclofenac Sodium ___ 50 mg PO DAILY 6. Lisinopril 5 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Facial trauma status post 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 being discharged with your home headache medications. No additional medications for pain are being prescribed; please take your home medications according to the prescribing physicians' instructions. You are also being prescribed Augmentin, to be taken twice daily for 7 days, and Afrin nasal spray, 2 puffs twice a day for 4 days, as well as sudafed 60mg every 6 hours for 4 days. Take the following sinus precautions advised by plastic surgery: no using straws, sneeze with mouth open, no sniffing, no smoking, keep head of bed elevated to 45 degrees). Please call your doctor or return to the emergency room if you have any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in 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 a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. Activity: No heavy lifting of items ___ pounds for 6 weeks. You may resume moderate, exercise at your discretion. No driving until cleared by your neurologist. Wound Care: You may shower, no tub baths or swimming. If there is clear drainage from your incisions, cover with clean, dry gauze. Your steri-strips will fall off on their own. Please remove any remaining strips ___ days after surgery. Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H Do not drink alcohol when taking this medication 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. Senna 8.6 mg PO BID Hold for loose stools RX *sennosides [senna] 8.6 mg 1 capsule by mouth twice a day Disp #*30 Capsule Refills:*0 4. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN pain Do not drink alcohol or drive when taking this medication RX *oxycodone 5 mg ___ tablet(s) by mouth Q3H Disp #*100 Tablet Refills:*0 5. Enoxaparin Sodium 40 mg SC DAILY Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 1 syringe SC daily Disp #*14 Syringe Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Right patella fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane or crutches). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - 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. - No dressing is needed if wound continues to be non-draining. ACTIVITY AND WEIGHT BEARING: - Right Lower Extremity: Weightbearing as tolerated in ___ locked in extension Physical Therapy: WBAT RLE in ___ locked in extension ROM - keep RLE in ___ locked in extension Mobilize frequently Treatment Frequency: Daily dressing changes as needed for drainage Daily wound checks TEDs Ice Staple/suture removal at 2-week Orthopedic Surgery follow-up visit</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Aspirin 325 mg PO DAILY RX *aspirin 325 mg 1 tablet(s) by mouth daily Disp #*28 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice daily Disp #*60 Capsule Refills:*0 4. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours Disp #*60 Tablet Refills:*0 5. Atorvastatin 10 mg PO QPM 6. TraZODone 50 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right tri-malleolar 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>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: - Non weight bearing of right leg 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 Aspirin daily for 4 weeks to prevent blood clots   WOUND CARE: - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet   DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns   Physical Therapy: Nonweight bearing of right leg in splint Treatments Frequency: Remain in splint until follow up</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LevETIRAcetam 500 mg PO BID 2. Aspirin 81 mg PO DAILY 3. Atenolol 25 mg PO DAILY 4. Celecoxib 100 mg oral DAILY:PRN pain 5. Mirtazapine 15 mg PO QHS 6. Pravastatin 40 mg PO QPM Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: seizure Discharge Condition: Mental Status: sometimes confused Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear ___ were hospitalized for symptoms of acute difficulty with your language which was initially thought to be due to stroke. ___ received tpa (clot busting medication). ___ subsequently underwent a MRI which did not show any acute stroke. We now believe that ___ actually had a seizure. ___ were started on an anti seizure medication called Keppra. Per ___ law ___ are not allowed to drive until ___ are seizure free for at least 6 months. We made the following medication changes: START KEPPRA 500mg twice daily Please take your medication as prescribed. Please keep your follow up appointments as mentioned below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. MetroNIDAZOLE 500 mg PO TID RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth three times a day Disp #*22 Tablet Refills:*0 2. Acetaminophen-Caff-Butalbital ___ TAB PO Q4H:PRN Headache 3. Albuterol Inhaler ___ PUFF IH Q6H:PRN shortness of breath 4. Amitriptyline 100 mg PO QHS 5. Creon 12 1 CAP PO QIDWMHS 6. Ferrous GLUCONATE 240 mg PO DAILY 7. Ketorolac 30 mg IM Q6H:PRN Pain - Moderate 8. LamoTRIgine 200 mg PO QAM 9. LamoTRIgine 100 mg PO QHS 10. Lisinopril 40 mg PO DAILY 11. LORazepam 2 mg PO QHS 12. LORazepam 1 mg PO Q6H:PRN anxiety/nausea 13. Omeprazole 20 mg PO BID 14. Promethazine 25 mg IM Q6H:PRN severe nausea 15. QUEtiapine Fumarate 400 mg PO BID 16. TraMADol 50 mg PO QID:PRN Pain - Moderate 17. Vitamin D ___ UNIT PO 1X/WEEK (SA) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: -Chronic pancreatitis -Clostridium Difficile Infection Secondary: -Hypertension -Migraine headache -Seizure disorder -Gastroesophageal reflux disease -Anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, WHY WAS I ADMITTED? -You were admitted for a recurrence of your chronic pancreatitis WHAT WAS DONE FOR ME WHILE I WAS IN THE HOSPITAL? -You were given IV fluids, pain medication, and nausea medication to help make you more comfortable during the exacerbation of your chronic pancreatitis -You were initially not taking in any food or water by mouth but we gradually introduced a diet as you could tolerate it. -You had an xray of your right hip performed which showed no evidence of complication, fracture, or issues with the hardware in your hip. - While you were in the hospital you were found to have loose stools likely due to C. diff infection, for which you were started on an antibiotic. WHAT SHOULD I DO WHEN I LEAVE THE HOSPITAL? - Please take all of your medications as prescribed. - Please take your prescribed antibiotic (flagyl) for the full course 14 day course, with the last dose on ___. - Please follow up with your primary care physician as described in this summary. - If you haven any fever, chills, nausea, vomiting, weight gain, increased swelling, or shortness of breath please call your PCP or come to the emergency department. It was a pleasure caring for you at ___. Best Wishes, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 500 mg PO TID:PRN heartburn 2. Fluticasone Propionate NASAL 1 SPRY NU DAILY 3. Multivitamins 1 TAB PO DAILY 4. Acidophilus Probiotic Blend (L.acidoph,saliva-B.bif-S.therm) 175 mg po Other 5. Banatrol Plus (banana flakes-TOS) 1 packet oral TID 6. Cholestyramine 4 gm PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: ileus/bowel obstruction nephrolithiasis (urinary stones) in ileal conduit 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 for evaluation of diarrhea with nausea, vomiting, and abdominal pain. Your CT scan revealed concern for a blockage in your bowels. Your symptoms improved with bowel rest and an NG tube. Your NG tube was removed on ___ and your diet was successfully advanced. You were also found to have inflammation in your ileal conduit and ureter and kidney concerning for infection, however, you had no evidence of this clinically, and you were evaluated by urology who found stones in your ileal conduit and recommended outpatient follow up which they will arrange, and felt you did not need antibiotic therapy. As we discussed, you likely have an antibiotic associated diarrhea. Yogurt and probiotics may be helpful. If this does not abate in the next ___ hours, your staff at ___ may need to consider repeat testing for C difficile. At this time I do not think you have c difficile colitis, as you have no abdominal pain, nausea, or fever, and you had a negative test for c difficile performed at the ___ on ___ for the same diarrhea, likely due to ceftriaxone therapy. Should you develop fever, worse diarrhea, abdominal pain, nausea, please alert your staff at the ___ immediately to evaluate.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sulfameth/Trimethoprim SS 1 TAB PO DAILY Duration: 14 Days RX *sulfamethoxazole-trimethoprim [Bactrim] 400 mg-80 mg 1 tablet(s) by mouth daily Disp #*14 Tablet Refills:*0 2. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild/Fever 3. Allopurinol ___ mg PO DAILY 4. Amitriptyline 10 mg PO QHS 5. Aspirin 325 mg PO DAILY 6. Calcitriol 0.25 mcg PO DAILY 7. Collagenase Ointment 1 Appl TP BID Apply to left stump infection twice a day RX *collagenase clostridium histo. [Santyl] 250 unit/gram Apply small amount to left stump infection twice a day Disp #*250 Gram Refills:*0 8. Digoxin 0.0625 mg PO EVERY OTHER DAY 9. Midodrine 20 mg PO TID 10. Nephrocaps 1 CAP PO DAILY 11. PredniSONE 5 mg PO DAILY 12. sevelamer CARBONATE 1600 mg PO TID W/MEALS 13. Thyroid ___ mg PO BID 14. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Infection of Left BKA site Secondary: ESRD on HD, DM type 2 Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you at ___. You were admitted to the hospital for an infection in your left leg. The was treated on your left stump and you are ready to be discharged home on a course of oral antibiotics for the next 2 weeks. It is important that you finish all of your medication. It is important to continue to monitor your left stump for any signs or symptoms of infection. Wound Instructions: Continue to change dressings twice a day and apply santyl to the affected area. The stump may be wrapped in Kerlix dressing. Do not submerge in water. Activity: Remain non-weight bearing to the left stump. Problems or concerns: Please call the vascular surgery office at ___. 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: [/INST] </s><s>Dear Ms. ___, You were admitted to ___ with abdominal pain. You were evaluated by vascular surgery and gastroenterology. The vascular surgeons did not feel that your symptoms were due to mesenteric ischemia. We increased your creon dosage and let your stomach rest. Your symptoms improved and you were slowly able to tolerate oral intake and you pain is now being managed on oral pain medications. Please follow up with your primary care doctor, vascular surgery and gastroenterology. Please continue to take your medications as prescribed. Please note the medication changes that we made. You should take 4 tabs of creon with meals and 2 tabs with snacks. It is important to continue to low-fat diet with avoidance of greasy foods. You can consider talking to your PCP about meeting with a dietician and pain psychologist given your underlying chronic pain. It has been a pleasure taking care of your, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 10 mg PO DAILY 2. Hydrochlorothiazide 25 mg PO DAILY 3. Levothyroxine Sodium 88 mcg PO DAILY 4. Ramipril 10 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Hydronephrosis 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 for management of your obstruction. You underwent placement of bilateral percutaneous nephrostomy tubes. You have recovered well, and the team feels that you are safe to be discharged home. Please follow these instructions: 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. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone [Oxecta] 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*120 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. Atorvastatin 80 mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. Finasteride 5 mg PO DAILY 6. Metoprolol Tartrate 25 mg PO BID 7. Milk of Magnesia 30 mL PO Q8H:PRN constipation 8. Nitroglycerin SL 0.3 mg SL PRN CP 9. Pantoprazole 40 mg PO Q24H 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation 11. Senna 1 TAB PO HS constipation 12. Tamsulosin 0.4 mg PO HS 13. Acetaminophen 1000 mg PO Q8H Discharge Disposition: Home Discharge Diagnosis: L1 lesion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. You have been cleared by physical therapy to go home without assistance. Followup Instructions: ___ [/INST] </s><s>•Your large dressing may be removed the second day after surgery. •If you have steri-strips in place, you must keep them dry for 72 hours. Do not pull them off. They will fall off on their own or be taken off in the office. You may trim the edges if they begin to curl. • No tub baths or pool swimming for two weeks from your date of surgery. •Do not smoke. •No pulling up, lifting more than 10 lbs., or excessive bending or twisting. •Limit your use of stairs to ___ times per day. •Have a friend or family member check your incision daily for signs of infection. •Take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. Pain medication should be used as needed when you have pain. You do not need to take it if you do not have pain. •Do not take any anti-inflammatory medications such as Motrin, Advil, and Ibuprofen etc. for two weeks. Because of your heart condition, you should be taking your home dose of Aspirin. •Increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. We recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •Clearance to drive and return to work will be addressed at your post-operative office visit. •You were recommended by both neurosurgery and urology to have a foley inserted at the time of your discharge because you were retaining urine. Since you declined catheterization, please seek medical attention if you go home and are still unable to void and are experiencing discomfort from your urinary retention.</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 at ___. You were admitted with heavy vaginal bleeding and low platelet count. We and the hematologists think that your low platelet count may be related to your alcohol use and is likely contributing to your heavy bleeding, therefore we advise stopping alcohol. We got an ultrasound of your uterus that was normal, but you did have a right ovarian cyst that should be followed up with repeat ultrasound in 6 weeks. We recommend you talk to you OB/GYN about starting a birth control method that will help regulate your bleeding. You also had a chlamydia infection that was treated with 1 dose of azithromycin. Your partner also needs to be treated for chlamydia prior to resuming sexual intercourse.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Calcium Carbonate 1500 mg PO DAILY 3. Citalopram 20 mg PO DAILY 4. Fluticasone Propionate 110mcg 2 PUFF IH BID 5. Levothyroxine Sodium 50 mcg PO DAILY 6. Omeprazole 40 mg PO DAILY RX *omeprazole 20 mg 1 capsule,delayed ___ by mouth daily Disp #*30 Capsule Refills:*0 7. Potassium Chloride 20 mEq PO 3X/WEEK (___) 8. Rivaroxaban 15 mg PO DAILY RX *rivaroxaban [Xarelto] 15 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 9. Spironolactone 25 mg PO DAILY 10. Vitamin D 1000 UNIT PO DAILY 11. Lorazepam 0.5 mg PO Q4H:PRN anxiety 12. Travatan Z (travoprost) 0.004 % ophthalmic qhs 13. Amiodarone 200 mg PO BID RX *amiodarone 200 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 14. Atorvastatin 10 mg PO DAILY RX *atorvastatin 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 15. Diltiazem Extended-Release 240 mg PO DAILY RX *diltiazem HCl 240 mg 1 capsule,extended release 24hr(s) by mouth daily Disp #*30 Capsule Refills:*0 16. Torsemide 40 mg PO DAILY RX *torsemide 20 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: 1. acute congestive heart failure exacerbation, diastolic 2. atrial fibrillation with rapid ventricular rate 3. esophageal stricutre SECONDARY: 4. chronic obstructive pulmonary disease 5. hypothyroidism 6. hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___. You came to the hospital because of worsening shortness of breath. This was related to your heart not functioning well. This was because you were not able to take your medications by mouth because of the trouble you were having swallowing. Because of the trouble you had swallowing, we had the gastroenterologists see you and perform a procedure to dilate your esophagus, which you tolerated well. You also underwent a procedure to bring your heart back into a regular rhythm, which you also tolerated well. Please weigh yourself every morning, call your MD if your weight goes up more than 3 lbs. See below for medication changes and follow up appointments. You were started on a medication called amiodarone. Please take 200 mg twice per day for one month. On ___, you may decrease to 200 mg daily unless your cardiologist give you different instructions at follow up.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM 2. Acetaminophen 325-650 mg PO Q6H:PRN fever RX *acetaminophen 500 mg 1 tablet(s) by mouth every 6 hours Disp #*20 Tablet Refills:*0 3. Cephalexin 500 mg PO Q6H RX *cephalexin 500 mg 1 tablet(s) by mouth every 6 hours Disp #*33 Tablet Refills:*0 4. Aspirin 81 mg PO DAILY 5. nebivolol 25 ng oral DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis Cellulitis Hypertensive emergency Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was our pleasure caring for you in ___ ___. You came to the hospital because you were feeling unwell and had high blood pressure. You were found to have a skin infection and we gave you antibiotics and you improved. Your blood pressure improved as well. You were doing better so you were able to go home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sertraline 50 mg PO DAILY 2. Risperidone 2 mg PO HS 3. LeVETiracetam 1500 mg PO BID RX *levetiracetam 750 mg 2 tablet(s) by mouth twice a day Disp #*120 Tablet Refills:*3 Discharge Disposition: Home Discharge Diagnosis: Increased Seizure Frequency in the setting of fever Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were evaluated at ___ for your increased seizure frequency which appears to have been in the context of contracting a viral illness which lowered your seizure threshold. We changed your anti-epileptic drugs from Trileptal to Keppra for better control of your seizures. Please stop taking your Trileptal medication in favor of your new medication, Keppra (levetiracetam) which will be taken twice a day. You will be contacted with an appointment with one of our epileptologists, Dr. ___ in the near future.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levothyroxine Sodium 100 mcg PO DAILY Take at 6AM with water. Do not take abx until 4 hrs after RX *levothyroxine 100 mcg 1 tablet(s) by mouth everyday at 6 AM Disp #*30 Tablet Refills:*0 2. Ciprofloxacin HCl 500 mg PO Q12H last dose ___ RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*77 Tablet Refills:*0 3. Aspirin 81 mg PO DAILY 4. Finasteride 5 mg PO DAILY 5. Lisinopril 10 mg PO DAILY 6. Tamsulosin 0.8 mg PO QHS 7. Torsemide 20 mg PO DAILY Weigh daily. If you gain >3 lbs in one day, give this medication and ___ MD 8. Triamcinolone Acetonide 0.1% Cream 1 Appl TP DAILY 9. Vancomycin Oral Liquid ___ mg PO Q6H RX *vancomycin 125 mg 1 capsule(s) by mouth at 10 AM, 2 ___, 6 ___ and 10 ___ Disp #*208 Capsule Refills:*0 10. HELD- Atorvastatin 40 mg PO QPM This medication was held. Do not restart Atorvastatin until you see PCP ___: Home With Service Facility: ___ Discharge Diagnosis: Hypothyroidism C. diff colitis Citrobacter prostatitis Prostate adenocarcinoma ___ 9 Discharge Condition: Activity Status: Ambulatory - requires assistance or aid (walker or cane). Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the ___ because you have have an issue with your thyroid. We started you on a new medication to help with this issue. Additionally you were found to have a infection in your urinary tract and prostate this was treated with an antibiotic. NEW MEDICATIONS * Levothyroxine 100 mcg: take first thing when you wake up. Wait at least four hours before taking other medications or food. Levothryoxine can only be taken with water. Other medications and food interact with the absorption of this medication. DO NOT take with other antibiotics, milk, orange juice or iron. WAIT 4 hrs before taking these medications or eating/drinking * Ciprofloaxcin 500 mg BID: take around 10 AM at 10 ___. Take this antibiotic until ___ or until another doctor tells you to stop this medication. This is to treat your urinary/prostate cancer * Vancomycin 125 mg daily four times a day. take at 10 AM, 2PM, 6PM and 10 ___. You should take this antibiotic until ___ or until stopped by another doctor. This is to treat your diarrhea infection c.diff * Call your doctor if your limbs are more swollen than usual, if you develop fevers, worsening diarrhea or are not urinating It was a pleasure participating in your care ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q8H 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN dyspnea 3. Artificial Tears ___ DROP BOTH EYES QID 4. Atovaquone Suspension 1500 mg PO DAILY 5. Fluconazole 200 mg PO Q24H 6. Heparin 5000 UNIT SC BID 7. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 8. Simethicone 80 mg PO TID 9. Morphine SR (MS ___ 15 mg PO Q12H 10. Mirtazapine 15 mg PO HS 11. Miconazole Powder 2% 1 Appl TP QID:PRN rash 12. Metoclopramide 5 mg IV TID 13. Lenalidomide 5 mg PO 3X/WEEK (___) 14. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H take from ___ - ___ for total ___. Daptomycin 220 mg IV Q48H 7 day course for presumed complicated UTI with antibiotic coverage from ___ to ___. Last day is ___. 16. Maalox/Diphenhydramine/Lidocaine 15 mL PO QID 17. HYDROmorphone (Dilaudid) ___ mg IV Q3H:PRN pain 18. Heparin Flush (10 units/ml) 2 mL IV PRN line flush Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Hypercalcemia acute on chronic renal failure hypotension c. diff colitis UTI - CoNS and VRE Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ with and altered mental status and your were found to have elevated calcium levels and renal failure. You were treated with medications and IV fluids to lower your calcium. Your blood pressure was also found to be low. This was thought to be due to an infection and you were found to have both a urinary tract infection and a bowel infection with an organism called C. diff, which is causing your diarrhea. Your blood pressure improved with IV fluids and treatment of your underlying infection. . Please take your medications as listed/prescribed below. . Please f/u with your doctors as listed below. .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN pain 2. Albuterol Inhaler 1 PUFF IH ONCE MR1 sob Duration: 1 Dose 3. Ibuprofen 600 mg PO Q6H:PRN pain RX *ibuprofen 600 mg 1 tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 4. Nitrofurantoin Monohyd (MacroBID) 100 mg PO DAILY Duration: 7 Days RX *nitrofurantoin monohyd/m-cryst 100 mg 1 capsule(s) by mouth daily Disp #*7 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Retained products of conception, endometritis, bladder perforation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Follow-up with urology in ___ weeks. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted to the hospital for retained products of conception and uterine infection. You underwent an uncomplicated ultrasound guided D+C and cystoscopy. You also received antibiotics. It is felt by the team that it is safe for you to be discharged. General instructions: * Take Macrobid (antibiotic) for one week as prescribed. * Care for your foley catheter leg bag as instructed. * Take your other medications as prescribed. We recommend ibuprofen and tylenol as needed for cramping. * 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) until your post-op appointment. * You may eat a regular diet. * You may walk up and down stairs. * You may shower. No bath tubs for at least two weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms. ___, You were admitted to ___ because you had confusion and weakness. WHILE YOU WERE HERE: -We treated you with fluids and medications to decrease your ammonia levels which can lead to confusion. -You were evaluated by the physical therapy team to assess your mobility and cognitive function. -We evaluated you for a possible infection but did not find anything concerning. MEDICATIONS THAT WERE STOPPED - stopped you GABAPENTIN, discuss with your liver doctor before restarting this ___. We think this medication was causing confrusion - stopped your blood pressure medication LISINOPRIL. Do not take until you talk with your primary care doctor. Your blood pressure in the hosptial was low MEDICATIONS THAT WERE CHANGED: - You should only take FUROSEMIDE (LASIX) 20 mg ONCE daily. We gave you a new prescription for this new dose - You should decrease the dose SPIRNOLACTONE to 50 mg daily. We gave you a new presciption for this new dose NEW MEDICATIONS: - We started a new medication Rifaxmin 550 mg BID that with the encepholpathy by decreasing the ammount of ammonia in the gut. WHEN YOU GO HOME: -You should take your lactulose such that you have ___ bowel movements per day. -You should take all medications as prescribed in this discharge packet. -You should follow up with transplant surgeon, Dr. ___ on ___, ___ at 10am. -You should follow up with hepatologist, Dr. ___ on ___, ___ at 4pm. -You should follow up with your primary care physician, ___. ___ and discuss your kidney function, diuretic dosing, thyroid medications, lung scans, and cognitive function. -In ___ of this year, you should get a follow-up ultrasound to assess a left ovarian cyst that was previously seen in an MRI. Thank you for allowing us to care for you here at ___. Warmly, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN asthma 2. Atorvastatin 20 mg PO 3X/WEEK (___) 3. Brimonidine Tartrate 0.15% Ophth. 1 DROP RIGHT EYE Q8H 4. Cyanocobalamin 500 mcg PO DAILY 5. Ferrous GLUCONATE 240 mg PO QHS 6. glimepiride 2 mg oral DAILY 7. Lidocaine 5% Patch 1 PTCH TD QAM 8. Lisinopril 20 mg PO DAILY 9. MetFORMIN XR (Glucophage XR) 1000 mg PO BID 10. Metoprolol Succinate XL 25 mg PO DAILY 11. Ranitidine 150 mg PO BID 12. Vitamin D 4000 UNIT PO DAILY 13. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*5 14. Co Q-10 (coenzyme Q10) 200 mg ORAL DAILY 15. Gabapentin 300 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: TIA Cognitive impairment 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 neurology service after presenting to the ED for evaluation of confusion and difficulty with speech. Images from your brain didn't show any evidence of stroke or new lesions. Images from your brain were stable when compared to prior imaging from ___. Lab work showed elevated glucose which could be secondary to uncontrolled diabetes. We think that your episode of confusion and speech difficulty was related to an ischemic event called a TIA. At this time, we recommended to switch your aspirin to Plavix for stroke prevention. Also, we recommended close follow up with your primary care doctor for better glucose level control. Please continue taking your medications as prescribed and follow up with neurology as scheduled.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ibuprofen 400 mg PO Q8H:PRN pain 2. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP TID:PRN rash apply to affected areas as needed, decrease to 2x a week 3. Hydroxychloroquine Sulfate 200 mg PO BID 4. Levofloxacin 750 mg PO DAILY RX *levofloxacin [Levaquin] 750 mg 1 tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 5. RX *ergocalciferol (vitamin D2) 2,000 unit 0.5 (One half) tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: bacterial pneumonia, organism unspecified Secondary: Systemic Lupus Erythematosis 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 hospitalization at ___. You were admitted with cough, fevers, and chest pain, and were found to have a pneumonia in the right lung. Your symptoms improved with antibiotics, which you should continue taking until ___. In order to evaluate you for blood clots in the lung, you had a CT of the chest which showed no blood clot but evidence of pneumonia.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: One (1) Disk with Device Inhalation BID (2 times a day). 2. tiotropium bromide 18 mcg Capsule, w/Inhalation Device Sig: One (1) Cap Inhalation DAILY (Daily). 3. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig: Two (2) Puff Inhalation Q6H (every 6 hours) as needed for wheezing. 4. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for headache. 5. propranolol 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. isosorbide dinitrate 10 mg Tablet Sig: Three (3) Tablet PO TID (3 times a day). 7. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 8. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) for 2 weeks. Disp:*28 Capsule(s)* Refills:*0* 9. hydromorphone 2 mg Tablet Sig: ___ Tablets PO every ___ hours as needed for pain for 7 days: Please taper from ___ tablets every 4 hours for 4 days, then to ___ tablets every 6 hours for 3 days. Disp:*50 Tablet(s)* Refills:*0* 10. cyclobenzaprine 5 mg Tablet Sig: One (1) Tablet PO once a day. 11. sumatriptan succinate 100 mg Tablet Sig: One (1) Tablet PO once a day. 12. promethazine 25 mg Tablet Sig: One (1) Tablet PO once a day. 13. ferrous fumarate 324 mg (106 mg iron) Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: Partial small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the surgical service for evaluation and management of your abdominal pain and nausea. You were treated for an obstruction of your intestines which resolved without surgical intervention. You are now being discharged home. Please follow these instructions to aid in your recovery: Please call your doctor or go to the emergency department if: * Your symptoms return * You experience new chest pain, pressure, squeezing or tightness. * You develop new or worsening cough, shortness of breath, or wheezing. * You are vomiting and cannot keep down fluids, or your medications. * If you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit, or have a bowel movement. * You experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * Your pain is not improving within 12 hours or is not under control within 24 hours. * Your pain worsens or changes location. * You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. * You develop any other concerning symptoms. General Discharge Instructions: * Please resume all regular home medications, unless specifically advised not to take a particular medication. * Please take any new medications as prescribed. Your reflux medication was increased to 40mg once daily from 20mg once daily. * Please take the prescribed analgesic medications as needed. You may not drive or operate heavy machinery while taking narcotic analgesic medications. You were prescribed dilaudid; please take ___ tablets every 4 hours for ___ days, then taper to ___ tablets every 6 hours for the remainder. You may also take acetaminophen (Tylenol) as directed, but do not exceed 4000 mg in one day. * Please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. * Avoid strenuous physical activity and refrain from heavy lifting greater than 10 lbs., until you ___ with your surgeon, who will instruct you further regarding activity restrictions. * Please also ___ with your primary care physician.</s>