Datasets:

Jarmac

/

llama2_di_dataset_train_prompt

like 0

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. metoprolol tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 times a day). Disp:*15 Tablet(s)* Refills:*2* 2. calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY (Daily). 3. digoxin 125 mcg Tablet Sig: One (1) Tablet PO 3X/WEEK (___). 4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 5. esomeprazole magnesium 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. 6. torsemide 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 7. hydroxyurea 500 mg Capsule Sig: One (1) Capsule PO 5X/WEEK (___). 8. econazole 1 % Cream Sig: One (1) application Topical twice a day as needed for rash. 9. warfarin 2 mg Tablet Sig: One (1) Tablet PO 5X/WEEK (___). 10. warfarin 1 mg Tablet Sig: One (1) Tablet PO 2X/WEEK (WE,SA). 11. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a day). 12. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at bedtime). 13. baking soda ___ teaspoon, by mouth, three times a week. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnoses: - Dyspnea, multifactorial - Acute on chronic kidney disease - Metabolic acidosis - Gait disturbance Secondary diagnoses: - Chronic diastolic and systolic heart failure - Atrial fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for shortness of breath. Extensive work up has been done for you over the last couple of months. You were not retaining too much fluid. However, it is thought that your shortness of breath was contributed partly from your underlying severe kidney disease. You made the decision not to have dialysis in the future. You were given baking soda in attempt to help with your sensation of shortness of breath. Your weight on the day of discharge was 134.8 lb. You were evaluated for your unsteadiness. It is thought that it is partly due to decreased sensation in your extremities as well as possible borderline low blood pressure. You need to walk with a cane or a walker at all time to prevent fall. Please note the following changes in your medications: - Please take baking soda, ___ teaspoon, by mouth, three times a week. This will help to balance the acid in your blood and potentially help with your breathing. - Please STOP metoprolol succinate - Please START metoprolol tartrate 12.5 mg, 1 tab, by mouth, twice a day. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Please be sure to follow up with your doctors as ___ below. You should talk to your doctor about cardiac rehabilitation as well as possible transition to palliative care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO DAILY RX *atorvastatin [Lipitor] 80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Aspirin 325 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: Probable TIA Secondary: LVH Secondary: HLD 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 your family found you to be confused and having trouble remembering events from earlier in the day. You came to the hospital for further evaluation. You were found to have some EKG changes from your last exam which was done in ___. You did not have any signs of heart damage. Your stress test showed normal heart function. You also went for a study to see if there were any blockages in the blood vessels in your neck as we were concerned for something called a TIA (Transient Ischemic Attack). This can be caused by a small piece of cholesterol breaking off from a blood vessel and traveling to the brain where it causes changes in your brain function temporarily. We think this may have been the cause of your confusion. We will be discharging you on a higher dose of a medication to control your cholesterol. You should also take Aspirin 325mg daily instead of the Aspirin 81mg daily to help prevent any stroke in the future, you may buy this at any pharmacy. Please follow up with the appointments listed below. We wish you well.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 20 mg PO DAILY 2. Clonazepam 1 mg PO QHS:PRN insomnia 3. Glargine 56 Units Breakfast Glargine 30 Units Bedtime Humalog 18 Units Breakfast Humalog 18 Units Lunch Humalog 18 Units Dinner 4. Lisinopril 10 mg PO DAILY 5. Metoprolol Tartrate 100 mg PO BID 6. Vitamin D 800 UNIT PO DAILY 7. Warfarin 8.75 mg PO 2X/WEEK (MO,FR) 8. Warfarin 10 mg PO 5X/WEEK (___) 9. oxyCODONE-acetaminophen *NF* ___ mg ORAL Q6H severe pain 10. MetFORMIN (Glucophage) 1000 mg PO BID 11. Vancomycin 1500 mg IV Q 12H RX *vancomycin 750 mg 1500 mg(s) IV every twelve (12) hours Disp #*20 Vial Refills:*0 12. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*10 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Neuropathic Diabetic Foot Ulcer c/b cellulitis Seconadry Diagnosis: Atrial Fibrillation s/p Cardioversion 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>Dear Mr. ___, It was a pleasure taking care of you at ___. You were admitted for treatment of cellulitis complicating an ulcer on your right foot. You were started on antibiotics to treat this infection. Your infection appears markedly improved and you are now safe to return home. You missed your ___ evening warfarin dose. Your INR was 1.6 (below your goal of ___ for two days (on ___ and ___. Please follow up in ___ clinic and have your INR checked again on ___, they are aware and will be expecting you. We made the following changes to your medication: Please START Vancomycin Please CONTINUE Augmentin</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 200 mg PO Q12H RX *cefpodoxime 200 mg 1 tablet(s) by mouth twice daily Disp #*2 Tablet Refills:*0 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO QPM 4. Furosemide 20 mg PO DAILY 5. MetFORMIN XR (Glucophage XR) 500 mg PO DAILY 6. Metoprolol Succinate XL 50 mg PO DAILY 7. Venlafaxine XR 75 mg PO DAILY 8. HELD- Clopidogrel 75 mg PO DAILY This medication was held. Do not restart Clopidogrel until told to do so by your physician 9. HELD- Lisinopril 10 mg PO DAILY This medication was held. Do not restart Lisinopril until told to do so by your doctor. Discharge Disposition: Home Discharge Diagnosis: PRIMARY: -Lower gastrointestinal bleed -Acute blood loss anemia SECONDARY: -Intramural thrombus -Urinary tract infection -Heart failure with preserved ejection fraction improved -Coronary artery disease -Hypertension -Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___. WHY WAS I ADMITTED TO THE HOSPITAL? You were admitted to the hospital because you were having copious amounts of bright red blood per rectum as well as some lightheadedness. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? -You had drops in your blood pressure and were feeling lightheaded, so you were given fluids through your IV. -You had a drop in your blood counts and received 2 blood transfusions. -You were seen by the gastroenterology doctors, and you had a colonoscopy done on ___ which showed diverticulosis and hemorrhoids, both of which were not actively bleeding at the time of the procedure. You had a sigmoidoscopy on ___ which showed the same thing. -Your ___ was held temporarily in the setting of your bleeding, but your aspirin was continued. -Your blood pressure medications were temporarily held in the setting of your lower blood pressures. We discussed your discharge medications with Dr. ___. -You were continued on antibiotics for your urinary tract infection. WHAT SHOULD I DO WHEN I LEAVE THE HOSPITAL? -Continue to take all medications as prescribed as listed on your discharge paperwork. -Please attend all ___ clinic appointments. -Please weigh yourself every morning, and call your cardiologist (Dr. ___ if you gain more than 3 lbs in a day or 5 lbs in a week. -Follow up with a gas colorectal surgeon near home about banding the hemorrhoids to prevent further bleeding. -Follow up with your cardiologist Dr. ___ your ___ in the setting of your recent and recurrent bleeding. -Do not take your lisinopril until instructed to do so by your doctor. -___ you are actively bleeding, go to the ED for a CTA scan to help localize the bleeding. We wish you all the best, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H Use only if necessary RX *acetaminophen 500 mg 2 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation Use only if necessary RX *bisacodyl 5 mg 2 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID Use only if necessary RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 4. Epoetin Alfa 5000 UNIT SC 1X/WEEK (SA) blood loss 5. Minocycline 100 mg PO Q12H Duration: 10 Days Take only 10 days RX *minocycline 100 mg 1 capsule(s) by mouth twice a day Disp #*20 Capsule Refills:*0 6. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN for pain on POD1 Use only if necessary RX *oxycodone 10 mg 1 tablet(s) by mouth four times a day Disp #*30 Tablet Refills:*0 7. Senna 8.6 mg PO BID:PRN constipation Use only if necessary RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*30 Tablet Refills:*0 8. lispro 35 Units Bedtime 9. amLODIPine 5 mg PO DAILY RX *amlodipine 5 mg 1 tablet(s) by mouth once a day Disp #*90 Tablet Refills:*0 10. Aspirin 81 mg PO DAILY RX *aspirin [Adult Low Dose Aspirin] 81 mg 1 tablet(s) by mouth once a day Disp #*90 Tablet Refills:*0 11. Carvedilol 25 mg PO BID RX *carvedilol 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 12. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth once a day Disp #*90 Tablet Refills:*0 13. Gabapentin 100 mg PO TID RX *gabapentin 100 mg 1 capsule(s) by mouth three times a day Disp #*90 Capsule Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Peripheral Vascular Disease s/p Left Below the Knee Amputation 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>ACTIVITY: • On the side of your amputation you are non weight bearing for ___ weeks. • You should keep this amputation site elevated when ever possible. • You may use the opposite foot for transfers and pivots. • No driving until cleared by your Surgeon. • No heavy lifting greater than 20 pounds for the next 3 weeks. BATHING/SHOWERING: • You may shower when you get home • No tub baths or pools / do not soak your foot for 4 weeks from your date of surgery WOUND CARE: • Sutures may have been 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. CAUTIONS: • If you smoke, please make every attempt to quit. Your primary care physician can help with this. Smoking causes narrowing of your blood vessels which in turn decreases circulation. 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 ___, It was a pleasure to care for you at ___. You were admitted to the hospital because you have influenza. You are being treated with oseltamivir ('tamiflu'). We also gave you IV fluids and cough medicine. You required supplemental oxygen for a short period to help your breathing. As your fevers, cough, and breathing improved, you were safe to be discharged home. You should continue taking tamiflu two times daily for a total of 5 days (day 1 = ___, final day ___. Please continue taking the rest of your medications and follow up with your physicians. 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. PredniSONE 20 mg PO DAILY Duration: 4 Doses 2. PredniSONE 10 mg PO DAILY Duration: 7 Doses RX *prednisone 10 mg 2 tablet(s) by mouth once a day Disp #*15 Tablet Refills:*0 3. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild 4. Amiodarone 200 mg PO DAILY 5. amLODIPine 10 mg PO DAILY 6. Docusate Sodium (Liquid) 100 mg PO BID 7. dorzolamide-timolol 22.3-6.8 mg/mL ophthalmic (eye) TID 8. Enoxaparin Sodium 90 mg SC DAILY Start: Tomorrow - ___, First Dose: First Routine Administration Time 9. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 10. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 11. melatonin 3 mg oral QHS:PRN insomnia 12. Mirtazapine 7.5 mg PO QHS 13. Ondansetron ODT 4 mg PO Q8H:PRN Nausea/Vomiting - First Line 14. OxyCODONE Liquid ___ mg PO Q6H:PRN Pain - Moderate 15. OxyCODONE SR (OxyCONTIN) 10 mg PO Q12H 16. Pegfilgrastim-cbqv 6 mg SC EVERY 2 WEEKS (___) 17. Prochlorperazine 5 mg PO Q6H:PRN Nausea/Vomiting - Second Line 18. Ranitidine 150 mg PO BID 19. HELD- Dronabinol 2.5 mg PO DAILY This medication was held. Do not restart Dronabinol until your doctor tells you it is safe to do so. Discharge Disposition: Home With Service Facility: ___ ___: Primary Diagnosis: Pseudogout flare Secondary Diagnoses: Diarrhea Thrombocytopenia Anemia Leukocytosis Monocytosis Dementia c/b ? delirium Acute kidney injury Gastric adenocarcinoma Atrial fibrillation History of PE Glaucoma Discharge Condition: Mental Status: Confused - sometimes, not always oriented to time and place. Level of Consciousness: Alert and interactive Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>====================== DISCHARGE INSTRUCTIONS ====================== Dear Mr. ___, It was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - You were admitted for diarrhea, right wrist pain, and a temperature of 100.2 measured at home. WHAT HAPPENED TO ME IN THE HOSPITAL? - You received a medication called prednisone to help the pain in your wrist and you knee. We believe the pain in your wrist and knee are due to a condition called pseudogout. - You were given a blood transfusion. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - We have made some changes to your medication list, so please take your medications as prescribed. - Specifically, please take your prednisone as follows: -- 20 mg (2 of the 10 mg tablets) for 4 days (___) -- 10 mg (1 of the 10 mg tablets) for 7 days (___) - Please go to your follow up appointments (scheduled below). - If you notice any of the danger signs listed below, please contact your oncologist or go to an emergency room immediately We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -400 unit oral 2 tabslet Daily 2. Mercaptopurine 75 mg PO DAILY 3. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin 500 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 4. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth 8 Disp #*42 Tablet Refills:*0 5. PredniSONE 40 mg PO DAILY Duration: 14 Doses Start: ___, First Dose: Next Routine Administration Time your gastroenterologist will continue this taper at follow up RX *prednisone 20 mg 2 tablet(s) by mouth daily Disp #*24 Tablet Refills:*0 6. PredniSONE 35 mg PO DAILY Duration: 7 Doses Start: After 40 mg tapered dose your gastroenterologist will continue this taper at follow up RX *prednisone 5 mg 7 tablet(s) by mouth daily Disp #*91 Tablet Refills:*0 7. PredniSONE 30 mg PO DAILY Duration: 7 Doses Start: After 35 mg tapered dose your gastroenterologist will continue this taper at follow up 8. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Discharge Worksheet-Discharge ___, MD on ___ @ 1131 Primary Diagnosis: Small Bowel Obstruction Secondary Diagnosis: ___ disease Discharge Condition: Discharge Worksheet-Discharge ___, MD on ___ @ 1131 Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Import Discharge Condition Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you during your hospitalization at ___. You were admitted with a small bowel obstruction secondary to a Chron's stricture. You were managed with bowel rest, decompression with an NG tube, IV steroids and antibiotics. Your obstruction improved. We were able to remove the NGT and you were able to tolerate a regular diet at discharge. You should continue to take you steroids and antibiotics at discharge. Your gastroenterologist will continue your taper when you have your follow up appointment. You are being provided with a prescription for 1 month of your steroids. Please ask your gastroenterologist for a prescription for the remainder of your taper at follow up next week</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Citalopram 10 mg PO DAILY RX *citalopram [Celexa] 10 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 2. Dronabinol 5 mg PO BID 3. Furosemide 10 mg PO DAILY Please Hold for SBP<95 4. Mirtazapine 15 mg PO HS 5. Ondansetron 8 mg PO Q8H:PRN nausea RX *ondansetron 8 mg 1 tablet(s) by mouth Every 8 Hours Disp #*60 Tablet Refills:*0 6. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q6H:PRN pain RX *oxycodone-acetaminophen 5 mg-325 mg ___ tablet(s) by mouth Every 6 hours Disp #*60 Tablet Refills:*0 7. Tiotropium Bromide 1 CAP IH DAILY RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 Capsule Inhaled Daily Disp #*30 Capsule Refills:*0 8. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 9. Albuterol Inhaler ___ PUFF IH Q6H:PRN SOB 10. CefePIME 2 g IV Q12H RX *cefepime 2 gram Please infuse 2 grams Q12 hours Disp #*5 Unit Refills:*0 11. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram/dose 17 grams by mouth Daily Disp #*300 Gram Refills:*0 12. Senna 2 TAB PO BID RX *sennosides [senna] 8.6 mg 2 Tabs by mouth twice a day Disp #*60 Capsule Refills:*0 13. Vancomycin 1000 mg IV QHS RX *vancomycin 1 gram Infuse 1000mg Daily Disp #*3 Unit Refills:*0 14. Oxycodone SR (OxyconTIN) 40 mg PO Q12H RX *oxycodone [OxyContin] 40 mg 1 tablet(s) by mouth Every 12 hours Disp #*60 Tablet Refills:*0 15. Nystatin Oral Suspension 5 mL PO QID:PRN Mouth pain RX *nystatin 100,000 unit/mL 5 ml by mouth four times a day Disp #*200 Milliliter Refills:*0 16. Lorazepam 1 mg PO Q6H:PRN anxiety RX *lorazepam 1 mg 1 mg(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 17. Morphine Sulfate Morphine Sulfate (20mg/ml) Please give 5mg by mouth or under tongue every 6 hours as needed for anxiety Disp: 30ml 18. Atropine 1% Drops 2 drops S/L (0.125mg) Place 2 drops under the tongue every four hours as needed for secretions Disp: 5ml Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Bleeding into biliary drain hospital-aquired pneumonia Gastrointestinal bleed . Secondary: gastric cancer 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>Mr ___, . It was a pleasure taking care of you while you were in the hospital. You were admitted for blood in your biliary drain. You were taken by intervetional radiology to fix the drain. This was successful. Your drain was closed and you were able to tolerate this over several days without change in your pain or labs, so the drain was pulled. Your course was unfortunately complicated by a hospital-aquired pneumonia. You also had low blood pressure and a decrease in your blood count, likely caused by a bleed somewhere in your GI tract. Given you sick you are, the decision was made to focus on your comfort. You will have a specialized nurse called ___ Hospice nurse coming to your house to help with your care. These nurses are very good at manageing pain, anxiety, and other symptoms that might arise. There will be someone from Hospice available on call ___, and this should be your first call with questions or concerns at home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Mrs. ___ you were admitted to ___ on ___ due to ischemic foot. Now you are ready for discharge. You need to follow-up with Dr. ___ given that you have lack of blood flow down to your foot on right side. Please follow these instructions closely. Here are your discharge instructions. LOWER EXTREMITY ANGIO/PLASTY/STENT MEDICATION: • Take Aspirin 81 (enteric coated) once daily • Take Lovenox, bridge to Coumadin ( INR goal ___ • Continue all other medications you were taking before surgery, unless otherwise directed • You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort WHAT TO EXPECT: It is normal to have slight swelling of the legs: • Elevate your leg above the level of your heart with pillows every ___ hours throughout the day and night • Avoid prolonged periods of standing or sitting without your legs elevated • It is normal to feel tired and have a decreased appetite, your appetite will return with time • Drink plenty of fluids and eat small frequent meals • It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing • To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication ACTIVITIES: • When you go home, you may walk and use stairs • You may shower (let the soapy water run over groin incision, rinse and pat dry) • Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area • No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) • After 1 week, you may resume sexual activity • After 1 week, gradually increase your activities and distance walked as you can tolerate • No driving until you are no longer taking pain medications CALL THE OFFICE at ___ FOR: • Numbness, coldness or pain in lower extremities • Temperature greater than 101.5F for 24 hours • New or increased drainage from incision or white, yellow or green drainage from incisions • Bleeding from groin puncture site FOR SUDDEN, SEVERE BLEEDING OR SWELLING (at the groin puncture site): • Lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. If bleeding stops, call vascular office at ___ • If bleeding does not stop, call ___ for transfer to the nearest Emergency Room</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Exelon (rivastigmine;<br>rivastigmine tartrate) 4.5 mg oral BID 2. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 3. Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 40 mg PO QPM 6. Calcium Carbonate 500 mg PO DAILY 7. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID:PRN eczema 8. dextran 70-hypromellose ___ gtt ophthalmic ___ BID 9. Erythromycin 0.5% Ophth Oint 1 in RIGHT EYE QHS 10. Famotidine 40 mg PO QHS 11. Fish Oil (Omega 3) 1000 mg PO DAILY 12. Fluticasone Propionate NASAL 2 SPRY NU DAILY as needed for allergies 13. Furosemide 40 mg PO BID 14. Gabapentin 100 mg PO QHS for arm pain 15. magnesium 144 mg oral DAILY to see if it will help with memory 16. Memantine 10 mg PO BID 17. Multivitamins 1 TAB PO DAILY 18. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 19. Omeprazole 40 mg PO BID 20. Potassium Chloride 10 mEq PO DAILY 21. rivastigmine tartrate 4.5 mg oral BID 22. Tamsulosin 0.4 mg PO BID 23. Tiotropium Bromide 1 CAP IH DAILY as needed for cough 24. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Incarcerated inguinal hernia within mesh Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were presented to ___ with abdominal pain and were found to have an incarcerated inguinal hernia. This was reduced in the Emergency Room and you were admitted for observation. Your pain has resolved and you are now tolerating a regular diet. You are medically cleared to be discharged home. You should follow-up to have the hernia and mesh repaired electively. 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.</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: 6 Days RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet by mouth twice a day Disp #*12 Tablet Refills:*0 2. LevETIRAcetam 500 mg PO Q12H RX *levetiracetam 500 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*2 3. Rivaroxaban 20 mg PO DAILY RX *rivaroxaban [___] 20 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*2 4. Albuterol Inhaler 2 PUFF IH Q4H:PRN cough 5. Atenolol 25 mg PO DAILY 6. Docusate Sodium 100 mg PO BID:PRN constipation 7. Losartan Potassium 100 mg PO DAILY 8. Omeprazole 40 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Choledocholithiasis with obstruction and cholangitis Acute aphasia which entirely resolved, likely due to partial left temporal New onset 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 Ms. ___, You were admitted with abdominal pain and jaundice (yellowing of the skin and eyes). You underwent an ERCP with removal of stones. You developed sudden onset of difficulty speaking which was concerning for a possible stroke initially, you underwent an MRI which did not show a stroke. You underwent an EEG which showed some slowing on the left side of your brain. You were started on an anti-seizure medication for a possible seizure. Your speaking difficulties entirely went away, please follow-up with a neurologist in ___ weeks either here or closer to home. You were found to be in an abnormal heart rhythm called atrial fibrillation. This increases the risk of developing a stroke. We are starting you on a blood thinner called Xarelto to reduce the risk of stroke. Please start this on ___. The ERCP team will call you to schedule a repeat ERCP in 4 weeks to remove your stent. Follow up with cytology reports. Please call Dr. ___ ___ in 7 days for the pathology results. Your CT scan showed a small nodule in your right adrenal gland, we recommend a repeat adrenal CT or MRI scan as an outpatient which your primary care physician can arrange.</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 RX *albuterol sulfate 2.5 mg/3 mL (0.083 %) 1 NEB IH every four (4) hours Disp #*50 Vial Refills:*0 2. PredniSONE 40 mg PO DAILY Duration: 5 Doses RX *prednisone 20 mg 2 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 3. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath 4. Allopurinol ___ mg PO DAILY 5. Atorvastatin 40 mg PO QPM 6. Carvedilol 25 mg PO BID 7. Furosemide 20 mg PO DAILY 8. GlipiZIDE 2.5 mg PO DAILY 9. Losartan Potassium 100 mg PO DAILY 10. MetFORMIN (Glucophage) 850 mg PO BID 11. Tiotropium Bromide 1 CAP IH DAILY 12. Vitamin D ___ UNIT PO DAILY 13. Warfarin 5 mg PO 4X/WEEK (___) 14. Warfarin 2.5 mg PO 3X/WEEK (___) 15.Nebulizer J44.9 COPD ___: Ongoing ___ years) Nebulizer and nebulizer supplies Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis COPD Exacerbation Secondary Diagnoses Acute on Chronic Heart Failure Exacerbation Hypertension Dyslipidemia Chronic Kidney Disease Type 2 Diabetes Mellitus Dementia Toxic Metabolic Encephalopathy Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your stay at ___. WHY WAS I HERE? -You were having a cough and trouble breathing WHAT WAS DONE WHILE I WAS IN THE HOSPITAL? -You were given steroids and breathing treatments WHAT SHOULD I DO WHEN I GO HOME? - You should use your inhaler every 4 hours for the next 3 days - As your breathing gets better, you can use it only when short of breath - Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Be well! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___. WHY WERE YOU IN THE HOSPITAL? - You were admitted to the hospital because you were found to be severely anemic and you had a fever. WHAT HAPPENED WHEN YOU WERE IN THE HOSPITAL? -You were transfused red blood cells to bring your levels up while we worked you up for a cause of your symptoms -Our rheumatology team evaluated you while you we admitted. They felt that your symptoms were most likely related to your previously diagnosed autoimmune disease -We had our blood specialists take a look at your blood to see if they could find anything abnormal. They only found changes consistent with iron deficiency anemia and recommended that we give you iron through your IV while you were in the hospital and then send you home with iron pills to take. WHAT SHOULD YOU DO AFTER YOU LEAVE THE HOSPITAL? - Continue to take all your medicines as prescribed below. - Show up to your appointments as listed below. You have follow up appointments scheduled with your primary care physician's office, rheumatology, and GI. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Ciprofloxacin 0.3% Ophth Soln 3 DROP RIGHT EAR TID Duration: 14 Days last dose ___ 3. Docusate Sodium 100 mg PO BID 4. Famotidine 20 mg PO BID 5. Heparin 5000 UNIT SC TID until patient ambulatory 6. Insulin SC Sliding Scale Fingerstick qid Insulin SC Sliding Scale using REG Insulin 7. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*12 Tablet Refills:*0 8. Senna 8.6 mg PO BID:PRN constipation 9. Valsartan 40 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: trauma: Right temporal bone fracture pneumo-cephalus maxilla fracture sphenoid sinus fracture Sternal fracture Disruption of the left L6-10 rib fracture Left acetabulum fracture TP L1, L2, and L5 fracture duodenal hematoma sternal fracture abducens palsy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after you were involved in a motor vehicle collusion. You sustained fractures to your face, head, back, ribs and left hip. You did not require any surgical intervention. You were evaluated by physical therapy and recommendations made for discharge to a rehabilitation center to help improve your mobility. You are being discharged with the following recommendations: Return to the Emergency Department or see your own doctor right away if any problems develop, including the following: • Persistent nausea or vomiting. • Increasing confusion, drowsiness or any change in alertness. • Loss of memory. • Dizziness or fainting. • Trouble walking or staggering. • Worsening of headache or headache feels different. • Trouble speaking or slurred speech. • Convulsions or seizures. These are twitching or jerking movements of the eyes, arms, legs or body. • A change in the size of one pupil (black part of your eye) as compared to the other eye. • Weakness or numbness of an arm or leg. • Stiff neck or fever. • Blurry vision, double vision or other problems with your eyesight. • Bleeding or clear liquid drainage from your ears or nose. • Very sleepy (more than expected) or hard to wake up. • Unusual sounds in the ear. • Any new or increased symptoms Because of your facial fractures, sinus precautions are recommended Because of the close relationship between the upper back teeth and the sinus, a communication between the sinus and the mouth sometimes results from surgery. This condition has occurred in your case, which often heals slowly and with difficulty. Certain precautions will assist healing and we ask that you faithfully follow these instructions: 1. Take the prescribed medications as directed. 2. Do not forcefully spit for several days. 3. Do not smoke for several days. 4. Do not use straws for several days. 5. Do not forcefully blow your nose for at least 2 weeks, even though your sinus may feel “stuffy” or there may be some nasal drainage. 6. Try not to sneeze; it will cause undesired sinus pressure. If you must sneeze, keep your mouth open. In addition to the above 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. Amlodipine 2.5 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Calcium Carbonate 500 mg PO BID 4. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 5. Metoprolol Succinate XL 25 mg PO DAILY 6. Nicotine Patch 21 mg TD DAILY 7. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation Inhalation ___ puffs Q6H SOB or wheezing 8. Simvastatin 40 mg PO DAILY 9. Sodium Bicarbonate 1300 mg PO TID 10. Vitamin D 800 UNIT PO DAILY 11. Haloperidol 5 mg PO HS 12. Haloperidol 1 mg PO DAILY 13. Linezolid ___ mg PO Q12H Duration: 3 Days Continue this medication through ___ 14. tiotropium bromide *NF* 18 mcg Inhalation daily Reason for Ordering: Wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. 15. Psyllium 1 PKT PO TID:PRN loose stool 16. Fish Oil (Omega 3) 1000 mg PO BID Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Primary: Complicated UTI, Acute on Chronic Kidney Injury, Delirium Secondary: Bladder Cancer post-surgery, schizophrenia, metabolic acidosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___! You were admitted with a urinary tract that caused you to have confusion and kidney injury. We treated you with antibiotics, IV fluids, and medications to help treat confusion. You should continue antibiotics through ___. You will have follow up appointments with the urology doctors and your ___. Please review your medication list below carefully, as there are some changes.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Artificial Tears ___ DROP BOTH EYES PRN dry eye 2. Ferrous GLUCONATE 324 mg PO DAILY 3. Levothyroxine Sodium 75 mcg PO DAILY 4. Lidocaine 5% Patch 1 PTCH TD QAM 5. Pantoprazole 40 mg PO DAILY 6. Alendronate Sodium 70 mg PO QSAT 7. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral daily 8. Furosemide 80 mg PO DAILY 9. Metoprolol Tartrate 37.5 mg PO BID 10. Spironolactone 12.5 mg PO DAILY 11. Outpatient Lab Work Please draw Chem-10 and ___ on ___ or ___. Fax results to Dr ___ ___. ICD-9 code: ___.3, 584.9 12. Warfarin 2.5 mg PO 4X/WEEK (___) 13. Warfarin 2 mg PO 3X/WEEK (___) RX *warfarin [Coumadin] 2 mg 1 tablet(s) by mouth On ___, ___, or as directed by your provider. Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Acute on chronic diastolic congestive heart failure Acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to care for you here at ___ ___. You were admitted on ___ with shortness of breath. This was likely due to extra fluid as a result of your heart failure. You were treating with medication to remove excess fluid and you had improvement in your symptoms. You also had occasional fast heart rates. You should see the Electrophysiology Doctors ___ special heart doctor) for this (please see below). You will need to have labs drawn in the next ___ days. Please weight yourself every day. If you gain more than 3-pounds, please call your Primary Care Doctor.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Ampicillin-Sulbactam 3 g IV Q6H 3. Ascorbic Acid ___ mg PO BID Duration: 14 Days 4. Docusate Sodium 100 mg PO BID 5. Ferrous Sulfate 325 mg PO DAILY 6. Ondansetron ODT 4 mg PO Q8H:PRN nausea 7. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*50 Tablet Refills:*0 8. Warfarin 2.5 mg PO ___ AND ___ 9. Warfarin 5 mg PO 5X/WEEK (___) 10. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB 11. Diazepam 5 mg PO Q6H:PRN anxiety RX *diazepam 5 mg 5 mg by mouth every six (6) hours Disp #*14 Tablet Refills:*0 12. Fluticasone Propionate NASAL 1 SPRY NU DAILY 13. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 14. Furosemide 20 mg PO DAILY 15. Levothyroxine Sodium 137 mcg PO DAILY 16. Metoprolol Tartrate 12.5 mg PO BID 17. Multivitamins 1 TAB PO DAILY 18. Omeprazole 20 mg PO DAILY 19. Polyethylene Glycol 17 g PO DAILY:PRN constipation 20. Potassium Chloride 20 mEq PO DAILY 21. Senna 8.6 mg PO BID:PRN constipation 22. Simvastatin 20 mg PO QPM Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1) left breast wound 2) dehiscence of the abdominal incision 3) Infection left breast wound and abdominal incision 4) poor nutrition Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. . Personal Care: 1. You will have a wound VAC dressing with a wound vac machine in place for discharge. This dressing will be changed every three days. 2. While VAC is in place, please clean around the VAC site and monitor for air leaks of the VAC 3. A written record of the daily output from the VAC drain should be brought to every follow-up appointment. In addition, you should bring a VAC dressing kit to your follow up appointments with your doctor so that he/she may remove your VAC dressing, evaluate your wound and then apply fresh VAC dressing. Your VAC drain will be removed as soon as possible and when it is determined that the wound is healthy enough to be surgically closed. 4. You may shower daily with assistance as needed. You should do this with wound vac apparatus disconnected from you. Once you have showered you will need to reconnect your dressing to the wound vac apparatus and make sure it is functioning properly. 5. No baths until after directed by your surgeon. . Activity: 1. Avoid strenuous activity with wound vac in place. . Medications: 1. Resume your regular medications unless instructed otherwise and take any new meds as ordered. 2. 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. Please note that Percocet and Vicodin have Tylenol as an active ingredient so do not take these meds with additional Tylenol. 3. Take prescription pain medications for pain not relieved by tylenol. 4. You will continue your antibiotic therapy until advised otherwise by Infectious Disease. 5. Take Colace, 100 mg by mouth 2 times per day, while taking the prescription pain medication. You may use a different over-the-counter stool softener if you wish. 6. Do not drive or operate heavy machinery while taking any narcotic pain medication. You may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. . 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) or drain(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: 1. Carbidopa-Levodopa (___) 1 TAB PO 5X/DAY 2. pramipexole 1.5 mg oral daily 3. Cephalexin 500 mg PO Q6H RX *cephalexin 500 mg 1 tablet(s) by mouth every 6 hours Disp #*46 Tablet Refills:*0 4. Furosemide 20 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Massage therapy Massage therapy for lymphedema ICD-9: 457.1 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Cellulitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure participating in your care at ___ ___. You were admitted with fever that is very likely an infection of the skin in your leg. It has improved with antibiotics. You need to continue taking antibiotics for a total of 10 days. A follow up appointment has been made with your primary care doctor. It is important to see your doctor for this visit to verify that you have improved and that it's safe to stop the antibiotic. An appointment has also been made with physical therapy to help your legs feel better. The details are described below. No other changes have been made to your medications. .</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. Sarna Lotion 1 Appl TP TID:PRN psoriasis rash 3. Amantadine 100 mg PO BID RX *amantadine HCl 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Docusate Sodium 100 mg PO BID 5. Triamcinolone Acetonide 0.1% Cream 1 Appl TP TID RX *triamcinolone acetonide 0.1 % Apply to affected area sparingly twice a day Disp #*30 Gram Refills:*0 6. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron HCl [Zofran] 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*25 Tablet Refills:*0 7. CloniDINE 0.1 mg PO TID RX *clonidine 0.1 mg 1 tablet(s) by mouth twice a day Disp #*21 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Traumatic brain injury Subarrachnoid hemorrhgage Epidural hematoma Skull fracture Respiratory failure Altered mental status Cerebral Edema Malnutrition Nausea Respiratory failure Fever Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>S/P crani for evacuation of an epidural hematoma and EVD placement. -- Observe your wounds for signs of infection and or draining and call the office if you see signs of either. -- Excercise should be limited to walking, no lifting greater than 10 pounds. -- You will need clearence to go back to work and to drive.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Hydrochlorothiazide 25 mg PO DAILY 2. Levothyroxine Sodium 125 mcg PO DAILY 3. Simvastatin 20 mg PO DAILY 4. Acetaminophen 650 mg PO TID 5. Calcium Carbonate 500 mg PO TID 6. Docusate Sodium 100 mg PO BID 7. Multivitamins 1 TAB PO DAILY 8. OxycoDONE (Immediate Release) 2.5 mg PO Q4H:PRN pain 9. Senna 2 TAB PO HS 10. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain 11. Vitamin D 800 UNIT PO DAILY 12. Lisinopril 40 mg PO DAILY 13. Enoxaparin Sodium 30 mg SC Q24H Duration: 2 Weeks Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Left bicondylar proximal tibial plateau fracture. Secondary: Second degree atrioventricular block: Mobitz type I (___). Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___. You were admitted for a L leg fracture and while in the emergency department you were noted to have a slow heart rate with an irregular heartbeat and a heart murmur. Your fracture was stabilized in the opertaing room by Dr. ___. Your heart rhythm was evaluated by the cardiologists; it is not a dangerous rhythm and you are now safe to return home. You will need to follow-up with a cardiologist as an outpatient and have a transthoracic echo done. We made the following changes to your medications: Please START Acetaminophen 650 mg by mouth three times a day for pain Please START OxycoDONE (Immediate Release) 2.5 mg by mouth every four hours as needed for pain Please START TraMADOL (Ultram) 25 mg by mouth every 6 hours as needed for pain Please START Enoxaparin Sodium 30 mg subcutaneous Daily for 2 weeks to prevent blood clots while you are recovering Calcium Carbonate 500 mg by mouth three times a day Vitamin D 800 UNIT by mouth daily Multivitamins 1 TAB by mouth daily Senna 2 TAB by mouth at night to prevent constipation Docusate Sodium 100 mg by mouth twice a day to prevent constipation</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>___, ___ por escoger ___ para ___. Ud presento con falta de aire, y descubrimos que tenia un ___ ___ de ___. Ud recibio medicaciones para evitar agua ___, y ___ mejoro. En el futuro, ___ de comer menos de 2g de sal al dia, y beber menos de 2L de fluidio al dia. ___ peso ___ dia, y llama ___ doctor ___ mas de 3 libras. Tambien es importante ir a todos sus citas. Espero que todo vaya bien con ud. ___ ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen (Liquid) 1000 mg PO TID pain 2. Docusate Sodium (Liquid) 100 mg PO BID:PRN constipation 3. Senna 1 TAB PO BID:PRN constipation 4. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 5. Lorazepam 0.5-1 mg PO Q6H:PRN anxiety 6. Morphine Sulfate (Concentrated Oral Soln) 2.5 mg PO Q1H:PRN SOB or pain 7. Morphine Sulfate (Concentrated Oral Soln) 5 mg PO Q4H 8. Scopolamine Patch 2 PTCH TD Q72H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Metastatic Lung cancer Chronic systolic heart failure Stroke Atrial fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you at ___. You had a fluid collection around your heart that was tapped. It was found that your lung cancer has worsened so the decision was made to stop aggressive therapy and concentrate on keeping you comfortable. You will be transferred to a hospice near your home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Docusate Sodium 100 mg PO BID 3. Enoxaparin Sodium 40 mg SC QHS RX *enoxaparin 40 mg/0.4 mL ___t bedtime Disp #*28 Syringe Refills:*0 4. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth q4h prn Disp #*20 Tablet Refills:*0 5. Senna 8.6 mg PO BID 6. Lisinopril 10 mg PO DAILY 7. Propranolol 10 mg PO TID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: right hip fracture 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>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: -Weightbearing as tolerated right lower extremity MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 3 hours as needed x 1 day, then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take Lovenox daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - If you have a splint in place, splint must be left on until follow up appointment unless otherwise instructed. Do NOT get splint wet. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever ___ 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE ___ DAYS OF REHAB Physical Therapy: Weightbearing as tolerated right lower extremity Treatments Frequency: Staples to removed at follow-up appointment in clinic in 2 weeks</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cyclobenzaprine 10 mg PO TID:PRN muscle stiffness RX *cyclobenzaprine 10 mg 1 tablet(s) by mouth Three times a day Disp #*60 Tablet Refills:*0 2. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Severe Reason for PRN duplicate override: Alternating agents for similar severity RX *oxycodone 5 mg ___ tablet(s) by mouth Every 4 hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Pathologic T3 fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege caring of you at ___. WHY WAS I IN THE HOSPITAL? - You were admitted to the hospital for surgery after you had an MRI that showed a mass in your spine. WHAT HAPPENED TO ME IN THE HOSPITAL? - You had surgery on your spine to remove the tumor and to fuse together part of your spine (vertebra T1-T5) following the removal. - You were transferred to the oncology service because the tumor they removed from your spine was a plasmacytoma, a tumor often associated with multiple myeloma a type of bone marrow cancer. - You had a PET scan that showed only one lesion in the back where the tumor was removed. You did not have any other lesions in your body. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. We wish you the best. Sincerely, Your ___ Team Discharge Instructions Spinal Fusion Surgery • Do not apply any lotions or creams to the site. • Please keep your incision dry until removal of your staples. • Please avoid swimming for two weeks after staple removal. • Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity • We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. • You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. • No driving while taking any narcotic or sedating medication. • No contact sports until cleared by your neurosurgeon. • Do NOT smoke. Smoking can affect your healing and fusion. Medications • Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. • Do not take any anti-inflammatory medications such as Motrin, Advil, Aspirin, and Ibuprofen etc… until cleared by your neurosurgeon. • You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. • It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: • Severe pain, swelling, redness or drainage from the incision site. • Fever greater than 101.5 degrees Fahrenheit • New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CefTRIAXone 2 gm IV Q 24H Klebsiella + blood cx RX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 2 grams IV daily Disp #*14 Dose Pack Refills:*1 2. MetroNIDAZOLE 500 mg PO TID RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth Three times a day Disp #*42 Tablet Refills:*1 3. Aspirin 81 mg PO DAILY 4. Dorzolamide 2% Ophth. Soln. 1 DROP BOTH EYES BID 5. HYDROcodone-Acetaminophen (5mg-325mg) 1 TAB PO Q ___ HOURS 6. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 7. Levothyroxine Sodium 25 mcg PO DAILY 8. MetFORMIN (Glucophage) 1000 mg PO BID 9. Metoprolol Succinate XL 12.5 mg PO QHS 10. Nitroglycerin SL 0.3 mg SL ASDIR chest pain 11. Ondansetron ___ mg PO Q8H:PRN nausea 12. Pantoprazole 40 mg PO Q24H 13. Timolol Maleate 0.25% 1 DROP BOTH EYES BID 14. Zolpidem Tartrate 10 mg PO QHS:PRN insomnia 15. HELD- Simvastatin 10 mg PO QPM This medication was held. Do not restart Simvastatin until advised by Dr. ___ it is safe to restart Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: liver abscess gram negative bacteremia s/p Y 90 ___ 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>___ arranged . Please call Dr. ___ office at ___ for fever > 101, chills, nausea, vomiting, diarrhea, constipation, increased abdominal pain, pain not controlled by your pain medication, swelling of the abdomen or ankles, worsening yellowing of the skin or eyes, itching, inability to tolerate food, fluids or medications, or any other concerning symptoms. . No lifting more than 10 pounds . No driving if taking narcotic pain medication . Drain and record the pigtail abscess drain output twice daily and as needed so that the drain is never more than ½ full. Call the office if the drain output increases by more than 50 cc from the previous day, becomes bloody or develops a foul odor. . Change the drain dressing once daily or after your shower. Do not allow the drain to hang freely at any time. Inspect the site for redness, drainage or bleeding. Make sure there is a stitch at the drain site and the stat lock in place. . Continue IV antibiotics as directed once a day using the PICC line. The visiting nurse ___ change the dressing. PICC line care per protocol</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Losartan Potassium 50 mg PO DAILY 2. Metoprolol Succinate XL 50 mg PO DAILY 3. Omeprazole 20 mg PO DAILY 4. QUEtiapine Fumarate 50 mg PO QHS 5. trospium 20 mg oral BID 6. Warfarin 4 mg PO 3X/WEEK (___) 7. Warfarin 5 mg PO 4X/WEEK (___) 8. Simvastatin 20 mg PO QPM RX *simvastatin 20 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*3 9. leflunomide 20 mg ORAL DAILY 10. Venlafaxine XR 300 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: MRI-negative ACUTE ISCHEMIC STROKE aortic valve replacement, on coumadin 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 hospitalized due to symptoms of a left facial droop resulting from an ACUTE ISCHEMIC STROKE, a condition in which 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. We did not see a stroke on your MRI but your symptoms are consistent with a small stroke. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: - high blood pressure - high cholesterol We are changing your medications as follows: - starting simvastatin 20 mg Please take your other medications as prescribed. We did not make any changes to your coumadin dose. Please followup with Neurology and your primary care physician as listed below. It was a pleasure providing you with care during this hospitalization.</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. Fragmin (dalteparin (porcine)) 15,000 unit/0.6 mL Subcutaneous qd 3. Morphine Sulfate ___ ___ mg PO Q4H:PRN pain RX *morphine 15 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 4. Simethicone 40-80 mg PO QID:PRN gas 5. Fish Oil (Omega 3) 1000 mg PO BID 6. Multivitamins 1 TAB PO DAILY 7. Rosuvastatin Calcium 5 mg PO DAILY 8. Famotidine 20 mg PO Q12H RX *famotidine 20 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: pancreatic mass and liver masses that likely represent pancreatic cancer portal vein thrombosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>you were admitted for evaluation of a pancreatic mass that is likely to be cancer. you underwent endoscopic ultrasound with FNA to send for cytology. you will need f/u with a cancer specialist, oncologist. you also have a blood clot in your portal vein. you are being treated with a blood thinner for this clot (Fragmin). this blood thinner can increase your risk of bleeding and if you have any injuries, trauma, bloody or dark/tarry stools, or bleeding that does not stop please seek medical attention med changes new morphine oral pepcid you can take colace, senna, or miralax for constipation (these are all available over the counter at the pharmacy) and simethicone for gas pains. TRANSITIONAL ISSUES []CYTOLOGY RESULTS []PORT TO BE SCHEDULED BASED ON CYTOLOGY []F/U WITH ONCOLOGY</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. insulin regular human 100 unit/mL Solution Sig: One (1) per sliding scale Injection ASDIR (AS DIRECTED). 2. glucagon (human recombinant) 1 mg Recon Soln Sig: One (1) Recon Soln Injection Q15MIN () as needed for hypoglycemia protocol. 3. montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. levetiracetam 100 mg/mL Solution Sig: One (1) PO BID (2 times a day). 6. valsartan 160 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. ipratropium-albuterol ___ mcg/actuation Aerosol Sig: ___ Puffs Inhalation Q6H (every 6 hours). 8. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 9. cyclosporine 0.05 % Dropperette Sig: One (1) Dropperette Ophthalmic TID (3 times a day). 10. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 12. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for Pain. Disp:*60 Tablet(s)* Refills:*0* 13. temazepam 15 mg Capsule Sig: Two (2) Capsule PO HS (at bedtime) as needed for Insomnia: to continue until follow-up with Neurosurgeon. 14. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for fever, pain. 15. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours): continue indefinitely for history of septic elbow. 16. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for wheeze. 17. furosemide 40 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 18. labetalol 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 19. famotidine 20 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours). 20. docusate sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 times a day). 21. dextrose 50% in water (D50W) Syringe Sig: One (1) per protocol Intravenous PRN (as needed) as needed for hypoglycemia protocol. 22. sodium chloride 0.9 % 0.9 % Syringe Sig: One (1) ML Injection PRN (as needed) as needed for line flush: 10ml flush for PICC daily and PRN. 23. sodium chloride 0.9 % 0.9 % Syringe Sig: One (1) ML Injection Q8H (every 8 hours) as needed for line flush. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Subarachnoid Hemorhage C4 ligamentous injury T11/T10 fracture post fusion Right posterior 1st rib fracture Discharge Condition: Mental Status: slightly withdrawn, but alert and oriented. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>General Instructions •Take your pain medicine as prescribed. •Exercise should be limited to walking; no lifting, straining, or excessive bending. •Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. •You were on Coumadin (Warfarin) before your injury, but you now have a filter in place to help prevent clots from returning to your heart. You will not have to continue your coumadin at this point. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING •New onset of tremors or seizures. •Any confusion, lethargy or change in mental status. •Any numbness, tingling, weakness in your extremities. •Pain or headache that is continually increasing, or not relieved by pain medication. •New onset of the loss of function, or decrease of function on one whole side of your body. Due to prolonged bedrest and the risk of developing a blood clot, you received an 'IVC filter' to prevent clots from returning to your heart. Due to weakened respiratory muscles secondary to prolonged ventilation and failure to adequately oxygenate without assistance, you underwent a tracheostomy. Due to weakened swallowing ability and difficulty feeding with a tracheostomy in place, you underwent PEG placement for tube feeds, which you have tolerated well. These will be continued until you get stronger to have the tracheostomy removed and undergo speech and swallow therapy to assess your ability to eat.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because you were thought to have an infection in your abdomen. You also had decreased output from your peritoneal dialysis catheter so this was repositioned. You received antibiotics through an IV to treat your infection and will continue to get IV antibiotics at dialysis. In order to ensure your peritoneal dialysis catheter would continue to work you were given medications to help you have bowel movements. Now that you are going home: -complete 14 days total of antibiotics (Day 1 = ___ Day 14 = ___ -ensure daily bowel movements, if not having daily bowel movements should call primary nephrologist or primary care provider - please see your paperwork for ___ with your nephrologist and transplant surgeon who will coordinate dialysis for you. - Per transplant surgery: please keep peritoneal dwells to <750cc ___ INSTRUCTIONS ___ for PD catheter repositioning: - No heavy lifting until cleared by transplant surgery 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. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. amLODIPine 5 mg PO DAILY 3. Aspirin EC 81 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. Furosemide 20 mg PO DAILY 6. Metoprolol Succinate XL 50 mg PO DAILY 7. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN Chest pain 8. Tamsulosin 0.4 mg PO QHS 9. HELD- ___ MD to order daily dose PO DAILY16 This medication was held. Do not restart Warfarin until you see your primary care as an outpatient. Discharge Disposition: Home Discharge Diagnosis: ======================= PRIMARY DIAGNOSIS: ======================= - acute, upper GI bleed - Melena - acute blood loss anemia - coagulopathy - demand ischemia ========================= SECONDARY DIAGNOSIS: ========================= - Chronic kidney disease - Hypertension - Coronary artery disease - 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 Mr. ___, It was a pleasure to care for you at the ___ ___. Please find detailed discharge instructions below: WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted because you had black stools and fatigue, concerning for bleeding from your gut. You were found to be very anemic. WHAT HAPPENED TO YOU IN THE HOSPITAL? - You received 4 blood transfusions to treat your anemia. - Your INR was very high initially, which means the warfarin you took was too effective at thinning your blood. We reversed the blood-thinning effects of the warfarin to prevent you from bleeding any more. - You received an upper endoscopy (EGD) to look in your stomach for a source of the bleeding. The upper endoscopy did not show any obvious source of the bleeding, but it did show a 1cm growth in the first part of your small intestine. The biopsy showed that this was an area of inflammation and was not cancerous. - You underwent a colonoscopy, which did not reveal a source of bleeding, so you underwent a capsule endoscopy. Your GI doctor ___ provide you with the results of this. - You were started on an antacid medication to help protect your stomach against injury and bleeding. WHAT SHOULD YOU DO WHEN YOU ARE DISCHARGED? - Please follow up with your primary care doctor and with gastroenterology for the results of your capsule endoscopy. - Please take your medications as prescribed. We wish you the best! - Your ___ treatment team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gemfibrozil 600 mg PO BID RX *gemfibrozil 600 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. TraZODone 100 mg PO QHS:PRN sleep RX *trazodone 100 mg 1 tablet(s) by mouth at bedtime as needed Disp #*30 Tablet Refills:*0 3. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice daily Disp #*60 Capsule Refills:*0 4. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice daily Disp #*60 Capsule Refills:*0 5. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN abdominal pain Duration: 1 Week RX *hydromorphone 2 mg 2 tablet(s) by mouth every 4 hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Acute Pancreatitis Hypertriglyceridemia Alcohol abuse Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted with acute pancreatitis. It was thought that this was related to heavy alcohol use. You did, however, also have very elevated triglycerides. You were started on a medication for your triglycerides, and you were given supportive treatments for your pancreatitis. You got significantly better, and your diet was advanced to a regular diet, which you tolerated well. You are being discharged with PCP ___. You should not drink any more alcohol, ever, and you should adhere to a low fat diet. . Please take your medications as listed below. . Please see your physicians as listed below. . Also, you had an elevated white blood cell count, which is likely from your pancreatitis. We recommend that you have your white blood cell count be repeated at follow-up with your PCP to ensure that the elevation has resolved. If the white blood cell count continues to remain high despite resolved pancreatitis, then you will need further work-up.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear ___, You were admitted to the hospital ___ because you had an infection in the skin over your right hand that was not responding to pill antibiotics. An X-ray of your hand showed no obvious infection of the bone. The hand surgeons were consulted who decided that you did not need surgery and recommended elevation, compression, and IV antibiotics. You were treated with IV antibiotics for 72 hours with dramatic improvement in the swelling, redness, and pain in your hand. On ___, you were switched to pill antibiotics which you will need to take for another 7 days. You should start take these antibiotics in the evening ___ and take the last dose in the evening on ___. You should also follow up with you primary care doctor on ___ to ensure that the infection has resolved. Also at that clinic visit, please have lab work drawn on ___ and faxed to Hepatology Dept at ___ Attn: Dr. ___ at ___. 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. Aspirin 81 mg PO DAILY 2. Cetirizine 10 mg PO BID 3. Colchicine 0.6-1.2 mg PO AS DIRECTED 4. Digoxin 0.25 mg PO DAILY 5. Enoxaparin (Treatment) 120 mg SC Q12H 6. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 7. Letrozole 2.5 mg PO DAILY 8. Lisinopril 20 mg PO BID 9. Multivitamins W/minerals 1 TAB PO DAILY 10. Omeprazole 20 mg PO DAILY 11. OxyCODONE--Acetaminophen (5mg-325mg) 2 TAB PO Q8H:PRN Pain - Severe 12. Panax ginseng root 518 mg oral BID 13. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q4H:PRN sob/wheeze 14. riTUXimab 1000 mg IV EVERY 6 MONTHS 15. Sarna Lotion 1 Appl TP QID:PRN itch 16. Simethicone 80 mg PO QID:PRN bloating 17. Spironolactone 50 mg PO DAILY 18. Torsemide 80 mg PO BID 19. Vitamin D 1000 UNIT PO DAILY 20. HELD- Potassium Chloride 20 mEq PO DAILY This medication was held. Do not restart Potassium Chloride until follow up with PCP ___: Home Discharge Diagnosis: PRIMARY DIAGNOSIS Acute on chronic heart failure with reduced ejection fraction Type II NSTEMI Pleural effusion SECONDARY DIAGNOSES COPD Exacerbation Herceptin-induced cardiomyopathy Rheumatoid arthritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you were feeling short of breath. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? - In the hospital, it was found that you had an exacerbation of your heart failure. You also had an increase in the fluid around your right lung. You were given IV medications to take fluid out of your lungs and you had the fluid drained by the interventional pulmonology team. You were restarted on your home diuretic and discharged home. WHAT SHOULD I DO WHEN I GO HOME? - Please take all of your medications exactly as prescribed and attend all of your follow-up appointments listed below. - Weigh yourself every morning, and call your doctor's office if weight goes up more than 3 lbs in 24 hours or 5 lbs in 48 hours. Your weight on the day you were discharged was 177 lbs. If you find yourself gaining weight at home you may take an extra 20 mg pill of torsemide (total 100 mg each administration) - Make sure to follow-up with your primary care and heart failure doctors for further ___ of your medications and diuretics. We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN arthritis pain 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO QPM 4. Efavirenz 600 mg PO DAILY HIV 5. Gabapentin 300 mg PO TID 6. LaMIVudine-Zidovudine (Combivir) 1 TAB PO BID 7. Multivitamins W/minerals 1 TAB PO DAILY 8. Nicotine Patch 21 mg TD DAILY 9. Ranitidine 150 mg PO BID:PRN heartburn 10. Tamsulosin 0.4 mg PO QHS 11. Tizanidine 4 mg PO Q8H:PRN Pain/Spasm 12. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 13. Metoprolol Succinate XL 12.5 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: DIAGNOSES ========= Abdominal pain Colitis SECONDARY DIAGNOSIS: HIV Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to the hospital after you continued to experience abdominal pain after a recent visit to the hospital in ___. You were found to have an area of inflammation in the intestine in your left lower abdomen, and underwent a procedure called a flex sigmoidoscopy, which consists of using a camera to view the area of inflammation. This area showed areas of inflammation. Biopsies were taken. However, you will require a full colonoscopy within four weeks time which the gasteroenterology team will schedule. During this hospitalization your blood pressures were slightly lower than what you normally run at. We, therefore, STOPPED your lisinopril. Please continue to take 12.5mg of metoprolol XL. 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. Cyanocobalamin 1000 mcg PO DAILY 3. Multivitamins W/minerals 1 TAB PO DAILY 4. FLUoxetine 60 mg PO DAILY 5. MethylPHENIDATE (Ritalin) 20 mg PO DAILY 6. TraZODone 50 mg PO QHS:PRN sleep Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Gait unsteadiness Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for evaluation of your recent episodes of difficulty with balance. We performed extensive evaluation including an MRI of your brain, which did NOT show an acute stroke or other large structural lesion. Likely your balance is due to low Vitamin B12 which you will need to supplement with oral vitamins to prevent further degradation in your balance and nerve functioning. Please continue to take this, and multivitamins with minerals to prevent your balance from worsening. Please also take ensure enlive twice a day in addition to your other meals. Please continue to take your home medications as prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO EVERY OTHER DAY 2. Carvedilol 6.25 mg PO BID 3. Docusate Sodium 100 mg PO BID 4. Lidocaine 5% Patch 1 PTCH TD DAILY 5. Ranitidine 300 mg PO DAILY 6. Senna 1 TAB PO HS 7. Epoetin Alfa 4000 units SC Q WEEK 8. Lactulose 30 mL PO DAILY 9. Ciprofloxacin HCl 500 mg PO Q24H Duration: 4 Doses RX *ciprofloxacin 500 mg 1 tablet(s) by mouth once a day Disp #*4 Tablet Refills:*0 10. Citrucel (methylcellulose (laxative);<br>methylcellulose (with sugar)) 1 dose ORAL DAILY 11. Outpatient Lab Work CBC, Chem 7, AST, ALT, Alk phos, T. bilirubin on ___ 576.2 BILE DUCT OBSTRUCTION Attn: Name: ___. Fax: ___ 12. Furosemide 80 mg PO EVERY OTHER DAY Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Bile obstruction/choledocholithiasis Early Cholangitis Chronic systolic CHF Moderate aortic stenosis Acute on chronic kidney disease Acidosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted with jaundice and abdominal pain. You were found to have a common bile duct obstruction due to a gallstone. A stent was placed with good drainage. However, you will need to return to have your stone removed. Please also consider consultation with a surgeon to have your gallbladder removed. Please take all medications as prescribed and finish your course of antibiotics.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, You were admitted to the ___ for abdominal pain and diarrhea. We were concerned for an infection due to your recent bowel infection. However, your labs and imaging did not seem to show that you were acutely infected and that your new kidney was functioning well. It was a pleasure taking care of you! Your ___ Kidney Team ***Please continue taking your Cipro and Flagyl antibiotics that you were previously prescribed until ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Mycophenolate Mofetil 500 mg PO QAM 2. Mycophenolate Mofetil 1000 mg PO QPM 3. Vitamin D 1000 UNIT PO DAILY Continue Home medications as appropriate: - betamethasone dipropionate topical - excedrine prn Discharge Disposition: Home Discharge Diagnosis: Primary: - Paresthesias Secondary: - Neuromyelitis Optica Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. 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 bilateral foot pain and paresthesias. Our evaluation included imaging if your spinal cord. Fortunately, no spinal cord injury or abnormal enhancement on contrast administration was found. No changes were made to your medications. You also were noted to have an episode of unresponsiveness in the MRI scanner which prompted us to perform a continuous EEG study of your brainwaves. Fortunately, no abnormalities were detected, and no seizure activity was seen as a cause of your symptoms. It appears that this event may have been due to heightened anxiety triggering a syncopal episode, which on review of your medical records has occurred multiple times before in the past years. Please follow up with your Neurologist, Dr. ___, on ___ as currently scheduled. It was a pleasure being part of your care team. Sincerely, ___ Neurology</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Creon ___ CAP PO TID W/MEALS 2. DULoxetine 30 mg PO DAILY 3. LORazepam 0.5 mg PO Q6H:PRN nausea or sleep 4. MethylPHENIDATE (Ritalin) 20 mg PO DAILY:PRN fatigue, decreased concentration 5. MethylPHENIDATE (Ritalin) 20 mg PO QAM 6. Nystatin Oral Suspension 5 mL PO QID 7. Pyridoxine 50 mg PO DAILY 8. Simethicone 80 mg PO TID:PRN gas 9. Tamsulosin 0.4 mg PO BID 10. Spironolactone 50 mg PO DAILY RX *spironolactone [Aldactone] 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 11. Furosemide 20 mg PO DAILY 12. MetFORMIN XR (Glucophage XR) 1000 mg PO BID 13. Erlotinib ___ mg PO DAILY dosing per outpatient oncologist 14. Capecitabine 1000 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: pancreatic cancer malignant ascites Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital for continued leakage after undergoing paracentesis. You had stitches placed to good effect to stop the leaking. While in the hospital, you underwent paracentesis with the interventional radiology team and your diuretics were increased to add spironolactone 50mg daily on top of your furosemide 20 mg daily to prevent fluid from accumulating. You are now safe for discharge home with close follow up. We left a message with out TPN team to adjust and concentrate your home TPN. You should also follow up with Dr. ___ in ___. You will continue your chemotherapy at home as planned until you get home delivery of xeldoa (1000 mg twice a day for two weeks on, then one week off) and Tarceva. It was a pleasure caring for you - we wish you well! Sincerely, Your ___ Oncology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gentamicin 0.3% Ophth. Soln 1 DROP LEFT EYE Q5MIN Duration: 3 Doses 2. Phenylephrine 2.5 % Ophth Soln 1 DROP LEFT EYE Q5MIN Duration: 3 Doses 3. Tropicamide 1 % 1 DROP LEFT EYE Q5MIN Duration: 3 Doses BUPROPION HCL - bupropion HCl XL 300 mg 24 hr tablet, extended release. 1 tablet(s) by mouth once a day BUPROPION HCL - bupropion HCl XL 150 mg 24 hr tablet, extended release. 1 tablet(s) by mouth once a day to take in addition to 300 mg for total daily dose of 450 mg CITALOPRAM - citalopram 40 mg tablet. 0.5 (One half) tablet(s) by mouth once a day - (Dose adjustment - no new Rx) EPINEPHRINE - epinephrine 0.3 mg/0.3 mL injection, auto-injector. 1 injection IM one time as needed for allergic reaction - (Prescribed by Other Provider: during ___ hospitalization) (Not Taking as Prescribed) FLUOCINONIDE - fluocinonide 0.05 % topical ointment. apply bid to palms and soles - (Not Taking as Prescribed) OMEPRAZOLE - omeprazole 20 mg capsule,delayed release. 1 capsule(s) by mouth once a day - (Not Taking as Prescribed) OSTOMY POUCHES - ostomy pouches . use as directed Dx Ileostomy 6 boxes is a 1 mo supply - (Not Taking as Prescribed) OSTOMY WAFERS - ostomy wafers . use as needed 6 boxes is a 1 mo supply Dx Ileostomy RIFAXIMIN [XIFAXAN] - Xifaxan 550 mg tablet. 1 tablet(s) by mouth twice a day Medications - OTC ACETAMINOPHEN - acetaminophen 325 mg tablet. 1 to 2 tablet(s) by mouth every six (6) hours as needed for pain - (Prescribed by Other Provider) (Not Taking as Prescribed) CHOLECALCIFEROL (VITAMIN D3) - cholecalciferol (vitamin D3) 1,000 unit capsule. 1 capsule(s) by mouth daily - (OTC) (Not Taking as Prescribed) Discharge Disposition: Home Discharge Diagnosis: Small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital for a small bowel obstruction. You were given bowel rest, intravenous fluids, and a nasogastric tube was placed in your stomach to decompress your bowels. Your obstruction has subsequently resolved after conservative management. You are tolerating a clear diet and pain is well controlled with oral pain medication. When you go home, please self regulate your diet and advance as tolerated. 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 extended constipation. Our hope is that you will have a quick return to your life and usual activities. Thank you for allowing us to participate in your care!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspart 12 Units Breakfast Aspart 12 Units Lunch Aspart 12 Units Dinner Glargine 80 Units Bedtime 2. Albuterol Inhaler 2 PUFF IH Q4H:PRN dyspnea 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 40 mg PO QPM 5. butalbital-acetaminophen-caff 50-300-40 mg oral Q6H:PRN 6. Docusate Sodium 100 mg PO BID 7. Dronabinol 10 mg PO TID 8. DULoxetine 120 mg PO DAILY 9. Esomeprazole 80 mg Other DAILY 10. Ferrex ___ Forte (iron ps complex-B12-folic acid) 150-25-1 mg-mcg-mg oral BID 11. FLUoxetine 20 mg PO DAILY 12. Fluticasone Propionate 110mcg 2 PUFF IH BID 13. Furosemide 80 mg PO QAM 14. Furosemide 40 mg PO QPM 15. GlipiZIDE 5 mg PO BID 16. Isosorbide Mononitrate 60 mg PO DAILY 17. LORazepam 0.5 mg PO DAILY:PRN anxiety 18. Metoprolol Succinate XL 50 mg PO DAILY 19. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 20. Potassium Chloride 30 mEq PO DAILY Hold for K > 21. Prasugrel 10 mg PO DAILY 22. Spironolactone 25 mg PO DAILY 23. Topiramate (Topamax) 50 mg PO QHS 24. TraMADol 100 mg PO TID 25. Vitamin D 3000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Coronary artery disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, It was a pleasure caring for you at ___. WHY WAS I IN THE HOSPITAL? ========================== - You were admitted because you had chest pain WHAT HAPPENED IN THE HOSPITAL? ============================== - You were found to have the same disease in your heart as was seen on the last cath in ___. - No new stents were placed - Your medications you take to prevent future blockages were continued. WHAT SHOULD I DO WHEN I GO HOME? ================================ - It is very important to take your aspirin and clopidogrel (also known as Plavix) every day. - These two medications help reduce your risk of having a future heart attack. - Please do not stop taking either medication without talking to your heart doctor. - Your weight at discharge is 201 pounds. Please weigh yourself today at home and use this as your new baseline - Please weigh yourself every day in the morning. Call your doctor if your weight goes up by more than 3 lbs. Thank you for allowing us to be involved in your care, we wish you all the best! Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H 2. Aspirin EC 81 mg PO DAILY 3. Cinacalcet 60 mg PO DAILY 4. ClonazePAM 0.5 mg PO BID 5. Clopidogrel 75 mg PO DAILY 6. Divalproex (DELayed Release) 500 mg PO BID 7. Lactulose 30 mL PO DAILY 8. Levothyroxine Sodium 25 mcg PO DAILY 9. Milk of Magnesia 30 mL PO DAILY constipation 10. Nephrocaps 1 CAP PO DAILY 11. Thiothixene 5 mg PO BID 12. Docusate Sodium 100 mg PO BID 13. Epoetin Alfa 1 8000 SC MWF 14. OLANZapine 25 mg PO DAILY 15. Senna 8.6 mg PO BID 16. sevelamer CARBONATE 3200 mg PO TID W/MEALS Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Primary: Atrial flutter Secondary: ESRD, schizoaffective disorder Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege to care for you at the ___ ___. You were admitted to the hospital due to low blood pressure and confusion and you were found to have an irregular heart rhythm. We started you on medications for your irregular heart rhythm and your symptoms improved. You also developed left arm swelling that is likely due to narrowing of one of the major veins in your arm. We strongly recommended a procedure called a fistulogram but you refused repeatedly and indicated a preference to have this done at BMC. It is very important you address this issue in the next few weeks. Please follow up with all scheduled appointments and continue taking all medications as prescribed. If you develop any of the danger signs below, please contact your health care providers or go to the emergency room immediately. We wish you the best. Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild RX *acetaminophen 500 mg ___ tablet(s) by mouth Q6 hours PRN 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. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals [Vitamins and Minerals] 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. glimepiride 4 mg oral DAILY 5. Lisinopril 10 mg PO DAILY 6. MetFORMIN (Glucophage) 500 mg PO BID 7. Pravastatin 20 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: Cervical spine fracture Alcohol withdrawal Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted for evaluation of your neck fracture. The orthopedic spine team determined that you do not need surgery and placed you in a neck brace for 6 weeks. While you were in the hospital you developed alcohol withdrawal treated with a medication called phenobarbital. It is very important that you stop drinking alcohol. Please follow up with your PCP who an offer you additional help. 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. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth Every 12 hours Disp #*78 Tablet Refills:*0 2. Aspirin EC 81 mg PO DAILY 3. Atorvastatin 40 mg PO DAILY 4. Clopidogrel 75 mg PO DAILY 5. Fludrocortisone Acetate 0.1 mg PO DAILY 6. Glargine 35 Units Breakfast Humalog 15 Units Breakfast Humalog 15 Units Lunch Humalog 20 Units Dinner 7. Lorazepam 1 mg PO QHS:PRN insomnia 8. Losartan Potassium 100 mg PO DAILY 9. Metoprolol Succinate XL 25 mg PO DAILY 10. PredniSONE 7.5 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Urinary tract infection Prostatitis 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 hospitalized with fevers and urinary symptoms. A CT scan showed that this infection may have also extended to you kidney and your prostate. You were treated with IV antibiotics and then transitioned to oral antibiotics. You improved and were stable for discharge. You will be on antibiotics for a total of 6 weeks to treat the possible infection in your prostate. Please take all medications as directed and follow up with your PCP in the next week.</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 ___! You first came to us after your G tube fell out and needed to be replaced. Our interventional radiologists replaced this, and you were able to tolerate tube feeds and medications through the new tube without issues. While you were here, we noticed that your heart rates and blood pressures were well controlled even off your metoprolol, so this was held at discharge. We also changed around your insulin regimen, as your sugars appeared well controlled on a lower dose. This will require ongoing modification at your nursing facility. Please take care, we wish you the very best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Linezolid ___ mg IV Q12H RX *linezolid in dextrose 5% 600 mg/300 mL 600 mg iv every twelve (12) hours Disp #*60 Intravenous Bag Refills:*1 2. PredniSONE 7.5 mg PO DAILY 3. Acyclovir 400 mg PO Q8H 4. Budesonide 3 mg PO TID 5. FoLIC Acid 1 mg PO DAILY 6. Isavuconazonium Sulfate 372 mg PO DAILY 7. Jakafi (ruxolitinib) 5 mg oral BID 8. LORazepam 1 mg PO BID: PRN anxiety 9. Magnesium Oxide 800 mg PO BID 10. Nicotine Patch 21 mg/day TD DAILY 11. Pantoprazole 40 mg PO Q12H 12. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 13. Tacrolimus 0.5 mg PO Q12H 14. Vitamin D ___ UNIT PO 1X/WEEK (WE) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: VRE Bacteremia Cavitary pulmonary nodules secondary to aspergillosis SECONDARY DIAGNOSIS ====================== -Acute myelogenous leukemia -Graft versus host disease 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 due to concern for blood stream infection. We did extensive infectious workup which showed bacteremia. We started you on antibiotics and your infection has cleared. You will continue on antibiotics as instructed for 6 weeks. You were also found to have presumed progressive fungal pneumonia. You will continue po antibiotics for this and follow up with ID as stated below. Please continue to take all of your medications as instructed. Sincerely, Your ___ TEAM</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H pain RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet(s) by mouth q6hr Disp #*50 Tablet Refills:*0 2. Albuterol Inhaler 1 PUFF IH Q4H:PRN wheezing 3. Metoprolol Tartrate 75 mg PO BID 4. Tamsulosin 0.4 mg PO QHS bph 5. Warfarin 2 mg PO ONCE Duration: 1 Dose Please have INR check in ___ days and adjust dose accordinly Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Lower back pain Deconditioning Spinal stenosis Discharge Condition: Good Alert and oriented x 3 Followup Instructions: ___ [/INST] </s><s>Activity: You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit or stand more than ~45 minutes without moving around. • Rehabilitation/ Physical Therapy: ___ ___ times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. ___ Limit any kind of lifting. • Diet: Eat a normal healthy diet. You may have some constipation after surgery. You have been given medication to help with this issue. Physical Therapy: Mobilize Weight bearing as tolerated Treatments Frequency: Acetaminophen 1000 mg PO Q8H pain RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet(s) by mouth q6hr Disp #*50 Tablet Refills:*0</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H fever, pain 2. Albuterol Inhaler 1 PUFF IH Q4H:PRN shortness of breath 3. Docusate Sodium 100 mg PO BID 4. Ferrous Sulfate 325 mg PO DAILY 5. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 6. Magnesium Oxide 800 mg PO DAILY 7. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 8. Prochlorperazine ___ mg PO Q8H:PRN nausea 9. Senna 8.6 mg PO BID:PRN c 10. Tamsulosin 0.4 mg PO QHS 11. Thiamine 100 mg PO DAILY 12. GlipiZIDE 10 mg PO BID 13. Lantus (insulin glargine) 100 units SC BID 14. MetFORMIN (Glucophage) 1000 mg PO BID 15. Phenazopyridine 100 mg PO TID:PRN dysuria 16. Sumatriptan Succinate 25 mg PO ONCE MR1 17. Vitamin D ___ UNIT PO EVERY 2 WEEKS (TH) Discharge Disposition: Home Discharge Diagnosis: dilation of R ureter R perinephric stranding Right sided abdominal 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 returned to the hospital at our request because your blood cultures from your recent admission were positive for bacteria. Repeat blood cultures were negative, showing that you do not have a blood infection. While in the hospital you underwent MRI of your abdomen and pelvis prior to the appointment with urology. You are safe for discharge home with close follow up with your PCP and with urology. It was a pleasure caring for you - we wish you all the best! Sincerely, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. anastrozole 1 mg oral daily 2. Multivitamins 1 TAB PO DAILY 3. Simvastatin 40 mg PO DAILY 4. Benzonatate 100 mg PO TID:PRN cough RX *benzonatate 100 mg One capsule(s) by mouth TID prn Disp #*30 Capsule Refills:*0 5. Guaifenesin ___ mL PO Q6H:PRN cough RX *guaifenesin 100 mg/5 mL ___ mL by mouth q6h prn Disp #*1 Bottle Refills:*0 6. Levofloxacin 750 mg PO DAILY RX *levofloxacin 750 mg One tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 7. Hydrochlorothiazide 25 mg PO DAILY 8. Lisinopril 10 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your stay. You were admitted on ___ for pneumonia, a bacterial infection in your lungs. You were started on antibiotics. You should continue the antibiotic, levofloxacin, for a total of 5 days until ___. Please follow up with your primary care physician soon after discharge. We wish you a speedy recovery. Best, Your ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) 5 mg PO TID:PRN pain Hold for oversedation and RR<10. 2. Clonazepam 1 mg PO TID:PRN anxiety Hold for oversedation and RR<10 Discharge Disposition: Home Discharge Diagnosis: Colitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted to the hospital because a CT scan showed evidence of inflamation in your lower intestine. You were seen and evaluated and we do not think that you have an infection. You also had a special type of abdominal MRI called an MRCP that imaged your bile ducts. You will be called by us with the results of this test. You also had a number of other tests run and we will contact you wiht the results of these tests.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 2. Chlorthalidone 25 mg PO DAILY 3. Lisinopril 40 mg PO DAILY 4. Simvastatin 20 mg PO DAILY 5. Lorazepam 0.5 mg PO UNDEFINED agitation 6. Amlodipine 10 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Hypertensive Urgency Vascular Dementia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, you were admitted to the ___ with complaints of syncope. You were found to have severe high blood pressure and confusion. Your heart was monitored and there were several instances when your heart rate slowed down which may be the reason you are passing out. You were given an "EVENT MONITOR" to wear at home. You were instructed on its use in case you feel light headed or that you may black out so your cardiologists can compare your heart rhythm to your symptoms It was also noted that you have memory impairments. This is likely due to uncontrolled high blood pressure. You have been started on several new blood pressure medications, and will need to followup with neurology Please see below for your follow-up appointments. Please have your labs checked sometime the week of ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 2. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone [Oxecta] 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*20 Tablet 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>You were admitted to the hospital with acute cholecystitis. You were taken to the operating room and had your gallbladder removed through an open incision. You tolerated the procedure well and are now being discharged home to continue your recovery with the following instructions. Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Severe Reason for PRN duplicate override: changing frequency RX *oxycodone 5 mg 1 tablet(s) by mouth every 6 hours Disp #*10 Tablet Refills:*0 2. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Sucralfate 1 gm PO QID RX *sucralfate [Carafate] 1 gram/10 mL 10 mL by mouth four times a day Refills:*0 4. TraZODone 25 mg PO QHS:PRN insomnia RX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth at night Disp #*5 Tablet Refills:*0 5. Vancomycin Oral Liquid ___ mg PO/NG Q6H RX *vancomycin 125 mg 125 mg by mouth every 6 hours Disp #*8 Capsule Refills:*0 6. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild 7. Allopurinol ___ mg PO DAILY 8. Aspirin EC 81 mg PO DAILY 9. Atenolol 12.5 mg PO DAILY 10. Losartan Potassium 25 mg PO DAILY 11. Simvastatin 20 mg PO QPM Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: C. difficile colitis Esophagitis/gastritis Secondary: Chronic pancreatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital with abdominal pain and diarrhea, likely due to an infection in your colon called C. difficile. You were treated with an antibiotic, and your diarrhea improved. Please continue this antibiotic (vancomycin) for a total of 10 days, through ___. You also underwent an endoscopy which showed some irritation of your stomach and esophagus from likely your prior episode of pancreatitis but no other concerning findings. You were also started on an acid blocker and a medication to coat the lining of your stomach and this should improve your abdominal pain over the next few weeks. Please continue to take the remainder of your medications as prescribed, with the exception of Lomotil, which you should discontinue. Follow up with Dr. ___ further management of your chronic pancreatitis. With best wishes, ___ Medicine</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fosfomycin Tromethamine 3 g PO ONCE Duration: 1 Dose 2. Miconazole Powder 2% 1 Appl TP BID groin fungal infection 3. RisperiDONE 2 mg PO BID 4. RisperiDONE 1.5 mg PO QPM give at 2pm 5. Albuterol Inhaler 2 PUFF IH Q6H:PRN shortness of breath/wheezing 6. Aspirin 81 mg PO DAILY 7. Atorvastatin 40 mg PO QPM 8. CefTRIAXone 2 gm IV Q24H 9. Fish Oil (Omega 3) 1000 mg PO DAILY 10. FoLIC Acid 1 mg PO DAILY 11. LACOSamide 300 mg PO BID 12. Loratadine 10 mg PO DAILY 13. Magnesium Oxide 400 mg PO DAILY 14. Metoprolol Succinate XL 25 mg PO DAILY 15. Milk of Magnesia 30 mL PO Q4H:PRN Constipation - Second Line 16. OXcarbazepine 900 mg PO BID 17. Phenytoin (Suspension) 250 mg PO Q12H 18. Prazosin 5 mg PO QHS 19. Ramelteon 8 mg PO QHS Should be given 30 minutes before bedtime 20. Senna 8.6 mg PO BID 21. Thiamine 200 mg PO DAILY 22. Torsemide 5 mg PO DAILY 23. Zinc Sulfate 220 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Toxic Metabolic Encephalopathy Urinary Tract Infection Perineal Candidiasis Type II Diabetes Seizure Disorder Hepatic Steatosis 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 IN THE HOSPITAL? • You were admitted to the hospital because your facility was worried about you and felt that you were confused. WHAT HAPPENED TO ME IN THE HOSPITAL? • While you were in the hospital you had tests done to determine why you might be confused. • You were found to have a urinary tract infection for which you were treated with antibiotics. • You were also found to have a yeast infection of your skin for which you were given medications. • You were given medications to help with your confusion. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? • When you leave the hospital you should take all of your medications as prescribed and follow up with your doctors as ___. We wish you the best! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to the neurology service at ___. You were diagnosed with a seizure based on your symptoms (likely unwitnessed seizure followed by post-seizure confusion that resolved over time). We did not capture any other seizures on EEG. We also took a picture of your brain with an MRI, which showed changes consistent with high blood pressure and high cholesterol. Medication changes: Please start levetiracetam (keppra) 750mg twice daily to help prevent seizures. Please continue all home medications as prescribed. Please follow up with your primary care doctor and with neurology. As discussed, in the state of MA, you are not allowed to drive for 6 months after a seizure. You should take caution with other activities as well, such as swimming or bathing alone. Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q8H:PRN Pain - Mild/Fever 2. Docusate Sodium 100 mg PO BID hold for diarrhea RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*14 Capsule Refills:*1 3. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate do not drive while on this ___ cause drowsiness RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 4. Senna 8.6 mg PO BID:PRN constipation hold for diarrhea Discharge Disposition: Home Discharge Diagnosis: acute appendicitis Discharge Condition: Mental Status: Clear and coherent. Activity Status: Ambulatory - Independent. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with abdominal pain. You underwent imaging and you were reported to have acute appendicitis. You were taken to the operating room to have your appendix removed. You are recovering nicely from your surgery and are preparing for discharge home with the following instructions: You were admitted to the hospital with acute appendicitis. You were taken to the operating room and had your appendix removed laparoscopically. You tolerated the procedure well and are now being discharged home with the following instructions: Please follow up at the appointment in clinic listed below. We also generally recommend that patients follow up with their primary care provider after having surgery. We have scheduled an appointment for you listed below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for ___ weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: You may feel weak or "washed out" a couple weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You could have a poor appetite for a couple days. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Tomorrow you may shower and remove the gauzes over your incisions. Under these dressings you have small plastic bandages called steristrips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay. Your incisions may be slightly red around the stitches. This is normal. You may gently wash away dried material around your incision. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Do not drink alcohol or drive while taking narcotic pain medication. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q12H 2. Levothyroxine Sodium 75 mcg PO DAILY 3. Pantoprazole 20 mg PO Q24H 4. Simvastatin 5 mg PO DAILY 5. Torsemide 20 mg PO DAILY 6. Vitamin D 1000 UNIT PO DAILY 7. Lorazepam 0.5 mg PO Q8H:PRN nausea, sleep, anxiety 8. Metoprolol Tartrate 25 mg PO BID hold for HR<60, SBP<90 (please ___ if holding) RX *metoprolol tartrate 25 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Atrial fibrillation with rapid ventricular response Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mrs. ___, ___ was a pleasure taking care of you in the hospital. As you know, you initially presented with chest pain that was not like the pain you had been having over the last severaly months. You were found to have an elevated heart rate, up to the 170's, and an irregular heart rhythm (atrial fibrillation). We were able to reduce your heart rate with medicines and your heart returned to its normal rhythm at that time. You were observed in the ICU for one day and then on the regular medicine floor after that. We were concerned that your blood pressure was dropping too low (86/45) when we were giving you the medicine to keep your heart rate in the healthy range (80's) so we asked the cardiologists at the hospital to see you. They recommended that you take 25 mg Metoprolol two times a day. We know that you don't like to take your Torsemide, but after talking it over we think that it is an important medication for you. If you still have concerns you should make sure you bring them up with your cardiologist Dr. ___ you meet with him next week. We made the following changes to your home medications: CHANGED metoprolol to 25 mg twice a day, you can take an extra 12.5mg if you feel your heart rate going fast</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. Acyclovir 400 mg PO QAM 3. ALPRAZolam 1 mg PO QID:PRN anxiety 4. Amitriptyline 150 mg PO QHS 5. amLODIPine 5 mg PO QAM 6. Benzonatate 100 mg PO TID cough 7. Cepacol (Sore Throat Lozenge) 2 LOZ PO Q2H:PRN Sore throat 8. Dextromethorphan-Guaifenesin (Sugar Free) ___ mL PO Q6H:PRN cough 9. Docusate Sodium 100 mg PO BID 10. GuaiFENesin ER 600 mg PO Q12H:PRN cough 11. Glargine 55 Units Breakfast 12. Lisinopril 10 mg PO DAILY 13. Morphine Sulfate ___ 15 mg PO Q6H:PRN pain 14. Senna 8.6 mg PO BID 15. Venlafaxine 300 mg PO QAM 16. Baclofen 5 mg PO TID:PRN pain do not take on an empty stomach RX *baclofen 10 mg 0.5 (One half) tablet(s) by mouth three times daily Disp #*30 Tablet Refills:*0 17. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 4 Days RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every 12 hours Disp #*7 Tablet Refills:*0 18. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 19. Bacitracin Ointment 1 Appl TP QID 20. Narcan (nalOXone) 4 mg/actuation nasal prn morphine overdose 21. ___ ___ UNIT PO Q8H 22. Probiotic (B.breve-L.acid-L.rham-S.thermo;<br>L.acidophilus-Bif. animalis;<br>L.rhamn ___ acidophilus;<br>lactobacillus comb no.10;<br>lactobacillus combination no.4;<br>lactobacillus combo no.11) 5 billion cell oral QHS 23. Celecoxib 200 mg ORAL BID 24. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram 1 powder(s) by mouth daily Disp #*30 Packet Refills:*0 25. PredniSONE 40 mg PO DAILY Duration: 1 Day RX *prednisone 20 mg 2 tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 Discharge Disposition: Home with Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS Tracheobronchitis Tracheobronchomalacia Acute on Chronic Pain SECONDARY DIAGNOSIS Diabetes Hypertension Fibromyalgia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking care of you during your hospitalization. You came to the hospital because you were having difficulty breathing and chest pain. A CT of your neck showed possible inflammation of your trachea and you were started on steroids and an antibiotic. Your T-tube was replaced with a trach and you were seen by our pain team to help manage your pain. Your discharge appointments and medicatiosn are detailed below. Take care, and we wish you the best. Sincerely, Your ___ medicine team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*20 Tablet Refills:*0 2. Hydrocortisone (Rectal) 2.5% Cream ___ID RX *hydrocorTISone 1 pea size amount rectally twice a day Disp #*1 Tube Refills:*0 3. Witch ___ 50% Pad ___SDIR RX *witch ___ [Hemorrhoidal Hygiene] 50 % Apply 1 pad every four (4) hours Disp #*100 Pad Refills:*0 4. Aspirin 81 mg PO DAILY 5. Bisacodyl 10 mg PO DAILY:PRN constipation 6. Lisinopril 20 mg PO DAILY 7. Metoprolol Succinate XL 25 mg PO DAILY 8. ofloxacin 0.3 % ophthalmic 2 DROPS AS PREVIOUSLY USED 9. Omeprazole 40 mg PO DAILY 10. Prolensa (bromfenac) 0.07 % ophthalmic 2 drops as previously used 11. Senna 8.6 mg PO BID:PRN constipation 12. Simvastatin 20 mg PO QPM 13. Tamsulosin 0.4 mg PO QHS 14.Outpatient Lab Work ICD-10 codes: E87.2, R74.0, ___.___ Labs: CBC, BMP, LFTs, ___ Date: ___ Please fax to ___, MD at ___ Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Primary diagnoses ================== # Sepsis ___ klebsiella bacteremia/pyelonephritis # Leukopenia # Pancytopenia Secondary diagnoses ================== # Acute on chronic anemia # Neutropenia # Coagulopathy # Transaminitis # Urinary retention # Non-anion gap metabolic acidosis # Emphysema # HTN # GERD # HLD # Cataracts Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___! Why was I admitted to the hospital? - You presented to an outside hospital with fevers and pain while urinating. They were concerned for an infection so checked your blood, urine and did a CT scan of your abdomen. Both your urine and blood grew a bacteria called Klebsiella and the CT scan showed the urinary tract infection spread to your left kidney. The bacteria was sensitive to several antibiotics. You were transferred here for further care. - At ___, your blood cultures and urine cultures were negative because of the antibiotics you were on. We kept you on the antibiotic and you continued to do very well. You will be discharged on ciprofloxacin. What to do on discharge? - Follow up with your hematologist. Your blood count showed your white blood cell count was a little low (lowest neutrophil count 850). Today, it is 1500 which is more reassuring. - Follow up with vascular surgery within 1 week given your recent procedure. Follow up with your primary care doctor as well. - You have not smoked a cigarette since being admitted. Congratulations! We encourage you to stop smoking. Your CT scan showed some lung changes from your long term smoking. To prevent further damage, it is important you stop smoking. - Please get your blood work done on ___. These labs will be faxed to your primary care doctor. - New medications: Ciprofloxacin to treat your kidney infection or pyelonephritis, take 500mg every 12 hours for 10 more days. Your first dose will be tonight. End date is ___ morning dose. Topical witch ___ pads for your hemorrhoids Topical hydrocortisone cream for hemorrhoids Thank you for allowing us to be involved in your care, we wish you all the best! Sincerely, Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. fluticasone 50 mcg/actuation Spray, Suspension Sig: ___ puffs Nasal twice a day as needed for allergies. 2. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. acetaminophen 325 mg Tablet Sig: ___ Tablets PO every four (4) hours as needed for fever or pain. 4. polyvinyl alcohol 1.4 % Drops Sig: One (1) drop Ophthalmic every four (4) hours as needed for dry eyes. 5. insulin lispro 100 unit/mL Solution Sig: Sliding scale units Subcutaneous three times a day: 150-200 - 2 units; 201-250 - 4 units; 251-300 - 6 units; 301-350 - 8 units; 351-400 - 10 units; over 400 - 10 units and call MD. 6. miconazole nitrate 2 % Powder Sig: One (1) application Topical three times a day as needed for rash. 7. vancomycin 125 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours) for 7 days: Last dose on ___. 8. heparin (porcine) 5,000 unit/mL Solution Sig: 5000 (5000) units Injection three times a day. 9. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation every four (4) hours as needed for shortness of breath or wheezing. 10. ipratropium bromide 0.02 % Solution Sig: One (1) neb Inhalation every six (6) hours as needed for shortness of breath or wheezing. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnoses: Altered mental status Hypoxia Secondary diagnoses: Clostridium difficule Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your admission to ___ for hypoxia/hypercarbia and altered mental status. Your mental status improved once we stopped your Zyprexa and your breathing improved. We looked for an infection but were not able to find a clear source. You received a few days of antibiotics while your cultures were pending. You will continue PO vanco for an additional 7 days. The following changes were made to your medications: CHANGE vancomycin 125mg by mouth every 6 hours for 7 days (last dose ___ START albuterol neb every 4 hours as needed for SOB/wheezing START ipratropium neb every 6 hours as needed for SOB/wheezing STOP Zyprexa</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO DAILY 2. NIFEdipine CR 60 mg PO DAILY 3. Aspirin 325 mg PO DAILY 4. Clopidogrel 75 mg PO DAILY 5. Gabapentin 100 mg PO HS 6. Levothyroxine Sodium 50 mcg PO DAILY 7. Acetaminophen 650 mg PO TID 8. Docusate Sodium 100 mg PO BID 9. Furosemide 20 mg PO DAILY 10. Lidocaine 5% Patch 1 PTCH TD QAM rib pain 11. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN PAIN 12. Albuterol Inhaler ___ PUFF IH Q4H:PRN shortness of breath, cough 13. Fluticasone Propionate 110mcg 2 PUFF IH BID 14. Fluticasone Propionate NASAL 1 SPRY NU BID 15. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 16. sitaGLIPtin 100 mg Oral Daily Discharge Disposition: Home With Service Facility: ___ ___: Right anterior rib fracture ___ Left anterior rib fractures ___, possibly ___ Bilateral comminuted, likely compound, nasal bone fractures Bilateral chronic subdural hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to the hospital after a motor vehicle crash and you sustained injuries including bilateral rib fractures, nasal fractures, and a head laceration. You have progressed well and you are ready to be discharged to recover outside of the hospital. 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. 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. Rib Fractures: * Your injury caused rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. * You should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. If the pain medication is too sedating take half the dose and notify your physician. * Pneumonia is a complication of rib fractures. In order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. This will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. * You will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. * Symptomatic relief with ice packs or heating pads for short periods may ease the pain. * Narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. * Do NOT smoke * If your doctor allows, non-steroidal ___ drugs are very effective in controlling pain ( ie, Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. * Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs (crepitus).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Multivitamins W/minerals 1 TAB PO DAILY 2. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ capsule(s) by mouth every four hours Disp #*10 Capsule Refills:*0 3. Polyethylene Glycol 17 g PO DAILY 4. Aspirin 81 mg PO DAILY 5. Rivaroxaban 15 mg PO DINNER 6. Senna 17.2 mg PO HS 7. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild 8. Atorvastatin 40 mg PO QPM 9. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation - Second Line 10. Calcium Carbonate Suspension 1250 mg PO QHS 11. Citalopram 10 mg PO DAILY 12. Fleet Enema (Saline) ___AILY:PRN constipation - third line 13. GuaiFENesin ___ mL PO Q4H:PRN cough 14. Levothyroxine Sodium 88 mcg PO DAILY 15. LOPERamide 2 mg PO QID:PRN diarrhea 16. Milk of Magnesia 30 mL PO Q3H:PRN Constipation - First Line 17. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 18. Salonpas (methyl salicylate-menthol) ___ % topical QAM 19. HELD- amLODIPine 5 mg PO DAILY This medication was held. Do not restart amLODIPine until you follow-up with your doctor 20. HELD- Lisinopril 7.5 mg PO DAILY This medication was held. Do not restart Lisinopril until you follow-up with your doctor 21. HELD- TraMADol 50 mg PO BID This medication was held. Do not restart TraMADol until you no longer have acute pain from the fractures. After pain improved, switch back to tramadol from oxycodone Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES ================== #Pelvic fractures #Left patellar tendon rupture #Hematomas #Anemia #Unwitnessed fall #Urinary tract infection SECONDARY DIAGNOSES ================== #Permanent atrial fibrillation #Chronic strokes #Hypertension #Unstageable sacral pressure injury Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You were admitted because you had a fall at home and hurt your left hip. X-rays showed that you had hip fractures and you were transferred to ___ for further care. WHAT HAPPENED TO ME IN THE HOSPITAL? - Imaging including X-rays and CT scans showed that you had fractures at your left hip, a displaced left patella and likely left patellar tendon rupture, and hematomas around your pelvic fracture. You do not have fracture or dislocation of the left elbow. - You were given medications to reduce your pain. - You were evaluated by the Orthopedic Surgery team who recommended that you be managed non-operatively (no surgery needed). - Your heart rhythm was monitored on telemetry. You were in atrial fibrillation throughout this admission but no other arrhythmias occurred. This is your known heart rhythm and is not new. - Your blood counts were monitored with regular lab checks. You have anemia (low red blood cell counts) likely from the bleeding from your fall. Fortunately, your bleeding stopped and you were restarted on your blood thinning medication successfully. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Please continue to take all of your medications and follow-up with your PCP and ___ surgery in appointments as listed below. - You should continue to wear your knee immobilizer brace at all times. You can walk and move around as tolerated, with the help of a rolling walker. When you see the Orthopedic surgeons in 3 weeks they will give you updated recommendations about caring for your fractures. - You should have your blood counts checked in 2 days to make sure this is stable and not getting lower. 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. fluticasone 220 mcg/actuation Aerosol Sig: Two (2) puff Inhalation twice a day. Disp:*3 inhalers* Refills:*2* 2. Spacer Please provide patient with spacer for inhaler use 3. prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily) for 3 days: Last Day is ___. Disp:*6 Tablet(s)* Refills:*0* 4. azithromycin 250 mg Tablet Sig: One (1) Tablet PO once a day for 3 days: Last Day ___. Disp:*3 Tablet(s)* Refills:*0* 5. triamterene-hydrochlorothiazid 37.5-25 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 6. metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 7. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig: ___ Puffs Inhalation Q4H (every 4 hours) as needed for SOB. Discharge Disposition: Home Discharge Diagnosis: Asthma exacerbation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you at ___ ___. You were admitted to the hospital with an asthma exacerbation most likely triggered by seasonal allergies and viral bronchitis. You were treated with a course of steroids and antibiotics and your breathing improved. Please follow up with Dr. ___ as scheduled below. The following changes have been made to your medications: TAKE Fluticasone 2 puffs twice a day everyday even if you are not having any asthma symptoms at all. This will prevent future exacerbations. TAKE Prednisone 40mg once a day until ___ TAKE Azithromycin 250mg once a day until ___ Please discuss with Dr. ___ your fast heart rate. Also, discuss whether you should be on an ACEI for blood pressure control as well as kidney protection.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 30mg daily for 2 weeks WOUND CARE: - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. ACTIVITY AND WEIGHT BEARING: - Left lower extremity: weight bearing as tolerated Physical Therapy: Weight bearing as tolerated Treatments Frequency: Dry dressing daily</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin EC 81 mg PO DAILY 2. Atorvastatin 40 mg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. MetFORMIN (Glucophage) 1000 mg PO BID 5. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain 6. Glargine 10 Units Breakfast 7. Metoprolol Succinate XL 100 mg PO DAILY RX *metoprolol succinate 100 mg one tablet extended release 24 hr(s) by mouth daily Disp #*30 Tablet Refills:*2 8. Fish Oil (Omega 3) 1000 mg PO DAILY 9. Terbinafine 1% Soln 1 Appl TP DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: dehydration Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with oral analgesia Incisions: Sternal - healing well, ___ erythema or drainage Leg Left - healing well, ___ erythema or drainage Edema trace Followup Instructions: ___ [/INST] </s><s>Please shower daily including washing incisions gently with mild soap, ___ baths or swimming, and look at your incisions Please ___ lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart ___ driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive ___ lifting more than 10 pounds for 10 weeks Please call with any questions or concerns ___ **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours** Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 80 mg SC BID Start: Today - ___, First Dose: Next Routine Administration Time 2. Atorvastatin 40 mg PO QPM 3. GlyBURIDE 2.5 mg PO BID 4. Lisinopril 5 mg PO DAILY 5. Sertraline 50 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: TIA or Stroke (Ischemic or Hemorrhagic) Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___ You were hospitalized due to symptoms of difficulty with language resulting from an ACUTE ISCHEMIC STROKE, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: 1. High Blood pressure 2. Diabetes Mellitus 3. High cholesterol 4. cervical cancer We are changing your medications as follows: <> Please take your other medications as prescribed. Please followup with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sprintec (28) (norgestimate-ethinyl estradiol) 0.25-35 mg-mcg oral DAILY RX *norgestimate-ethinyl estradiol [Sprintec (28)] 0.25 mg-35 mcg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. HELD- Amphetamine-Dextroamphetamine XR Dose is Unknown PO DAILY This medication was held. Do not restart Amphetamine-Dextroamphetamine XR until speaking to your doctor 3. HELD- Amphetamine-Dextroamphetamine 10 mg PO DAILY:PRN unknown This medication was held. Do not restart Amphetamine-Dextroamphetamine until you speak with a doctor about restarting 4. HELD- Cyproheptadine 4 mg PO BID This medication was held. Do not restart Cyproheptadine until speaking to your doctor Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis ================== Acute psychosis due to medication effect Secondary Diagnosis ==================== Anxiety ADHD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to take care of you at ___. WHY WERE YOU HERE? You were admitted to the hospital because you were acting differently at home, not sleeping, and saying things that concerned your friends. WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL - While you were in the hospital you were seen by neurology and psychiatry. - We think that you took too much of your medications which caused these symptoms and behaviors. WHAT SHOULD YOU DO WHEN YOU GET HOME? 1) Please follow up at your outpatient appointments. 2) Stop taking your Adderall and cyproheptadine. 3) Please also stop using marijuana. 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. Ciprofloxacin HCl 250 mg PO Q24H 2. FoLIC Acid 1 mg PO DAILY 3. Gabapentin 600 mg PO QAM 4. Gabapentin 300 mg PO QPM 5. Lactulose 15 mL PO TID 6. Multivitamins 1 TAB PO DAILY 7. Omeprazole 20 mg PO DAILY 8. Ondansetron 4 mg PO Q8H:PRN nausea 9. OxycoDONE (Immediate Release) 5 mg PO Q12H:PRN pain 10. Rifaximin 550 mg PO BID 11. Simethicone 80 mg PO TID:PRN gas/bloating 12. Testosterone 2 mg Patch 1 PTCH TD Q24H 13. Thiamine 100 mg PO DAILY 14. Vitamin D 50,000 UNIT PO 1X/WEEK (WE) Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: ================== # Diuretic refractory ascites # Volume overload SECONDARY DIAGNOSIS: ==================== # Child ___ Class C Alcoholic Cirrhosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you during your stay at ___. You presented with volume overload and worsened ascites. An infectious workup was negative, and you underwent a therapeutic paracentesis. You will follow up with your scheduled Liver Center appointment ___, as well as a scheduled paracentesis ___. It is essential that you adhere to a strict sodium restriction of less than 2g daily and limits total fluid intake to 1500cc per day.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H 2. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID 3. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Morphine Sulfate ___ 20 mg PO Q4H:PRN pain RX *morphine 20 mg 1 capsule(s) by mouth every 4 hours Disp #*84 Capsule Refills:*0 5. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*0 6. Polyethylene Glycol 17 g PO DAILY 7. Pregabalin 75 mg PO BID RX *pregabalin [Lyrica] 75 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 8. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 by mouth twice a day Disp #*60 Capsule Refills:*0 9. Simethicone 40-80 mg PO QID:PRN gas pain 10. TraZODone 50 mg PO QHS:PRN insomnia 11. Tizanidine 4 mg PO BID RX *tizanidine 2 mg 2 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 1. Acetaminophen 1000 mg PO Q6H 2. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID 3. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Morphine Sulfate ___ 20 mg PO Q4H:PRN pain RX *morphine 20 mg 1 capsule(s) by mouth every 4 hours Disp #*84 Capsule Refills:*0 5. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*0 6. Polyethylene Glycol 17 g PO DAILY 7. Pregabalin 75 mg PO BID RX *pregabalin [Lyrica] 75 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 8. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 by mouth twice a day Disp #*60 Capsule Refills:*0 9. Simethicone 40-80 mg PO QID:PRN gas pain 10. TraZODone 50 mg PO QHS:PRN insomnia 11. Tizanidine 4 mg PO BID RX *tizanidine 2 mg 2 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Right ___ rib fracture, small apical Right pneumothorax, right gluteal hematoma, 8mm right elbow laceration Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after a fall. You suffered multiple injuries which are now resolved or are resolving. You were followed by the ACS service and chronic pain service for your injuries. You are now doing well and you are ready to return home. * Your injury caused multiple rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. * You should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. If the pain medication is too sedating take half the dose and notify your physician. * Pneumonia is a complication of rib fractures. In order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. This will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. * You will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. * Symptomatic relief with ice packs or heating pads for short periods may ease the pain. * Narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. * Do NOT smoke * If your doctor allows, non-steroidal ___ drugs are very effective in controlling pain ( ie, Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. * Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs (crepitus).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Docusate Sodium 100 mg PO DAILY:PRN constipation 4. FoLIC Acid 1 mg PO DAILY 5. Polyethylene Glycol 17 g PO DAILY:PRN constipation 6. Omeprazole 40 mg PO DAILY 7. pramipexole 0.5 mg oral TID 8. Simvastatin 10 mg PO DAILY 9. Triamterene-HCTZ (37.5/25) 1 CAP PO DAILY 10. Thiamine 100 mg PO DAILY 11. Tamsulosin 0.4 mg PO HS 12. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain RX *tramadol 50 mg 1 tablet(s) by mouth Q6HR Disp #*30 Tablet Refills:*0 13. Cyanocobalamin 500 mcg PO DAILY 14. Furosemide 20 mg PO DAILY:PRN leg swelling 15. Klor-Con (potassium chloride) 10 mEq oral daily 16. Carbidopa-Levodopa (___) 1 TAB PO 5X/DAY 17. entacapone 200 mg oral 5 times/day with Sinemet 18. Gabapentin 300 mg PO DAILY 1 tab daily for 2 days, then take 1 tab every 12 hours for 2 days, then 1 tab every 8 hours RX *gabapentin 300 mg 1 capsule(s) by mouth DAILY Disp #*60 Capsule Refills:*1 19. Humalog ___ 10 Units Breakfast Humalog ___ 6 Units Dinner 20. Ciprofloxacin HCl 500 mg PO Q12H Duration: 8 Days RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth twice a day Disp #*16 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Parkinsons Disease with dyskinesias Secondary Diagnosis: Urinary Tract Infection Degenerative Disease of the Lumbar Spine Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized for concern about increasing dyskinesias. You were also found to have a urinary tract infection. For your increasing dyskinesias, we decreased your dosing of Sinemet from 2 tablets four times a day (8am, 11am, 2pm and 5pm) to 1 tablet five times a day (8am, 11am, 2pm, 5pm and 8pm). Comtan was also increased to five times a day to match with with your sinemet dosing. This has improved your dyskinesias. For your urinary tract infection, we started you on antibiotics. Please take ciprofloxacin as prescribe at home to complete a course of antibiotics. You also described lower back and leg pain during your hospitalization. We did a CT scan and MRI of your back to further explore this issue. These studies showed abnormalities consistent with degenerative changes. Please follow-up with your primary care doctor for further management. We also started you on two new medications for your leg pain, gabapentin and tramadol. When starting the gabapentin, you may feel sleepy at first. Please continue to take this medication for one week and if you continue to feel sleepy, please speak with your primary care doctor about discontinuing the medication. The tramadol is a medication that you only need to take as needed for pain. We hope you all the best.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H Do not take more than 4000 mg of acetaminophen in any 24 hour period. 2. Vancomycin Oral Liquid ___ mg PO Q6H RX *vancomycin 125 mg 1 capsule(s) by mouth every 6 hours Disp #*52 Capsule Refills:*0 3. Ferrous Sulfate 325 mg PO DAILY 4. Multivitamins 1 TAB PO DAILY 5. Nexplanon (etonogestrel) 68 mg Other q ___ Discharge Disposition: Home Discharge Diagnosis: Severe C. diff colitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Gen: young woman who is in no acute distress HEENT: EOMI, sclera anicteric, OP clear Lung: CTAB CV: RR, no m/r/g Abd: soft, not distended, mildly TTP in all quadrants, no rigidity or guarding, no rebound tenderness Ext: WWP, no rashes or edema Neuro: AAOx3, grossly normal strength, sensation and mentation Followup Instructions: ___ [/INST] </s><s>You were admitted with nausea, vomiting and abdominal pain. A CT scan showed diffuse inflammation from your colon. You were found to have an infection with a bacteria called Clostridium dificile (C. diff), likely a result of your recent treatment with the antibiotic clindamycin. This infection was treated with oral antibiotics. Your symptoms improved dramatically during your stay and you were discharged to complete a course of oral antibiotics for your C. diff infection. You should follow up with your primary care doctor in 2 weeks, after completing the antibiotics. Please seek immediate medical attention if you develop new fevers, chills, abdominal distention, worsening diarrhea, or worsening abdominal pain. It was a pleasure caring for you while you were in the hospital, and we wish you a fully and speedy recovery! Sincerely, The ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amantadine 50 mg PO BID 2. Docusate Sodium 100 mg PO BID Patient may refuse. Hold if patient has loose stools. 3. Vitamin D 800 UNIT PO DAILY 4. Amlodipine 2.5 mg PO DAILY 5. OLANZapine 10 mg PO HS 6. Fluticasone Propionate NASAL 1 SPRY NU DAILY 7. Warfarin 2.5 mg PO DAILY16 8. Magnesium Oxide 400 mg PO BID 9. Enoxaparin Sodium 60 mg SC Q12H 10.Bactrim DS 1 tab BID for 3 days 11. Metoprolol Tartrate 12.5 mg PO TID hold for SBP < 120 or HR < 60 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right sided stroke Urinary tract infection Discharge Condition: Right arm cogwheeling, spasticity. Resting tremor on right arm. Does not speak or follow commands. Does track visual stimuli. Increased tone in both legs, toes upgoing. Withdraws legs to pain but not arms. Followup Instructions: ___ [/INST] </s><s>The patient should continue coumadin daily, INR checked ___ Continue tube feeds through PEG tube, Fibersource run continuously at 50ml/hr with 250cc q8h water flushes Complete Ceftriaxone through ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 2. levofloxacin 500 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) for 2 days: end date ___. Disp:*2 Tablet(s)* Refills:*0* 3. enoxaparin 60 mg/0.6 mL Syringe Sig: One (1) injection Subcutaneous Q12H (every 12 hours). 4. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day. 5. spironolactone 25 mg Tablet Sig: One (1) Tablet PO twice a day. 6. Miralax 17 gram/dose Powder Sig: One (1) packet PO once a day as needed for constipation. 7. prochlorperazine maleate 10 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for nausea. Discharge Disposition: Home Discharge Diagnosis: Febrile neutropenia Ascites Gastroenteritis 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 fever and low white blood cell count. The source of your fever was possibly a gastrointestinal infection, or possibly a pneumonia. You were treated with strong IV antibiotics, and your white blood cell count improved. On discharge you should continue taking an antibiotic tablet for the possible pneumonia. You were also treated for a bowel dysfunction with a suction tube in your stomach. We removed 6.5 liters of fluid from your abdominal cavity as well. With these treatments, your symptoms improved.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. PredniSONE 60 mg PO DAILY Duration: 3 Doses Start: Future Date - ___, First Dose: First Routine Administration Time Take once per day: 60mgx3 days, 50mgx3 days, 40mgx3 days, 30 mgx3 days, 20mgx3 days, 10 mgx3 days. This is dose # 1 of 6 tapered doses 2. PredniSONE 50 mg PO DAILY Duration: 3 Doses Start: After 60 mg DAILY tapered dose Take once per day: 60mgx3 days, 50mgx3 days, 40mgx3 days, 30 mgx3 days, 20mgx3 days, 10 mgx3 days. This is dose # 2 of 6 tapered doses 3. PredniSONE 40 mg PO DAILY Duration: 3 Doses Start: After 50 mg DAILY tapered dose Take once per day: 60mgx3 days, 50mgx3 days, 40mgx3 days, 30 mgx3 days, 20mgx3 days, 10 mgx3 days. This is dose # 3 of 6 tapered doses 4. PredniSONE 30 mg PO DAILY Duration: 3 Doses Start: After 40 mg DAILY tapered dose Take once per day: 60mgx3 days, 50mgx3 days, 40mgx3 days, 30 mgx3 days, 20mgx3 days, 10 mgx3 days. This is dose # 4 of 6 tapered doses 5. PredniSONE 20 mg PO DAILY Duration: 3 Doses Start: After 30 mg DAILY tapered dose Take once per day: 60mgx3 days, 50mgx3 days, 40mgx3 days, 30 mgx3 days, 20mgx3 days, 10 mgx3 days. This is dose # 5 of 6 tapered doses 6. PredniSONE 10 mg PO DAILY Duration: 3 Doses Start: After 20 mg DAILY tapered dose Take once per day: 60mgx3 days, 50mgx3 days, 40mgx3 days, 30 mgx3 days, 20mgx3 days, 10 mgx3 days. This is dose # 6 of 6 tapered doses 7. ValACYclovir 1000 mg PO Q8H Discharge Disposition: Home Discharge Diagnosis: Transverse myelitis 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 ___ in ___ from ___ to ___ because of recurrent ascending weakness in your legs and torso. While hospitalized, you had numerous tests done to try to determine the cause of your symptoms. You had imaging of your spine which did not show any masses or other lesions. You had a nerve conduction study which was normal. We obtained a sample of your cerebrospinal fluid in order to test for other infectious and inflammatory causes. You were started on a second course of steroids as well as antiviral medication as empiric treatment while we continue to investigate the underlying cause of your symptoms. There are still several pending lab results, both from ___ and ___. We will continue to investigate these results and to workup your symptoms for potential infectious or inflammatory causes. Please follow up with your neurology provider at ___, as noted below. Should your symptoms worsen, please do not hesitate to call or present to the emergency room. Thank you for involving us in your care. It was our pleasure to care for you. Sincerely, ___ Neurology</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. HydrOXYzine 50 mg PO QHS:PRN itching 3. Lorazepam 1 mg PO DAILY:PRN anxiety 4. Multivitamins 1 TAB PO DAILY 5. Omeprazole 40 mg PO BID 6. Ropinirole 1.5 mg PO QPM 7. Ursodiol 1000 mg PO QHS 8. Sarna Lotion 1 Appl TP TID RX *camphor-menthol Apply to itchy skin Three times daily as needed Disp #*1 Tube Refills:*0 9. Cetirizine 10 mg PO DAILY 10. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID 11. Clobetasol Propionate 0.05% Soln 1 Appl TP BID 12. Lidocaine-Prilocaine 1 Appl TP ONCE 13. Triamcinolone Acetonide 0.1% Cream 1 Appl TP BID 14. Cholestyramine 4 gm PO BID RX *cholestyramine (with sugar) 4 gram 1 powder(s) by mouth twice daily Disp #*60 Packet Refills:*0 15. Budesonide 9 mg PO DAILY RX *budesonide 3 mg 3 capsule(s) by mouth daily Disp #*90 Capsule Refills:*0 16. Azathioprine 50 mg PO DAILY RX *azathioprine 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Transaminitis Autoimmune hepatitis Pruritis Secondary diagnosis: Auto-immune hepatitis Celiac disease Restless leg syndrome Depression 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 ___ with elevated liver enzymes. We did a liver biopsy to determine the cause. The preliminary result is consistent with auto-immune hepatitis. Please follow up with Dr. ___ the definitive results and for additional treatment. We have started you on budesonide, azathioprine and cholestyramine. We also wrote for a lotion to help with the itching. It was a pleasure taking care of you, best of luck. Your ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Multivitamins 1 TAB PO DAILY 2. Rifaximin 550 mg PO BID 3. Vitamin D 50,000 UNIT PO 1X/WEEK (TH) 4. Ciprofloxacin HCl 500 mg PO Q12H Please take one dose ___ ___, one ___ AM, one ___ ___ RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth every 12 hours Disp #*3 Tablet Refills:*0 5. Lactulose 30 mL PO BID:PRN ___ BM/day Please take for a target of ___ bowel movements/day RX *lactulose 20 gram/30 mL 30 mL by mouth up to three times a day as needed Refills:*0 6. Hydrocortisone (Rectal) 2.5% Cream ___ID:PRN Hemorrhoids 7. Potassium Chloride ___ mEq PO TID 8. Outpatient Lab Work Please check on ___ (___.2): CBC, chem 10, LFTs, ___ Fax results to ___ attn: Dr. ___ ___ Disposition: Home Discharge Diagnosis: Primary: ======== Cryptogenic Cirrhosis Hypotension Anemia Secondary: =========== Chronic kidney disease Crohns disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, Thank you for choosing to receive your care at ___. You were admitted for general malaise and increased lower extremity swelling. You underwent a workup for infection, which did not show any acute findings but for which you were treated for likely infection in your abdominal cavity with antibiotics. The blood tests we measured while you were in the hospital showed worsening liver disease, and you had a couple episodes of low blood pressure and red blood cell counts which required intravenous therapy and blood transfusion. Your labs finally improved, and you were sent home with ongoing monitoring. You should continue to take your antibiotics through the evening of ___. We will continue to monitor your liver function as an outpatient, and make sure that if your liver function worsens that you remain properly placed on the transplant list. We wish you the best with this ongoing process. Sincerely, 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 RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 2. Atorvastatin 80 mg PO DAILY RX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 3. BuPROPion (Sustained Release) 150 mg PO QAM RX *bupropion HCl 150 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 4. Ciprofloxacin HCl 250 mg PO Q24H Duration: 5 Days RX *ciprofloxacin 250 mg 1 tablet(s) by mouth daily for three days Disp #*3 Tablet Refills:*0 5. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*2 Capsule Refills:*0 6. GlipiZIDE 5 mg PO DAILY RX *glipizide 5 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 7. LaMOTrigine 25 mg PO BID RX *lamotrigine 25 mg 1 tablet(s) by mouth twice a day Disp #*2 Tablet Refills:*0 8. Lithium Carbonate 300 mg PO QHS RX *lithium carbonate 300 mg 1 capsule(s) by mouth at bedtime Disp #*1 Capsule Refills:*0 9. Lorazepam 0.5 mg PO Q8H:PRN anxiety 10. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 11. Omeprazole 20 mg PO BID RX *omeprazole 20 mg 1 capsule(s) by mouth twice a day Disp #*2 Capsule Refills:*0 12. Polyethylene Glycol 17 g PO DAILY 13. Quetiapine extended-release 300 mg PO DAILY RX *quetiapine 300 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 14. Quetiapine extended-release 600 mg PO HS RX *quetiapine 300 mg 2 tablet(s) by mouth at bedtime Disp #*2 Tablet Refills:*0 15. Zolpidem Tartrate 10 mg PO HS RX *zolpidem 10 mg 1 tablet(s) by mouth at bedtime Disp #*1 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Gait imbalance, possible medication side effect 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 after a fall. This was likely a mechanical fall, where your foot got caught in the wheels of a shopping cart. However, on physical exam we discovered that you were a little bit unsteady on your feet. We obtained an MRI of your brain, and there was nothing of concern on that. Specifically, you did not have a stroke. Your unsteadiness is likely secondary to your psychiatric medications. This may improve as you get used to the new doses of the medications. However, you should also discuss this issue with your psychiatrist, to see if some of your medications can be changed. Incidentally, we discovered that you have a urinary tract infection. Please finish the antibiotic course that you started in the hospital: we will give you three more days of ciprofloxacin tablets. Please follow up with your primary care physician and your psychiatrists.</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 ___ at ___. ___ came to us because ___ were having abdominal pain and nausea after eating. We got some imaging of your abdomen and noticed a small mass inside your gallbladder, which we are concerned about. As a result, we thought it was best for ___ to have your gallbladder removed, not only to prevent future symptoms, but also so we can find out what if any gallbladder disease is present. ___ tolerated this procedure well and were sent home after your operation in stable condition. Please call Dr. ___ office if ___ develop any of the following: fever (temperature of 101 or greater), shaking chills, nausea, vomiting, increased abdominal pain, jaundice (yellowing of the whites of your eyes or skin), abdominal distension/bloating, incision redness/bleeding/drainage, constipation or any questions. ___ may shower with soap and water, rinse, pat dry. No tub baths or swimming until healed Do not apply powder, lotion or ointment to your incision. Do not lift anything heavier than 10 pounds or strain. No driving while taking narcotic pain medication.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, You were seen at ___ for your shortness of breath. Based on our tests, it is unlikely that your shortness of breath is due to either a clot in your lungs or pneumonia. There was also no indication that there was a cardiac cause of your difficulty breathing. You did have a fever on admission but no source of infection is found. Please call your doctor if you have any additional fevers or if your shortness of breath worsens. You also experienced a pain exacerbation during your hospitalization because your home pain medication was not available. Please bring your home medication, if possible, to future hospitalizations to help avoid this complication in the future. Please follow up with your future appointments. We wish you the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 60 mg SC Q12H 2. Pantoprazole 40 mg PO Q24H 3. B Complex ___ (vit B1-B2-B3-B5-B6;<br>vitamin B complex-folic acid) 0.4 mg oral DAILY 4. BuPROPion (Sustained Release) 100 mg PO BID 5. Codeine Sulfate 30 mg PO TID:PRN Pain 6. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID 7. Ferrous Sulfate 325 mg PO DAILY 8. LORazepam 0.5 mg PO TID:PRN anxiety 9. Multivitamins 1 TAB PO DAILY 10. Venlafaxine XR 300 mg PO DAILY 11. HELD- Testosterone Gel 1% 25 mg TP DAILY This medication was held. Do not restart Testosterone Gel 1% until your doctor tells you to restart it Discharge Disposition: Home Discharge Diagnosis: PRIMARY Metastatic lung adenocarcinoma bilateral deep vein thromboses pulmonary embolism SECONDARY: fibromyalgia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospitalization at ___! Why did you come to the hospital? - You came to the hospital because you were found to have clots in your legs What happened while you were in the hospital? - You were found to have clots in both your legs and in your lungs. The lung scan also showed a large mass concerning for lung cancer. - We imaged your brain and your body, which showed metastases to your brain and in your liver, ribs, and lymph nodes in your belly. - The metastases in your brain had signs of bleeding inside of them, so we had to adjust your blood thinning medication so we can both treat the clots and prevent you from having a brain bleed. - You had a filter placed in your vein to prevent more clots from your legs from going to your lungs - You had a biopsy of your liver which confirmed that you have lung cancer called 'adenocarcinoma'. You were seen by our radiation oncologist, neuro-oncologist and hematology/oncologist, all of whom will continue to care for you as you start your radiation therapy to your brain and chemotherapy after you leave the hospital. What should you do after you leave the hospital? - Please continue taking the lovenox - Please follow up with your Oncologist Dr. ___ on ___ at 10:30 am. - Please follow up with the Radiation Oncology team in a week for your treatment. - You have follow-up with Dr. ___ Neuro-oncology on ___. - If you have any questions, concerns or new symptoms such as worse swelling in the legs, trouble breathing, severe pain, weakness in an arm or leg, speech trouble or vision changes, please call Dr. ___ right away. We wish you the best. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gabapentin 300 mg PO TID 2. Hydrochlorothiazide 25 mg PO DAILY 3. Pantoprazole 40 mg PO Q24H 4. PredniSONE 10 mg PO DAILY ___ 60mg qd ___ 40mg qd ___ 20mg qd ___ 10mg qd ___ 5mg qd Tapered dose - DOWN Discharge Disposition: Home Discharge Diagnosis: Sequelae of transverse myelitis Discharge Condition: Alert and oriented to person/place/time, able to walk, stable Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized for leg heaviness and periumbilical allodynia thought to be caused by your previous episode of transverse myelitis. Your MRI of your spine showed that the previous lesion seen in ___ is smaller suggesting improvement of your transverse myelitis. There were no blood vessel abnormalities seen either. We think your symptoms are residual effects of the transverse myelitis you experienced earlier this year. Should these symptoms worsen after a course of prednisone (steroids), please call Dr. ___ office to be evaluated or come to the emergency room. At that time, we would like to perform a lumbar puncture to obtain spinal fluid and obtain a CT scan of your chest. This is the schedule for your prednisone taper: ___: 60mg (6 tabs) once per day ___ 40mg (4 tabs) once per day ___ 20mg (2 tabs) once per day ___ 10mg (1 tab) once per day ___ 5mg qd (0.5 tab) once per day It was a pleasure taking care of you in the hospital. We wish you well!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcitriol 0.5 mcg PO 3X/WEEK (___) 2. Cetirizine 10 mg PO DAILY 3. Escitalopram Oxalate 10 mg PO DAILY 4. Pantoprazole 40 mg PO Q12H 5. Sulfameth/Trimethoprim SS 1 TAB PO 3X/WEEK (___) 6. Vitamin D ___ UNIT PO DAILY 7. Calcium Acetate 1334 mg PO TID W/MEALS RX *calcium acetate 667 mg 2 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 8. ValACYclovir 500 mg PO Q24H 9. Nephrocaps 1 CAP PO DAILY RX *B complex with C#20-folic acid [Nephrocaps] 1 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*0 10. Vancomycin Oral Liquid ___ mg PO Q6H Last day is ___. RX *vancomycin 125 mg 1 capsule(s) by mouth every six (6) hours Disp #*40 Capsule Refills:*0 11. PredniSONE 20 mg PO DAILY Duration: 4 Doses Start: Tomorrow - ___, First Dose: First Routine Administration Time This is dose # 1 of 2 tapered doses RX *prednisone 10 mg 1 tablet(s) by mouth once a day Disp #*20 Tablet Refills:*0 12. PredniSONE 10 mg PO DAILY Duration: 5 Doses Start: After 20 mg DAILY tapered dose This is dose # 2 of 2 tapered doses 13. PredniSONE 2 mg PO DAILY Start: After last tapered dose completes This is the maintenance dose to follow the last tapered dose Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: Colostrum difficle infection End Stage Renal Disease Systolic congestive heart failure Gout SECONDARY: Acute Myeloid Leukemia Bronchiolitis obliterans organizing pneumonia Gastrointestinal Reflux Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for nausea/vomiting/diarrhea. You were found to have an infection called clostridium difficile that was causing your diarrhea. We are treating this infection with an antibiotic called Vancomycin 125 mg fours times daily, you should continue to take this medication until ___. While you were in the hospital, you were diagnosed with gout. We increased the amount of steroids (prednisone) you were taking, you should follow the instructions on how to finish this medication. It is important to take this medication every day, if you stop this medication call you doctor. Also, while you were in the hospital, we identified that your kidney function was worsen than before. In order to clear toxins from your body and remove fluid, we started a treatment called hemodialysis. You will continue hemodialysis when you leave the hospital every ___ and ___. It is extremely important that you do not miss dialysis. If you miss dialysis, ensure that you call your doctor. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Thank you for allowing us to participate in your care, we wish you the best! You ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen (Liquid) 1000 mg PO Q8H 2. Acetylcysteine 20% ___ mL NEB BID 3. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID 4. Glycopyrrolate 1 mg PO BID:PRN increase secretions 5. GuaiFENesin 10 mL PO Q6H 6. Hyoscyamine 0.125 mg SL QID 7. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 8. Miconazole Powder 2% 1 Appl TP BID 9. Ondansetron 4 mg IV Q8H:PRN Nausea/Vomiting - First Line 10. Polyethylene Glycol 17 g PO DAILY 11. Ranitidine 150 mg PO DAILY 12. Senna 8.6 mg PO BID 13. Simethicone 40-80 mg PO QID:PRN gas, dyspepsia 14. Warfarin 2.5 mg PO DAILY16 15. Ascorbic Acid ___ mg PO TID 16. Baclofen 25 mg PO QID 17. BuPROPion 100 mg PO DAILY 18. Citalopram 40 mg PO DAILY 19. Docusate Sodium 100 mg PO BID 20. Finasteride 5 mg PO DAILY 21. Gabapentin 1200 mg PO TID 22. Simvastatin 40 mg PO QPM 23. Tamsulosin 0.4 mg PO BID 24. Tizanidine 2 mg PO BID 25. Tizanidine 1 mg PO Q8H:PRN Muscle spasm 26. TraZODone 100 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: # Hypopharyngeal SCC (invasive) # Glottic and supraglottic narrowing, now s/p trach # Aspiration # R pleural effusion, suspected aspiration pneumonitis vs pneumonia # Constipation # Reflux # Groin rash Secondary: # BPH # Urinary retention # Insomnia # Cervical fracture with residual spasticity, wheelchair bound # Neck Pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital for problems associated with your new throat cancer. We have inserted a tracheostomy, and are in the process of planning your future cancer care. You also received a PEG tube to help with nutrition. You were treated for pneumonia related to aspiration (inhaling material down the wrong way because part of the breathing apparatus (larynx) is not working). You do not need to be in the hospital at this time, so we are discharging you to a rehab facility to gain more strength, and we will follow-up with your care plan in the outpatient clinic. Please see below for your followup appointments and medicines. In addition to the scheduled appointments, you will need a radiation oncology appointment, a stress test, and a PET scan, which will be scheduled after discharge. We wish you the very best with your health. ___ Medicine</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 2. Docusate Sodium 100 mg PO BID hold for loose stool 3. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate do NOT drink alcohol or drive while taking this medication RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 4. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: Acute appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You were admitted to the hospital with acute appendicitis (inflammation of the appendix). You were taken to the operating room and had your appendix removed laparoscopically. This procedure went well, you are now tolerating a regular diet and your pain is better controlled. You are now ready to be discharged home to continue your recovery. Please note the following discharge instructions: Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o 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. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild 2. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol 3. Docusate Sodium 100 mg PO BID 4. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 5. Glucose Gel 15 g PO PRN hypoglycemia protocol 6. Heparin 5000 UNIT SC BID 7. Insulin SC Sliding Scale Fingerstick QACHS, HS Insulin SC Sliding Scale using REG Insulin 8. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN SOB/wheeze 9. LevETIRAcetam 500 mg PO BID 10. Senna 17.2 mg PO HS 11. Allopurinol ___ mg PO DAILY 12. Aspirin 81 mg PO DAILY 13. Atorvastatin 20 mg PO QPM 14. Bumetanide 0.5 mg PO EVERY OTHER DAY 15. Finasteride 5 mg PO DAILY 16. GlipiZIDE 5 mg PO BID 17. Losartan Potassium 50 mg PO DAILY 18. Metoprolol Succinate XL 50 mg PO DAILY 19. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: ___ 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>Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •If you experienced a seizure while admitted, you are NOT allowed to drive by law. •No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications •***Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •***You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •You may have difficulty paying attention, concentrating, and remembering new information. •Emotional and/or behavioral difficulties are common. •Feeling more tired, restlessness, irritability, and mood swings are also common. •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 symptom after a brain bleed. •Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. •Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. •There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •Nausea and/or vomiting •Extreme sleepiness and not being able to stay awake •Severe headaches not relieved by pain relievers •Seizures •Any new problems with your vision or ability to speak •Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: •Sudden numbness or weakness in the face, arm, or leg •Sudden confusion or trouble speaking or understanding •Sudden trouble walking, dizziness, or loss of balance or coordination •Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY hold sbp<100 2. Clonazepam 1 mg PO BID hold for sedation, RR<10 3. CloniDINE 0.2 mg PO QHS hold sbp<100 4. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every 4 hours Disp #*30 Tablet Refills:*0 5. Lidocaine 5% Patch 1 PTCH TD DAILY please keep on 12 hours, off twelve hours for the patch 6. Lisinopril 10 mg PO DAILY hold SBP<100 7. Nitroglycerin SL 0.4 mg SL PRN chest pain 8. Zonisamide 200 mg PO QAM 9. Zonisamide 300 mg PO QHS 10. Aspirin 81 mg PO DAILY 11. Polyethylene Glycol 17 g PO DAILY constipation please do not take this medication if you develop loose, watery stools RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 17 gram by mouth daily Disp #*1 Bottle Refills:*0 12. Senna 1 TAB PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*0 13. Atorvastatin 20 mg PO DAILY 14. Escitalopram Oxalate 20 mg PO DAILY 15. Outpatient Physical Therapy Please work with patient for back pain. 16. Amitriptyline 50 mg PO TID RX *amitriptyline 50 mg 1 tablet(s) by mouth three times a day Disp #*30 Tablet Refills:*0 17. Clopidogrel 75 mg PO DAILY 18. Gabapentin 600 mg PO TID RX *gabapentin [Neurontin] 600 mg 1 tablet(s) by mouth three times daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary --altered mental status --elevated transaminases Secondary --lower back pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, It was a pleasure taking care of you here at ___ ___! You came to the hospital because you were found to be lethargic and someone found it difficult for you to wake up. We think this was because you were taking too many pain medications to help your back pain. You slowly woke up during this admission. We had our psychiatrists see you and they recommended you continue your home lexapro as well as continue your clonazepam. Our pain doctors also were ___ and recommended the following medications for your pain. Your PAIN MEDICATIONS WILL BE AS FOLLOWS --amitriptyline 50 mg three times a day. --gabapentin 600 mg three times a day --hydromorphone ___ every 4 hours only as needed --lidocaine patch daily</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Omeprazole 40 mg PO DAILY 3. Vitamin D 1000 UNIT PO DAILY 4. Metoprolol Succinate XL 12.5 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*5 5. Multivitamins 1 TAB PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Presyncope Supraventricular Tachycardia Anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane), with additional gait instability requiring ongoing ___ management. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It has been a pleasure working with you during your recent hospitalization. You were admitted to assess what was causing episodes of vertigo and dizziness at home. While in the hospital, we discovered that your heart was experiencing intermittent episodes of supraventricular tachycardia, which is when your heart beats quickly but ineffectively; we believe this may be causing your dizzy spells. You will be sent home with a monitor that measures your heart rhythm, and which you should activate whenever you experience dizziness or vertigo symptoms. You are also being sent home on a new medication, metoprolol 12.5mg daily, which will help control your heartrate and potentially limit these spells. We wish you the best with your ongoing recovery! Fondly, Your entire ___ medical care team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN ___ 2. Amitriptyline 100 mg PO HS 3. Atenolol 50 mg PO DAILY 4. Bisacodyl 10 mg PR HS:PRN constipatin 5. Docusate Sodium 100 mg PO BID 6. HYDROmorphone (Dilaudid) 4 mg PO Q3H:PRN ___ RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every four (4) hours Disp #*45 Tablet Refills:*0 7. Lisinopril 20 mg PO DAILY 8. Nucynta *NF* (tapentadol) 100 mg Oral q 6 hours RX *tapentadol [Nucynta] 100 mg 1 tablet(s) by mouth every six (6) hours Disp #*56 Tablet Refills:*0 9. Omeprazole 20 mg PO DAILY 10. Verapamil SR 240 mg PO Q24H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Partial 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 ___ with abdominal ___ on ___. A CT of the abdomen showed that you likely had a partial small bowel obstruction. You were admitted overnight for observation. You were kept NPO and given IV fluids. Soon after admission, you were passing gas and having bowel movements. You're tolerating a regular diet and are now being discharged home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Cinacalcet 30 mg PO 3X/WEEK (___) 3. Clopidogrel 75 mg PO DAILY 4. Furosemide 40 mg PO BID 5. Pravastatin 10 mg PO QPM 6. PredniSONE 5 mg PO DAILY 7. Tamsulosin 0.4 mg PO QHS 8. HELD- Lisinopril 5 mg PO DAILY This medication was held. Do not restart Lisinopril until you speak with your doctor. Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis Acute on chronic pancreatitis Secondary Diagnosis Hypercalcemia ESRD 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 to the hospital because of pancreatitis. You likely have chronic pancreatitis that was exacerbated. The exact reason is not clear, but may be related to your high calcium levels. You were treated with IV fluids and pain medication. Before discharge, you were able to eat normally and had minimal abdominal pain. You had peritoneal dialysis during your stay as well. Thank you for allowing us to participate in your care, - Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN pain 2. Aspirin 81 mg PO DAILY 3. Cyclobenzaprine 5 mg PO BID 4. Lidocaine-Prilocaine 1 Appl TP APPLY TO PORT BEFORE ACCESSING 5. Metoprolol Tartrate 37.5 mg PO BID Please hold for SBP <90 or pulse <60 RX *metoprolol tartrate 25 mg 1.5 tablet(s) by mouth twice a day Disp #*90 Tablet Refills:*2 6. Morphine SR (MS ___ 60 mg PO Q12H 7. Omeprazole 20 mg PO DAILY 8. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 9. Risperidone (Disintegrating Tablet) 0.25 mg PO BID 10. Sertraline 25 mg PO DAILY 11. traZODONE 25 mg PO HS:PRN insomnia 12. Vancomycin Oral Liquid ___ mg PO BID 13. Levofloxacin 750 mg PO DAILY Duration: 4 Days RX *levofloxacin [Levaquin] 750 mg 1 tablet(s) by mouth daily Disp #*4 Tablet Refills:*0 14. lactobacillus acidophilus *NF* 1 billion cell Oral Unknown 15. Quetiapine Fumarate 25 mg PO Q2H:PRN agitation Not to exceed 800mg/day 16. Insulin SC Sliding Scale Insulin SC Sliding Scale using HUM Insulin Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right Lower Lobe Bacterial Pnuemonia Locally Advanced Pancreatic Cancer (adenocarcinoma) 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 choosing us for your care. You were admitted for shortness of breath. When we did a CT scan of your chest, we found that you had a pneumonia in your right lung. Due to this, we treated you with antibiotics and your shortness of breath got better. Please complete your course of the antibiotic (Levofloxacin) when you leave the hospital. In addition, we found that your kidney function was slightly less than it is at baseline. We suspected that you were mildly dehydrated so we did not give you any of the diuretic Lasix while you were here. Your kidney function improved somewhat. Please follow up with your outpatient oncologist Dr. ___ on whether this medicine should be restarted. While you were here, we also performed a therapeutic paracentesis to remove some of the fluid that is pooling in your abdomen as a result of your pancreatic cancer We have changed your frequency for the following medicine: METOPROLOL TARTRATE 37.5 mg TWICE A DAY for treatment of high blood pressure We have STARTED the following medicine. Please complete this course of antibiotics: LEVOFLOXACIN 750 mg DAILY for treatment of pneumonia We have temporarily stopped this medicine: Please STOP the LASIX. Please consider restarting this with your outpatient oncologist Dr. ___. Please keep the appointments listed below:</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q6H:PRN sob, wheeze 2. Hyoscyamine 0.125 mg SL QID:PRN abdominal pain RX *hyoscyamine sulfate 0.125 mg 1 tablet(s) sublingually four times a day Disp #*30 Tablet Refills:*0 3. Pantoprazole 40 mg PO Q24H 4. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth Q 4 hours Disp #*14 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Abdominal pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted for abdominal pain with elevated infectious markers. You had an NGT placed for decompression. You started to have return of bowel function shortly after that and the NGT was removed, your diet was advanced and by ___ you were tolerating a regular diet, your nausea was gone and you had no episodes of vomiting.</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. Divalproex (EXTended Release) 500 mg PO QAM 3. Divalproex (EXTended Release) 1000 mg PO QPM 4. Doxepin HCl 50 mg PO HS 5. Fentanyl Patch 25 mcg/h TP Q72H remove if RR<12 or oversedations 6. Hydrocodone-Acetaminophen (5mg-500mg ___ TAB PO Q8H:PRN pain 7. LeVETiracetam 750 mg PO BID 8. Bisacodyl 10 mg PO DAILY:PRN constipation 9. Bisacodyl 10 mg PR HS:PRN constipation 10. CeftriaXONE 1 gm IV Q24H 11. Docusate Sodium 100 mg PO BID 12. Heparin 5000 UNIT SC TID Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: PRIMARY urinary tract infection SECONDARY abdominal pain altered mental status multiple sclerosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you during your recent hospitalization. You were admitted with difficulty concentrating and abdominal pain and some urinary retention. Your urine was suggestive of a UTI and we started treatment with antibiotics. Your mental status improved. Although your urine culture did not show anything, we sent a repeat culture to verify. You will need a 7 day course total so will go back with an IV so that this can be administered for the full course.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Docusate Sodium 100 mg PO BID 3. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN Pain - Moderate 4. Ibuprofen 400-600 mg PO Q8H:PRN Pain - Mild please take with food 5. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Second Line 6. Sarna Lotion 1 Appl TP BID:PRN rash 7. Senna 8.6 mg PO BID:PRN Constipation - First Line 8. Albuterol Inhaler ___ PUFF IH BID 9. azelastine 137 mcg (0.1 %) nasal DAILY 10. Chlorthalidone 25 mg PO DAILY 11. Citalopram 20 mg PO QHS 12. Fluticasone Propionate NASAL 2 SPRY NU DAILY 13. Levothyroxine Sodium 100 mcg PO 3X/WEEK (___) 14. Levothyroxine Sodium 50 mcg PO 4X/WEEK (___) 15. Lisinopril 30 mg PO DAILY 16. Ranitidine 150 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Perforated Appendicitis abdominal abscesses secondary: lesion left lower ext. 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 abdominal pain and found to have a perforation in your appendix. You were given IV antibiotics but continued to have pain and signs and symptoms of infection. You were taken to the operating room to have your appendix removed laparoscopically, and the infection washout out of your abdomen. After surgery, you continued to an elevation in your white blood cell count. On imaging, you were reported to have fluid collections in your abdomen for which drains were placed. Since then, your white blood cell count and your pain has decreased. You continue on antibiotics. Your are preparing for discharge home with ___ services for drain care assistance with the following instructions: Please follow up at the appointment in clinic listed below. We also generally recommend that patients follow up with their primary care provider after having surgery. We have scheduled an appointment for you listed below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for ___ weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: You may feel weak or "washed out" a couple weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You could have a poor appetite for a couple days. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Tomorrow you may shower and remove the gauzes over your incisions. Under these dressings you have small plastic bandages called steristrips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay. Your incisions may be slightly red around the stitches. This is normal. You may gently wash away dried material around your incision. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Do not drink alcohol or drive while taking narcotic pain medication. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound You will also need to follow-up with Dermatology to have excision of lesion left lower leg. . . . . You are now doing better, tolerating a regular diet and ready to be discharged home to continue your recovery. Please note the following discharge instructions:</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms ___ it was a pleasure caring for you during your hospital stay here at ___. You were admitted with severe pain and generalized weakness. Your muscle enzymes were found to be extremely elevated. MRI of the arm showed inflammation of the muscle called myositis. It is unclear if this was caused by your medications, it can happen with statin drugs and you were on pravastatin. It is not common to occur with the chemotherapy you have been on but your oncologist has been notified.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID RX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Furosemide 10 mg PO DAILY RX *furosemide 20 mg 0.5 (One half) tablet(s) by mouth once daily Disp #*15 Tablet Refills:*0 3. Metoprolol Succinate XL 75 mg PO BID RX *metoprolol succinate 25 mg 3 tablet(s) by mouth twice a day Disp #*180 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Atrial fibrillation with rapid ventricular rate Acute systolic heart failure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because of a rapid heart rate with an irregular rhythm and signs of heart failure. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? - You had an echocardiogram which showed a low ejection fraction (pumping action) of your heart and severe enlargement of the atria of your heart - You were given medications to help slow your heart down - You were given medications to help thin your blood and prevent strokes and blood clots - You had a stress test done which was normal - You had a CT of you abdomen done which was normal with the exception of a small 1cm ill-defined area in the liver which should be followed up as an outpatient with an MRI - You were diagnosed with diabetes WHAT SHOULD I DO WHEN I GO HOME? - Please follow up with your PCP ___ 1 week. - You should continue to take your medications as prescribed. - If you are experiencing new or concerning chest pain that is coming and going you should call the heartline at ___. If you are experiencing persistent chest pain that isn't getting better with rest or nitroglycerine you should call ___. - You should also call the heartline if you develop swelling in your legs, abdominal distention, or shortness of breath at night. - You should attend the appointments listed below. It is important that you establish with a primary care doctor and see your cardiologist at follow up - Weigh yourself every morning, call your doctor if your weight goes up more than 3 lbs. - Your discharge weight: 94.14 lbs. You should use this as your baseline after you leave the hospital. We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain 2. Ondansetron 4 mg PO Q8H:PRN nausea 3. Ciprofloxacin HCl 500 mg PO Q12H Last day of antibiotic ___ RX *ciprofloxacin 500 mg 1 tablet(s) by mouth every 12 hours Disp #*25 Tablet Refills:*0 4. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H Last day of antibiotics ___ RX *metronidazole 500 mg 1 tablet(s) by mouth every 8 hours Disp #*38 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY: -Appendiceal phlegmon versus Crohn's exacerbation SECONDARY: -Crohn's Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to care for you at ___. You were admitted with abdominal pain and found to have slight improvement in the inflammation in your intestines. We treated you with 2 antibiotics called ciprofloxacin and metronidazole (also known as "Flaygl"). You should continue to take those antibiotics for a total of 14 days, making your final day of antibiotics ___. In addition, please continue the liquid diet you were taking in the hospital for 7 days. After that time, slowly advance your diet back to regular. If you experience any exacerbation of your pain at that time, please call your gastroenterologist. In the near future, you will need an MRE (magnetic resonance enterography). Your gastroenterologist will help to arrange that imaging study. While you are on these antibiotics, do not drink alcohol since it can cause a severe flushing reaction.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: One (1) Puff Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 2. dabigatran etexilate 150 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. diazepam 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) as needed for back spasm. 4. metaxalone 800 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. modafinil 100 mg Tablet Sig: 1.5 Tablets PO qam (). 6. mycophenolate mofetil 500 mg Tablet Sig: Three (3) Tablet PO BID (2 times a day). 7. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 8. prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. pyridostigmine bromide 60 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. pyridostigmine bromide 180 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO DAILY (Daily). 11. sertraline 50 mg Tablet Sig: Two Hundred (200) mg PO DAILY (Daily). 12. ascorbic acid ___ mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. cyanocobalamin (vitamin B-12) 100 mcg Tablet Sig: 0.5 Tablet PO DAILY (Daily). 14. pyridoxine 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 16. ferrous sulfate 300 mg (60 mg iron) Tablet Sig: One (1) Tablet PO BID (2 times a day). 17. oxybutynin chloride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Tablet(s) 18. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 19. Outpatient Physical Therapy Outpatient ___ eval and treat for left achilles tendonitis and orthotics, 2x/wk for 4 weeks 20. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day. 21. lisinopril 10 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: Lightheadedness likely due to medication reaction Chronic back pain Myasthenia ___ Atrial Fibrillation CHF CAD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during this hospitalization. You were admitted primarily due to feeling extremely lightheaded and unsteady. Given your history of back injury and chronic back pain which has been worse over the last several months, we obtained imaging to evaluate for any structural cause of your thoracic and lumbar spine. This was stable from your previous imaging. Your lightheadedness improved with both fluids and stopping your trileptal. You should continue to take all other medications as prescribed and follow-up with your PCP and the pain clinic as scheduled. Please also follow-up in ___ clinic as scheduled. Should you experience any new symptoms or any of the below listed danger signs, please seek immediate medical attention.</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/fever 2. Alendronate Sodium 70 mg PO QTUES 3. Aspirin 81 mg PO DAILY 4. Calcium Carbonate 500 mg PO BID 5. Docusate Sodium 100 mg PO BID pt may refuse. hold for loose stool 6. Ferrous Sulfate 325 mg PO DAILY 7. Fluticasone Propionate NASAL 1 SPRY NU DAILY 8. Ipratropium Bromide Neb ___ NEB IH Q4H:PRN dyspnea 9. Lidocaine 5% Patch 1 PTCH TD DAILY 10. Lisinopril 5 mg PO DAILY 11. Omeprazole 40 mg PO DAILY 12. OxycoDONE (Immediate Release) 5 mg PO Q8H:PRN pain 13. Senna 1 TAB PO BID:PRN constipation 14. Simvastatin 10 mg PO DAILY 15. Vitamin D 400 UNIT PO DAILY 16. Albuterol-Ipratropium ___ PUFF IH Q4H:PRN wheeze 17. Budesonide Nasal Inhaler *NF* 0.25mg/2ml neb Other q12hrs 1 neb inhaled via nebulization 18. Metoprolol Succinate XL 25 mg PO DAILY hold for SBP <95 or HR <55 19. tetrahydrozoline-peg *NF* ___ % ___ BID:PRN dry eyes 20. Nystatin Cream 1 Appl TP BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: primary diagnosis: hyponatremia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you while you were admitted to ___. You were admitted to the hospital because you were found to have a low sodium. The geriatrics doctors think that this may be due to a recent increase in your water pill (Lasix). We will be stopping this medication upon discharge. We think that it is VERY important that you weigh yourself everyday at home. Please see below for a list of your follow up appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levothyroxine Sodium 112 mcg PO DAILY 2. Omeprazole 40 mg PO DAILY 3. Rosuvastatin Calcium 10 mg PO QPM 4. Vitamin D 4000 UNIT PO DAILY 5. Aspirin 81 mg PO DAILY 6. cranberry 450 mg oral daily 7. Evista (raloxifene) 60 mg oral daily 8. Natural B-100 Complex (vitamin B complex ___ #2-herbs) 100 mg oral daily 9. Levofloxacin 750 mg PO DAILY Duration: 5 Days RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 10. Metoprolol Tartrate 12.5 mg PO BID RX *metoprolol tartrate 25 mg 0.5 (One half) tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 11. Lorazepam 0.25 mg PO BID:PRN anxiety, nausea RX *lorazepam 0.5 mg 0.5 (One half) tablet by mouth twice a day Disp #*5 Tablet Refills:*0 12. Acetaminophen w/Codeine ___ TAB PO Q6H:PRN pain Discharge Disposition: Home With Service Facility: ___ ___: Primary: Community Acquired Pneumonia Secondary: Anxiety Hypertension Hypothyroidism CAD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure participating in your care at ___ ___. You were admitted with very low blood pressure, nausea and abdominal pain. You initially went to the ICU because you needed medications to keep your blood pressure up. You had scans of your belly which were normal. You also had an ultrasound of your uterus which was normal. Because you were so sick and your lungs sounded badly, you were treated for a pneumonia. You will have two additional days of antibiotics when you leave the hospital. Since your blood pressure was low when you first presented to the hospital, we have decreased your dose of Metoprolol. The visiting nurse will be checking your blood pressure and you and your primary care doctor can make a decision to increase the Metoprolol back to your home dose if necessary. We wish you the best. Sincerely, Your ___ Team</s>