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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 40 mg PO QPM 4. Gabapentin 300 mg PO BID 5. Lisinopril 40 mg PO DAILY 6. Omeprazole 20 mg PO DAILY 7. Tiotropium Bromide 1 CAP IH DAILY 8. Vitamin D 1000 UNIT PO DAILY 9. Amlodipine 5 mg PO DAILY RX *amlodipine 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 10. MetFORMIN (Glucophage) 1000 mg PO BID 11. Tamsulosin 0.8 mg PO QHS RX *tamsulosin 0.4 mg 2 capsule(s) by mouth at night Disp #*60 Capsule Refills:*0 12. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 13. OLANZapine (Disintegrating Tablet) 2.5 mg PO QHS agitation 14. Labetalol 200 mg PO BID 15. Acetaminophen 650 mg PO Q8H:PRN pain or fever Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Hypertensive urgency Delirium Urinary Retention SECONDARY DIAGNOSIS: Dementia Benign prostatic hyperplasia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___. You came to the hospital for a headache and were found to have an extremely high blood pressure. You were given IV medications and your blood pressure improved. You will be discharged on: amlodipine 5mg daily, labetalol 200mg twice a day, and lisinopril 40mg daily. Please stop taking your metoprolol. You became confused while in the hospital. This was most likely an effect of the benadryl you were given in the ED. Once your confusion improved, you were ready to be sent home. You were also started on tamsulosin to help your urinary problems. Sincerely, Your medical team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Potassium Chloride 20 mEq PO DAILY Duration: 24 Hours Hold for K >5 RX *potassium chloride 20 mEq 1 tab by mouth daily Disp #*14 Tablet Refills:*0 2. Amiodarone 200 mg PO DAILY 3. Aspirin 325 mg PO DAILY 4. Atorvastatin 20 mg PO DAILY 5. Carvedilol 25 mg PO BID hold for SBP <100 or HR <55 6. Dabigatran Etexilate 150 mg PO BID 7. Diltiazem 30 mg PO BID hold for SBP <100 or HR <55 8. Hydrochlorothiazide 25 mg PO DAILY hold for SBP <100 9. Omeprazole 20 mg PO DAILY 10. GlipiZIDE 10 mg PO BID 11. Loratadine *NF* 10 mg Oral daily 12. MetFORMIN (Glucophage) 1000 mg PO BID 13. TraMADOL (Ultram) 50-100 mg PO BID:PRN pain hold for oversedation or rr<12 14. Outpatient Lab Work Diagnosis: diabetes mellitus ICD9 250 Labs: potassium, magnesium Fax results to ___. ___ f# ___, t# ___ Discharge Disposition: Home Discharge Diagnosis: Prolonged QT interval Presyncope Secondary diagnoses: Type 2 diabetes Chronic pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (___ or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___. You came in initially for dizziness. In the emergency deparment, you were found to have an abnormal EKG and required monitoring overnight on a heart monitor. Fortunately, we did not see any heart rhythm abnormalities on your monitor while you were here. However, you should see your cardiologist when you leave the hospital to be sure you are on the right heart medications. We did not find any concerning causes of your dizziness, and we now feel it is safe for you to leave the hospital. While you were here, your potassium was found to be low. We have given you a prescription for daily potassium supplementation. You should have your potassium checked midweek. Your PCP ___ follow up the results. Below are the changes we made to your medications: START potassium chloride 20meq daily</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild Reason for PRN duplicate override: Alternating agents for similar severity 2. Calcium Carbonate 500 mg PO QID 3. CefTRIAXone 1 gm IV Q24H RX *ceftriaxone ___ dextrose,iso-os 1 gram/50 mL ONE gram IV Q24hrs Disp #*13 Intravenous Bag Refills:*0 4. Docusate Sodium 100 mg PO BID:PRN constipation RX *docusate sodium [Colace] 100 mg one capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 5. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush 6. Ibuprofen 600 mg PO Q8H:PRN Pain - Mild RX *ibuprofen 600 mg ONE tablet(s) by mouth Q8hrs Disp #*30 Tablet Refills:*0 7. MetroNIDAZOLE 500 mg PO TID RX *metronidazole [Flagyl] 500 mg ONE tablet(s) by mouth Q8hrs Disp #*42 Tablet Refills:*0 8. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth Q4hrs Disp #*40 Tablet Refills:*0 9. Polyethylene Glycol 17 g PO DAILY 10. Senna 8.6 mg PO BID 11. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line flush Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Fournier's Gangrene Elevated transaminases (liver functions) Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>-You will be discharged home with ___ & Home IV therapy services to further assist your transition. Also, wound vac services will be set up. For your safety and the safety of others; PLEASE DO NOT drive, operate dangerous machinery, or consume alcohol while taking narcotic pain medications or while wound vac is ___ place -Follow up with UROLOGY for wound check and post-op evaluation as directed. Follow up with your PCP as directed for further eval of your abnormal liver functions tests. Follow up with ID as directed. -ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor. -___ scrotum/phallus supported/elevated. Use a jock-supporter/strap or jockey-type briefs or tight, tighty-whities to facilitate this; Subsequently you may transition to loose fitting briefs or boxer-briefs for support--they should be cotton and/or breathable. -Do NOT use penis for intercourse/sex until explicitly advised by your urologist that is may be ok to do so. -You may want to coordinate your showers with your ___ provider and the planned dressing changes. -You may shower, but do NOT bathe, swim or otherwise immerse your incision. -Tylenol should be your first line pain medication, a narcotic pain medication has been prescribed for breakthough pain >4. -Colace has been prescribed to avoid post-surgical constipation and constipation related to narcotic pain medication, discontinue if loose stool or diarrhea develops. Colace is a stool "softener"; it is NOT a laxative -Resume your home medications, except as noted. -If you have fevers > 101.5 F, vomiting, or increased redness, swelling, or discharge from your incision, call your doctor or go to the nearest emergency room.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Potassium Chloride 30 mEq PO DAILY Duration: 24 Hours Hold for K > 2. Warfarin 4 mg PO DAILY16 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO DAILY 5. Clopidogrel 75 mg PO DAILY 6. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 7. Caltrate 600 + D *NF* (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit Oral BID 8. Dexilant *NF* (dexlansoprazole) 30 mg Oral daily 9. Ferrous Sulfate 325 mg PO DAILY 10. GlipiZIDE XL 2.5 mg PO BID 11. Sodium Chloride Nasal ___ SPRY NU TID:PRN dryness 12. Metoprolol Succinate XL 150 mg PO BID 13. Torsemide 80 mg PO DAILY 14. Vitamin B Complex w/C 1 TAB PO DAILY 15. Nitroglycerin SL 0.3 mg SL PRN chest pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: NSTEMI Secondary: diastolic CHF Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at ___. You were admitted for fatigue and found to have a small heart attack called an NSTEMI. You underwent a procedure to relieve blockage in the arteries that supply your heart. You were feeling better after the procedure. You need to go to rehab to continue to work on strength and conditioning. Please see the attached med list for changes made to your medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Posaconazole Delayed Release Tablet 300 mg PO BID On day 1 take 3 pills in the morning and 3 at night. For day 2 onward take 3 pills once daily. RX *posaconazole [Noxafil] 100 mg 3 tablet(s) by mouth twice daily Disp #*84 Tablet Refills:*0 2. Acyclovir 400 mg PO TID 3. Carvedilol 12.5 mg PO BID 4. Cyanocobalamin 1000 mcg PO DAILY 5. Enoxaparin Sodium 80 mg SC Q12H 6. Triamcinolone Acetonide 0.1% Cream 1 Appl TP BID:PRN rash 7. Hydrocodone-Acetaminophen (5mg-325mg) 1 TAB PO Q6H:PRN pain 8. MetFORMIN (Glucophage) 1000 mg PO BID 9. Cetirizine 10 mg PO DAILY itching RX *cetirizine 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 10. Diltiazem Extended-Release 120 mg PO DAILY 11. Torsemide 10 mg PO DAILY Duration: 10 Days 12. NovoLIN ___ (insulin NPH and regular human) 9 units subcutaneous QAM 13. NovoLIN ___ (insulin NPH and regular human) 5 units subcutaneous QPM Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES: - Acute myeloid leukemia - Rash - Peripheral edema SECONDARY DIAGNOSES: - Fungal Pneumonia - Type 2 Diabetes Mellitus - 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 Ms. ___, It was a pleasure participating in your care here are ___ ___ . You came to us with some light headedness, shortness of breath and a rash. You got a CT scan upon admission which showed no acute heart or lung problems. We addressed your light headedness by stopping your diuretic pill, decreasing your diltiazem to 15mg QID and giving you a small amount of intravenous fluids. You walked around the nursing station without difficulty and we monitored the oxygen content in your blood which remained at 100%. For your rash we stopped the voriconazole and switched your lasix to torsemide. Your rash is resolving but itchy so we are treating the itch with Zyrtec and topical steroid cream for no longer than 2 weeks. A list of your changed medications are below: 1. Please stop taking voriconazole, we think this my be causing your rash. 2. Please stop taking your lasix, instead please take torsemide daily for your leg swelling. Weigh yourself daily and call you doctor if your weight changes by more than 3 lb. 3. Please apply the topical steroid cream to the itchy areas twice daily for no longer than two weeks, please do not apply to the face and use sparingly on the folds of your skin. 4. Please fill the posaconazole prescription but do not start it until after your next round of chemotherapy. You are planned for another admission this upcoming ___ ___ to have a pheresis catheter placed and start receiving consolidative chemotherapy. Please follow the line preparation instructions you previously received, including holding your lovenox the day prior to the procedure. Thank you for choosing ___ for your healthcare needs. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 10 mg PO DAILY 2. Atorvastatin 40 mg PO QPM 3. Clopidogrel 75 mg PO DAILY 4. Lisinopril 20 mg PO DAILY 5. Aspirin 81 mg PO DAILY STOP THIS ON ___ and continue Plavix indefinitely 6. Cyanocobalamin 100 mcg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute Ischemic Stroke Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear ___, You were hospitalized due to symptoms of walking difficulty resulting from an ACUTE ISCHEMIC STROKE, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: high blood pressure We are changing your medications as follows: START Atorvastatin 40mg by mouth nightly START Clopidogrel 75mg by mouth daily indefinitely Continue Aspirin 81mg until ___ and then STOP aspirin Please see your medication list for directions regarding your other medications. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q8H:PRN Pain - Mild/Fever 2. Carbidopa-Levodopa (___) 0.5 TAB PO DAILY Duration: 1 Week Please uptitrate (increase the dose) according to the schedule in your discharge paperwork. 3. Gabapentin 300 mg PO TID 4. Multivitamins W/minerals 1 TAB PO DAILY 5. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Hyponatremia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>====================== DISCHARGE INSTRUCTIONS ====================== Dear Ms. ___, It was a privilege caring for you at ___! WHY WAS I IN THE HOSPITAL? - You came to the hospital because you were feeling confused with hallucinations, and insomnia and weakness. - You also were noted to have decreased food intake, weight loss, and worsening of your tremors. WHAT HAPPENED TO ME IN THE HOSPITAL? - While you were in the hospital we monitored you and your blood for your sodium levels which were low when you came in. To treat this we encouraged you to eat and also not to drink too much water. Your sodium levels continued to improve. - We consulted our nutrition team who encouraged you to continue to eat healthy fats and healthy meals to gain weight so you can get stronger. We gave you two Ensure drinks per meal to help you gain some of the weight you have lost. - We started you on a new medication for your ___ Disease called Sinemet (carbidopa-levodopa) which will help with your tremors. We discontinued your Ativan. - We discontinued your Escitalopram as we think this may have contributed to your low sodium. We started you on a new medication, Gabapentin to try to help with your anxiety. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Please continue to take all of your medications. - Please continue to eat healthy fats and to try to increase your caloric intake. - Please continue to drink Ensures to help gain weight to get stronger. Do not drink too much water so that you are too full to eat. NEW MEDICATIONS Gabapentin Carbidopa-Levodopa (___) (Also known as Sinemet) Please Increase the dose of the Carbidopa-Levodopa as follows: Week 1 (___) Take half tablet in the morning Week 2 (___) Take half tablet in the morning, half tablet at noon Week 3 (___) Take half tablet in the morning, half tablet at noon, half tablet in the early evening Week 4 (___) Take one tablet in the morning, half tablet at noon, half tablet in the early evening Week 5 (___) Take one tablet in the morning, one tablet at noon, half tablet in the early evening Week 6 (___) Take one tablet in the morning, one tablet at noon, one tablet in the early evening and continue on this regimen CHANGED MEDICATIONS NONE STOPPED MEDICATIONS Escitalopram Lorazepam 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. Cefpodoxime Proxetil 200 mg PO Q12H RX *cefpodoxime 200 mg 1 tablet(s) by mouth twice a day Disp #*6 Tablet Refills:*0 2. Haloperidol 0.5 mg PO BID:PRN agitation RX *haloperidol 0.5 mg 1 tablet(s) by mouth BID PRN Disp #*15 Tablet Refills:*0 3. LORazepam 0.5 mg PO SEE INSTRUCTIONS Taper Ativan to 0.5mg PO BID ___ and ___, then 0.5mg x1 on ___ and ___ then stop 4. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild/Fever 5. Atorvastatin 20 mg PO QPM 6. Bisacodyl 10 mg PR QHS:PRN Constipation - Second Line 7. Docusate Sodium 100 mg PO BID 8. guaiFENesin 100 mg/5 mL oral Q6H:PRN cough 9. melatonin 5 mg oral QHS 10. Milk of Magnesia 30 mL PO Q6H:PRN Constipation - Third Line 11. Mirtazapine 7.5 mg PO QAM 12. Mirtazapine 15 mg PO QHS 13. Polyethylene Glycol 17 g PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Dementia Discharge Condition: Level of Consciousness: Alert and interactive. Wheelchair bound (chronic ___ weakness) Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for altered mental status. You have dementia and your behavior is consistent with your dementia. Please see the recommendations by psychiatry below. YOU SHOULD FOLLOW UP WITH A NEUROLOGIST IN THE OUTPATIENT SETTING TO ESTABLISH CARE. You may have a mild UTI. Please take Cefpodoxime for three more days starting ___. RECOMMENDATIONS: - does not meet ___ criteria - d/c back to ___ - no indication for ___ placement as patient is not manic, psychotic or depressed - Continue Mirtazapine 7.5mg AM and 15 QHS - Continue Melatonin 5mg QHS - Taper Ativan to 0.5mg PO BID ___ and ___, then 0.5mg x1 on ___ and ___ then stop - Haldol 0.5mg BID prn agitation - Monitor QTc on Haldol SNF should get another EKG in about a week to monitor QTc. All the best, Dr. ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 2. Doxycycline Hyclate 100 mg PO Q12H RX *doxycycline hyclate 100 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 3. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth q6hr Disp #*30 Tablet Refills:*0 4. Glargine 40 Units Breakfast Glargine 40 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 5. Atorvastatin 40 mg PO QPM 6. BuPROPion XL (Once Daily) 300 mg PO DAILY 7. Citalopram 10 mg PO DAILY 8. Hydrochlorothiazide 25 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Left foot infection 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 Podiatric Surgery service after your Left foot surgery. You are being discharged home with the following instructions: ACTIVITY: There are restrictions on activity. Please remain heel weightbearing to your left foot in a post op shoe until your follow up appointment. You should keep this site elevated whenever possible (above the level of the heart!). No driving until cleared by your podiatric surgeon. PLEASE MONITOR FOR THE FOLLOWING SIGNS: Watch for signs and symptoms of infection in your foot. These are: -a fever greater than 101 degrees Fahrenheit, -increased redness around your wounds, -increased pain with swelling, -pus draining from the incision site. If you experience any of these signs or symptoms or see active bleeding at the incision site, please call our office at ___. Then, one of our on-call podiatrists will speak to you and determine if you need to proceed to the emergency room or can be scheduled for an urgent clinic appointment. Also, please call the office in you experience any increased swelling, redness, or pain in your leg or calf, chest pain, shortness or breath. You may experience some nausea but this could be related to your medication (either antibiotics or pain medication). You should not take these medications on an empty stomach. EXERCISE: -Limit strenuous activity for 6 weeks. -No heavy lifting greater than 20 pounds for the next ___ days. -Try to keep leg elevated when able. BATHING/SHOWERING: You may shower immediately upon coming home, but you must keep your dressing CLEAN, DRY and INTACT. You can use a shower bag taped around your ankle/leg or hang your foot/leg outside of the bathtub. Shower bags or “Reuseable Cast and Wound Protectors” are available at most convenience stores such as ___, ___, ___, and online on ___. Avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery or until cleared by your physician. WOUND CARE: Leave surgical dressing intact until next clinic visit. It is important to keep them dry as noted in the “Bathing/Showering” instructions above. MEDICATIONS: Unless told otherwise, you should resume taking all of the medications you were taking at home before surgery. Antibiotics If you are prescribed antibiotics, you may feel an upset stomach or experience nausea from the medication. This does not mean you are allergic to it. Nausea is a common side effect of many antibiotics. If you are a woman and you get a yeast infection after taking an antibiotic, that does not mean you are allergic to it. Yeast infections are a common side effect of antibiotics. Symptoms of an antibiotic allergy can be mild and include a flat rash and itching, hives (raised, red, itchy rashes), lip swelling, difficulty breathing or swallowing. If you experience an allergic reactive, please call ___ immediately. If you experience constant discomfort or persistent diarrhea, please call the office as you may be able to be placed on a different antibiotic. If you are receiving intravenous antibiotics through a peripherally inserted central catheter (___) line, you will have a nurse visiting your home to set up antibiotic treatments. This has all been organized for you prior to going home. You may also have appointments set for you to follow up with the infectious disease doctors regarding important ___ work to monitor any toxicities or reactions to the medications. Pain Medication Aside from resting and elevating your foot at home, there are medications we may provide you to help reduce your pain. Unless instructed to not take them, acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) should be taken first to help relieve pain. Acetaminophen can be taken up to 1000 mg every 6 hours (not to exceed 4000 mg daily). Ibuprofen can be taken up to 800 mg every 6 hours (not to exceed 3200 mg daily). Narcotic pain medications such as oxycodone, Percocet, Vicodin, etc. can be constipating and you should increase the fluid and bulk foods in your diet. If you feel that you are constipated, do not strain at the toilet. If a laxative is not prescribed for you, you may use over the counter Metamucil, Milk of Magnesia, or Miralax daily while taking opioid pain medications. Appetite suppression may occur shortly after surgery and while taking these medications but this will improve with time. Eat small balanced meals throughout the day. DIET: There are no special restrictions on your diet postoperatively. Poor appetite is not unusual for weeks after surgery and small, frequent meals may be preferred. FOLLOW-UP APPOINTMENTS: Be sure to keep your medical appointments with your surgeon but also your primary care physician (PCP). Please follow up with your podiatric surgeon, Dr. ___. If a follow-up appointment was not made prior to your discharge, please call the office on the first working day after your discharge from the hospital to schedule a follow-up visit (Phone Number: ___. This should be scheduled on the calendar for one to two weeks after discharge. Our surgeons have locations in ___, ___, and ___. If you would prefer one of these locations, please ask the main office if your surgeon has clinic at any of these other locations. Please make sure to follow up with your primary care physician (PCP) as well regarding your hospital admission within one to two weeks to review why you were in the hospital, what you underwent, and if you need any of your regular medications refilled or adjusted (for example, blood pressure medication). While your podiatric physician may manage your other medical conditions while in the hospital, it is important to see your PCP for further management. PLEASE FEEL FREE TO CALL THE PODIATRIC SURGERY OFFICE AT ___ WITH ANY OTHER CONCERNS OR QUESTIONS THAT MIGHT ARISE. Thank you for staying with us at ___ Center and we wish you a healthy and speedy recovery!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 110 mg SC Q12H RX *enoxaparin 120 mg/0.8 mL 110 mg SC twice a day Disp #*28 Syringe Refills:*0 2. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing 3. ALPRAZolam 0.25-0.5 mg PO TID:PRN anxiety 4. axitinib 5 mg oral BID 5. Fentanyl Patch 300 mcg/h TD Q48H 6. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN wheezing 7. Lactulose 15 mL PO Q8H:PRN Constipation 8. Lidocaine 5% Patch 1 PTCH TD QAM Pain 9. OxycoDONE (Immediate Release) 40 mg PO Q3H:PRN pain 10. Polyethylene Glycol 17 g PO DAILY 11. Prochlorperazine 10 mg PO Q6H:PRN Nausea 12. Senna 8.6 mg PO BID:PRN Constipation 13. Furosemide 20 mg PO DAILY 14. zoledronic acid 4 mg INJECTION MONTHLY Discharge Disposition: Home Discharge Diagnosis: 1. Pulmonary embolism 2. Metastatic renal cell carcinoma 3. Bony metastases 4. Pathalogic elbow fracture 5. Hypercalcemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were seen at ___ for your back pain. You were also found to have clots in your lungs which may be new. You were started on a blood thinner to prevent your clots from progressing. You had an MRI done to evaluate your back pain. Although you have extensive spinal lesions, there is no role for surgery at this time. You also do not need to wear a back brace at this time. Your elbow pain was diagnosed as an elbow fracture. Please continue to wear your sling, move it as tolerated, and do not lift anything heavier than 2lbs. Please follow up with your orthopedic surgery appointment. You were also noted to have increased calcium. Please avoid calcium-containing foods and drink plenty of water. You should have your calcium level checked at your appointment next week. If you start to develop tremors or altered mental status, please call your doctor. Please take all of your medications as directed and follow up with your outpatient appointments. Best wishes, -Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PR Q6H:PRN fever max dose 4gm/day 2. Bisacodyl 10 mg PR HS:PRN constipation 3. Senna 1 TAB PO BID:PRN constipation 4. Warfarin 2 mg PO DAYS (___) Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Fever of unknown origin Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking part in your care during your admission to ___. As you know, you were admitted for intermittent fevers. Reason for fevers was not entirely clear. You had numerous studies and tests and none of the tests suggested an infectious source. We had a family meeting to discuss your fevers and the decision was made not to perform any more studies since it would not change management. The plan is to send you back to rehab. Medication changes: -Please hold coumadin until ___. If INR<3 on ___, may resume home coumadin dose.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 2. rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. hydralazine 10 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). 4. fluoxetine 20 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 5. carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q3H (every 3 hours) as needed for pain. 9. acetaminophen 500 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain/fever. 10. diazepam 10 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for pain/anxiety. 11. fentanyl 50 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr Transdermal Q72H (every 72 hours). 12. divalproex ___ mg Capsule, Sprinkle Sig: One (1) Capsule, Sprinkle PO BID (2 times a day). Discharge Disposition: Home Discharge Diagnosis: Dysphagia following revision anterior cervical spine surgery Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>1. PO diet: thin liquids, moist, soft solids. 2. All medications crushed with puree such as applesauce or yogurt. 3. Aspiration precautions including: a. Chin tuck for all liquids and solids. b. Alternate bites and sips. c. Take small sips of liquid, one at a time. d. Keep foods moist with sauce, butter, gravy, condiments, etc. e. Continue to swallow ___ times per bite/sip. 4. Encourage regular oral care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB, wheezing 3. Benzonatate 200 mg PO TID cough 4. Cepacol (Sore Throat Lozenge) 1 LOZ PO Q2H:PRN sore throat 5. Fluticasone Propionate NASAL 1 SPRY NU BID 6. Glycerin Supps 1 SUPP PR PRN constipation 7. GuaiFENesin ___ mL PO Q6H:PRN cough 8. Ibuprofen 200-400 mg PO Q8H:PRN Pain - Mild 9. Miconazole Powder 2% 1 Appl TP BID 10. Omeprazole 40 mg PO BID 11. Polyethylene Glycol 17 g PO DAILY:PRN constipation 12. QUEtiapine Fumarate 50 mg PO QHS:PRN agitation, insomnia Duration: 7 Days 13. Sarna Lotion 1 Appl TP TID:PRN pruritus 14. Docusate Sodium 100 mg PO BID 15. Gabapentin 300 mg PO TID 16. Senna 8.6 mg PO DAILY:PRN constipation Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Pneumonia Small bowel obstruction Gastritis Secondary: - Bladder cancer - History of DVT Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Dr. ___, ___ was a pleasure taking care of you at ___. You came to the hospital after vomiting contents from the intestinal tract. You aspirated some of this material, and had to be intubated to help you breathe. After a course in the ICU with intubation, you came to the medical floor. On the floor you had a small bowel obstruction that got better. After you leave the hospital: - follow-up with your doctors that ___ have made appointments with - avoid foods that slow GI motility or that cause you nausea/vomiting as was discussed Again, it was an honor taking care of you. 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 RX *acetaminophen 650 mg 1 tablet(s) by mouth every ___ hours Disp #*90 Tablet Refills:*1 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every ___ hours Disp #*60 Tablet Refills:*0 4. Senna 1 TAB PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a day Disp #*30 Tablet Refills:*0 5. Aspirin 81 mg PO DAILY 6. Glucosamine 1500 Complex *NF* (glucosamine-chondroit-vit C-Mn) 500-400 mg Oral daily 7. Losartan Potassium 50 mg PO DAILY 8. Simvastatin 20 mg PO QHS 9. Vitamin D 1000 UNIT PO DAILY 10. ZYRtec *NF* 5 mg Oral qhs Discharge Disposition: Home Discharge Diagnosis: 1) gallstone pancreatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Stable. Followup Instructions: ___ [/INST] </s><s>You were admitted to the Acute Care Surgery service for gallstone pancreatitis and laparoscopic cholecystectomy. Please call your doctor or go to the emergency department if: *You experience new chest pain, pressure, squeezing or tightness. *You develop new or worsening cough, shortness of breath, or wheeze. *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 an unusual discharge. *Your pain is not improving within 12 hours or is not under control within 24 hours. *Your pain worsens or changes location. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *You develop any concerning symptoms. Please resume all regular home medications. Please take any new medications as prescribed. Please take the prescribed analgesic medications as needed. You may not drive or heavy machinery while taking narcotic analgesic medications. You may also take acetaminophen (Tylenol) as directed, but do not exceed 4000 mg in one day. Please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. Avoid strenuous physical activity and refrain from heavy lifting greater than 20 lbs., until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Please also follow-up with your primary care physician as soon as possible.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. famotidine 20 mg Tablet Sig: One (1) Tablet PO once a day. 2. oxycodone-acetaminophen ___ mg Tablet Sig: ___ Tablets PO every six (6) hours as needed for pain: Do not drive or take Tylenol while taking this medication. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Acute cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___. You were admitted to the hospital for acute cholecystitis, or inflammation in your gallbladder. You had surgery to remove your gallbladder. You should take the pain medication as prescribed if you need it. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. You could have a poor appetite for a while. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: You may gently wash away dried material around your incision. The glue will come off on its own. Do not scrape or scrub it off. 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 clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 2. senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 3. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 5. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 8. acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 9. Famotidine 20 mg IV Q12H 10. LeVETiracetam 750 mg IV BID 11. HydrALAzine 10 mg IV Q6H:PRN SBP>160 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: subdural hematoma 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>General Instructions •Take your pain medicine as prescribed. •Exercise should be limited to walking; no lifting, straining, or excessive bending. •Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. •You have been instructed to hold your Plavix (clopidogrel), until clearance from Neurosurgery •If you have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. •Clearance to drive and return to work will be addressed at your post-operative office visit. •Make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING •New onset of tremors or seizures. •Any confusion or change in mental status. •Any numbness, tingling, weakness in your extremities. •Pain or headache that is continually increasing, or not relieved by pain medication. •Any signs of infection at the wound site: redness, swelling, tenderness, or drainage. •Fever greater than or equal to 101° F.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Mr. ___, You were admitted for weakness and fatigue and you were found to have a urinary tract infection. We treated you with IV fluids and antibiotics. Your kidney function and weakness improved. You also had pain in your left knee which was tapped by our Rheumatologists and showed that you had a gout flare. You were treated for this with colchicine and an intra-articular steroid injection. Please see below for information regarding follow up care and medications to take on discharge. It was a pleasure taking part in your care. Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 2. Acetaminophen 650 mg PO Q6H:PRN pain 3. Docusate Sodium 100 mg PO BID 4. Prenatal Vitamins 1 TAB PO DAILY 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>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: 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 ___ 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" a couple 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 could have a poor appetite for a couple days. 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 dressings 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. 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. 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. o If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. simvastatin 10 mg Tablet Sig: One (1) Tablet PO once a day. 2. multivitamin Tablet Sig: One (1) Tablet PO once a day. 3. prednisone 5 mg Tablet Sig: One (1) Tablet PO once a day. 4. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. albuterol sulfate 90 mcg/actuation HFA Aerosol Inhaler Sig: Two (2) Puff Inhalation Q4H (every 4 hours) as needed for shortness of breath or wheezing. 6. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. 7. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. 8. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). 9. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 10. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). 11. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary- Respiratory failure Health Care Associated Pneumonia Diverticular bleed Gastritis Renal failure Secondary- Coronary artery disease Hyperlipidemia Hypertension COPD BPH 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 kidney and lung failure. While here, you were admitted to the ICU and placed on a breathing machine. You underwent hemodialysis due to the kidney failure. You were treated with IV antibiotics for a pneumonia and also developed two GI bleeds, one that was secondary to inflammation in your stomach and a second that was related to a diverticulum in your colon. You were treated with an acid-blocking medication and bowel rest. You did well in the ICU and were transferred to the medicine floor for further management. You had no further bleeding and passed a swallowing exam so are being trialed on a soft diet. You will continue to get feeds by the ___ tube until you are stronger and eating well. You are being discharged to rehab. The following changes were made to your medications: 1. START omeprazole 40mg by mouth twice daily 2. START finasteride 5mg daily 3. START tamsulosin 0.4 mg qHS 4. STOP aspirin until otherwise instructed by a doctor 5. STOP nifedipine until otherwise instructed by a doctor 6. STOP cyclobenzaprine 7. STOP doxycycline 8. STOP lisinopril 9. START lidocaine patch as needed for pain Please continue your other medications as prescribed by your outpatient providers. You will need to keep the foley catheter in for at least 2 weeks and will need to see a urologist as an outpatient for further evaluation of your urinary obstruction. You will also need to follow up with gastroenterology. It was a pleasure taking care of you. We wish you a speedy recovery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Acetaminophen-Caff-Butalbital ___ TAB PO Q4H:PRN pain do not exceed >4g tylenol in 24 hours 3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 4. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol 5. Docusate Sodium 100 mg PO BID 6. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 7. Glucose Gel 15 g PO PRN hypoglycemia protocol 8. Heparin 5000 UNIT SC TID 9. HydrALAzine ___ mg IV Q6H prn SBP> 180 10. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 11. LeVETiracetam 500 mg PO BID 12. Methocarbamol 750 mg PO QID 13. Nimodipine 60 mg PO Q4H You should take this medications for total 21 day course. Stop date is ___ 14. Ondansetron 4 mg IV Q8H:PRN nausea 15. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN pain 16. Sarna Lotion 1 Appl TP TID:PRN itchiness 17. Senna 17.2 mg PO QHS 18. Sodium Chloride 2 gm PO Q8H 19. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ ___) Discharge Diagnosis: SAH Hydrocephalus Hyponatremia UTI Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Surgery/ Procedures: •You had a cerebral angiogram which showed no aneurysm. You may experience some mild tenderness and bruising at the puncture site (groin). •You had a VP shunt placed for hydrocephalus. •Your shunt is a ___ Strata Valve which is programmable. This will need to be readjusted after all MRIs or exposure to large magnets. Your shunt is programmed to 1.0 **** 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. •You make take a shower. •No driving while taking any narcotic or sedating medication. •If you experienced a seizure while admitted, you must refrain from driving. Medications •Resume your normal medications and begin new medications as directed. •Please do NOT take any blood thinning medication (Aspirin, Plavix, Coumadin) until cleared by the neurosurgeon. •***You have been discharged on a medication called Nimodipine. This medication is used to help prevent cerebral vasospasm (narrowing of blood vessels in the brain). •You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication until follow-up. 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: •Mild to moderate headaches that last several days to a few weeks. •Difficulty with short term memory. •Fatigue is very normal •Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site or puncture site. •Fever greater than 101.5 degrees Fahrenheit •Constipation •Blood in your stool or urine •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. Humalog ___ 70 Units Breakfast Humalog ___ 65 Units Dinner 2. Aspirin 81 mg PO DAILY 3. Clopidogrel 75 mg PO DAILY to prevent stent thrombosis 4. DULoxetine ___ 120 mg PO DAILY 5. irbesartan 37.5 mg oral DAILY 6. MetFORMIN (Glucophage) 1000 mg PO BID 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 10. Prazosin 1 mg PO TID 11. Rosuvastatin Calcium 40 mg PO QPM 12. Tamsulosin 0.4 mg PO BID 13. Victoza 3-Pak (liraglutide) 0.6 mg/0.1 mL (18 mg/3 mL) subcutaneous DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY: -NSTEMI -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 caring for you at ___ ___. WHY WERE YOU IN THE HOSPITAL? - You were admitted to the hospital for chest pain. WHAT HAPPENED WHEN YOU WERE IN THE HOSPITAL? - You had a small heart attack. - You felt better after a blood transfusion. - You went for a cardiac cath, which is a study to evaluate the blood vessels in your heart. This showed no new blockages in your heart. No new stents were placed. 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. 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 fever 2. Amlodipine 2.5 mg PO DAILY 3. Ascorbic Acid ___ mg PO DAILY 4. Azathioprine 150 mg PO DAILY 5. Cetirizine 10 mg PO DAILY 6. Fluticasone Propionate NASAL 2 SPRY NU BID 7. Lisinopril 20 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Omeprazole 40 mg PO DAILY 10. Zolpidem Tartrate 5 mg PO QHS 11. Levofloxacin 750 mg PO DAILY RX *levofloxacin 750 mg 1 tablet(s) by mouth once daily Disp #*2 Tablet Refills:*0 12. PredniSONE 60 mg PO DAILY RX *prednisone 20 mg as directed tablet(s) by mouth once daily Disp #*60 Tablet Refills:*0 13. Sulfameth/Trimethoprim DS 1 TAB PO DAILY RX *sulfamethoxazole-trimethoprim 400 mg-80 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 14. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg(1,500mg) -200 unit oral daily Discharge Disposition: Home Discharge Diagnosis: Polyarteritis granulomatosis exacerbation 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 shortness of breath and fever very likely an exacerbation of your Wegener's disease. You improved with prednisone, which is important to take 60mg daily for the next 7 days, then 40mg daily. Please complete the course of antibiotics as well as use your nebulizer. Finally, a new protective antibiotic, bactrim, has been prescribed to protect you from infection while you are taking prednisone. You have appointments described below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 10 mg PO DAILY RX *atorvastatin 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 2. Aspirin 325 mg PO DAILY RX *aspirin 325 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 3. Outpatient Physical Therapy Discharge Disposition: Home Discharge Diagnosis: cerebral embolism with infarction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, You were admitted to the Neurology Service at ___ ___ after presenting with difficulty speaking. You were found to have a stroke in the part of your brain that controls the muscles on the upper left side of your body. You were restarted on aspirin and a statin. The cause of your stroke was unclear at the time of discharge. Additional testing will likely be undertaken as an outpatient when you see Dr ___ in follow-up. Please note that it is very important that you continue to take aspirin every day once you leave the hospital. You should take the statin every day as well to help lower your cholesterol.</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 50 mcg PO DAILY 3. Paroxetine 60 mg PO DAILY 4. Aspirin 81 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: - Transient Global Amnesia Secondary: - Hypertension - Pre-Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were evaluated at ___ for your difficulty with memory, cognition, and performing your work. As these symptoms were concerning for stroke, we evaluated you first with a CT scan and then an MRI which demonstrated no abnormality concerning for hemorrhage, mass, or stroke. We also performed an EEG which demonstrated no evidence for sub-clinical seizure activity. As a result of these negative studies and normal blood work, your symptoms are most likely due to a phenomenon known as Transient Global Amnesia, which has resolved. As you do have some vascular risk factors including high blood pressure, pre-diabetes, and a smoking history, we recommend a baby aspirin (81mg daily) which will protect against any future stroke.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Glycopyrrolate 0.1-0.2 mg IV Q4H:PRN excess secretions 2. HYDROmorphone (Dilaudid) 1 mg IV Q1H:PRN BREAKTHROUGH PAIN 3. HYDROmorphone (Dilaudid) 2 mg PO Q4H 4. LORazepam 1 mg IV Q6H anxiety, agitation 5. LORazepam 1 mg IV Q4H:PRN anxiety/agitation 6. Acetaminophen 650 mg PO Q6H 7. Allopurinol ___ mg PO DAILY 8. Escitalopram Oxalate 10 mg PO DAILY 9. Levothyroxine Sodium 25 mcg PO DAILY Discharge Disposition: Expired Discharge Diagnosis: NSTEMI Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>=================================== WHY DID YOU COME TO THE HOSPITAL? =================================== You came to the hospital due to nausea, vomiting, diarrhea. ================================ WHAT HAPPENED AT THE HOSPITAL? ================================ We discussed with your husband that ever since you had the stroke, you hadn't recovered as expected, and decided it was best to transition to hospice care. ==================================================== WHAT NEEDS TO HAPPEN WHEN YOU LEAVE THE HOSPITAL? ===================================================== -You will be transitioned to home hospice care. It was a pleasure taking care of you during your stay. Sincerely, Your ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amitriptyline 10 mg PO HS 2. Guaifenesin-CODEINE Phosphate ___ mL PO Q6H:PRN cough 3. Lorazepam 0.5 mg PO BID:PRN anxiety, nausea 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 5. Lovastatin 40 mg oral daily 6. Multivitamins 1 TAB PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: 1. Recurrent Hemoptysis ___ to radiation changes 2. Metastatic non-small cell lung cancer Secondary: 1. Chronic atypical chest pain ___ to metastasis 2. Ductal Carcinoma in situ 3. Peripheral Artery disease 4. 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. ___: It was a pleasure taking care of you during your hospitalization at ___. You had come in with coughing up small amounts of blood. You were evaluated with imaging and the interventional pulmonologist who found no concerning sources for your bleeding. Your blood levels remained normal and you were on room air with no further coughing up blood the next day. We believe that the reason you had this was due to radiation causing some irritation in your lung. If you have any significant blood with couging (greater that 2 tablespoons) or trouble breathing, please come back to the emergency room immediately. We have scheduled follow up appointments for your with your doctors. ___ have made no changes to your medications. We wish you all the best!!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ensure (food supplemt, lactose-reduced) 1 bottle oral TID W/MEALS malnutrition RX *food supplemt, lactose-reduced 1 bottle by mouth TID with meals Disp #*14 Package Refills:*2 2. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram/dose 1 dose by mouth daily as needed Refills:*1 3. Tacrolimus 3 mg PO Q12H 4. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath 5. CARVedilol 12.5 mg PO BID 6. Fluticasone Propionate 110mcg 2 PUFF IH BID 7. LevETIRAcetam 500 mg PO BID 8. Lidocaine 5% Patch 1 PTCH TD QPM 9. Mycophenolate Mofetil 500 mg PO BID 10. OLANZapine 10 mg PO DAILY 11. OXcarbazepine 600 mg PO BID 12. Prazosin 1 mg PO TID 13. PredniSONE 5 mg PO DAILY 14. Sulfameth/Trimethoprim SS 1 TAB PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis ================= Abdominal pain likly due to increased stool burden ESRD ___ hypertensive nephropathy s/p DDRT transplant in ___, complicated by active Antibody mediated rejection Hypertension Polysubstance use Secondary diagnosis =================== # seizure disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear,Mr ___ You were admitted to the hospital because pain around your left side and fullness of your abdomen WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - You have blood work and imaging to look for signs of infection in your abdomen and none was found. - You were found to have alot of stool on your intestines and were given medications to help you go to the bath - You were found to have cocaine in your urine which can cause damage to your kidney - You improved and were ready to leave the hospital. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - You must never do cocaine again or you will damage your kidney - Take all of your medications as prescribed (listed below) - Keep your follow up appointments with your doctors - Obtain a blood pressure machine and measure your blood pressure at home - If you experience any of the danger signs listed below please call your primary care doctor or come to the emergency department immediately. 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. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -200 unit oral daily 3. Lorazepam 1 mg PO HS:PRN insomnia 4. Doxycycline Hyclate 100 mg PO Q12H Please continue till ___ for a total of 10days of treatment RX *doxycycline hyclate 100 mg 1 tablet(s) by mouth Twice daily Disp #*16 Tablet Refills:*0 5. Cyanocobalamin 50 mcg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Likely rickettsial infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure caring for you at the ___ ___. You were admitted on ___ initially to the intensive care unit for 2 days, and later to the regular medicine floor with severe headaches and fevers. On arriving to us, your lab tests showed signs of infection in your blood, as well as abnormal platelet counts and liver function, which taken together with your history of hiking and gardening, strongly suggested a tick-borne infection. We sent further testing to determine the precise cause of this infection, and all of these are still pending. In the meantime, we continued you on the Doxycycline antibiotic that was started at ___ before you were transferred to us; this covers many tick-borne illnesses, and you seemed to improve with this medication. We also had to give you fluids and platelet transfusion in order to get the lumbar puncture, the test we did by drawing some fluid through a needle inserted in your lower back. This test showed no infection in the fluid surrounding your spinal cord and brain. You developed some fluids in your lung, which gave you some shortness of breath and we gave you some medications to help remove some of the fluid, and that also seemed to help with your breathing. Please continue the Doxycycline antibiotic till ___ for a total of ___nd please follow up with our Infectious Diseases team (as detailed below). Please also schedule an appointment with your PCP for review and further management of your symptoms.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation - First Line 2. Docusate Sodium 100 mg PO BID 3. Heparin 5000 UNIT SC BID 4. LORazepam 0.25 mg PO BID PRN anxiety RX *lorazepam 0.5 mg 0.5 (One half) tablet(s) by mouth BID PRN Disp #*6 Tablet Refills:*0 5. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth every 6 hours as needed Disp #*15 Tablet Refills:*0 6. Polyethylene Glycol 17 g PO DAILY hold for loose stool 7. Sarna Lotion 1 Appl TP TID:PRN itchy 8. Senna 8.6 mg PO DAILY 9. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild/Fever 10. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine 5 % 1 PTCH TD qAM Disp #*3 Patch Refills:*0 11. LORazepam 0.25 mg PO BID AT 8AM AND 2PM RX *lorazepam 0.5 mg 0.5 (One half) tablet(s) by mouth BID 8am and 2pm Disp #*6 Tablet Refills:*0 12. LORazepam 0.5 mg PO QHS RX *lorazepam 0.5 mg 1 tablet(s) by mouth at bedtime Disp #*3 Tablet Refills:*0 13. Omeprazole 20 mg PO DAILY 14. Sertraline 25 mg PO DAILY 15. TraZODone 25 mg PO QHS RX *trazodone 50 mg 0.5 - 1 tablet(s) by mouth at bedtime Disp #*6 Tablet Refills:*0 16. TraZODone 25 mg PO QHS:PRN insomnia Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Lumbar Stenosis L3, L4 fractures Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Spinal Fusion Surgery - Your incision is closed with staples. You will need staple removal ___ days after surgery. Please call clinic to schedule appointment. - 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 - You must wear your brace at all times when out of bed. You may apply your brace sitting at the edge of the bed. You do not need to sleep with it on. - You must wear your brace while showering. - 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. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every ___ hours as needed for pain: Do not take while operating machinery/vehicle. Do not take with alcohol. Disp:*30 Tablet(s)* Refills:*0* 2. acetaminophen 500 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain, fever: Do not exceed 2g (4 tablets) in 24 hours. Discharge Disposition: Home Discharge Diagnosis: Viral meningitis EBV hepatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___ ___. You were admitted with a headache and fevers and were found to have meningitis caused by the ___ Virus (which causes mononucleosis). You will continue to shed the EBV virus for the next several months, however you can go back to work after you are feeling better. Transitional Issues: Pending labs: Blood cultures ___, CSF Spinal fluid viral culture ___, fluid culture ___. HCV viral Load; Lyme serology Medications started: 1. Acetaminophen, do not take more than 2g in 24 hours 2. Oxycodone 5mg- do not take prior to driving or operating machinery . Follow-up needed for: 1. Check your liver function tests and platelets to make sure they are still stable 2. Have splenomegaly on exam, avoid contact sports. Your PCP ___ let you know when you can participate in sports again</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 10 mg PO DAILY 2. Metoprolol Tartrate 50 mg PO TID 3. Nystatin 1,000,000 UNIT PO Q8H:PRN thrush 4. PredniSONE 2 mg PO DAILY 5. Furosemide 20 mg PO DAILY 6. Ciprofloxacin HCl 500 mg PO Q12H day 1 ___ RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*20 Tablet Refills:*0 7. Glargine 40 Units Breakfast Glargine 10 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 8. Mycophenolate Mofetil 500 mg PO BID RX *mycophenolate mofetil 500 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 9. Tacrolimus 1 mg PO Q12H Please do not give am dose until after labs are drawn RX *tacrolimus 1 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 10. Ondansetron 4 mg PO Q8H:PRN nausea Discharge Disposition: Home Discharge Diagnosis: Primary: Urinary tract infection, bacteremia, pyelonephritis Secondary: diabetes, s/p renal transplant Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you at ___ ___. You were admitted for a blood stream infection that likely started in your bladder. You were treated with IV antibiotics and will complete a course of oral antibiotics on discharge. Medication Changes: Ciprofloxacin 500 mg PO/NG Q12H ___ Mycophenolate Mofetil 500 mg PO BID Tacrolimus 1 mg PO Q12H Please go to transplant clinic to have usual labs drawn in 10 days.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 40 mg PO QPM 3. GlipiZIDE 10 mg PO DAILY 4. Indapamide 2.5 mg PO DAILY 5. Labetalol 600 mg PO BID 6. liraglutide 0.6 mg/0.1 mL (18 mg/3 mL) subcutaneous DAILY 7. Losartan Potassium 100 mg PO DAILY 8. MetFORMIN (Glucophage) 500 mg PO BID 9. Ranitidine 150 mg PO DAILY:PRN dyspepsia Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: ============= Dizziness Secondary diagnosis: ================ HTN DM HLD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You had dizziness and lightheadedness. WHAT HAPPENED TO ME IN THE HOSPITAL? - You received brain imaging (CT scan and MRI) that did not show any concerning finding. - You received IV fluids with improvement in lightheadedness and dizziness. - Your blood sugar was found to be poorly controlled. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Please continue to take all of your medications and ___ with your appointments as listed below. We wish you a speedy recovery! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ClonazePAM 2 mg PO DAILY 2. Fluoxetine 60 mg PO DAILY 3. BusPIRone 30 mg PO DAILY 4. HYDROmorphone (Dilaudid) 2 mg PO Q6H:PRN breakthrough pain avoid driving while taking this medication. RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth every 6 hours Disp #*15 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: - Acute alcoholic pancreatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for acute pancreatitis. We believe this was a result of your alcohol use. You were treated with bowel rest, intravenous fluids, and pain medication - in addition to the placement of a nasojejunal tube for enteral feeding. This intervention resulted in resolution of your symptoms. We advise you ABSTAIN from alcohol use to avoid future episodes of pancreatitis. You also should maintain a LOW FAT diet and exercise regularly. Please ___ with your primary care physician, ___. Also you should ___ with the gastroenterology specialists. Thank you for allowing us to be part of your medical care. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ferrous Sulfate 325 mg PO DAILY 2. Ascorbic Acid ___ mg PO BID 3. Citalopram 40 mg PO DAILY 4. Cyanocobalamin 50 mcg PO DAILY 5. FoLIC Acid 1 mg PO DAILY 6. Lactulose 30 mL PO TID 7. Lorazepam 0.5 mg PO QHS:PRN insomnia 8. Mirtazapine 7.5 mg PO QHS 9. Pancrelipase 5000 1 CAP PO TID W/MEALS 10. Rifaximin 550 mg PO BID 11. Thiamine 100 mg PO DAILY 12. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: -acute blood loss anemia -urinary tract infection Secondary Diagnosis: -chronic pancreatitis -chronic alcoholism -anxiety/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. ___, It was a pleasure taking care of you at the ___ ___. You came here from ___ after having worsening fatigue at home. You were found to have low a red blood cell count that was causing your weakness. It was not clear what caused this bleeding, but was likely from your GI tract. You were given blood transfusions to increase the red blood cells in your body, which led to an improvement in your energy status. You were monitored closely and you did not have any further bleeding. You were also found to have an infection in your urine for which you were given a full course of antibiotics. Your medications were adjusted while you were here. Please see the attached sheet for an updated list and follow up with your primary care doctor to make further changes. Please follow-up with the appointments listed below and take your medications as instructed below. It is very important that you stop drinking alcohol to prevent any further damage to your pancreas and liver. Wishing you the best, Your ___ Care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 2. Carvedilol 3.125 mg PO BID RX *carvedilol 3.125 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 3. HydrALAzine 50 mg PO Q8H RX *hydralazine 50 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*1 4. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY RX *isosorbide mononitrate 60 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 5. Lisinopril 20 mg PO DAILY RX *lisinopril 20 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 6. Torsemide 20 mg PO DAILY RX *torsemide 20 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Dilated cardiomyopathy Congestive heart failure Hypertensive Emergency Secondary Diagnosis: Tachycardia Transaminitis Diabetes type 2 Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege to care for you at the ___ ___. You were admitted to the hospital for management of your severe heart failure. Unfortunately, your heart was not pumping blood well enough to meet the demands of your body. Several therapies were tried. You underwent a cardiac catheterization procedure to examine your heart, and this showed that your coronary arteries did not have any blockages, but you did have some elevated pressures in your heart. We gave you medicine to remove the excess fluid from your body. We also added several other medications to treat your heart failure. During your stay, you required an IV medication called lasix to assist your heart's ability to pump blood. We then transitioned you to another similar medication called torsemide, which you took by mouth. You responded well to this medication and the swelling in your legs and shortness of breath improved significantly. We have arranged for you to have an appointment with your new PCP, ___, and a cardiologist, Dr. ___. Please feel free to contact his office or contact the hospital sooner if you have any questions or other important issues. Thank you for letting us participate in your care. 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 Q4H:PRN pain 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Clopidogrel 75 mg PO DAILY 5. Cyanocobalamin 1000 mcg PO DAILY 6. Eplerenone 25 mg PO DAILY 7. Finasteride 5 mg PO DAILY 8. FoLIC Acid 1 mg PO DAILY 9. Gabapentin 100 mg PO QID 10. Glargine 24 Units Breakfast Insulin SC Sliding Scale using Apidra Insulin 11. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY RX *isosorbide mononitrate 30 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 12. Polyethylene Glycol 17 g PO DAILY 13. Tamsulosin 0.4 mg PO QHS 14. Vitamin D 1000 UNIT PO DAILY 15. Losartan Potassium 25 mg PO DAILY 16. Magnesium Oxide 400 mg PO DAILY 17. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 18. Amiodarone 200 mg PO DAILY 19. Furosemide 40 mg PO BID Take one pill in the morning and two in the afternoon RX *furosemide 40 mg 1 tablet(s) by mouth twice a day Disp #*90 Tablet Refills:*0 20. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: -Acute on Chronic Systolic Heart Failure -Hypertension -Diabetes Type 1 -Acute Kidney Injury Secondary Diagnosis: -CAD s/p CABG and recent PCI BMS D1 (diagonal) ___ after VT arrest -Anemia -BPH -Peripheral Neuropathy 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 ___ on ___ with findings of fluid overload in your lungs and your legs, and were treated for acute heart failure with IV diuretics. We monitored your weight and your urine output with the IV medications. Your leg ultrasound and your urine studies did not show any other reasons for your swelling. We transitioned you to an oral diuretic, to be taken twice a day. Please follow up with your primary care physician and Dr. ___. We encourage you to limit your water intake to about 2 L in a day and to eat a low sodium diet. Please also weigh yourself every morning, call MD if weight goes up more than 3 lbs. It was a pleasure taking care of you Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Diazepam 5 mg PO BID:PRN pain 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 90 mg SC Q12H Start: Today - ___, First Dose: Next Routine Administration Time Stop when INR is 2.0 or higher with Coumadin therapy 5. Gabapentin 100 mg PO Q8H 6. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*50 Tablet Refills:*0 7. Senna 8.6 mg PO BID 8. Warfarin 5 mg PO DAILY afib started on ___ 9. Dronedarone 400 mg PO BID 10. Multivitamins 1 TAB PO DAILY 11. Omeprazole 20 mg PO DAILY 12. Pyridoxine 100 mg PO DAILY 13. Vitamin B Complex 1 CAP PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. Lumbar spinal stenosis, L3-L5. 2. Lumbar degenerative grade 1 spondylosis at L4-5. 3. Neurogenic claudication. 4. Left lower extremity radiculopathy. 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>Lumbar Decompression Without Fusion You have undergone the following operation: Lumbar Decompression Without Fusion Immediately after the operation: • Activity:You should not lift anything greater than 10 lbs for 2 weeks.You will be more comfortable if you do not sit or stand more than~45 minutes without moving around. • Rehabilitation/ Physical ___ times a day you should go for a walk for ___ minutes as part of your recovery.You can walk as much as you can tolerate.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. • Brace:You may have been given a brace.If you have been given a brace, this brace is to be worn when you are walking.You may take it off when sitting in a chair or lying in bed. • Wound Care: Remove the dressing in 2 days.If the incision is draining cover it with a new sterile dressing.If it is dry then you can leave the incision open to the air.Once the incision is completely dry (usually ___ days after the operation) you may take a shower.Do not soak the incision in a bath or pool.If the incision starts draining at anytime after surgery,do not get the incision wet.Cover it with a sterile dressing and call the office. • You should resume taking your normal home medications. • You have also been given Additional Medications to control your pain.Please allow 72 hours for refill of narcotic prescriptions,so please plan ahead.You can either have them mailed to your home or pick them up at the clinic located on ___.We are not allowed to call in or fax narcotic prescriptions(oxycontin,oxycodone,percocet) to your pharmacy.In addition,we are only allowed to write for pain medications for 90 days from the date of surgery. • Follow up: Please Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. At the 2-week visit we will check your incision, take baseline X-rays and answer any questions.We may at that time start physical therapy. We will then see you at 6 weeks from the day of the operation and at that time release you to full activity. Please call the office if you have a fever>101.5 degrees Fahrenheit and/or drainage from your wound. Physical Therapy: 1)Weight bearing as tolerated.2)Gait,balance training.3)No lifting >10 lbs.4)No significant bending/twisting. Treatments Frequency: If the incision is draining cover it with a new sterile dressing.If it is dry then you can leave the incision open to the air.Once the incision is completely dry (usually ___ days after the operation) you may take a shower.Do not soak the incision in a bath or pool.If the incision starts draining at anytime after surgery,do not get the incision wet.Cover it with a sterile dressing and call the office</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Neomycin-Polymyxin-Bacitracin 1 Appl TP QID apply to your hand 2. Ascorbic Acid ___ mg PO DAILY 3. copper gluconate 2 mg oral DAILY 4. Cyanocobalamin 1000 mcg IM/SC MONTHLY 5. Ferrous Sulfate 325 mg PO DAILY 6. FoLIC Acid 1 mg PO DAILY 7. Hyoscyamine 0.125 mg SL Q8H:PRN Nausea 8. ipratropium bromide 0.03 % nasal Q6H:PRN runny nose 9. Lactobacillus acidophilus 5 billion cell oral DAILY 10. Lidocaine 5% Patch 1 PTCH TD DAILY:PRN Abdominal pain 11. melatonin 5 mg oral DAILY 12. Methadone 40 mg PO BID 13. Multivitamins 1 TAB PO DAILY 14. OxyCODONE (Immediate Release) 30 mg PO BID:PRN Pain - Severe 15. OxyCODONE (Immediate Release) 20 mg PO BID:PRN Pain - Severe 16. Pantoprazole 40 mg PO Q12H 17. Thiamine 100 mg PO DAILY 18. Tizanidine 4 mg PO DAILY:PRN Abdominal discomfort 19. Vitamin D ___ UNIT PO 1X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: -clogged feeding tube -roux-en-Y complicated by jejuno-jejunosotmy anastomotic stricture, adhesions/SBO, afferent limb syndrome) likely requiring revision surgery, malnutrition -Chronic pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted with a clogged feeding tube, which was replaced on ___ via upper endoscopy procedure. You were restarted at tube feeds and you were monitored until tube feeds were at goal. 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. Levothyroxine Sodium 150 mcg PO DAILY 2. norgestimate-ethinyl estradiol *NF* 0.18/0.215/0.25 mg-35 mcg (28) Oral daily 3. Atovaquone Suspension 750 mg PO BID RX *atovaquone [Mepron] 750 mg/5 mL 750 mg by mouth twice a day Disp #*60 Unit Refills:*0 4. anakinra *NF* 100 mg SC BID Reason for Ordering: Wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. 5. PredniSONE 80 mg PO BID RX *prednisone 20 mg 4 tablet(s) by mouth twice a day Disp #*112 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: macrophage activation syndrome Secondary: Adult Onset ___ Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dr. ___, ___ was a pleasure taking care of you at ___ ___. You were admitted with macrophage activation syndrome and treated with steroids and continued Anakinra, which you tolerated well. You were followed by rheumatology and hematology-oncology. You had a bone marrow biopsy that was consistent with macrophage activation syndrome. New Medications: START prednisone 80 mg BID START Anakinra (Kineret) Kineret 100 mg/0.67 mL Sub-Q Syringe BID START atovaquone 750 mg/5mL solution BID with meals STOP Bactrim STOP Colchicine Please follow up with Dr. ___ ___ or ___. Please have labs drawn every two days. Dr. ___ will write this script for you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You were admitted to the hospital with confusion and agitation. You had a lumbar puncture that was normal, but due to agitation you were admitted to the ICU and intubated. You have made a dramatic improvement in your thinking and physical strength. We think that your confusion was due to a viral illness, medications and a small stroke and perhaps also from untreated sleep apnea. We expect that your confusion will continue to improve slowly. You had a stroke because your blood was not thinned appropriately. It is very important that you remain on Coumadin and that your INR remain above 2 at all times!</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. Lisinopril 20 mg PO DAILY 3. Omeprazole 20 mg PO BID Duration: 8 Weeks 4. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone [Oxaydo] 5 mg ___ tablet(s) by mouth every four hours Disp #*15 Tablet Refills:*0 5. levocetirizine 5 mg oral DAILY 6. HELD- Ibuprofen 400 mg PO Q8H:PRN Pain - Mild This medication was held. Do not restart Ibuprofen until for the next 5 days as you had a biopsy and we don't want you to bleed Discharge Disposition: Home Discharge Diagnosis: Cirrhosis Splenomegaly, Hyperbilirubinemia, Abnormal LFTS and concern for PSC or Autoimmune hepatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came to the hospital with abdominal pain and were found to have evidence of liver disease without clear explanation. We performed several tests most importantly a biopsy of your liver to assess for autoimmune conditions that can cause chronic liver disease. You will follow up in clinic with Dr. ___ at ___ who is a liver specialist. He will discuss the results of your liver biopsy with you and decide on further tests and/or treatments as needed. We also performed an endoscopy of your feeding tube (esophagus) and small intestine. This is a routine test we perform in any patients with chronic liver disease or cirrhosis. We found inflammation in your feeding tube or esophagitis which may explain some of the pain that you've been experiencing. We have started you on an acid blocker called omeprazole or prilosec which you should take daily first thing in the morning for the next 8 weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 80 mg SC BID Inject this medication subcutaneously twice a day until your PCP says that it is okay to stop. RX *enoxaparin [Lovenox] 80 mg/0.8 mL 80 mg SC twice a day Disp #*30 Syringe Refills:*0 2. Simvastatin 20 mg PO QPM RX *simvastatin 20 mg 1 tablet(s) by mouth nightly Disp #*30 Tablet Refills:*2 3. Warfarin 5 mg PO DAILY Please start this medication on ___ and continue it daily RX *warfarin [Coumadin] 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*2 Discharge Disposition: Home Discharge Diagnosis: Transient Ischemic Attack Left ICA dissection Discharge Condition: Alert and oriented. Able to ambulate independently. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of headache, neck pain and word finding difficulties resulting from a CAROTID ARTERY CLOT AND DISSECTION CAUSING TRANSIENT ISCHEMIC ATTACK. This is a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot due to a tear in the lining of the artery wall. This caused brief decreased oxygen to your brain. The clot is still in the blood vessel. 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: - Coronary artery disease, prior heart attacks - Hyperlipidemia (high cholesterol) - Pre-diabetes (HgA1c 5.8%) - High blood pressure We are changing your medications as follows: - start simvastatin 20 mg nightly, your primary care doctor ___ increase this if you tolerate it - start lovenox (enoxaparin) and continue until you see your primary care doctor - please start warfarin 5 mg daily on ___, 2 days prior to your primary care doctor appointment on ___ You have had some neck pain and headache during your admission that is related to the clot in your neck. Your tooth pain may be related to this as well however if you have had the tooth pain for a long time it may be related to a primary dental issue. Please make an appointment to see your dentist. Make sure your dentist knows you are receiving anticoagulation. It is very important that you take your medications as prescribed given your risk for bleeding and ischemic stroke. Please avoid heavy lifting (greater than 15 lb), strenuous physical activity and neck manipulation. Avoid NSAIDs (advil) as much as possible while receiving anticoagulation. You will have a repeat MRI in 3 months to make sure that this dissection is healing. It is important to ___ in neurology clinic to get clearance to stop taking the blood thinner. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl ___AILY RX *bisacodyl 10 mg 1 suppository(s) rectally once a day Disp #*30 Suppository Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth every twelve (12) hours Disp #*60 Capsule Refills:*0 3. Lactulose 15 mL PO DAILY RX *lactulose [Constulose] 10 gram/15 mL ___ ml by mouth once a day Refills:*0 4. Polyethylene Glycol 17 g PO TID RX *polyethylene glycol 3350 [ClearLax] 17 gram/dose 1 dose by mouth twice a day Disp #*1 Package Refills:*0 5. QUEtiapine Fumarate 25 mg PO TID:PRN agitation RX *quetiapine 25 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 6. Senna 8.6 mg PO BID RX *sennosides ___ (sennosides)] 8.6 mg 1 ml by mouth twice a day Disp #*60 Tablet Refills:*0 7. Sulfameth/Trimethoprim DS 2 TAB PO BID Duration: 3 Days RX ___ [Bactrim DS] 800 ___ mg 1 tablet(s) by mouth twice a day Disp #*8 Tablet Refills:*0 8. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild/Fever 9. Finasteride 5 mg PO DAILY RX *finasteride 5 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 10. Fluvoxamine Maleate 200 mg PO DAILY RX *fluvoxamine 100 mg 2 tablet(s) by mouth once a day Disp #*60 Capsule Refills:*0 11. Memantine 10 mg PO BID RX *memantine 10 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 12. QUEtiapine Fumarate 100 mg PO QHS RX *quetiapine 100 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 13. Tamsulosin 0.4 mg PO BID RX *tamsulosin [Flomax] 0.4 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Abdominal pain and nausea, likely due to constipation Haloperidol induced EPS Purulent cellulitis of LLE Leukocytosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___! You came to us from ___ after experiencing nausea, vomiting, abdominal pain. We did imaging with a CT scan that showed increased stool burden without other concerning findings. Your symptoms improved with a bowel regimen, indicating that you were constipated. We started you on a bowel regimen that will need to be continued at ___. Additionally, it was noted by your outpatient psychiatrist that you previously had nausea with fluvoxamine. We recommend that the NP at ___ consider tapering you off of this to see if this additionally improves your nausea. Your sisters also mentioned that you had been more sleepy and less interactive after starting haldol at ___. We were worried about potential side effects of this medication, and asked our psychiatrists for assistance. They agreed that it is likely that the haldol caused side effects, and we have listed it as an allergy. You showed improvement off of this medication, further consistent with this side effect. We spoke with your sister regarding your left shin infection. You should see a care provider next week to ensure resolution of the infection and to have your blood work checked. It was a pleasure meeting you. We wish you all the best! - Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Clonazepam 0.5 mg PO BID:PRN anxiety 3. Fish Oil (Omega 3) 1000 mg PO QHS 4. Gabapentin 600 mg PO TID 5. LaMOTrigine 200 mg PO QPM 6. LaMOTrigine 150 mg PO QAM 7. Multivitamins 1 TAB PO DAILY 8. Simvastatin 40 mg PO HS 9. Tamsulosin 0.4 mg PO HS 10. traZODONE 200 mg PO HS 11. Venlafaxine 75 mg PO QPM 12. Venlafaxine 37.5 mg PO QAM 13. Vitamin D ___ UNIT PO DAILY 14. Albuterol-Ipratropium 2 PUFF IH PRN SOB or wheeze RX *ipratropium-albuterol [Combivent] 18 mcg-103 mcg (90 mcg)/actuation 2 puffs inhaled every 4 hours Disp #*1 Inhaler Refills:*0 15. atenolol-chlorthalidone *NF* 50-25 mg Oral daily 16. benazepril-hydrochlorothiazide *NF* ___ mg Oral daily 17. Cheratussin AC *NF* (codeine-guaifenesin) ___ mg/5 mL Oral 2 tsp qhs:PRN 18. Colchicine 0.6 mg PO PRN gout 19. Cyclobenzaprine 10 mg PO PRN muscle spasm 20. dutasteride *NF* 0.5 mg Oral QHS 21. Flovent HFA *NF* (fluticasone) 220 mcg/actuation Inhalation 2 puffs BID RX *fluticasone [Flovent HFA] 220 mcg 2 puffs inhaled twice a day Disp #*1 Inhaler Refills:*0 22. garlic *NF* 1,000 mg Oral daily 23. glimepiride *NF* 2 mg ORAL DAILY:PRN AM blood glucose 24. Ibuprofen 600 mg PO TID 25. MetFORMIN (Glucophage) 1000 mg PO BID 26. Victoza *NF* (liraglutide) 0.8 Subcutaneous daily Discharge Disposition: Home Discharge Diagnosis: COPD exacerbation 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 at ___ ___. You were transferred here from ___ for evaluation of shortness of breath and low oxygen levels. We did not find any evidence of a clot in your lungs. Your shortness of breath was likely a combination of inflammation in your lungs and also increased fluid in your lungs. We gave you medicine to remove excess fluid and your breathing improved.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Carvedilol 12.5 mg PO BID 3. Multivitamins 1 TAB PO DAILY 4. Mirtazapine 15 mg PO HS 5. Vancomycin Oral Liquid ___ mg PO Q6H 6. Nitroglycerin SL 0.3 mg SL PRN CP Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Severe constipation Acute on chronic 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 Mr ___, You were admitted to the hospital with severe constipation. This was probably related to pain medications. You improved with stool softeners. Your abdominal pain resolved prior to discharge. You also had some fluid in your lungs from heart failure, so we gave you extra diuretic. However, you developed CDiff diarrhea and became hypovolemic, so we have held your diuretics. 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 ___, ___ were admitted to ___ on ___ with shortness of breath. ___ were diagnosed with an exacerbation of your heart failure from excessive fluid retention. ___ were treated with diuretics to remove this excess fluid and your shortness of breath subsequently improved significantly. ___ also experienced a flare of your gout during your stay. This was treated with a medication called 'prednisone' which ___ will continue for several days outside of the hospital. Continue to take all of the medications in your blister packs EXCEPT for glipizide (small white round tablet with 'WPI 845' on one side) which is in BOTH the morning and bedtime blister segments. Medications which are NOT contained within the blister pack but which ___ should continue to take separately are AMLODIPINE, ALLOPURINOL, RENAGEL, TORSEMIDE and PREDNISONE. On ___, please REDUCE the dose of Novolog (mealtime) insulin by 3 units compared to the sliding scale given to ___ at discharge. At that time, please also reduce the dose of Levemir that ___ take each evening from 30 units to 20 units. Please weight yourself every morning and call your doctor immediately if your weight goes up by more than 3 lbs. It was a pleasure to take care of ___ during your stay. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Sertraline 100 mg PO DAILY 3. Acetaminophen 325-650 mg PO Q6H:PRN fever, pain 4. Bisacodyl ___AILY:PRN constipation Duration: 1 Doses 5. Docusate Sodium (Liquid) 100 mg PO BID 6. Polyethylene Glycol 17 g PO DAILY hold if having regular BM 7. Quetiapine Fumarate 12.5 mg PO BID:PRN aggitation 8. Senna 1 TAB PO HS 9. Fluticasone Propionate NASAL 1 SPRY NU DAILY 10. Fleet Enema ___AILY:PRN constipation 11. Midodrine 10 mg PO TID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Metabolic encephalopathy (delerium) mechanical ventillation for acute respiratory distress Tremor, NOS cellulitis/phlebitis constipation 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 after a fall. You had a CT scan of your head that was unremarkable. You were acutely confused and you improved. You were treated for a skin infection (cellulitis) that developed after an IV was placed on your arm, but there is no evidence of active infection. TRANSITIONAL ISSUES: []treatment of constipation (no BM for >4d prior to admission, resceived miralax, dulcolax on ___ []referral to movement disorders specialist and a cognitive neurologist for evaluation of possible memory disorder and tremor</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Doxazosin 4 mg PO HS 3. Finasteride 5 mg PO DAILY 4. Simvastatin 40 mg PO DAILY 5. Vitamin D 800 UNIT PO DAILY 6. Vitamin E 400 UNIT PO DAILY 7. GlyBURIDE 5 mg PO BID 8. GlyBURIDE 2.5 mg PO QPM 9. MetFORMIN XR (Glucophage XR) 500 mg PO DAILY 10. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth qday Disp #*30 Tablet Refills:*0 11. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet extended release 24 hr(s) by mouth qday Disp #*30 Tablet Refills:*0 12. Furosemide 80 mg PO DAILY RX *furosemide 40 mg 2 tablet(s) by mouth QDAY Disp #*60 Tablet Refills:*0 13. Outpatient Lab Work Please have a basic metabolic panel checked on ___ and have the results faxed to Dr ___ Dr ___, at Phone: ___ Fax: ___ Discharge Disposition: Home Discharge Diagnosis: primary diagnoses: Acute decompensated heart failure (systolic) coronary artery disease secondary diagnoses: type 2 diabetes mellitus not on insulin no complications hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for symptoms of fluid overload. You were found to have congestive heart failure. You have been started on medications which will help you to feel better and also to help improve your heart over time. However, it will be very important for you to take all of your medications as prescribed and follow up closely with your physicians. If you gain 3 lbs, please call your MD. ___ was a pleasure taking care of you and we wish you all the best. YOU MUST EAT A LOW SALT DIET. THE FOLLOWING FOODS ARE HIGH IN SALT: FAST FOOD, CANNED FOOD, BACON, AMONG OTHERS.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Moderate Please take lowest effective dose and wean as tolerated. RX *oxycodone 5 mg ___ tablet(s) by mouth every six (6) hours Disp #*16 Tablet Refills:*0 3. Polyethylene Glycol 17 g PO DAILY:PRN Constipation 4. Senna 8.6 mg PO BID Hold for loose stool. Discharge Disposition: Home Discharge Diagnosis: Acute cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ because you were having abdominal pain, which was concerning for an infected gallbladder. You had an ERCP on ___, where a stone was removed. The next day you went to the OR to have your gallbladder removed laparoscopically. You have since been tolerating a regular diet, ambulating, and your pain has been well-controlled. You are ready to be discharged home to continue your recovery. Please follow the instructions 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. Isoniazid ___ mg PO DAILY 2. Pyridoxine 50 mg PO DAILY 3. Rifampin 750 mg PO Q24H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis =================== #Sepsis ___ malaria #Soft tissue abscess #Disseminated TB #Acute on chronic anemia #Acute thrombocytopenia #Hypoglycemia #Hepatitis B infection #Leukocytosis Secondary diagnosis ==================== #Hypercalcemia #Hx of light chain proteinemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, Why was I admitted to the hospital? - You were admitted to the ___ because you had fevers and low blood pressures concerning for a serious infection. You were treated with antibiotics and given medications to support your blood pressures. You were tested for malaria due to your recent travels to ___, which came back positive. You were treated for three days with a drug called Malarone. We monitored your blood everyday for parasites, and it looks like the antibiotic worked to get rid of it. - You had fluid removed from your chest and abdomen that were felt to be from the tuberculosis. These were tested for other infections in addition to TB which did not grow any other bacteria. - You were also tested for Dengue Fever since you just traveled to ___ which was still being processed when you were discharged from the hospital. - You were found to be a carrier for hepatitis B, which is a virus that infects the liver and can cause problems with liver function over time. - You were continued on treatment for your tuberculosis. What should I do after discharge? - Follow up with your primary care physician ___ 7 days of discharge - Your drain will stay in place until draining less than 10 cc per day for two days in a row. When this happens, please call ___ to arrange an appointment with Interventional Radiology to have them remove the drain - Follow up with the doctor that treats your tuberculosis and take your medications as directed - Follow up with infectious disease to discuss possibly treating your hepatitis B - Follow up with Hematology for your history of elevated calcium Thank you for allowing us to take care of you. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild/Fever RX *acetaminophen 500 mg ___ tablet(s) by mouth every 6 hours Disp #*60 Tablet Refills:*0 2. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth twice daily Disp #*10 Tablet Refills:*0 3. Atovaquone Suspension 1500 mg PO DAILY RX *atovaquone 750 mg/5 mL 10 mL by mouth daily Refills:*3 4. Doxycycline Hyclate 100 mg PO Q12H RX *doxycycline hyclate 100 mg 1 tablet(s) by mouth twice daily Disp #*10 Tablet Refills:*0 5. FoLIC Acid 1 mg PO DAILY 6. Gabapentin 300 mg PO TID 7. Multivitamins 1 TAB PO DAILY 8. Thiamine 200 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Cellulitis Frostbite injury progressive to dry gangrene of ___ and ___ toes on right foot, slowly healing 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 cellulitis associated with your toe wounds. You were treated with antibiotics and you improved. You were seen by podiatry and they felt your wounds were improving. You were provided with a surgical shoe to help protect your toes from injury. You are being discharged with close PCP and ___ followup.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Midodrine 10 mg PO TID 2. Metoprolol Succinate XL 50 mg PO QAM Take two 25mg pills every morning for a total morning dose of 50mg. 3. Metoprolol Succinate XL 12.5 mg PO QHS Take one-half (0.5) of a 25mg pill every evening. 4. Fluocinonide 0.05% Cream 1 Appl TP BID 5. Furosemide 20 mg PO DAILY 6. Simvastatin 40 mg PO QPM 7. Warfarin 5 mg PO DAILY16 Discharge Disposition: Home Discharge Diagnosis: Primary: -cardiogenic shock -atrial fibrillation with rapid ventricular rate -acute on chronic heart failure with reduced ejection fraction Secondary: -mitral regurgitation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___! WHY WAS I IN THE HOSPITAL? ========================== - You were admitted because you were in AFib with RVR and had several days-weeks of heart failure symptoms. WHAT HAPPENED IN THE HOSPITAL? ============================== - You received several cardioversions for your atrial fibrillation, and were started on amiodarone. You converted to sinus rhythm, but unfortunately the amiodarone needed to be discontinued because you had a prolonged QTc. - You were initially in the CCU requiring support for low blood pressure and to help your heart squeeze. This was able to be weaned and we restarted you on medications for your heart failure, including metoprolol. You should restart your Lasix upon returning home - Your blood pressure remained low during your hospitalization, so we started you on a medication called midodrine to help keep your blood pressure up. - You had several long pauses when changing from atrial fibrillation back to normal rhythm that concerned us; for this reason, you had a pacemaker/ICD placed to decrease the frequency of these pauses. This device also reduces your risk of a fatal arrhythmia from your heart failure. WHAT SHOULD I DO WHEN I GO HOME? ================================ - You can take off your dressing when you get home tonight. You can take a shower as early as tomorrow ___. Be gentle around the incision site. Do not scrub or irritate the area. Wash gently with soap and water letting water run down over the wound and pat dry gently with a clean towel. - Your weight at discharge is 141 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. - If you experience chest pain, SOB, persistent lightheadedness or dizziness, fatigue, malaise, significant lower extremity swelling, or severe palpitations, you should report to your local emergency department immediately. 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. Cephalexin 500 mg PO Q6H end ___ 2. Ethambutol HCl 1200 mg PO DAILY 3. Isoniazid ___ mg PO DAILY 4. OxyCODONE (Immediate Release) 2.5 mg PO Q8H:PRN Pain - Moderate RX *oxycodone 5 mg 0.5 (One half) tablet(s) by mouth Q8H:PRN Disp #*10 Tablet Refills:*0 5. Pyrazinamide 1500 mg PO DAILY 6. Pyridoxine 25 mg PO DAILY 7. Rifampin 600 mg PO Q24H may turn urine orange/red Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Disseminated TB Pott's disease TB Lymphangitis Scrofuloderma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ with worsened draining abscess on your chest, back, neck, and underarms. We did CT scans and MRIs which showed abscesses ___ your spine and back as well. We found you to have a tuberculosis infection and you were started on antibiotics. You will need antibiotics for a long period of time. Some of these antibiotics can cause visual abnormalities and we recommend follow up with the eye doctors ___. We also found a mass ___ your lung for which you will need a follow-up imaging for ___ ___ weeks. You also tested positive for a hepatitis B infection. You will need weekly monitoring of your liver function for this. Wishing you the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild RX *acetaminophen [Acetaminophen Extra Strength] 500 mg ___ tablet(s) by mouth Every 8 hours Disp #*30 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth Twice per day Disp #*30 Tablet Refills:*0 3. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN BREAKTHROUGH PAIN RX *oxycodone 5 mg 1 tablet(s) by mouth Every 4 hours Disp #*10 Tablet Refills:*0 4. Senna 8.6 mg PO BID:PRN Constipation RX *sennosides [senna] 8.6 mg 1 tab by mouth Twice per day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: -Abdominal Pain -Right adnexal mass 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 you were having abdominal pain and nausea. While in the hospital we gave you medications to control your pain. We also did imaging of your abdomen to identify the source of your pain. An abdomen MRI showed a right adnexal mass, in close proximity to you right ovary. We consulted the Gynecology service who recommended outpatient follow up in their clinic (see below details of the appointment. Please follow up with your PCP as soon as possible and return to the ED if you experience any symptoms that concern you. Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Please start taking the following 1. Levaquin 2. Miconazole (topical) for yeast infection as needed Please continue taking the following meds: 1. Breo Ellipta ___ mcg/dose inhalation DAILY 2. Cyanocobalamin 1000 mcg PO DAILY 3. Diazepam 10 mg PO QHS:PRN anxiety 4. ___ Neb 1 NEB NEB Q4H:PRN sob 5. Levothyroxine Sodium 75 mcg PO DAILY 6. Montelukast 10 mg PO DAILY 7. Pantoprazole 40 mg PO Q12H 8. PARoxetine 10 mg PO DAILY 9. Pregabalin 300 mg PO BID 10. Topiramate (Topamax) 200 mg PO BID 11. TraZODone 200 mg PO QHS:PRN insomnia 12. Verapamil 80 mg PO Q24H 13. Zonisamide 100 mg PO TID Discharge Disposition: Home Discharge Diagnosis: Bronchitis Discharge Condition: Stable Followup Instructions: ___ [/INST] </s><s>Please take the levaquin until it is all gone You can use miconazole as needed for your groin irritation. Keep the area dry and clean and do not use scented soaps or vaginal douches.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Duloxetine 60 mg PO DAILY 2. Acetaminophen 650 mg PO TID Please take for only ___ days, then may take every 6 hours as needed 3. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain may cause dizziness, avoid driving while on this medicaiton RX *hydromorphone 2 mg 1 tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 4. Levothyroxine Sodium 100 mcg PO DAILY 5. Pregabalin 100 mg PO TID 6. ZIPRASidone Hydrochloride 120 mg PO QHS 7. Docusate Sodium 100 mg PO BID hold for loose stool RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 8. Senna 8.6 mg PO BID:PRN constipation 9. Lidocaine 5% Patch 1 PTCH TD QPM apply to right rib cage RX *lidocaine 5 % (700 mg/patch) apply to right rib cage once a day Disp #*6 Patch Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Trauma: acute on chronic sternal fracture Right ___, 8th rib fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after you a sustained a fall out of bed. You sustained a sternal fracture and right sided rib fractures. Your pain has been controlled with pain medication. You are ambulatory and ready for discharge home with the following instructions: Your injury caused right 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 antiinflammatory drugs are very effective in controlling pain ( ie, Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. * Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs ( crepitus ). In addition to the above recommendations: Please call your doctor or return to the emergency room if you have any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Discharge Instructions: MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take aspirin 81mg a day for anticogulation for 2 weeks. Please follow-up with your primary care physician regarding anticoagulation in the future. 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: - Weight bearing as tolerated, left lower extremity Physical Therapy: Weight bearing as tolerated Knee range of motion as tolerated Unlocked ___ for comfort Treatments Frequency: Dry dressing until no drainage Leave sutures in until discharge</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY RX *amlodipine 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*11 2. LeVETiracetam 750 mg PO BID RX *levetiracetam 750 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*11 Discharge Disposition: Home Discharge Diagnosis: Viral meningitis, organism unknown Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted with headaches. You were found to have spinal fluid with many white blood cells, which may indicate infection or inflammation. Your initial tests, for bacterial infection, herpes simplex virus, and HIV, are negative. There are more specialized tests that are still pending. You will have a follow up appointment with Neurology to discuss the results of these tests - if any test is positive, you will be contacted about starting treatment. You have been diagnosed with seizures with loss of consciousness. Due to your impaired consciousness, you should not drive for 6 months after your last event, by law. You should not participate in activities in which you could be injured if you lost consciousness, such as but not limited to swimming, bathing, cooking or using knifes, especially when unsupervised. It was a pleasure caring for you during this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 40 mg SC Q24H To be taken through ___. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 3. Aspirin 81 mg PO DAILY 4. Bisacodyl 10 mg PO DAILY:PRN consitpation 5. Docusate Sodium 100 mg PO BID 6. Donepezil 10 mg PO QHS 7. Fluticasone Propionate 110mcg 2 PUFF IH BID 8. Furosemide 40 mg PO DAILY 9. Memantine 10 mg PO DAILY 10. Metoprolol Succinate XL 200 mg PO DAILY 11. Milk of Magnesia 30 mL PO Q6H:PRN indigestion 12. Polyethylene Glycol 17 g PO DAILY 13. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation BID 14. Simvastatin 20 mg PO QPM 15. Tiotropium Bromide 1 CAP IH DAILY 16. Travatan Z (travoprost) 0.004 % ophthalmic (eye) BID 17. Vitamin D ___ UNIT PO MONTHLY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: ------------ Right femur fracture Thoracic aortic aneurysm Acute kidney injury . Secondary: -------------- Pyuria Dementia Chronic kidney disease Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair - to work with ___ to try and return to baseline with walker Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking part in your care. You were admitted to the hospital after a fall from your bed and a fracture in your right leg. You underwent a number of tests, and you were also found to have a urinary tract infection and a kidney injury. You were treated with antibiotics which treated the urinary infection, fluids which improved your kidneys, and you underwent surgery with the orthopedic surgeons to fix your broken right leg. . You were also found to have an enlargement of your aorta, the blood vessel carrying blood away from the heart. You were seen by the vascular surgery team, who recommended you follow up with them in their clinic, but noted that the risks of surgery would outweigh the possible benefit, and therefore they would not do surgery. . Please continue to take your medications as prescribed. Please follow up with the appointments as listed below. Should you have any new or concerning symptoms, please seek medical attention urgently. . 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: [/INST] </s><s>Dear ___ were hospitalized because ___ had a seizure. A CT scan of your brain was normal. Dr. ___ while ___ were in the hospital, and she felt ___ were back to your usual self. There have been no recent changes in your psychiatric medication regimen, or in ___ seizure medications. Your VNS device was interrogated, and it was shown to be functioning normally. We decided it would be best for ___ to be discharged home since ___ were at your baseline, and ___ agreed. Your home nursing services will be resumed in the morning to continue to help with your medications. ___ will call ___ with an appointment to see her within the next few months. It was a pleasure taking care of ___ and we wish ___ the best! Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 3. 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 4. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron HCl 4 mg 1 tablet(s) by mouth q8h prn Disp #*20 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Left wrist fracture and T12 endplate fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ and underwent Open reduction and internal fixation of scaphoid, triquetral-lunate pinning & hamate-capitate pinning. You are recovering well and are now ready for discharge. Please follow the instructions below to continue your recovery: * 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. * 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. *You can ambulate as tolerated while in TLSO brace at all times. you can take TLSO brace off while in bed. *</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H 2. Clopidogrel 75 mg PO DAILY to prevent stent thrombosis 3. Collagenase Ointment 1 Appl TP DAILY 4. Doxycycline Hyclate 100 mg PO Q12H 5. Glargine 50 Units Breakfast Glargine 50 Units Lunch Glargine 50 Units Dinner Insulin SC Sliding Scale using REG Insulin 6. Probiotic Blend (___) 2 billion cell-50 mg oral DAILY 7. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild 8. alfuzosin 10 mg oral DAILY 9. amLODIPine 10 mg PO DAILY 10. Artificial Tears ___ DROP BOTH EYES Q4H 11. Ascorbic Acid ___ mg PO DAILY 12. Aspirin 81 mg PO DAILY 13. Atorvastatin 40 mg PO QPM 14. Ferrous Sulfate 65 mg PO DAILY 15. Gabapentin 600 mg PO BID 16. Isosorbide Mononitrate (Extended Release) 90 mg PO DAILY 17. LORazepam 1 mg PO DAILY:PRN anxiety 18. Metoprolol Succinate XL 200 mg PO DAILY 19. Multivitamins W/minerals 1 TAB PO DAILY 20. Polyethylene Glycol 17 g PO DAILY:PRN constipation 21. Ranitidine 150 mg PO DAILY 22. TraZODone 50 mg PO QHS 23. Valsartan 320 mg PO DAILY 24. Vitamin D 1000 UNIT PO DAILY 25. HELD- Furosemide 40 mg PO EVERY OTHER DAY This medication was held. Do not restart Furosemide until your doctor tells you to 26. HELD- Hydrochlorothiazide 50 mg PO DAILY This medication was held. Do not restart Hydrochlorothiazide until your doctor tells you to Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: PRIMARY DIAGNOSES ================== #Diabetic foot infection SECONDARY DIAGNOSES =================== ___ on CKD #T2DM #HFpEF #CAD #HTN #Thrombocytopenia #OSA 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 our pleasure to care for you at ___ ___. WHY WERE YOU IN THE HOSPITAL? Your podiatrist referred you to the hospital because he was concerned that your foot ulcer was infected. WHAT DID WE DO IN THE HOSPITAL? - We gave you antibiotics to treat a possible infection of your foot ulcer. - You underwent a procedure called an angiogram of your right leg, where the arteries of the leg are evaluated for blockages. A blockage in one of the arteries was opened with a stent. WHAT SHOULD YOU DO WHEN YOU LEAVE? - Please continue your antibiotics (last day: ___. - Please continue taking your other medications, especially the aspirin and Plavix (clopidogrel) that help keep the stent in your right leg open. - Continue working with physical therapy to improve your mobility. - Weigh yourself every morning, and call your doctor if your weight goes up by more than 3 lbs in one day or 7 lbs in 3 days. 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: [/INST] </s><s>You were admitted to ___ because you had a heart attack or NSTEMI. The cath found you had severe 3 vessel CAD however you declined any intervention. Continue all your current medications with the following changes: -continue steroid taper for gout flare -hold lisinopril and hydrocholorthiazide until seen by Dr. ___ antibiotic for pneumonia -start atorvastatin 80mg every night, this replaces your pravastatin -start isosorbide 30mg daily -increased labetalol to 200mg twice a day Please refer to cardiac rehab information sheet. You will need to make an appointment to see them so that you can safety exercise post heart attack We have made changes to your medication list, so please make sure to take your medications as directed. You will also need to have close follow up with your heart doctor and your primary care doctor. It was a pleasure to take care of you. We wish you the best with your health! Your ___ Cardiac Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H:PRN pain, fever 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing 3. Aspirin EC 81 mg PO DAILY 4. Bisacodyl ___AILY:PRN constipation 5. CefePIME 2 g IV Q8H stop on ___ 6. Clonidine Patch 0.1 mg/24 hr 1 PTCH TD QMON Duration: 1 Dose discontinue on ___ RX *clonidine 0.1 ___ to back for one week Disp #*1 Patch Refills:*0 7. Docusate Sodium 100 mg PO BID 8. Gabapentin 600 mg PO Q8H RX *gabapentin 600 mg one tablet(s) by mouth every eight hours Disp #*42 Tablet Refills:*0 9. Heparin IV No Initial Bolus Initial Infusion Rate: 1100 units/hr Start: Today - ___, First Dose: 1800 goal ptt 55-80. discontinue heparin when INR greater than 2 10. Heparin Flush (10 units/ml) 1 mL IV DAILY and PRN, line flush 11. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 12. Lactulose 15 mL PO DAILY:PRN constipation 13. Metoprolol Tartrate 12.5 mg PO BID Hold for SBP<95 or HR<55 14. Milk of Magnesia 30 ml PO DAILY 15. Morphine SR (MS ___ 30 mg PO Q12H RX *morphine [MS ___ 30 mg one tablet(s) by mouth every twelve hours Disp #*60 Tablet Refills:*0 16. Morphine Sulfate ___ 15 mg PO Q4H:PRN pain RX *morphine 15 mg one tablet(s) by mouth every four hours Disp #*40 Tablet Refills:*0 17. Polyethylene Glycol 17 g PO DAILY 18. Ranitidine 150 mg PO BID 19. Vancomycin 1000 mg IV Q 8H 20. Warfarin 5 mg PO ONCE Duration: 1 Dose Administer daily dose of coumadin to achieve INR of ___ for a left ventricular thrombus Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: asthma, newly diagnosed 2 months ago pneumonia times two over past two months, most recently finished antibiotics two weeks ago "Slipped discs", previously taken Percocet and Baclofen for this Anxiety Depression IV drug use of ___, opiates, amphetamines, heroine, cocaine Discharge Condition: Alert and oriented x3, severe left sided weakness Able to take ___ steps with 2 person assist Sternal pain managed with oral analgesics, chronic pain service guided her pain management during her admission Sternal Incision - healing well, no erythema or drainage Followup Instructions: ___ [/INST] </s><s>Please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns ___ **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours** Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Clonidine Patch 0.3 mg/24 hr 1 PTCH TD QTUES 4. HYDROmorphone (Dilaudid) 2 mg PO Q3H:PRN pain RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth Every 3 hours Disp #*60 Tablet Refills:*0 5. Glargine 14 Units Breakfast Glargine 22 Units Bedtime Insulin SC Sliding Scale using REG Insulin 6. Labetalol 1000 mg PO TID 7. Lisinopril 40 mg PO DAILY 8. Nephrocaps 1 CAP PO DAILY 9. sevelamer CARBONATE 1600 mg PO TID W/MEALS 10. Valproic Acid ___ mg PO Q8H Seizure prophylaxis. 11. Meropenem 500 mg IV Q12H Pseudomonas VAP Last day is ___. Nystatin Oral Suspension 5 mL PO QID:PRN thrush 13. Lidocaine Viscous 2% 20 mL PO TID 14. Acetaminophen 325-650 mg PO Q6H:PRN fever 15. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN wheezing/perRT 16. Clonidine Patch 0.1 mg/24 hr 1 PTCH TD QTUES Total dose of 0.4mg/24 hr 17. Doxazosin 2 mg PO DAILY 18. Heparin 5000 UNIT SC TID 19. HydrALAzine 75 mg PO Q6H 20. Isosorbide Dinitrate 60 mg PO TID 21. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 22. Lanthanum 1000 mg PO TID W/MEALS 23. LeVETiracetam 500 mg IV Q12H 24. LeVETiracetam 500 mg IV 1X:ASDIR 25. Tobramycin 130 mg IV QHD Please check trough post HD and give dose if levels less than 1. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Hypoglycemic encephalopathy Ventilator associated pneumonia Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic and not arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ after being found unresponsive with very low blood sugar. A breathing tube was placed and we found that you had damage to your brain due to low blood sugar. This was complicated by seizures and we started you on seizure medications. Because you are still unable to protect your airway we placed tracheostomy and PEG tube on ___. You also developed a pneumonia while here, and you will need to finish a course of antibiotics at your facility. You will need to follow up with neurlogy as scheduled.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Docusate Sodium 100 mg PO BID 3. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain 4. Milk of Magnesia 30 ml PO BID:PRN Constipation 5. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 6. Nicotine Patch 21 mg TD DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Tibio-femoral dislocation ACL rupture PCL rupture LCL rupture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers medications. - 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 325mg of aspirin daily for 6 weeks. ACTIVITY AND WEIGHT BEARING: - You may be weight bearing as tolerated on your right lower extremity. - Please do not remove or alter the external fixator in any way. Physical Therapy: WBAT RLE.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H cholangitis Duration: 2 Weeks RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 2. Dronabinol 2.5 mg PO BID 3. Docusate Sodium 100 mg PO BID:PRN Constipation - First Line 4. Omeprazole 20 mg PO BID 5. Acetaminophen-Caff-Butalbital 1 TAB PO Q6H:PRN Headache 6. acetaminophen 500 mg oral Q6H:PRN 7. cetirizine-pseudoephedrine ___ mg oral Q12H:PRN allergies 8. FLUoxetine 40 mg PO DAILY 9. Ibuprofen 400 mg PO Q8H:PRN Pain - Mild 10. Ursodiol 300 mg PO BID 11.Outpatient Lab Work stat labs on ___ chem 10 Discharge Disposition: Home Discharge Diagnosis: cholangitis Near Occluded biliary catheter ___ Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please call Dr. ___ office at ___ for fever of 101 or greater, chills, nausea, vomiting, diarrhea, constipation, increased abdominal pain, pain not controlled by your pain medication, swelling of the abdomen or ankles, yellowing of the skin or eyes, inability to tolerate food, fluids or medications, the drain insertion site has redness, drainage or bleeding, or any other concerning symptoms. You may shower. Allow water to run over the drain. no lotion or powder to the biliary drain insertion site. The PTBD drain will remain capped at this time. Change the gauze dressing daily and prn You will be sent home with an empty drain bag in the event that you are instructed to open your PTBD No driving if taking narcotic pain medication (tramadol). No No tub baths or swimming</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H 2. Cyclobenzaprine 5 mg PO TID 3. Docusate Sodium 100 mg PO BID 4. Lidocaine 5% Patch 1 PTCH TD QPM RX *lidocaine 5 % daily Disp #*30 Patch Refills:*0 5. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tab by mouth BID:PRN Disp #*20 Tablet Refills:*0 6. Tamsulosin 0.4 mg PO QHS RX *tamsulosin 0.4 mg 1 capsule(s) by mouth at bedtime Disp #*30 Capsule Refills:*0 7. OxyCODONE (Immediate Release) 10 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 10 mg 2 tablet(s) by mouth Q4H:PRN Disp #*30 Tablet Refills:*0 8. Albuterol Inhaler ___ PUFF IH Q6H:PRN shortness of breath 9. Apixaban 2.5 mg PO BID 10. Benicar (olmesartan) 20 mg oral daily 11. CloniDINE 0.1 mg PO Q6H:PRN withdrawal symptoms 12. Diazepam 2 mg PO Q6H:PRN spasm 13. Gabapentin 300 mg PO BID 14. Gabapentin 800 mg PO HS 15. Morphine SR (MS ___ 30 mg PO Q12H Discharge Disposition: Home Discharge Diagnosis: Right clavicle fracture Right ___ rib fracture 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 ___ after falling down 4 stairs and having a right clavicle fracture, right ___ rib fractures. You are recovering well and are now ready for discharge. Please follow the instructions below to continue your recovery: Rib Fractures: * Your injury caused 8 ribs 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. Nephrocaps 1 CAP PO DAILY RX *B complex with C#20-folic acid [Nephrocaps] 1 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 2. Vancomycin 1000 mg IV WITH HD RX *vancomycin 1 gram 1 g IV with HD Disp #*15 Vial Refills:*0 3. Glargine 8 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 4. Polyethylene Glycol 17 g PO DAILY:PRN constipation 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 20 mg PO QPM 7. Calcitriol 0.25 mcg PO DAILY 8. Calcium Carbonate 500 mg PO TID 9. Epoetin ___ ___ UNIT IV Q14 DAYS 10. Furosemide 20 mg PO DAILY 11. Lisinopril 5 mg PO DAILY 12. LORazepam 0.5 mg PO PRE DIALYSIS RX *lorazepam 0.5 mg 1 tablet by mouth predialysis Disp #*2 Tablet Refills:*0 13. Vitamin D ___ UNIT PO DAILY 14.Outpatient Lab Work Weekly CBC/diff, vanc levels at least every other week, and CRP every ___ weeks, and surveillance blood cultures at the end of his course. Please draw with HD, ALL LAB RESULTS SHOULD BE SENT TO: ATTN: ___ CLINIC - FAX: ___. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: MRSA Bacteremia ESRD on HD Hyperkalemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ with fevers. You had bacteria in your blood and were treated with intravenous antibiotics. We suspected the source of this infection to be from your hemodialysis line which was removed. We replaced your hemodialysis line. You underwent echocardiograms of your heart which found a bacteria in one of your heart valves. You will need antibiotics for several weeks with your hemodialysis sessions. It was a pleasure caring for you. Wishing you the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild RX *acetaminophen 325 mg 2 capsule(s) by mouth four times a day Disp #*240 Capsule Refills:*0 2. Azithromycin 250 mg PO DAILY Duration: 1 Dose Last day ___ RX *azithromycin 250 mg 1 tablet(s) by mouth once a day Disp #*1 Tablet Refills:*0 3. Guaifenesin-Dextromethorphan 5 mL PO Q4H:PRN cough RX *dextromethorphan-guaifenesin 100 mg-10 mg/5 mL 5 mL by mouth every four (4) hours Refills:*0 4. pen needle, diabetic 32 gauge x ___ subQ DAILY RX *pen needle, diabetic [BD Ultra-Fine Nano Pen Needle] 32 gauge X ___ Use daily with ___ Solostar pen Disp #*1 Box Refills:*0 5. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Second Line RX *polyethylene glycol 3350 17 gram 1 powder(s) by mouth once a day Disp #*30 Packet Refills:*0 6. PredniSONE 40 mg PO DAILY Duration: 1 Day Last day ___ RX *prednisone 20 mg 2 tablet(s) by mouth once a day Disp #*2 Tablet Refills:*0 7. Senna 17.2 mg PO BID RX *sennosides [senna] 8.6 mg 2 tablets by mouth twice a day Disp #*120 Tablet Refills:*0 8. Tiotropium Bromide 1 CAP IH DAILY RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 capsule inhaled once a day Disp #*30 Capsule Refills:*0 9. CloNIDine 0.1 mg PO BID:PRN anxiety RX *clonidine HCl 0.1 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 10. Glargine 30 Units Bedtime RX *insulin glargine ___ Solostar U-100 Insulin] 100 unit/mL (3 mL) AS DIR 30 Units before BED; Disp #*20 Syringe Refills:*0 11. Albuterol Inhaler 2 PUFF IH Q6H:PRN bronchitis RX *albuterol sulfate [Ventolin HFA] 90 mcg 2 puffs inhaled every 6 hours Disp #*1 Inhaler Refills:*0 12. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 13. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 14. Gabapentin 600 mg PO TID RX *gabapentin 600 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 15. Lisinopril 20 mg PO DAILY RX *lisinopril 20 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 16. MetFORMIN (Glucophage) 1000 mg PO BID RX *metformin 1,000 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 17. Methadone 10 mg PO BID chronic pain Consider prescribing naloxone at discharge RX *methadone 10 mg 1 tablet by mouth twice a day Disp #*14 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: COPD exacerbation Secondary: Diabetes Mellitus Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital with shortness of breath. We diagnosed you with a COPD exacerbation, gave you nebulizer treatments, and your breathing improved. You are being discharged back to a shelter and we are delivering all of your medications (a 1 month supply of most of them) directly to you before you leave the hospital. Please follow up with your doctors as listed below, especially your PCP ___ you only have a 7 day supply of methadone and your appointment with him is 7 days after discharge. It was a pleasure taking care of your, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 3 Days RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tab-cap by mouth every twelve (12) hours Disp #*5 Tablet Refills:*0 2. Buprenorphine 8 mg SL TID 3. Cetirizine 10 mg PO DAILY 4. Enoxaparin Sodium 80 mg SC Q12H 5. Ethanol 70% Catheter DWELL (Tunneled Access Line) 2 mL DWELL DAILY 6. Furosemide 10 mg PO DAILY:PRN edema 7. Gabapentin 600 mg PO TID 8. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush 9. Mirtazapine 45 mg PO QHS 10. Ondansetron 4 mg IV Q6H 11. Prochlorperazine 10 mg PO TID:PRN nausea 12. Promethazine 12.5 mg IV Q6H 13. Ranitidine 150 mg PO DAILY 14. rOPINIRole 2 mg PO QHS 15. Tizanidine 4 mg PO TID prn 16. Zolpidem Tartrate 10 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: Acute on chronic abdominal pain and nausea Impaired bowel motility History of Roux-en-Y gastric bypass and bowel resections Short gut syndrome on chronic TPN Chronic pain syndrome on chronic opioid therapy Uncomplicated UTI SECONDARY DIAGNOSES: Anxiety Insomnia History of DVT ___ Edema 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 ___. WHY YOU WERE ADMITTED TO THE HOSPITAL: ======================================= - You were having abdominal pain and vomiting not controlled by your medicines at home. WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL: ============================================== - Your symptoms were treated with nausea and pain medicines. - You had a CT scan that did not show any bowel obstructions. - You had an endoscopy that showed some retained food and no ulcers. - You were started on Bactrim for a UTI. WHAT YOU NEED TO DO WHEN YOU GO HOME: ====================================== - Please take Bactrim twice a day for total 3 days (take last dose in the morning on ___ - Please follow up with your primary care doctor on ___ ___. It was a pleasure taking care of you. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin 500 mg PO Q12H 2. Doxycycline Hyclate 100 mg PO BID 3. Lidocaine 5% Ointment 1 Appl TP DAILY Please discontinue after 1 week 4. Glargine 16 Units Bedtime Humalog 5 Units Breakfast Humalog 5 Units Lunch Humalog 4 Units Dinner Insulin SC Sliding Scale using HUM Insulin 5. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild/Fever 6. Apixaban 2.5 mg PO BID 7. Atorvastatin 20 mg PO QPM 8. Cyanocobalamin 1000 mcg PO DAILY 9. Ferrous Sulfate 325 mg PO DAILY 10. Gabapentin 600 mg PO DAILY 11. Lisinopril 10 mg PO DAILY 12. Senna 8.6 mg PO BID:PRN Constipation - First Line 13. Tamoxifen Citrate 20 mg PO DAILY 14. Torsemide 140 mg PO DAILY 15. Vitamin D 400 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right leg cellulitis Wrist pain Diabetes with hypoglycemia Acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during your recent hospitalization. You came to the hospital with right wrist and leg pain. Further testing showed that you had an infection of your right shin. There was no fractures in any bones. Your skin infection improved with antibiotics. You are now being discharged, but will need to continue taking antibiotics. It is important that you continue to take your medications as prescribed and follow up with the appointments listed below. Good luck! Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Brimonidine Tartrate 0.15% Ophth. 1 DROP RIGHT EYE Q8H 2. Bumetanide 2 mg PO DAILY 3. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP RIGHT EYE BID 4. Humalog ___ 15 Units Lunch 5. Lidocaine 5% Patch 1 PTCH TD QAM 6. Ketorolac 0.4 % OPHTHALMIC TID Right Eye 7. Tricor (fenofibrate nanocrystallized) 145 mg oral Daily 8. Vigamox (moxifloxacin) 0.5 % ophthalmic TID Left Eye 9. Metoprolol Succinate XL 25 mg PO DAILY CHF RX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 10. Ranitidine 150 mg PO DAILY RX *ranitidine HCl 150 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*2 11. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*2 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Diastolic Heart Failure Community Acquired Pneumonia Chronic Kidney Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure participating in your care. You were admitted to ___ for shortness of breath. We saw on chest X-ray that you had small fluid collections on both lungs. We sampled the fluid on the right lung and performed a number of other tests to see what was causing it. At this time we believe it is from congestive heart failure. For your shortness of breath, we also treated you with antibiotics for a community acquired pneumonia. Please continue this medicine (Levofloxacin) for one more day. When you were admitted, some of your blood tests (troponin) were concerning for damage to your heart. We monitored the projection of this blood test and at this time believe this is not due to a heart attack, but rather poor clearance of this chemical by your kidneys. Going forward, we have started you on the medicine Metoprolol to try to prevent worsening heart failure. We also started you on an aspirin daily. You can also try to keep yourself out of the hospital with heart failure exacerbations by limiting your intake of sodium to no more than 2 grams daily.</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 were here because your blood sugar was found to be very low and your heart was beating very slow. While your were here, your insulin was decreased so your sugars would not get too low. We also stopped one of your medications (propranolol/metoprolol) which can prevent you from feeling the signs of low blood sugar. When you leave, it is important to take your medications as prescribed. Make sure to check your sugar at least 4 times daily, with a value first thing in the morning and before every meal. If you have any feelings of dizziness, feeling "foggy," or shaky, check your blood sugar immediately. ****Before you give yourself insulin in the morning, please check your sugar levels. If your sugar is below 100 in the morning, please eat something and check again. If your sugar is above 100 at that time, you may give yourself the long acting insulin (lantus) that we prescribed you. If your sugar is above 350, please contact your primary care physician about your insulin regimen**** Also, make sure to look for any signs of bleeding, including bright red blood in your stool or dark, tarry stools. Come bake to the ER immediately if you notice this. We wish you the best of luck! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Alendronate Sodium 70 mg PO QMON Takes weekly. 2. Atorvastatin 80 mg PO QPM 3. calcium carbonate-vitamin D3 600 mg(1,500mg) -400 unit oral DAILY 4. Furosemide 20 mg PO 3X/WEEK (___) 5. Metoprolol Succinate XL 50 mg PO DAILY 6. Ocuvite with Lutein (vit A,C and E-lutein-minerals) 1,000 unit-200 mg-60 unit-2 mg oral DAILY 7. Omeprazole 20 mg PO DAILY 8. Sarna Lotion 1 Appl TP BID:PRN itching Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: left displaced scapular body 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>Dear Ms. ___, You were admitted to the Acute Care Surgery Service on ___ after a fall sustaining a fracture in your left scapula also known as the shoulder bone or shoulder blade. You were seen and evaluated by the orthopedic surgeon who recommend non-operative management with a sling for comfort. You can use your left arm as tolerated. You were seen by the physical therapist who recommend you are discharged from the hospital to rehab. You are now doing better and ready to be discharged to rehab to continue your recovery. Please note the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 50 mg PO DAILY 2. TraZODone 50 mg PO HS:PRN insomnia 3. Fluoxetine 20 mg PO DAILY RX *fluoxetine 20 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 4. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 6. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Viagra (sildenafil) ___ mg oral prn sexual activity Discharge Disposition: Home Discharge Diagnosis: PRIMARY: 1. alcoholic hepatitis 2. bilateral lower extremity edema 3. alcohol abuse Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___. You came into the hospital because you were concerned about swelling in your legs and your drinking. While you were here, we found that your liver enzymes were elevated meaning your liver was irritated and inflammed. We think that th emost likely cause of this is alcoholic hepatitis. We talked about the importance of abstaining from alcohol to prevent downstream complications from heavy drinking, including cirrhosis. We also talked about immediate health benefits including improvement in your blood pressure and weight. We are excited that you are taking this important step in your life to stay healthy. You should look out for withdrawal symptoms from alcohol including nausea, tremors and shaking, hearing or seeing things that aren't there, and feeling things on your skin. If you feel these, call your doctor for further advice. The lower extremity swelling that you experienced we think is most likely related to poor nutrition since you had been drinking a lot. We gave you compression stockings to help get rid of some of the swelling. We started you an anti-depressant called prozac. We also changed your blood pressure medication, atenolol, to once daily because your blood pressure was very well controlled while in the hospital. We wish you all the best, Your primary medicine team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear ___ was a pleasure to take care of you at ___. WHY WERE YOU HERE? You were admitted to the hospital because you felt weak WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL - While you were in the hospital, you had build up of urine in your bladder - Tests showed your kidney function was not working properly, but it was fixed with fluids - Some of your medications were changed. We increased your amlodipine (blood pressure medication) and held your lisinopril and hydrochlorthiazide (other blood pressure medications). WHAT SHOULD YOU DO WHEN YOU GET HOME? 1) Please follow up at your outpatient appointments. 2) Please take your medications as prescribed. 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: [/INST] </s><s>You were admitted to the hospital with a bloodstream infection. You also were found to have a pneumonia. You were treated with IV antibiotics and IV fluids. You were seen by the infectious disease service. You will need to continue to take antibiotics after you leave the hospital.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO BID maximum 2 grams per day RX *acetaminophen 500 mg ___ tablet(s) by mouth twice a day Disp #*120 Tablet Refills:*0 2. Furosemide 20 mg PO DAILY RX *furosemide 20 mg 1 tablet(s) by mouth once a day Disp #*14 Tablet Refills:*0 3. Multivitamins W/minerals 1 TAB PO DAILY 4. Nicotine Patch 14 mg/day TD DAILY RX *nicotine 14 mg/24 hour 1 patch once a day Disp #*30 Patch Refills:*0 5. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 17 g by mouth once a day Refills:*0 6. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 7. Tresiba 7 Units Bedtime Insulin SC Sliding Scale using novolog Insulin 8. Morphine Sulfate ___ 45 mg PO Q4H:PRN Pain - Moderate temporary increase in dosage RX *morphine 15 mg 1 tablet(s) by mouth every four (4) hours Disp #*40 Tablet Refills:*0 9. Bismuth Subsalicylate 15 mL PO TID:PRN abdominal cramping 10. Creon 12 3 CAP PO TID W/MEALS 11. Desipramine 50 mg PO QHS 12. DICYCLOMine 20 mg PO TID:PRN abdominal cramping 13. Morphine SR (MS ___ 30 mg PO DAILY 14. Ondansetron ODT 4 mg PO Q8H:PRN Nausea/Vomiting - Second Line 15. Pantoprazole 40 mg PO Q24H 16. Pregabalin 300 mg PO BID 17. HELD- Tizanidine 8 mg PO TID This medication was held. Do not restart Tizanidine until you see your PCP/pain doctor and BP is better Discharge Disposition: Home Discharge Diagnosis: Acute on chronic abdominal pain Colitis Cirrhosis Type 1 diabetes mellitus Hypotension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted for evaluation of abdominal pain and inflammation of your colon seen on CT scan. You were seen by our GI team. We ruled out infection in your colon. The cause of your inflammation in unclear, but possibly related to low blood supply or as a result of your liver disease. We recommend close follow up in our GI clinic for ongoing care. We also found that you have failure of your liver called cirrhosis. It is very important that you abstain from any alcohol. We recommend close follow up our liver doctors for this. You have been given a limited increase in your morphine. It is very important that you speak to your pain doctor about this and follow up closely in that clinic. DO not drive or drink alcohol on this medication. You were also started on medication called Lasix to help reduce fluid in your legs and abdomen. As we discussed, if you feel dizzy or lightheaded, drink fluids and talk with your primary care doctor since this medication can increase risk of dehydration. For the stye on your left eyelid, would encourage warm compresses on the face for about 15 minutes four times per day, in order to facilitate drainage. Massage and gentle wiping of the affected eyelid after the warm compress can also aid in drainage. There is little evidence that treatment with topical antibiotics and/or glucocorticoids promotes healing. Your primary care doctor can re-assess later this week and if not improving, can consider whether steroids should be used.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 2. dextromethorphan-guaifenesin ___ mg/5 mL Syrup Sig: ___ MLs PO Q4H (every 4 hours) as needed for cough. 3. benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3 times a day) as needed for cough. Disp:*30 Capsule(s)* Refills:*0* 4. labetalol 200 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: hold until instructed to restart by your primary care provider. 6. omega-3 fatty acids Capsule Sig: One (1) Capsule PO BID (2 times a day). 7. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 8. pravastatin 40 mg Tablet Sig: One (1) Tablet PO once a day. 9. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 10. Ambien 10 mg Tablet Sig: One (1) Tablet PO at bedtime. 11. oxycodone-acetaminophen ___ mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. 12. lorazepam 1 mg Tablet Sig: One (1) Tablet PO once a day as needed for anxiety. 13. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day for 3 days: Complete a five day course. First day ___. Disp:*3 Tablet(s)* Refills:*0* 15. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for fever or pain. 16. diltiazem HCl 120 mg Capsule, Extended Release Sig: One (1) Capsule, Extended Release PO DAILY (Daily). Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Pneumonia Secondary diagnosis: Atrial fibrillation, 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. ___, You were evaluated for your lightheadedness and cough. During your emergency department evaluation you had a chest x-ray consistent with a pneumonia. You were started on the antibiotic levoquin and admitted to the intensive care unit and then transferred to the regular unit as you improved. We recommend you have repeat chest x-ray in about 1 month to confirm resolution of the lung changes. The following changes were made to your medications: # START levofloxacin 750mg daily for 3 more days # stop your coumadin until instructed to restart by your primary care provider.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. GlipiZIDE 2.5 mg PO DAILY 2. MetFORMIN (Glucophage) 1000 mg PO BID 3. Simvastatin 20 mg PO QPM 4. Venlafaxine XR 75 mg PO DAILY 5. Acetaminophen 325-650 mg PO Q6H:PRN fever or pain 6. LeVETiracetam 1000 mg PO BID 7. Lisinopril 5 mg PO DAILY 8. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 9. Dexamethasone taper Discharge Disposition: Home Discharge Diagnosis: Brain tumor Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Surgery •You underwent surgery to remove a tumor from your brain. •Frozen preliminary was: glioblastoma •Please keep your incision dry until your staples are removed. •You may shower at this time but keep your incision dry. •It is best to keep your incision open to air but it is ok to cover it when outside. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •If you experienced a seizure while admitted, you are NOT allowed to drive by law. •No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications •Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. •You have been discharged on a Decadron (dexamethsone) taper. Please take this medication as follows: -4mg every 6 hours x 8 doses (2 days); then, -4mg every 12 hours x 4 doses (2 days); then, -2mg every 6 hours x 8 doses (2 days); then, -2mg every 12 hours x 4 doses (2 days); then, -2mg once daily until follow-up appointment •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •You may experience headaches and incisional pain. •You may also experience some post-operative swelling around your face and eyes. This is normal after surgery and most noticeable on the second and third day of surgery. You apply ice or a cool or warm washcloth to your eyes to help with the swelling. The swelling will be its worse in the morning after laying flat from sleeping but decrease when up. •You may experience soreness with chewing. This is normal from the surgery and will improve with time. Softer foods may be easier during this time. •Feeling more tired or restlessness is also common. •Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Lisinopril 20 mg PO DAILY 3. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 4. Atorvastatin 80 mg PO QPM to treat your cholesterol. RX *atorvastatin 80 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 5. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY to treat your blood pressure and heart. RX *isosorbide mononitrate 30 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 6. Albuterol Inhaler ___ PUFF IH Q4H:PRN shortness of breath RX *albuterol sulfate 90 mcg ___ puffs inhaled every four hours Disp #*1 Inhaler Refills:*0 Discharge Disposition: Home Discharge Diagnosis: #chest pain #microvascular CAD #hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, It was a pleasure caring for you during your hospitalization at ___. You presented at our emergency department for chest pain and shortness of breath after shoveling snow. In the emergency department, the heart marker in your blood, called troponin, was normal and your ECG showed some changes, which were already seen on a prior ECG. We got an image of your lungs, which was normal. You received aspirin and nitroglycerin, which improved your pain. As your chest pain and dyspnea are symptoms raising concern for disease in the vessels that supply your heart with blood, called coronary vessels, you were admitted to our cardiology floor. You were treated with your home blood pressure medication and atorvastatin 80 mg. You underwent a catheterization to check your coronary vessels, which did not show any blockage. As you noticed that you are wheezing from time to time, we recommend have lung function testing. If you get chest pain, chest tightness, shortness of breath, palpitations, dizziness, lightheadedness, leg swelling or syncopes, please contact your doctor urgently. ** Do not take viagra or cialis while taking Imdur (isosorbide moninitrate) because this can cause an unsafe drop in blood pressure** Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Aspirin 81 mg PO 3X/WEEK (___) 3. Cyanocobalamin 500 mcg PO DAILY 4. Fluticasone Propionate NASAL 1 SPRY NU DAILY 5. Memantine 10 mg PO BID 6. Neutra-Phos 1 PKT PO 2X/WEEK (MO,TH) 7. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Acute pancreatitis Dementia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted with abdominal pain caused by inflammation in your pancreas. We could not identify a clear cause. With time you improved. Please drink lots of fluid and eat a low fat diet. It is very important that you follow up with your PCP as scheduled, as well as GI. We recommend follow up imaging of your pancreas once the inflammation subsides to exclude an underlying process</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN dyspnea 3. Allopurinol ___ mg PO DAILY 4. Ascorbic Acid ___ mg PO BID 5. Calcium Carbonate 500 mg PO DAILY 6. Furosemide 60 mg PO DAILY hold for sbp<100 7. Levothyroxine Sodium 88 mcg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Senna 1 TAB PO BID 10. Vitamin D ___ UNIT PO DAILY 11. Humalog ___ 10 Units Breakfast 12. Metoprolol Tartrate 37.5 mg PO BID hold for sbp < 90 13. Pantoprazole 40 mg PO Q12H 14. Lorazepam 0.5 mg IV Q6H:PRN nausea please hold for rr<12, altered mental status 15. Ondansetron 4 mg IV Q8H:PRN nausea 16. nystatin *NF* 100,000 unit/g Topical BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Gastro-intestinal bleed secondary to gastric tumor Discharge Condition: Condition: stable Mental Status: alert and oriented x3. Clear. Pleasant and conversant Ambulatory status: non-ambulatory Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___! You were admitted because of a gastro-intestinal bleed. We monitored your blood counts, and they were stable while you were hospitalized. Multiple teams of doctors ___ in your care including medicine, gastrointestinal medicine, surgical oncology, medical oncology, and radiation oncology. Tests showed that you have a large stomach cancer. We set up appointments with you for follow-up with the cancer doctors once ___ leave the hospital. You are now ready for discharge back to your nursing home. Please see below regarding follow-up appointments.</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. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB 3. Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN heart burn 4. ClonazePAM 0.5 mg PO BID:PRN anxiety 5. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 6. Fluvoxamine Maleate 200 mg PO HS 7. Fluvoxamine Maleate 100 mg PO DAILY 8. Nasonex (mometasone) 50 mcg/actuation nasal DAILY 9. Pantoprazole 40 mg PO Q24H 10. Rifaximin 550 mg PO TID Discharge Disposition: Home Discharge Diagnosis: Non epileptic events Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the Neurology ICU after an episode of generalized stiffening during which you required ventilator support. After extubation, your brain wave activity was monitored on EEG during multiple episodes and we found no evidence of seizure activity. Your neurologic exam remained completely normal. We did not change any of your medications and discharged you home in stable condition. It has been a pleasure caring for you, Your ___ Neurology team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Bisacodyl 10 mg PR QHS:PRN constipation 3. Levothyroxine Sodium 75 mcg PO DAILY 4. Polyethylene Glycol 17 g PO DAILY 5. Senna 17.2 mg PO QHS:PRN constipation 6. Citracal Regular (calcium citrate-vitamin D3) 250 mg calcium- 200 unit PO DAILY 7. Docusate Sodium 100 mg PO BID 8. Magnesium Citrate 300 mL PO DAILY:PRN constipation 9. Vitamin B Complex 1 CAP PO DAILY 10. Vitamin D 400 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Pubic symphysis fracture or osteitis pubis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>___, It was a pleasure to care for you. On the MRI we saw swelling exactly where you are having pain. This pain will get better with time, but it may take some time. For some patients it takes several months to go away. We usually recommend ibuprofen but you cannot take this so instead we would recommend Tylenol. As we discussed, you can walk and do things as you can tolerate.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain, fever. 2. raltegravir 400 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for Chest pain: KEEP ONE PILL UNDER TONGUE FOR CHEST PAIN, REPEAT 2 TIMES EVERY 5 MINUTES IF PAIN NOT RESOLVED. 5. atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): NO SUBSTITUTION . 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). Disp:*60 Capsule(s)* Refills:*2* 7. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every four (4) hours as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 8. temazepam 15 mg Capsule Sig: One (1) Capsule PO HS (at bedtime) as needed for insomnia. 9. emtricitabine-tenofovir 200-300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 10. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 11. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 12. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): Hold for loose stools/patient may refuse . 13. Heparin Flush (10 units/ml) 2 mL IV PRN line flush Mid-line, heparin dependent: Flush with 10 mL Normal Saline followed by Heparin as above, daily and PRN per lumen. 14. ceftriaxone 1 gram Recon Soln Sig: One (1) Intravenous once a day for 9 days. Disp:*QS QS* Refills:*0* 15. Outpatient Lab Work please obtain screening labs next ___ including CBCw/diff, bun/cr and LFTs. Results can be faxed to ___ clinic at ___ ___, MD. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Gram negative bacteremia, nephrolithiasis, hydronephrosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>-Please also refer to the handout provided on ""Taking Care of Your Nephrostomy Tube" NEPHROSTOMY TUBE INSTRUCTIONS FOR CARE---FOR ___ & FAMILY: Please leave LEFT PCN tube to external gravity drainage and flush forward with 10 mL normal saline solution twice daily to maintain tube patency. Please monitor and record urine output from the PCN tube. Catheter flushing: If there are excessive blood clots or debris or thick urine within the connecting tubing, this can also be flushed as needed to clear from the stopcock into the drainage bag. Change dressing daily. Gently cleanse around the skin entry site of the catheter with povidone iodine or dilute hydrogen peroxide. Dry and apply sterile gauze dressing. Catheter security: a) Every shift, check to be sure the catheter, the connecting tubing and thedrainage bag are securely attached to the patient and are not kinked. b) If the catheter appears ___ pulling, please notify Interventional Radiology. c) If the catheter pulls out, please notify Interventional Radiology with in 8 hours. SAVE THE CATHETER for us to inspect. Do not throw it away. Call Angio for ANY catheter related questions or problems. ___ or Fellow/Resident (___) Catheter is attached to drainage bag for external drainage; please measure and record the net output every shift (or more often if the urine output is high). DISCHARGE INSTRUCTIONS --No vigorous physical activity for 2 weeks. -Expect to see occasional blood in your urine and to experience urgency and frequency over the next month. -You may experience some pain associated with spasm of your ureter. This is normal. Take the narcotic pain medication as prescribed if additional pain relief is needed. -Tylenol should be your first line pain medication, a narcotic pain medication has beenprescribed for breakthrough pain >4. Replace Tylenol with narcotic pain medication. -Max daily Tylenol (acetaminophen) dose is 4 grams from ALL sources, note that narcotic pain medication also contains Tylenol -Make sure you drink plenty of fluids to help keep yourself hydrated and facilitate passage of stone fragments (if applicable). -You may shower but do not bathe or immerse in water. -Do not drive or drink alcohol while taking narcotics or operate dangerous machinery -Colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. Discontinue if loose stool or diarrhea develops. Colace is a stool softener, NOT a laxative -Resume all of your PRE-admission/home medications, unless otherwise noted. -Call your urologist’s office for follow-up AND if you have any questions. -You will be discharged home with visiting nurse services to facilitate care of your left PCN and administration of your IV antibiotics--please complete the course as instructed. -Resume your pre-admission/home medications except as noted. ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CefTRIAXone 2 gm IV Q 24H RX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 2 g IV Q24H Disp #*5 Intravenous Bag Refills:*0 2. Apixaban 2.5 mg PO BID RX *apixaban [Eliquis] 2.5 mg 1 (One) tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 4. Acyclovir 400 mg PO Q12H 5. Albuterol Inhaler ___ PUFF IH Q6H:PRN SOB 6. Aspirin 81 mg PO DAILY 7. Atorvastatin 80 mg PO DAILY 8. Calcium Carbonate 500 mg PO DAILY 9. Dexamethasone 4 mg PO ASDIR 10. Docusate Sodium 100 mg PO BID:PRN constipation 11. GuaiFENesin ___ mL PO Q6H:PRN cough 12. Metoprolol Succinate XL 37.5 mg PO DAILY 13. ___ ___ UNIT PO Q8H 14. Omeprazole 20 mg PO BID 15. Pomalyst (pomalidomide) 4 mg oral EVERY OTHER DAY 16. PredniSONE 7.5 mg PO DAILY 17. Senna 8.6 mg PO BID:PRN constipation 18. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 19. Tamsulosin 0.4 mg PO QHS 20. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Strep viridans bacteremia hematuria bright red bleeding per rectum multiple myeloma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you at the ___ ___. You came to the hospital because you developed weakness at home. We found that you have an infection in your blood. You spent one day in the Intensive Care Unit because of this infection. We treated you with antibiotics and you got better with this treatment. We do not know the source of your infection. You will continue to receive antibiotics for several days at home after you leave the hospital. You also retained urine while in the hospital so we placed a foley catheter to help you urinate. You had some blood in your urine and your stools. When you go home, you will have a foley catheter in place. You have an outpatient appointment scheduled with a urologist, they will determine when your foley catheter can be removed. Please continue to follow-up with your doctors as ___ and to take your medications as prescribed. 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. Lorazepam 0.5 mg PO Q4H:PRN anxiety 2. Acetaminophen 650 mg PO Q6H:PRN pain 3. Amiloride HCl 20 mg PO DAILY RX *amiloride 5 mg 4 tablet(s) by mouth daily Disp #*120 Tablet Refills:*0 4. Docusate Sodium 100 mg PO BID:PRN constipation 5. Fentanyl Patch 25 mcg/h TD Q72H RX *fentanyl 25 mcg/hour apply 1 patch change every 72 hours Disp #*10 Transdermal Patch Refills:*0 6. Fentanyl Patch 12 mcg/h TD Q72H use this in addition to the 25mcg/h patch for total daily of 37 mcg/h RX *fentanyl 12 mcg/hour apply to skin new patch every 72 hours Disp #*30 Transdermal Patch Refills:*0 7. Heparin Flush (10 units/ml) 5 mL IV DAILY and PRN, line flush 8. Lidocaine 5% Patch 3 PTCH TD QAM apply these daily to affected areas. 12 hours on and 12 hours off daily. RX *lidocaine [Lidoderm] 5 % (700 mg/patch) use three patches apply to affected area daily, 12 hours on 12 hours off Disp #*120 Transdermal Patch Refills:*0 9. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 10 mg 1 to 1.5 tablet(s) by mouth every 4 hours Disp #*200 Tablet Refills:*0 10. Senna 1 TAB PO BID:PRN constipation 11. Simethicone 40-80 mg PO QID:PRN gas 12. Pantoprazole 40 mg PO Q24H 13. Polyethylene Glycol 17 g PO DAILY:PRN constipation 14. Ranitidine 150 mg PO DAILY 15. Potassium Chloride (Powder) 10 mEq PO DAILY Hold for K > RX *potassium chloride [Klor-Con] 20 mEq one half packet by mouth daily Disp #*30 Packet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Pancreatitis secondary to pancreatic tail mass SECONDARY DIAGNOSIS: Small cell laryngeal cancer with diffuse metastases Hypokalemia from cesium toxicity Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Hi Mr. ___, It was a pleasure taking care of you during your recent admission. You were admitted with pancreatitis from your cancer. You underwent stenting of the pancreas which ultimately seemed to improve your ability to eat without vomiting. You also had severely low potassium which was most likely due to taking cesium in the past. We started a medication called amiloride to prevent you from urinating out all of your potassium and it seemed to work well. We also started a fentanyl patch and a few other things for pain control.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gabapentin 300 mg PO TID 2. PrevPAC *NF* (amoxicil-clarithromy-lansopraz) 500-500-30 mg Oral twice daily Duration: 10 Days Take right before meals. First dose in the morning, second dose in the evening RX *amoxicil-clarithromy-lansopraz [Prevpac] 30 mg-500 mg-500 mg 0.5 (One half) pack by mouth twice daily Disp #*10 Packet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Epigastric abdominal pain, gallstones (with no evidence of 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 surgery service at ___ for evaluation and treatment of your abdominal pain. You have done well in the hospital and are now safe to return home to complete your recovery with the following instructions: Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. Please call your doctor or nurse practitioner if you experience the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain is not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you.</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 RX *multivitamin,tx-minerals [Vitamins and Minerals] 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. PredniSONE 40 mg PO DAILY Please take at this dose until discussing further with your outpatient gastroenterologist RX *prednisone [Deltasone] 20 mg 2 tablet(s) by mouth Daily Disp #*60 Tablet Refills:*0 3. Hydrocortisone Acetate Suppository 1 SUPP PR QHS:PRN flare 4. Hydrocortisone Enema 100 mg PR QHS:PRN flare 5. Asacol HD (mesalamine) 1600 mg oral TID 6. Mesalamine (Rectal) 1000 mg PR QHS 7. HELD- Budesonide 9 mg PO DAILY This medication was held. Do not restart Budesonide until you discuss re-starting with your outpatient gastroenterologist Discharge Disposition: Home Discharge Diagnosis: Primary: Severe ulcerative colitis flare Anemia Diarrhea 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 Mr. ___, It was a pleasure taking part in your care. You were admitted to ___ on ___ for frequent bloody diarrhea, abdominal pain, and fevers. A number of studies were conducted, which did not show evidence of any obvious infection. The gastroenterology doctors performed ___ flexible sigmoidoscopy on ___ which found extensive inflammation in your lower colon, likely due to a severe ulcerative colitis flare. You received intravenous steroids for 2 days to which you had a positive response, and your laboratory tests improved, showing less inflammation. At the time of discharge from the hospital, you were feeling much better with fewer bowel movements. The IV steroids were switched to an oral form, and you should continue this until you meet up with Dr. ___ in ___ weeks to discuss the steroid taper plan as well as possibly starting TNF-inhibitor therapy. You may resume your home mesalamine and hydrocortisone medications but please limit enemas to once nightly and do not take budesonide until instructed to by your outpatient gastroenterology doctor. 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. Divalproex (DELayed Release) 875 mg PO QAM RX *divalproex ___ mg 7 capsule(s) by mouth daily in the morning Disp #*210 Capsule Refills:*3 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 3. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO QID:PRN indigestion 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 10 mg PO QPM 6. Bisacodyl ___AILY:PRN constipation 7. Divalproex (DELayed Release) 1000 mg PO QPM 8. Docusate Sodium 200 mg PO DAILY 9. Fleet Enema (Saline) ___AILY:PRN constipation 10. LevETIRAcetam 500 mg PO BID 11. Milk of Magnesia 30 mL PO DAILY:PRN constipation 12. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Breakthrough seizure Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Mental Status: Confused - sometimes. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the Neurology Service at ___ after you had a prolonged seizure, which we believe was due to having a low level of Depakote, your anti-seizure medication. You received extra medication and did not have any more seizures. We increased your Depakote dose by 125mg to 875mg qam / 1000mg qpm. It is unclear why your Depakote level was so low, but on the new dose, your level was at a good level (90). We monitored you for fever or other signs of infection that also might have predisposed you to having a seizure, but did not find evidence of this. It is important that after discharge you continue to take all your medications, particularly your anti-seizure medications, on time as prescribed, as this should minimize your chances of having future seizures. Medication changes: - Increase your Depakote to 875mg qam + 1000mg qpm. After discharge, you should follow up with both your primary care provider and neurologist. You should call your primary care provider to arrange an appointment within the next ___ weeks, and we will set up your follow-up appointment in neurology clinic. You should also have bloodwork done in one week to check your Depakote level to make sure your medication dose is adequate. It was our pleasure taking care of you during your stay. All the best, ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Cyanocobalamin 500 mcg PO DAILY 3. Diltiazem Extended-Release 120 mg PO BID 4. Ferrous Sulfate 325 mg PO BID 5. Humalog ___ 10 Units Breakfast 6. Lisinopril 5 mg PO DAILY 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Simvastatin 10 mg PO QPM 10. Vitamin D 1000 UNIT PO DAILY 11. Warfarin 2 mg PO 6X/WEEK (___) 12. Potassium Chloride 20 mEq PO DAILY Hold for K > 13. Warfarin 4 mg PO 1X/WEEK (SA) 14. Torsemide 60 mg PO DAILY RX *torsemide 10 mg 1 tablet(s) by mouth daily Disp #*10 Tablet Refills:*0 RX *torsemide 20 mg 3 tablet(s) by mouth daily Disp #*90 Tablet Refills:*0 15. Outpatient Lab Work Please draw chem7 on ___ and fax results to: ___. MD Phone: ___, Fax: ___ ICD-10 I50.3 Diastolic (congestive) heart failure Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnoses: Aortic stenosis Mitral regurgitation Acute on chronic diastolic heart failure Secondary diagnoses: Atrial fibrillation Chronic kidney disease Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized at ___ because you were having difficulty breathing. This was due to fluid in your lungs. This happened because your heart is not able to pump blood forward as effectively as it should. The major reason your heart has difficulty pumping blood is due to problems with two valves in your heart: one of them is leaky and one of them does not open all of the way. You decided that you did not want to have a procedure called a heart catheterization which would tell us more information about how well the valves were functioning. You also did not want any surgeries or procedures to fix or replace the valves. We increased your dose of torsemide to 60 mg, which should help prevent the build up of fluid in your lungs. You can take an additional 10 mg if your weight has increased by more than 2 lbs in a day. It was a pleasure participating in your care. We wish you all the best in the future. Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Furosemide 40 mg PO 3X/WEEK (___) 2. Cyanocobalamin 1000 mcg IM/SC QMONTH 3. Fish Oil (Omega 3) 1000 mg PO BID 4. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheeze, SOB 5. Aspirin 325 mg PO DAILY 6. Lidocaine 5% Patch 1 PTCH TD QAM 7. Metoprolol Succinate XL 50 mg PO DAILY 8. Omeprazole 20 mg PO BID 9. Simvastatin 20 mg PO QPM 10. Vitamin D ___ UNIT PO DAILY 11. Acetaminophen 650 mg PO TID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: Bilateral Deep Venous Thrombosis and Acute Exacerbation of Diastolic Heart Failure Secondary Diagnosis: HYPERTENSION OSTEOARTHRITIS Chronic kidney disease SPINAL STENOSIS - LUMBAR Hypercalcemia Hyperparathyroidism history of Gastrointestinal bleed Atrial fibrillation Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You were admitted because it was discovered that you had developed blood clots in your lower extremities. These blood clots were not causing you any significant discomfort and so it was decided that we would not treat them given the significant risks associated with treatment, namely a high risk of bleeding. You were also noted to have some evidence of fluid overload and so we have restarted your lasix (water pills).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 400 mg PO Q12H RX *cefpodoxime 200 mg 2 tablet(s) by mouth twice a day Disp #*18 Tablet Refills:*0 2. OxyCODONE (Immediate Release) 2.5-5 mg PO Q6H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four to six hours Disp #*25 Tablet Refills:*0 3. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 4. Atorvastatin 80 mg PO QPM 5. Bisacodyl ___AILY:PRN constipation 6. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -400 unit oral BID 7. Dabigatran Etexilate 75 mg PO BID 8. Docusate Sodium 100 mg PO DAILY:PRN constipation 9. LACOSamide 100 mg PO BID 10. Lisinopril 40 mg PO DAILY 11. LORazepam 2 mg IM PRN seizure > 5min 12. Metoprolol Succinate XL 12.5 mg PO DAILY 13. Milk of Magnesia 30 mL PO DAILY:PRN constipation 14. Multivitamins 1 TAB PO DAILY 15. Namzaric (memantine-donepezil) ___ mg oral QPM 16. Ranitidine 150 mg PO QHS 17. Senna 8.6 mg PO DAILY:PRN constipation 18. Travatan Z (travoprost) 0.004 % ophthalmic QPM Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: R hip 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>Discharge Instructions: INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - weight bearing as tolerated right lower extremity MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please continue your pradaxa. WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Please remain in your dressing and do not change unless it is visibly soaked or falling off. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet Physical Therapy: - weight bearing as tolerated RLE - range of motion as tolerated RLE Treatment Frequency: - dressing to come off on POD5 - if oozing, may place ABDs+tape - ok to leave incision open to air</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q12H 2. amLODIPine 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. Clopidogrel 75 mg PO DAILY to prevent stent thrombosis 6. Cyanocobalamin 250 mcg PO DAILY 7. FoLIC Acid 1 mg PO DAILY 8. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 9. Metoprolol Succinate XL 25 mg PO DAILY 10. Omeprazole 20 mg PO DAILY:PRN reflux 11. sevelamer CARBONATE 1600 mg PO TID W/MEALS 12. Torsemide 60 mg PO DAILY 13. Vitamin D ___ UNIT PO 1X/WEEK (SA) 14. Warfarin 7.5 mg PO 3X/WEEK (___) 15. Warfarin 5 mg PO 4X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Altered Mental Status Anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because you had an episode of confusion during your dialysis session. We this this was likely do to low blood pressure during your session. At the hospital you were found to have a low red blood cell level. You were given a transfusion of blood. When you leave the hospital you should follow up with all of your outpatient doctor's appointments. You should continue to take all of your medicine as prescribed. Weigh yourself every morning, call your doctor if weight goes up more than 3 lbs. It was a pleasure taking care of you. We wish you the best! Sincerely, Your ___ Treatment Team</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. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP RIGHT EYE BID 3. Acetaminophen 650 mg PO 3X/WEEK (___) RX *acetaminophen 650 mg 1 tablet(s) by mouth three times per week Disp #*30 Tablet Refills:*0 4. Atovaquone Suspension 1500 mg PO DAILY RX *atovaquone 750 mg/5 mL 1500 mg by mouth daily Refills:*0 5. Zidovudine 250 mg PO BID RX *zidovudine 100 mg 2.5 capsule by mouth twice daily Disp #*60 Capsule Refills:*0 6. ValGANCIclovir 900 mg PO Q12H RX *valganciclovir [Valcyte] 450 mg 2 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO BID Constipation RX *polyethylene glycol 3350 17 gram/dose 17 gram powder(s) by mouth twice daily Refills:*0 8. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice daily Disp #*30 Tablet Refills:*0 9. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every 6 hours as needed Disp #*15 Tablet Refills:*0 10. Maalox/Diphenhydramine/Lidocaine ___ mL PO TID:PRN Epigastric/Abdominal Pain RX *calcium-simethicone [Maalox Advanced] 1,000 mg-60 mg 1 tablet(s) by mouth three times daily as needed Disp #*30 Tablet Refills:*0 11. LaMIVudine 100 mg PO DAILY RX *lamivudine 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 12. Interferon Alfa-2B 3 Million Units SC 3/WEEK RX *interferon alfa-2b [Intron A] 6 million unit/mL 3 million units injection three times per week Disp #*12 Vial Refills:*0 13. Fluconazole 400 mg PO Q24H RX *fluconazole 200 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 14. Vancomycin Oral Liquid ___ mg PO Q6H RX *vancomycin 125 mg 1 capsule(s) by mouth every 6 hours Disp #*10 Capsule Refills:*0 15. Syringe 3cc/20Gx1 (syringe with needle (disp)) 3 mL 20 x 1 miscellaneous 3 times per week RX *syringe with needle (disp) 20 gauge X ___ three times per week Disp #*30 Syringe Refills:*0 16. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin 500 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Adult T-cell Leukemia/Lymphoma, CMV gastritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were admitted to the hospital on ___ and were diagnosed with HTLV-1 associated Adult T cell Leukemia/Lymphoma. ___ completed one round of chemotherapy and were then started on medications (Interferon and Zidovudine) to treat the HTLV-1 infection that is associated with your cancer. ___ were also started on several other antibiotics to treat and prevent infections. While ___ were in the hospital, ___ were also diagnosed with stomach ulcers and were started on medication to treat these ulcers. Please note the changes in medications: START: Interferon Alfa-2B 3 Million Units SC 3/WEEK (___) Zidovudine 250 mg PO/NG twice a day Atovaquone Suspension 1500 mg PO/NG DAILY Fluconazole 400 mg PO/NG daily Ciprofloxacin 500 mg PO twice a day ValGANCIclovir 900 mg PO twice a day LaMIVudine 100 mg PO DAILY Pantoprazole 40 mg PO twice a day We have set up a visiting nurse to help ___ with your medications. Please follow up with Dr. ___ on ___ (appointment has already been scheduled for ___. It was a pleasure meeting and taking care of ___ while ___ were in the hospital. -Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO BID PRN pain 2. Amlodipine 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Calcium Acetate 1334 mg PO TID W/MEALS 5. Combigan (brimonidine-timolol) 0.2-0.5 % ophthalmic BID 6. HydrALAzine 100 mg PO BID 7. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 8. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q6H:PRN dyspnea 9. Vancomycin 1000 mg IV HD PROTOCOL RX *vancomycin 1 gram 1 g IV once Disp #*1 Vial Refills:*0 10. Carvedilol 25 mg PO BID 11. Lisinopril 20 mg PO DAILY RX *lisinopril 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 12. Simvastatin 10 mg PO QPM 13. Warfarin 7.5 mg PO DAILY16 RX *warfarin [Coumadin] 7.5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES ================= 1. Atrial Fibrillation 2. Sinus Node Dysfunction SECONDARY DIAGNOSES =================== 1. ESRD 2. Hypertension 3. Type II diabetes mellitus 4. Lung cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during you admission to ___ ___. You were admitted for evaluation of slow heart rate and had a pacemaker placemennt. You will need to follow up in the cardiac device clinic on ___ to ensure your device is working properly. In addition, you were noted to have an abnormal heart rhythm called atrial fibrillation. You were started on a blood-thinning medication called warfarin to help reduce the risk of strokes. You will need to have your warfarin levels checked by your primary care physician to ensure you on the correct dose. Your will need to have your warfarin level checked tomorrow at your primary care physician's office (Dr. ___, you are scheduled to have this done at 1pm tomorrow. We hope you continue to feel better. - Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aripiprazole 20 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO DAILY 4. Clozapine 250 mg PO HS 5. Cyanocobalamin 250 mcg PO DAILY 6. ___ Oil (Omega 3) 1000 mg PO DAILY 7. Fluoxetine 60 mg PO DAILY 8. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 9. Gabapentin 1200 mg PO TID 10. Ibuprofen 800 mg PO Q8H:PRN pain 11. Lisinopril 2.5 mg PO DAILY 12. Multivitamins 1 TAB PO DAILY 13. Oxcarbazepine 600 mg PO BID 14. Tiotropium Bromide 1 CAP IH DAILY 15. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 16. Albuterol Inhaler 1 PUFF IH Q6H:PRN SOB 17. Levofloxacin 750 mg PO DAILY Please take through ___. RX *levofloxacin 750 mg 1 tablet(s) by mouth once a day Disp #*3 Tablet Refills:*0 18. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H Please take through ___. RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*10 Tablet Refills:*0 19. Outpatient Lab Work check ___ on ___. Fax results to HCA ACMS at ___. ICD-9: 453.42 20. Warfarin 5 mg PO DAILY16 21. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 22. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Recurrent aspiration pneumonia Supratherapeutic INR Secondary: Deep vein thrombosis COPD Coronary artery disease Schizophrenia Seizure disorder Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking part in your care during your admission to ___. As you know, you were admitted to our hospital with shortness of breath. Your lung exam, blood results and chest x-ray were consistent with pneumonia, or an inflammation in your lungs. This most likely occurred because food or water went to your lungs and caused some inflammation. Your condition improved on antibiotics while you were in the hospital. Your INR was also very high when you were admitted, meaning your blood was very thin. It is very important that you continue to take warfarin (Coumadin) as prescribed in order to prevent your INR from becoming too high or too low. Given that your INR sometimes becomes too high, it is important that you seek immediate medical attention if you hit your head or notice excessive bleeding of any kind. You are discharged home on 2 antibiotics, levofloxacin and metronidazole, which you are to take until ___. Please take your medications as prescribed and follow up with your doctors as detailed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ALPRAZolam 2 mg PO 5X/DAY:PRN anxiety 2. Diazepam 10 mg PO TID:PRN anxiety 3. Fentanyl Patch 450 mcg/h TD Q24H 4. Ondansetron 4 mg PO Q8H:PRN nausea 5. Topiramate (Topamax) 400 mg PO BID 6. Maxalt (rizatriptan) 10 mg oral daily: prn headache 7. zinc acetate 50 mg (zinc) oral TID 8. OxycoDONE Liquid ___ mg PO Q6H:PRN headache Hold for sedation or RR<12 9. Prochlorperazine ___AILY:PRN nausea/vomiting Hold for AMS, sedation or RR<12 10. Furosemide 20 mg PO DAILY:PRN leg swelling Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. Acute on chronic venous stasis 2. Altered mental status 3. Chronic headaches Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___. You were admitted because of increased swelling in your legs as well as some altered mental status. Your mental status improved once you were admitted and there were no lab or physical exam abnormalities to explain the change that both you and your father noticed at home. We suspect that these intermittent changes in mental status are most likely due to the high dose of pain medicine and anxiety medicines that you are taking, and possibly some changes in blood gases due to your obstructive sleep apnea. We recommend that you continue the evaluation/treatment of your sleep disorder with your PCP ___. ___. For your leg swelling, we did not believe that there was an infection, as you had no increase in your white blood cell count and no fevers. We treated the swelling with IV lasix initially and then a by mouth. Your pain and swelling improved with this. We recommend that you continue to wear compression hose, keep your legs elevated while resting, and continue to do physical therapy/stay active, as this will prevent reaccumulation of fluid. You should weigh yourself daily at home. He normally takes fentaNYL citrate 800 mcg buccal q4-6h:prn headache at home but this will not be available at ___, so this was held on discharge and he was rx'd oxycodone ___ mg Q6H prn headache. You should examine your legs daily. If you notice that they are swollen or red, please take your lasix 20 mg by mouth until the swelling resolves. Call your PCP if the swelling does not improve with your lasix.</s>