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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Escitalopram Oxalate 10 mg PO DAILY 3. Estrogens Conjugated 0.625 mg VG DAILY Duration: 3 Weeks 4. Hydrochlorothiazide 50 mg PO DAILY 5. Acetaminophen 650 mg PO Q6H:PRN pain RX *acetaminophen 325 mg 2 tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 6. TraMADOL (Ultram) 50 mg PO Q4H:PRN severe joint pain RX *tramadol 50 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 7. PredniSONE 5 mg PO daily Duration: 3 Days Start: After 10 mg tapered dose. Tapered dose - DOWN RX *prednisone 5 mg ___ tablet(s) by mouth as directed by taper Disp #*30 Tablet Refills:*0 8. Desonide 0.05% Cream 1 Appl TP BID Please apply to erythematous intertriginous regions of abdomen, groin. thanks! RX *desonide 0.05 % Apply to affected areas twice daily Disp #*1 Tube Refills:*0 9. Promethazine 25 mg PO TID:PRN nausea Give 30 minutes before meals if nausea RX *promethazine 25 mg 1 tablet by mouth three times a day before meals Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: Inverse psoriasis Calcium pyrophosphate dihydrate deposition disease (CPDD) Iron deficiency anemia Anemia of chronic disease Gait instability Cervical spondylosis 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 ___ at ___. ___ were admitted for worsening rashes on your abdomen and ear, as well as for shoulder pain. ___ were examined by our internal medicine, dermatology, and rheumatology, and neurology teams while ___ were here. Your skin rash is consistent with a condition called inverse psoriasis, for which dermatology recommended desonide cream 0.05% applied to the skin twice a day for no more than two weeks. ___ have a follow-up appointment with the dermatologists scheduled (See below). Your joint pain work up was consistent with a diagnosis of calcium pyrophosphate deposition disease (also called "pseudogout"). Your xrays of the knees and fluid analyzed from your knee joint helped to make this diagnosis of CPDD. ___ were placed on a steroid taper (see medication list), and have a follow-up appointment with the ___ clinic. ___ were found to have anemia. ___ were started on a daily iron supplement, which ___ should take with orange juice or other acidic drinks to improve absorption. Iron can make ___ constipated, so please continue your home bowel regimen. ___ were evaluated by the neurology team for your gait imbalance. They did not feel that this was the result of any acute process, however, they would like to see ___ in an outpatient follow-up appointment. They felt ___ had symptoms of cervical spondylosis (narrowing of the cerivcal spine) and recommended ___ wear a soft collar to help the symptoms. They also recommended the following lab tests to further workup your symtpoms: folate levels, SPEP, UPEP, RPR, ___. Please discuss with your PCP getting these labs drawn. ___ also have been complaining of nausea, weight loss, and night sweats. It is very important ___ discuss these symptoms with your PCP to determine what further workup is needed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 95 mg SC Q12H Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 100 mg/mL 95 mg SC twice a day Disp #*28 Syringe Refills:*0 2. Warfarin 5 mg PO DAILY16 RX *warfarin [Coumadin] 5 mg 1 tablet(s) by mouth once a day Disp #*14 Tablet Refills:*0 3. Acetaminophen ___ mg PO Q6H:PRN pain RX *acetaminophen 500 mg ___ tablet(s) by mouth every 6 hours Disp #*40 Tablet Refills:*2 Discharge Disposition: Home Discharge Diagnosis: bilateral pulmonary emboli Discharge Condition: Stable Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please take your medications as prescribed. Please call your primary care provider if you have any concerns regarding new chest pain, shortness of breath, or fever >100.4. If you are truly concerned, please go to the Emergency Room for further evaluation. In terms of post partum care, please be aware of the following warning signs and contact your primary OBGYN immediately if you have any of the following: Passing clots larger than a fist Heavy vaginal bleeding Fever greater than 101 Foul smelling blood Pain not adequately relieved with medication</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 30 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 40 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Acute Ischemic Stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, You were hospitalized due to symptoms of problems with speech, left facial droop, and left sided weakness resulting from an ACUTE ISCHEMIC STROKE, a condition in which a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: high blood pressure high cholesterol We are changing your medications as follows: aspirin 81 atorvastatin 40 Please take your other medications as prescribed. Please purchase a blood pressure cuff at your nearest pharmacy and start measuring your blood pressure daily. Keep a log of your blood pressures and bring them to every appointment. We also recommend a heart healthy diet (low fat, low salt), daily exercise, and stress reduction techniques. You were evaluated by ___ who recommended ___ rehab to help you improve your ability to walk, talk, and use your arms. Please follow up with Neurology, your Cardiologist, 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 - sudden difficulty pronouncing words (slurring of speech) - sudden blurring or doubling of vision - sudden onset of vertigo (sensation of your environment spinning around you) - sudden clumsiness of the arm and leg on one side or sudden tendency to fall to one side (left or right) - sudden severe headache accompanied by the inability to stay awake It was a pleasure providing you with care during this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Vancomycin Oral Liquid ___ mg PO Q6H RX *vancomycin 125 mg/2.5 mL 1 syringe(s) by mouth four times a day Disp #*56 Syringe Refills:*0 RX *vancomycin 125 mg/2.5 mL 1 syringe(s) by mouth daily Disp #*30 Syringe Refills:*0 2. Vancomycin Oral Liquid ___ mg PO DAILY prophylaxis cdiff AFTER ___omplete 3. PredniSONE 20 mg PO DAILY RX *prednisone [Deltasone] 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Sulfameth/Trimethoprim DS 1 TAB PO DAILY Discharge Disposition: Home Discharge Diagnosis: c.diff colitis ulcerative colitis 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 bloody diarrhea. You were found to have severe colitis due to a "c.diff" infection and ulcerative colitis flare. You were started on antibiotic medication....and given a dose of remicade on ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Morphine Sulfate (Concentrated Oral Soln) ___ mg PO Q1H:PRN pain, discomfort 2. OLANZapine (Disintegrating Tablet) 5 mg PO TID:PRN Aggitation 3. Acetaminophen 650 mg PR Q4H:PRN pain, fever 4. Lorazepam 0.5 mg SL Q4H:PRN aggitation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Acute ischemic stroke Hyperlipidemia Hypertension Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized due to symptoms of trouble with speech and swallowing 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 High cholesterol Please followup with Neurology and your primary care physician as listed below. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PR HS:PRN constipation 2. Calcium Carbonate 1000 mg PO BID 3. ClonazePAM 0.5 mg PO BID 4. Gabapentin 800 mg PO TID 5. LeVETiracetam 1000 mg PO BID 6. Multivitamins 1 TAB PO DAILY 7. Levothyroxine Sodium 50 mcg PO DAILY 8. Oxcarbazepine 300 mg PO BID 9. Oxcarbazepine 150 mg PO HS 10. Phenytoin (Suspension) 100 mg PO QAM 11. Phenytoin (Suspension) 200 mg PO QPM 12. Polyethylene Glycol 17 g PO DAILY:PRN constipation 13. Rufinamide 1600 mg PO BID 14. Sodium Chloride Nasal ___ SPRY NU QID:PRN nasal dryness 15. Vitamin D 400 UNIT PO DAILY 16. Baclofen 10 mg PO DAILY 17. Baclofen 5 mg PO BID 18. Calcitonin Salmon 200 UNIT NAS DAILY 19. Doxazosin 2 mg PO HS 20. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN shortness of breath/wheezing 21. Loratadine 10 mg PO DAILY 22. Nystatin Oral Suspension 5 mL PO TID:PRN oral thrush 23. Piperacillin-Tazobactam 4.5 g IV Q8H Q8H until ___. Vancomycin 750 mg IV Q 12H Q12 hours until ___, please check trough after 4th dose 25. clotrimazole 1 % Topical biweekly 26. DuoNeb (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 mL Inhalation q6h prn 27. FoLIC Acid 1 mg PO DAILY cough 28. Guaifenesin ___ mL PO Q6H:PRN congestion 29. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 30. mometasone 50 mcg/actuation NU BID PRN 31. Nitrofurantoin (Macrodantin) 50 mg PO HS 32. Pseudoephedrine 60 mg PO Q6H:PRN nasal consgestion Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Seizure Discharge Condition: Awake, follows only very occasional simple commands, non verbal. Not ambulatory. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for seizures and associated altered mental status. Your seizures occured in the setting of a low phenytoin level, and also while you were on certain antibiotics for a UTI which lower the seizure threshold. We gave you some extra dilantin, and sent you out on an increased dose of phenytoin. You improved back to your baseline, and we sent you home with the following updates and appointments: CHANGED MEDICATIONS Dilantin 125/100 changed to 175/100 Please make sure to go to the follow up appointments that are listed below. It was a pleasure taking care of you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 2. Atorvastatin 40 mg PO QPM 3. Fenofibrate 67 mg PO DAILY 4. Finasteride 5 mg PO DAILY 5. Ipratropium-Albuterol Neb 1 NEB NEB Q6H PRN shortness of breath 6. MetFORMIN XR (Glucophage XR) 500 mg PO DAILY 7. Pantoprazole 40 mg PO Q24H 8. Ranitidine 150 mg PO DAILY 9. Tamsulosin 0.4 mg PO QHS 10. Tiotropium Bromide 1 CAP IH DAILY 11. Vitamin D 1000 UNIT PO DAILY 12. HELD- losartan-hydrochlorothiazide 100-25 mg oral daily This medication was held. Do not restart losartan-hydrochlorothiazide until you follow up with your primary care doctor Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Orthostatic hypotension Secondary diagnosis: Acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because: - You were feeling dizzy and lightheaded - Your speech was slurred While you were here: - You had imaging of your brain which showed no evidence of a stroke - Our brain specialists evaluated you who agrees that there was no stroke or problem in the brain - You were given IV fluids - You worked with physical therapy and ultimately your walking, dizziness and weakness improved and you were discharged home When you leave: - Please take all of your medications as prescribed - Please make a follow up appointment with you primary care doctor It was a pleasure to care for you during your hospitalization! - Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. ipratropium bromide 0.02 % Solution Sig: One (1) INH Inhalation Q6H (every 6 hours) as needed for shortness of breath or wheezing. 4. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO HS (at bedtime). 6. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation every four (4) hours as needed for shortness of breath or wheezing. 7. camphor-menthol 0.5-0.5 % Lotion Sig: One (1) application Topical four times a day as needed for itching. 8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain, fever. 9. diphenhydramine HCl 25 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for itching. 10. metformin 1,000 mg Tablet Sig: One (1) Tablet PO once a day. 11. fluticasone 110 mcg/actuation Aerosol Sig: One (1) Puff Inhalation BID (2 times a day). 12. losartan 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 13. terazosin 5 mg Capsule Sig: Two (2) Capsule PO HS (at bedtime). 14. linezolid ___ mg Tablet Sig: One (1) Tablet PO twice a day for 17 doses. Disp:*17 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Pneumonia Cellulitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for fever and cough, and you were found to have an infection of your leg (cellulitis) and pneumonia. You were treated with intravenous antibiotics, which improved both the infection in your lung and leg. Changes to your medications: START linezolid ___ twice daily for 8 days (to treat your infection) It was a pleasure to take care of you at ___!</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 Reason for PRN duplicate override: Alternating agents for similar severity RX *acetaminophen 325 mg 2 tablet(s) by mouth every six (6) hours Disp #*40 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID please hold for loose stool RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 3. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity do NOT drink alcohol or drive while taking this medication RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 4. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*10 Tablet Refills:*0 5. Escitalopram Oxalate 15 mg 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>Dear Ms. ___, You were admitted to the hospital with acute appendicitis (inflammation of the appendix). You were taken to the operating room and had your appendix removed laparoscopically. You are now tolerating a regular diet and your pain has improved. You are now ready to be discharged home. Please follow the discharge instructions below to ensure a safe recovery: Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H RX *acetaminophen [Acetaminophen Extra Strength] 500 mg 2 tablet(s) by mouth three times daily Disp #*180 Tablet Refills:*0 2. Bisacodyl 10 mg PR ONCE Duration: 1 Dose RX *bisacodyl 10 mg 1 suppository(s) rectally daily as needed Disp #*30 Suppository Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice daily Disp #*60 Capsule Refills:*0 4. Narcan (naloxone) 4 mg/actuation nasal PRN RX *naloxone [Narcan] 4 mg/actuation 1 spray nasal as needed Disp #*1 Spray Refills:*3 5. Polyethylene Glycol 17 g PO BID RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 17 grams by mouth up to three times daily as needed Refills:*3 6. Senna 8.6 mg PO TID RX *sennosides [senna] 8.6 mg 1 tablet by mouth three times daily Disp #*90 Tablet Refills:*0 7. Fentanyl Patch 75 mcg/h TD Q72H RX *fentanyl 75 mcg/hour 1 patch every 72 hours Disp #*3 Patch Refills:*0 8. OxyCODONE (Immediate Release) 10 mg PO Q2H:PRN Pain - Severe RX *oxycodone 10 mg 1 tablet(s) by mouth every three hours as needed Disp #*50 Tablet Refills:*0 9. amLODIPine 10 mg PO DAILY 10. Ascorbic Acid ___ mg PO DAILY 11. Atorvastatin 80 mg PO QPM 12. Cyanocobalamin 3000 mcg PO DAILY 13. Famotidine 20 mg PO DAILY 14. Gabapentin 300 mg PO TID 15. HydrALAZINE 50 mg PO DAILY 16. MetFORMIN (Glucophage) 500 mg PO DAILY 17. Metoprolol Tartrate 50 mg PO DAILY 18. Multivitamins 1 TAB PO DAILY 19. Ondansetron 8 mg PO Q8H:PRN nausea 20. Prochlorperazine 10 mg PO Q8H:PRN nausea 21. Pyridoxine 100 mg PO DAILY 22. Spironolactone 50 mg PO DAILY 23. Vitamin D 4000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Rectal Cancer Pain Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You presented to the hospital with worsening of your back pain. You were seen by the palliative care team who adjusted your pain medications. Your pain improved, and so you were discharged on the new higher dose of fentanyl patch and oxycodone. Please continue to follow the precautions we discussed while on high doses of narcotics. In particular, if you do not have a bowel movement soon with the regimen we have prescribed you will need to contact your doctors for further instructions. We have prescribed you for about one week worth of pain medication, after which your outpatient providers ___ need to continue the prescriptions, and so as we discussed, it will be important to sort out which provider ___ be handling this and ensure close follow-up.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID:PRN constipation RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 3. Dexamethasone 2 mg PO DAILY Duration: 7 Days RX *dexamethasone 2 mg 1 tablet(s) by mouth once a day Disp #*7 Tablet Refills:*0 4. Bismuth Subsalicylate 30 mL PO TID:PRN diarrhea/nausea/abdominal pain 5. Lisinopril 20 mg PO DAILY 6. LOPERamide 4 mg PO TID:PRN diarrhea 7. LORazepam 0.5 mg PO BID:PRN anxiety,nausea 8. ___ ___ UNIT PO QID 9. Omeprazole 20 mg PO DAILY 10. Ondansetron 8 mg PO Q8H:PRN nausea/vomiting 11. Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting 12. TraMADol 50-100 mg PO Q6H:PRN Pain - Moderate Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Primary: Chemotherapy-related nausea Secondary: Pancreatic adenocarcinoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for nausea/vomiting/diarrhea and inability to tolerate food after your recent chemotherapy. You were given medicine which resolved your diarrhea and helped with nausea. Since you continued to have difficulty eating, you were started on a course of steroids. Please follow up with your oncologist to determine your ongoing chemotherapy plans. It was a pleasure caring for you, Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Codeine Sulfate 30 mg PO Q 8 HRS PRN pharyngitis 2. DiCYCLOmine 10 mg PO DAILY 3. Duloxetine 60 mg PO DAILY 4. Gabapentin 100 mg PO TID 5. Hydroxychloroquine Sulfate 400 mg PO QHS 6. Lorazepam 0.5 mg PO HS:PRN insomnia 7. NIFEdipine 30 mg PO QHS 8. Simvastatin 40 mg PO DAILY 9. TraZODone 50 mg PO HS:PRN insomnia 10. Triamterene-Hydrochlorothiazide (37.5/25) 1 CAP PO DAILY 11. DiphenhydrAMINE 25 mg PO Q6H:PRN itching 12. Sarna Lotion 1 Appl TP PRN itching 13. Vitamin D 50,000 UNIT PO 1X/WEEK (___) 14. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID lichen sclerosis 15. Potassium Chloride 40 mEq PO DAILY Duration: 24 Hours RX *potassium chloride 20 mEq 2 tablets PO daily Disp #*40 Packet Refills:*0 16. Ranitidine 150 mg PO BID RX *ranitidine HCl 150 mg 1 capsule(s) by mouth twice a day Disp #*60 Tablet Refills:*0 17. Maalox/Diphenhydramine/Lidocaine ___ mL PO PRN mouth pain RX *alum-mag hydroxide-simeth 200 mg-200 mg-20 mg/5 mL ___ mL by mouth daily Disp #*1 Bottle Refills:*0 18. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN throat pain RX *oxycodone 5 mg 1 capsule(s) by mouth every six (6) hours Disp #*15 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: ___ Syndrome Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to participate in your care at ___ ___. As you know, you were admitted for a rash over your entire body. The Dermatologists were consulted and believed that you had a reaction to a medicine that you were taking. Most likely this was a medication that you started recently, in particular Celecoxib. They also considered the possibility that you had an infection, however we have not identified an infectious source that would explain your symptoms. When the eye doctors saw ___, they did not believe you have involvement of your eyes with your rash. After you leave the hospital, please do not take any unnecessary medications. Do NOT restart taking Celecoxib or any NSAIDs including tylenol or ibuprofen. You will need to follow-up with Dermatology within the next 7 days, and with Allergy after your rash has resolved. Please call the allergist office at ___ to schedule an appointment. We also noted that your platelets were low; we think that this could be due to your omeprazole. We stopped your omeprazole, and started you on another acid medication.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___. You were hospitalized due to symptoms of left-sided weakness that was concerning for 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: - hypertension - history of tobacco use - large left heart chamber increasing risk of hear arrhythmia We gave you a medication called tPA, which helped break up the blood clot that caused the stroke. Your weakness improved after we gave you this medication. You got better from your stroke, but then you experienced some vomiting, and we found that you had a small bowel obstruction. We got CT scans of your abdomen, and put in an NG tube. The surgery team reduced a hernia which may have contributed to your small bowel obstruction. The GI doctors did ___ to look for Crohn's as a cause of your small bowel obstruction. They weren't able to get past a stricture, so they didn't get a full look at your intestines, but they did get to take a biopsy to look for Crohn's or other kinds of cancers. We didn't have the results back before you were discharged, but they said that you will be called with the results, and based on the results you can schedule follow up in the next two weeks. You also had some blood in your stool after your colonoscopy. However, they took biopsies so a small amount of blood is expected. Your hemoglobin was stable, and they will continue to check it at rehab. Your GI doctor can continue to follow your stool. The hematology doctors also saw ___ in the hospital because we were concerned about an abnormal number of white blood cells. They believe you have something called chronic lymphocytic leukemia (CLL). This is a blood disorder that doesn't have any treatment, but fortunately is not a malignant process. You will need to follow up with the hematologists for follow up as an outpatient, which we have scheduled for you. We are changing your medications as follows: Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body 35 minutes were spent on discharge. Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin 250 mg PO DAILY 2. Diazepam 10 mg PO Q8H:PRN msucle spasm 3. Docusate Sodium 100 mg PO BID 4. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 5. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q4H:PRN pain RX *oxycodone-acetaminophen 5 mg-325 mg ___ tablet(s) by mouth q4hrs Disp #*60 Tablet Refills:*0 6. Symbicort *NF* (budesonide-formoterol) 80-4.5 mcg/actuation INHALATION QDAY 7. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation INHALATION Q6HRS PRN sob Discharge Disposition: Home Discharge Diagnosis: back pain spinal lesions hypercalcemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please follow up as directed. •Do not smoke. •No pulling up, lifting more than 10 lbs., or excessive bending or twisting. •Limit your use of stairs to ___ times per day. •Increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. We recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •Clearance to drive and return to work will be addressed at your post-operative office visit.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levofloxacin 750 mg PO Q24H RX *levofloxacin [Levaquin] 750 mg 1 tablet(s) by mouth daily Disp #*10 Tablet Refills:*0 2. Glargine 18 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 3. Atorvastatin 10 mg PO QPM 4. Creon ___ CAP PO TID W/MEALS 5. LORazepam 0.5 mg PO Q6H:PRN nausea or insomnia 6. MethylPHENIDATE (Ritalin) 5 mg PO BID 7. Pantoprazole 40 mg PO Q24H Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Fever SECONDARY DIAGNOSES: Stage 2a pancreatic cancer S/p splenectomy 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 DID YOU COME TO THE HOSPITAL? --You came to the hospital because you had a fever at home WHAT HAPPENED WHILE YOU WERE AT THE HOSPITAL? --We checked you for an infection, and we can't find any evidence of infection --We treated you with antibiotics WHAT SHOULD YOU DO WHEN YOU GO HOME? --You should start taking levofloxacin (an antibiotic) that is once daily and complete five days of treatment total ___ to ___. --You will be discharged with extra doses of levofloxacin. If you EVER have a fever at home, you should take this medication and call your doctor ___. This is because you don't have a spleen and are at increased risk of infection. --The doctors in the hospital ___ call you if any of your culture data shows that you have an infection. If you develop symptoms concerning for infection, please call your doctor. Symptoms include abdominal pain, nausea/vomiting, diarrhea, congestion, fevers, cough. 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 TID 2. Docusate Sodium 100 mg PO BID 3. OxyCODONE (Immediate Release) ___ mg PO Q3H:PRN Pain - Moderate 4. Senna 8.6 mg PO BID 5. Tamsulosin 0.8 mg PO QHS 6. PredniSONE 10 mg PO DAILY take 10 mg daily until ___, and then increase to 20 mg daily 7. alfuzosin 10 mg oral DAILY 8. ClonazePAM 1 mg PO TID 9. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN SOB, wheezing 10. Nicotine Patch 14 mg TD DAILY 11. RisperiDONE 1 mg PO QHS 12. Sertraline 200 mg PO DAILY 13. Sulfameth/Trimethoprim DS 1 TAB PO DAILY 14. Tiotropium Bromide 1 CAP IH DAILY Discharge Disposition: Home Discharge Diagnosis: recurrent spontaneous left pneumothorax urinary retention Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, * You were admitted to the hospital for a recurrent episode of collapsed lung. You underwent decompression with chest tube placement and had a chemical pleurodesis (purposeful inflammation of your lung lining to prevent recurrent lung collapse) and you've recovered well. You are now ready for discharge. * It is crucial for your health that you stop smoking. * Continue to use your incentive spirometer 10 times an hour while awake. *Check your incisions daily and report any increased redness or drainage. Cover the area with a gauze pad if it is draining. * Your chest tube dressing may be removed in 48 hours. If it starts to drain, cover it with a clean dry dressing and change it as needed to keep site clean and dry. * You will continue to need pain medication once you are home but you can wean it over a few weeks as the discomfort resolves. Make sure that you have regular bowel movements while on narcotic pain medications as they are constipating which can cause more problems. Use a stool softener or gentle laxative to stay regular. * No driving while taking narcotic pain medication. * Take Tylenol ___ mg every 6 hours in between your narcotic. If your doctor allows you may also take Ibuprofen to help relieve the pain. * Continue to stay well hydrated and eat well to heal your incisions * Shower daily. Wash incision with mild soap & water, rinse, pat dry * No tub bathing, swimming or hot tubs until incision healed * No lotions or creams to incision site * Walk ___ times a day and gradually increase your activity as you can tolerate. Call Dr. ___ office at ___ if you experience -Temp > 101, chills, increased shortness of breath, chest pain or any other symptoms that concern you. Thank you for allowing us to participate in your care! Our hope is that you will have a quick return to your life and usual activities.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM 2. Cyanocobalamin 1000 mcg PO 3X/WEEK (___) 3. Docusate Sodium 100 mg PO BID 4. Levothyroxine Sodium 75 mcg PO DAILY 5. Metoprolol Succinate XL 100 mg PO BID 6. Multivitamins 1 TAB PO DAILY 7. Rivaroxaban 20 mg PO DAILY 8. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Visual disturbance Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted with symptoms of abnormal vision, disorientation, and dizziness. You were evaluated for stroke and your MRI brain did not show stroke. Your symptoms may have been due to migraine without headache or due to an intraocular cause. You should follow up with your ophthalmologist Dr. ___ 1 month. You should call ___ for a follow up with neurology. 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: Pt was discharged and admitted to inpatient hospice, please see discharge summary from ___ Discharge Disposition: Expired Facility: ___ Discharge Diagnosis: Pt was discharged and admitted to inpatient hospice, please see discharge summary from ___ Discharge Condition: Pt was discharged and admitted to inpatient hospice, please see discharge summary from ___ Followup Instructions: ___ [/INST] </s><s>Pt was discharged and admitted to inpatient hospice, please see discharge summary from ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lisinopril 2.5 mg PO DAILY RX *lisinopril 2.5 mg 1 tablet(s) by mouth Daily Disp #*14 Tablet Refills:*0 2. Metoprolol Succinate XL 200 mg PO DAILY RX *metoprolol succinate 100 mg 2 tablet(s) by mouth daily Disp #*28 Tablet Refills:*0 3. Glargine 40 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 4. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 80 mg PO QPM 7. Clopidogrel 75 mg PO DAILY 8. Docusate Sodium 100 mg PO BID 9. Ferrous Sulfate 325 mg PO DAILY 10. MetFORMIN (Glucophage) 1000 mg PO BID 11. Ranitidine 150 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: NSTEMI Secondary: Systolic Heart Failure, Atrial tachycardia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure to take care of you at ___ ___! Why were you hospitalized? ========================== -You were having shortness of breath What happened while you were in the hospital? ============================================= -You had an ultrasound that showed that part of your heart is not pumping as well. A cardiac catheterization showed that you have a block in your heart vessel and a block in the connection between your graft and your original heart vessel. A stent was placed to clear the block in your original heart vessel. -You also had a fast heart rate, which is probably part of why you had difficulty breathing, and is probably a result of scarring from your heart surgery. Your heart rate slowed down when we increased your medicine, metoprolol. -You saw a Podiatrist who looked at your ankle wound and wound vac and there was no infection. What should you do after leaving the hospital? ============================================== -Keep taking your medications as prescribed, especially ___, Asprin, Atorvastatin, as before -Start taking Lisinpril 2.5mg daily, and start taking Metoprolol 200mg XL daily -See your primary doctor, and vascular surgery -See podiatry for a wound vac change every three days We wish you the best! Sincerely, Your ___ Cardiology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Atorvastatin 40 mg PO DAILY 3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 4. Diltiazem Extended-Release 180 mg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. Enoxaparin Sodium 40 mg SC QPM RX *enoxaparin 40 mg/0.4 mL 40 mg/0.4mL SC QPM Disp #*14 Syringe Refills:*0 7. Famotidine 20 mg PO BID 8. Levothyroxine Sodium 150 mcg PO DAILY 9. Milk of Magnesia 30 mL PO Q6H:PRN Constipation 10. Ondansetron 4 mg PO Q8H:PRN nausea 11. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 to 2 tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 12. PNEUMOcoccal 23-valent polysaccharide vaccine 0.5 ml IM NOW X1 13. Polyethylene Glycol 17 g PO DAILY:PRN constipation 14. Senna 17.2 mg PO BID 15. Simethicone 40-80 mg PO QID:PRN gas pain 16. Calcium Carbonate 500 mg PO TID 17. Vitamin D 400 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left acetabular fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily 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: - Activity as tolerated - Left lower extremity: touchdown weight bearing Physical Therapy: - Activity as tolerated - Left lower extremity: touchdown weight bearing Treatments Frequency: Site: L hip, L groin Wound: Surgical incisions Description: Dry gauze and elastoplast tape dressing Care: Change dressing every other day or as needed to keep clean and dry. If incision remains non-draining, OK to leave open to air. Follow-up: Pt is to follow-up in 7 days for removal of staples.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ibuprofen 800 mg PO Q8H Duration: 30 Days 2. Colchicine 0.6 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Pericarditis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted for pain in your chest caused by an inflammation around the outside of your heart (pericarditis). You were treated with fluids, ibuprofen and colchicine. You should continue to take these medications for ___ months. We also would strongly recommend that you follow-up with your regular doctor once you return home from your travels, ideally within 1 month of this hospitalization. Best wishes, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 80 mg PO QPM 3. Furosemide 40 mg PO DAILY 4. Metoprolol Succinate XL 25 mg PO DAILY 5. Valsartan 20 mg PO BID 6. Levothyroxine Sodium 150 mcg PO DAILY 7. Sertraline 150 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: Acute systolic HF exacerbation Secondary: HTN Hypothyroidism 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 caring of you at ___. WHY WAS I IN THE HOSPITAL? -You came into the hospital because of shortness of breath. WHAT HAPPENED TO ME IN THE HOSPITAL? -You were found to be short of breath because you had too much fluid on board. You received medications to help you pee off the extra fluid and your breathing improved. -You were found to have new heart failure and decreased function of your heart muscle. -You underwent a procedure called a left heart cath to look for blockages in the coronary arteries. While this procedure did show that you have coronary artery disease, you did not have blockages significant enough to require stent placement. -You will need an MRI of the heart to further determine the cause of your heart failure, which you will have done after leaving the hospital. -You were started on several new medications for your heart failure. You will follow-up with a cardiologist after leaving the hospital who will help treat your heart failure going forward. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines as prescribed and keep your appointments. - Please weigh yourself every day and call your PCP if your weight goes up by more than 3lbs. Discharge weight: 151.9lb. 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. Aspirin EC 81 mg PO DAILY 2. Calcium Carbonate 1500 mg PO DAILY 3. Citalopram 10 mg PO QHS 4. Loperamide 2 mg PO DAILY:PRN diarrhea 5. Metoprolol Tartrate 50 mg PO BID 6. Simvastatin 10 mg PO DAILY 7. Lisinopril 10 mg PO DAILY 8. Docusate Sodium 100 mg PO BID 9. Ferrous Sulfate 325 mg PO DAILY 10. Furosemide 20 mg PO DAILY 11. Heparin 5000 UNIT SC BID Duration: 2 Weeks (to end ___ Discharge Disposition: Extended Care Facility: ___ ___ Rehabilitation and Sub-Acute Care) Discharge Diagnosis: Primary diagnosis: Left hip pathologic subcapital fracture from metastatic breast cancer Secondary diagnoses: Hypoxia Transaminitis Anemia Aortic stenosis IBS Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to care for you during your hospitalization. You were admitted after developing severe left hip pain. After a thorough work-up including x-ray and MRI, you were found to have a broken left hip that occurred due to the presence of cancer that has spread there. You underwent stabilization of this fracture in surgery on ___ and tolerated the procedure well. Two days after the surgery, you began to develop lower red blood cell counts and oxygen in your blood. You therefore received a blood transfusion which helped to stabilize your red blood cells. You also underwent imaging studies to rule out any serious causes of low oxygen. The most likely cause of this low oxygen was too much fluid in your lungs - this was treated with a drug that takes fluid out of your body, and since this treatment your oxygen levels have normalized. You also underwent additional imaging studies including a bone scan and brain MRI which showed the presence of the cancer in multiple different bones of your body including your skull. Importantly, there was no evidence of any spread to your brain. It is important that you follow-up at the appointments listed below for further management and treatment.</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. Topiramate (Topamax) 75 mg PO BID 3. Nicotine Patch 14 mg TD DAILY RX *Nicoderm CQ 14 mg/24 hour Daily Disp #*1 Box Refills:*1 4. Lorazepam 1 mg PO Q12H:PRN Seizure activity RX *Ativan 1 mg Every 12 hours as needed Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Cerebral Vasculitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>•You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort. What activities you can and cannot do: •When you go home, you may walk and go up and down stairs. •You may shower (let the soapy water run over groin incision, rinse and pat dry) •Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed •No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal). •After 1 week, you may resume sexual activity. •After 1 week, gradually increase your activities and distance walked as you can tolerate. •No driving for 24 hours. What to report to office: •Changes in vision (loss of vision, blurring, double vision, half vision) •Slurring of speech or difficulty finding correct words to use •Severe headache or worsening headache not controlled by pain medication •A sudden change in the ability to move or use your arm or leg or the ability to feel your arm or leg •Trouble swallowing, breathing, or talking •Numbness, coldness or pain in lower extremities •Temperature greater than 101.5F for 24 hours •New or increased drainage from incision or white, yellow or green drainage from incisions •Bleeding from groin puncture site *SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site) Lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. If bleeding stops, call our office. If bleeding does not stop, call ___ for transfer to closest Emergency Room!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain or fever 2. Docusate Sodium 100 mg PO BID 3. Lorazepam 1 mg PO Q8H:PRN nausea 4. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule,delayed ___ by mouth daily Disp #*30 Capsule Refills:*2 5. Rosuvastatin Calcium 10 mg PO DAILY 6. Cefpodoxime Proxetil 400 mg PO Q12H Duration: 10 Days RX *cefpodoxime 200 mg 2 tablet(s) by mouth every 12 hours Disp #*19 Tablet Refills:*0 7. Cephalexin 250 mg PO Q24H Please start after you finish taking the other antibiotic. RX *cephalexin [Keflex] 250 mg 1 capsule(s) by mouth daily Disp #*60 Capsule Refills:*2 8. Mirtazapine 15 mg PO HS 9. Nitrofurantoin Monohyd (MacroBID) 100 mg PO Q12H Duration: 9 Days RX *nitrofurantoin monohyd/m-cryst 100 mg 1 capsule(s) by mouth twice daily Disp #*18 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Urinary Tract 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 ___. You came to the hospital because you were having fevers. We found that you had a urinary tract infection. We treated you with antibiotics and your symptoms improved. You will need to continue taking antibiotics to finish treatment for your urinary tract infection. You will also need to take antibiotics to prevent infection. You should also continue to take your neupogen per your previously established schedule.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 20 mg PO QPM 2. Hydrochlorothiazide 25 mg PO DAILY 3. Lisinopril 10 mg PO DAILY 4. Omeprazole 20 mg PO DAILY 5. Acetaminophen 325-650 mg PO Q6H:PRN headache do not exceed 4 grams in 24hrs. 6. Acetaminophen-Caff-Butalbital ___ TAB PO Q6H:PRN headache This med contains tylenol please do not exceed more than 4 grams in 24hrs. RX *butalbital-acetaminophen-caff 50 mg-325 mg-40 mg ___ tablet(s) by mouth Q 6hrs Disp #*60 Tablet Refills:*0 7. Bisacodyl 10 mg PO/PR DAILY 8. Docusate Sodium 100 mg PO BID 9. Ascorbic Acid ___ mg PO BID 10. Multivitamins 1 TAB PO DAILY 11. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Right subdural fluid collection. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Hemorrhage without Surgery 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) for one week from your head injury (___). · You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: · You may have difficulty paying attention, concentrating, and remembering new information. · Emotional and/or behavioral difficulties are common. · Feeling more tired, restlessness, irritability, and mood swings are also common. · Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Headaches: · Headache is one of the most common symptom after a brain bleed. · Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. · Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. · There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: · Severe pain, swelling, redness or drainage from the incision site. · Fever greater than 101.5 degrees Fahrenheit · Nausea and/or vomiting · Extreme sleepiness and not being able to stay awake · Severe headaches not relieved by pain relievers · Seizures · Any new problems with your vision or ability to speak · Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: · Sudden numbness or weakness in the face, arm, or leg · Sudden confusion or trouble speaking or understanding · Sudden trouble walking, dizziness, or loss of balance or coordination · Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Glargine 40 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 2. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild 3. albuterol sulfate 90 mcg/actuation INHALATION Q4H:PRN shortness of breath 4. B Complete (vitamin B complex) 1 pill oral DAILY 5. Bisacodyl 10 mg PO DAILY:PRN constipation 6. budesonide-formoterol 160-4.5 mcg/actuation INHALATION BID 7. Calcipotriene 0.005% Cream 1 Appl TP DAILY 8. Calcium Carbonate 500 mg PO BID 9. Clobetasol Propionate 0.05% Cream 1 Appl TP BID 10. Docusate Sodium 100 mg PO BID 11. Ferrous Sulfate 325 mg PO DAILY 12. Fluoxetine 40 mg PO DAILY 13. Lactulose 30 mL PO Q8H:PRN constipation 14. Loratadine 10 mg PO DAILY 15. LORazepam 0.5 mg PO DAILY:PRN anxiety 16. Magnesium Oxide 800 mg PO BID 17. Midodrine 5 mg PO TID 18. Milk of Magnesia 30 mL PO DAILY:PRN constipation 19. Mylanta 30 mL oral Q4H:PRN 20. Omeprazole 20 mg PO DAILY 21. Pen Needle (pen needle, diabetic) 31 gauge x ___ miscellaneous BID 22. Rifaximin 550 mg PO BID 23. Simvastatin 40 mg PO QPM 24. Spironolactone 100 mg PO DAILY 25. Torsemide 80 mg PO DAILY 26. TraZODone 50-100 mg PO QHS:PRN insomnia 27. Ursodiol 300 mg PO BID 28. Vitamin B Complex 1 CAP PO DAILY 29. Vitamin D 4000 UNIT PO DAILY 30. Vitamin E 400 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnoses: - Anemia - GI bleed - NASH cirrhosis Secondary Diagonoses: - Diabetes mellitus type 2 - Cecal polyp Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital for anemia (low blood count). You were given a blood transfusion and your blood counts improved and had remained stable since. The exact source of your bleeding in not clear at this time. Some bleeding may be coming from the polyp in your intestine, but at this point it would be too dangerous to remove it because your platelets are very low and it may worsen bleeding. It is important that you follow up with your liver doctor to continue to monitor your blood counts and make a safe plan for your care. It is also important you follow your blood counts every so often after you leave the hospital. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Also call your doctor if you have difficult breathing or chest pain. Call your doctor if you pass black or bloody stool. Thank you for letting us participate in your care, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levofloxacin 750 mg PO ONCE Duration: 1 Dose 2. OSELTAMivir 75 mg PO Q12H Duration: 28 Days RX *oseltamivir 75 mg 1 capsule(s) by mouth twice a day Disp #*10 Capsule Refills:*0 3. Acyclovir 400 mg PO Q8H 4. Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB/Cough 5. ALPRAZolam 4 mg PO QHS insomnia 6. Cyclosporine 0.05% Ophth Emulsion 0.05 % ophthalmic BID 7. Dexamethasone Oral Soln (0.1mg/1mL) 5 mL ORAL QID 8. DiphenhydrAMINE 50 mg IV QHS:PRN INSOMNIA 9. FoLIC Acid 1 mg PO DAILY 10. Ibuprofen 800 mg PO Q6H:PRN Pain - Moderate 11. Multivitamins 1 TAB PO DAILY 12. PredniSONE 1 mg PO EVERY OTHER DAY 13. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: ILI Secondary Diagnosis: Relapsed AML Chronic GVHD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted with influenza-like symptoms. You received antibiotics, you will continue this at home. You have been given a prescription for 5 days of Tamiflu, we are working on a prior authorization to complete your 28 day course of this antibiotic. Our case manager will follow up with you early next week in regards to this. You will be discharge today and your follow up with Dr. ___ is listed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*2* 2. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). 3. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 4. prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 7. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily): tsh in 6 weeks. Disp:*30 Tablet(s)* Refills:*2* 8. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. 9. hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for incision pain. Disp:*30 Tablet(s)* Refills:*0* 10. tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every 12 hours). 11. ferrous sulfate 325 mg (65 mg iron) Tablet Sig: One (1) Tablet PO three times a day. 12. sodium polystyrene sulfonate Powder Sig: Four (4) tsp PO As directed: Only as recommended by transplant clinic. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: internal hernia/mesenteric defect hypothyroidism h/o liver transplant Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>please call the Transplant Office ___ if you have any of the warning signs listed below. -You will need blood drawn every ___ and ___ for lab monitoring. Labs to be faxed to Transplant clinic at ___ -You may shower, allow water to run over incisions and pat dry. Do not rub incision, no powder or lotions. No tub baths or swimming -Do not lift anything heavier than 10 pounds No driving if taking narcotic pain medication There have been several changes to your medications. Please assure med sheet is up to date and correct with your visiting nurse, and you fill all new medications and make dosage adjustments</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lactulose 30 mL PO QID 2. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 3. Albuterol Inhaler ___ PUFF IH Q4H:PRN wheeze, SOB 4. ARIPiprazole 10 mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Breo Ellipta (fluticasone-vilanterol) 100-25 mcg/dose inhalation DAILY 7. Famotidine 20 mg PO BID 8. Ibuprofen 600 mg PO Q8H:PRN Pain - Mild 9. LevETIRAcetam 1000 mg PO BID 10. Magnesium Oxide 400 mg PO DAILY 11. Meclizine 25 mg PO Q8H:PRN dizziness 12. Omeprazole 40 mg PO DAILY 13. Propranolol 20 mg PO DAILY 14. QUEtiapine Fumarate 600 mg PO QHS 15. Rifaximin 550 mg PO BID 16. Robafen Cough (dextromethorphan HBr) 15 mg oral Q4H:PRN 17. Spironolactone 25 mg PO DAILY 18. Tiotropium Bromide 1 CAP IH DAILY 19. TraZODone 200 mg PO QHS 20. Vitamin D ___ UNIT PO 1X/WEEK (MO) Discharge Disposition: Home Discharge Diagnosis: PRIMARY: hepatic encephalopathy, adrenal mass SECONDARY: HCV/EtOH cirrhosis, hepatocellular carcinoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were found to be confused at your clinic appointment, and sent to the hospital for management of your confusion, as well as investigation into the new mass seen in your adrenal gland (sitting on top of your kidney). WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - You were given extra doses of lactulose to help improve the confusion you were having, which was likely due to your liver disease. - You had a CT scan of your chest and a bone scan to look for any other masses in your body. - You had a lot of blood tests drawn in the hopes that we could figure out what kind of mass you have in your adrenal gland. These tests were all normal. - You grew a bacteria in your blood, but it was not a true infection. You were on an antibiotic for one day and it was stopped. You repeat blood cultures had no bacteria. - You had a biopsy of the mass in your adrenal gland to find out what it is. The results were not yet back by the time you left the hospital. WHAT WILL HAPPEN WHEN YOU LEAVE THE HOSPITAL? - You will follow-up with Dr ___ Dr ___ in the liver tumor clinic. - Continue to take all of your medicines as prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild/Fever RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours as needed Disp #*30 Tablet Refills:*2 2. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 3. Rivaroxaban 15 mg PO BID pulmonary embolism Duration: 21 Days with food RX *rivaroxaban [Xarelto] 15 mg (42)- 20 mg (9) 1 tablets(s) by mouth twice daily Disp #*32 Dose Pack Refills:*0 4. Rivaroxaban 20 mg PO DAILY RX *rivaroxaban [Xarelto] 20 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*1 5. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 3 Days RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice daily Disp #*5 Tablet Refills:*0 6. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Citalopram 20 mg PO DAILY 8. Levothyroxine Sodium 75 mcg PO DAILY 9. Mirtazapine 15 mg PO QHS 10. Multivitamins 1 TAB PO DAILY 11. Naproxen 500 mg PO Q12H:PRN Pain - Mild 12. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q4H:PRN 13. TraZODone 100 mg PO QHS Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Pulmonary embolism Pneumonia Urinary tract infection Discharge Condition: Stable Mentating appropriately Ambulatory Followup Instructions: ___ [/INST] </s><s>You were admitted for several serious issues - a pneumonia that has been treated with antibiotics. Also affecting your lungs and breathing was a blood clot that had traveled there from your leg. You were treated with blood thinners and oxygen through your nose, which improved gradually. You will need to continue the rivaroxaban. Initially this will be at 15mg TWICE a day until ___. On ___ you should switch to the 20mg pill ONCE per day. Please also take Bactrim as prescribed for a total of three days, ending ___, for your urinary tract infection. When you see your primary care doctor, please ask to get a sleep study to evaluate for obstructive sleep apnea. This is a condition when your oxygen levels decrease during sleep, and we saw some evidence for it in the hospital. However, the evaluation for this condition is tested as an outpatient. It was a pleasure 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. CeftriaXONE 2 gm IV Q24H 2. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID 3. Dexmedetomidine 0.2-1.4 mcg/kg/hr IV DRIP TITRATE TO RASS -1 Awakens to voice (eye opening/contact)>10 seconds 4. Docusate Sodium (Liquid) 100 mg PO BID 5. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using HUM Insulin 6. Lactulose 30 mL PO Q4H 7. Pantoprazole 40 mg IV Q12H 8. PHENYLEPHrine 0.5-1.4 mcg/kg/min IV DRIP TITRATE TO SBP> 85 9. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line flush Discharge Disposition: Extended Care Discharge Diagnosis: Septic shock secondary to klebsiella Urinary tract infection Cirrhosis complicated by ascites and hepatic hydrothorax Delerium, Altered Mental Status Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic and not arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear ___ and the ___ family, It was a pleasure caring for you at ___ ___. Mrs. ___ was admitted with an infection in her bloodstream. This most likely originated in her urine. The infection was very severe and dropped her blood pressures to levels that were unsafe so we had her on a powerful medicine to help improve them. Unfortunately, her mental status, or thinking, remained confused and she was unable to be taken off the breathing machine. Also, her kid After discussions with the family, the decision was made to transfer Mrs. ___ closer to home to be with family. It was also decided that she be do not resuscitate. Thank you for allowing us to participate in the care of your loved one, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lisinopril 2.5 mg ___ DAILY 2. Aspirin 325 mg ___ DAILY 3. Atorvastatin 80 mg ___ DAILY 4. Multivitamins 1 TAB ___ DAILY 5. Vitamin D 800 UNIT ___ DAILY 6. Furosemide 20 mg ___ BID 7. Klor-Con 8 *NF* (potassium chloride) 8 mEq Oral daily 8. Metoprolol Succinate XL 12.5 mg ___ DAILY 9. Clindamycin 300 mg ___ Q8H Duration: 7 Days Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: NSTEMI Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the cardiology service at ___ for management of your heart attack. For this, you received a cardiac stress test which showed some abnormalities consistent with a heart attack, and a pacemaker to keep your heart rate stable.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 2. Hydrocortisone (Rectal) 2.5% Cream ___ID:PRN rectal irritation RX *hydrocorTISone 1 (s) rectally twice a day Disp #*1 Package Refills:*0 3. Nicotine Patch 7 mg TD DAILY nicotine withdrawal RX *nicotine 7 mg/24 hour Apply 1 patch to skin daily Disp #*28 Patch Refills:*0 4. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Third Line RX *polyethylene glycol 3350 17 gram 1 powder(s) by mouth daily Disp #*30 Packet Refills:*0 5. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 6. Citalopram 40 mg PO DAILY 7. FoLIC Acid 5 mg PO DAILY 8. Gabapentin 300 mg PO TID 9. Hydroxyurea 500 mg PO QAM 10. Hydroxyurea 1000 mg PO QPM 11. LACOSamide 200 mg PO BID 12. OxyCODONE (Immediate Release) 20 mg PO Q4H:PRN Pain - Severe RX *oxycodone 10 mg ___ tablet(s) by mouth every four (4) hours Disp #*72 Tablet Refills:*0 13. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H RX *oxycodone 20 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*10 Tablet Refills:*0 14. Senna 8.6 mg PO BID:PRN Constipation 15. Zonisamide 400 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Sickle cell vaso-occlusive crisis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital for sickle cell vaso-occlusive crisis. You did not have evidence of acute chest syndrome or pneumonia on imaging or on labs. Your blood counts were low, so you were given a blood transfusion and your blood counts were stable after that. Your pain was treated with a PCA initially and you were eventually transitioned back to oral pain medications. Your primary care doctor (___) was contacted and informed of this hospital stay. You should follow up in his office next week as detailed below. Best of luck with your continued healing. Take care, 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 Reason for PRN duplicate override: Alternating agents for similar severity Do not exceed 4000mg acetaminophen in 24 hours RX *acetaminophen 500 mg 2 tablet(s) by mouth every 6 hours Disp #*30 Tablet Refills:*0 2. Ibuprofen 600 mg PO Q6H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity do not exceed 2400mg ibuprofen in 24 hours RX *ibuprofen 600 mg 1 tablet(s) by mouth every 6 hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Chorioamnionitis, D&C Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, We are so sorry for your loss. You were admitted to the gynecology service after your procedure, and for treatment of an infection in your uterus called chorioamnionitis. You have recovered well and the team believes you are ready to be discharged home. Please call Dr. ___ office with any questions or concerns. Please follow the instructions below. General instructions: * Take your medications as prescribed. * No intercourse and nothing in the vagina until your follow up appointment (at least 6 weeks). * Do not combine narcotic and sedative medications or alcohol. * Do not take more than 4000mg acetaminophen (APAP) in 24 hrs. To reach medical records to get the records from this hospitalization sent to your doctor at home, call ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H RX *acetaminophen 500 mg 1 tablet(s) by mouth four times daily. Disp #*120 Tablet Refills:*3 2. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine 5 % Apply one patch daily for 12 hours at a time. Disp #*30 Patch Refills:*3 3. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 4. Simethicone 40-80 mg PO QID:PRN gas RX *simethicone 80 mg 1 tablet by mouth ___ times daily Disp #*30 Tablet Refills:*0 5. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID back/elbows Duration: 2 Weeks RX *triamcinolone acetonide 0.1 % Apply to eczematous areas twice daily Refills:*0 6. BusPIRone 10 mg PO BID RX *buspirone 10 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 7. Fentanyl Patch 25 mcg/h TD Q72H RX *fentanyl 25 mcg/hour Apply one patch every 72 hours Disp #*8 Patch Refills:*0 8. Furosemide 80 mg PO DAILY 9. Lactulose 30 mL PO ___ 10. Midodrine 5 mg PO TID RX *midodrine 5 mg 1 tablet(s) by mouth three times daily Disp #*90 Tablet Refills:*3 11. Spironolactone 150 mg PO DAILY 12. Creon 12 2 CAP PO QIDWMHS 13. cyanocobalamin (vitamin B-12) 2,500 mcg sublingual DAILY 14. dextroamphetamine-amphetamine 5 mg oral BID RX *dextroamphetamine-amphetamine 5 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 15. Ferrous Sulfate 325 mg PO BID 16. FoLIC Acid 1 mg PO DAILY 17. Glargine 35 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 18. LevETIRAcetam 1500 mg PO BID 19. Lidocaine 5% Ointment 1 Appl TP PRN pain 20. Magnesium Oxide 400 mg PO TID 21. Mupirocin Ointment 2% 1 Appl TP BID back 22. Norethindrone-Estradiol 1 TAB PO DAILY 23. Rifaximin 550 mg PO BID 24. rizatriptan 10 mg oral DAILY:PRN migraine 25. Tacrolimus 0.1 % topical BID 26. Tizanidine ___ mg PO QHS:PRN muscle spasms 27. Venlafaxine XR 300 mg PO DAILY 28. Vitamin D3 (cholecalciferol (vitamin D3)) 2,000 unit oral DAILY 29. HELD- Topiramate (Topamax) 100 mg PO QHS This medication was held. Do not restart Topiramate (Topamax) until your neurologist tells you it is safe to do so 30.Glucerna Frappes Dose: Glucerna Frappes TIDAC (1 with each meal) Dx: E46 (malnutrition) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS ================ Altered mental status secondary to hepatic encephalopathy and polypharmacy SECONDARY DIAGNOSES ==================== Chronic pain Depression/anxiety Seizure disorder ___ cirrhosis Left foot wound Pancreatic diabetes History of gastric bypass Chronic malnutrition Anemia Leg cramps Attention deficit disorder Migraine headaches Cardiomyopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you were feeling confused because of your liver disease. WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - You were started on lactulose and your confusion resolved - You improved and were ready to leave the hospital. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Please take all of your medications as prescribed and go to your follow up appointments with your doctors ___ below) - Weigh yourself every morning, before you eat or take your medications. Call your doctor if your weight increases by more than 3 pounds - Please maintain a low salt diet and monitor your fluid intake - Please make sure to take lactulose as prescribed to avoid mental status change. As discussed, you can mix lactulose with foods you like. - Seek medical attention if you have new or concerning symptoms or you develop 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. Bisacodyl 10 mg PO DAILY RX *bisacodyl 5 mg 2 tablet(s) by mouth daily Disp #*7 Tablet Refills:*0 2. Bisacodyl ___AILY:PRN Constipation - Second Line RX *bisacodyl [The Magic Bullet] 10 mg 1 suppository(s) rectally daily as needed Disp #*7 Suppository Refills:*0 3. Metoclopramide 5 mg PO QIDACHS RX *metoclopramide HCl 5 mg 1 tablet by mouth up to three times daily as needed Disp #*90 Tablet Refills:*0 4. Ondansetron ODT 4 mg PO Q8H:PRN Nausea/Vomiting - First Line RX *ondansetron 4 mg 1 tablet(s) by mouth up to 4 times daily as needed Disp #*28 Tablet Refills:*0 5. Polyethylene Glycol 17 g PO DAILY 6. Senna 17.2 mg PO BID RX *sennosides [senna] 8.6 mg 2 tab by mouth twice daily Disp #*28 Tablet Refills:*0 7. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 8. Betamethasone Dipro 0.05% Augmented Gel 1 Appl TP 3X/DAY 9. Citalopram 30 mg PO DAILY 10. Levothyroxine Sodium 125 mcg PO DAILY 11. Levothyroxine Sodium 125 mcg PO DAILY 12. Omeprazole 20 mg PO DAILY 13. QUEtiapine Fumarate 25 mg PO BID 14. Ramelteon 8 mg PO QHS:PRN Insomnia Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: High grade glioma Encephalopathy Nausea Headache Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You came to the hospital because you were confused and you were unable to walk. We were initially concerned that you had an infection of your brain, but it was ultimately determined by a brain biopsy that you had brain cancer. After discussion with your family, it was felt that you would prefer to focus on comfort rather than undergo treatments such as chemotherapy, which would not be able to cure the disease. You went home on hospice, where you can be with your family and your care can be focused on comfort and quality of life. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. PredniSONE 60 mg PO DAILY RX *prednisone 10 mg 6 tablet(s) by mouth once a day Disp #*100 Tablet Refills:*0 2. Ferrous Sulfate 325 mg PO TID RX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 3. Isoniazid ___ mg PO DAILY RX *isoniazid ___ mg 1 tablet(s) by mouth once a day Disp #*90 Tablet Refills:*0 4. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 capsule(s) by mouth once a day Disp #*90 Capsule Refills:*0 5. Pyridoxine 50 mg PO DAILY RX *pyridoxine 50 mg 1 tablet(s) by mouth once a day Disp #*90 Tablet Refills:*0 6. Outpatient Lab Work PLEASE CHECK A CBC IN 1 WEEK AND LFT'S IN 1 MONTH AND HBV AB TITERS IN 2 MONTHS AND FAX TO ___. ___ ___ Discharge Disposition: Home Discharge Diagnosis: ULCERATIVE COLITIS, ACUTE SEVERE FLARE STAPH LUGDUNINENSIS SEPTICEMIA MODERATE MALNUTRTION LATENT MYCOBACTERIAL TUBERCULOSIS INFECTION Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>YOU WERE HOSPITALIZED FOR TREATMENT OF ULCERATIVE COLITIS. YOU RECEIVED A FIRST ___ OF INFLIXIMAB ON ___. YOUR SECOND ___ SHOULD BE AROUND ___. YOU WILL TAPER YOUR STEROIDS BY 10MG FOR THE FIRST WEEK, YOU ARE ON 60MG PREDNISONE AS OF ___ (DECREASE TO 50 MG ON ___. AFTER THAT DECREASE YOUR ___ BY 5 MG EVERY WEEK. IF YOU DEVELOP ABDOMINAL PAIN, WORSE DIARRHEA, FEVER YOU NEED TO SPEAK WITH A DOCTOR IMMEDIATELY. YOU ARE BEING TREATED FOR LATENT (NOT ACTIVE) TUBERCULOSIS. YOU ARE TAKING INH AND B6 VITAMIN DAILY FOR THIS FOR 9 MONTHS OF TREATMENT. YOU WILL NEED REGULAR BLOOD WORK INCLUDING CBC AND LFTS TO MONITOR YOUR LIVER FUNCTION AND BLOOD COUNTS WHILE ON THIS (LABS APPROX ONE A MONTH) YOU HAVE HAD PRIOR HEPATITIS B, BUT YOU ARE CONSIDERED IMMUNE. HOWEVER, WITH INFLIXIMAB THIS IMMUNITY CAN BE WEAKNED. THUS YOU WILL NEED TO HAVE BLOOD WORK TO MEASURE THE LEVEL OF THIS ANTIBODY (TITERS) TO MAKE SURE YOU REMAIN IMMUNE AND THAT HEPATITIS B DOES NOT REACTIVATE. THIS SHOULD BE DONE EVERY ___ MONTHS. YOU WERE TREATED FOR A STAPH BLOOD STREAM INFECTION. THERE IS NO INDICATION OF A CARDIAC INFECTION. YOU FINISHED IV ANTIBIOTICS ON ___. . MEDICATION CHANGES: SEE NEXT PAGE</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You were admitted for abdominal pain, vomiting, and diarrhea. You were found to have Clostridium difficile colitis. You were started on Vancomycin oral antibiotics, and should also take probiotics when you leave the hospital. It is important that you keep all follow up appointments, and take all medications as prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Labetalol 200 mg PO QAM 2. Labetalol 100 mg PO QPM 3. Multivitamins W/minerals 1 TAB PO DAILY 4. Tamoxifen Citrate 20 mg PO DAILY 5. Valsartan 160 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Syncope, reduplicative paramesia Secondary: Hypertension, stage III chronic kidney disease, history of breast 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 taking care of you during your stay at ___ ___. You were admitted after you lost consciousness while getting your nails done. Upon admission, you were seen by the Neurology team and imaging of your head was performed which did not show any evidence of stroke. Your heart rhythm was normal and there was no evidence of cardiac damage. It is likely that your symptoms were a result of a "vagal" response that was triggered by putting your feet into the warm water. Specifically, this a benign condition that is characterized by lightheadedness, sweating, feeling nauseas, and can lead to fainting. Your symptoms improved without any further episodes. Please follow-up with your primary care provider for further management. Best Wishes, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg ONE capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*1 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 3. Atenolol 12.5 mg PO DAILY 4. Clotrimazole Cream 1 Appl TP TID 5. glimepiride 4 mg oral DAILY 6. HydrALAZINE 10 mg PO Q12H 7. MetFORMIN (Glucophage) 250 mg PO BID 8. Simvastatin 20 mg PO QPM 9. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: nephrolithiasis; Left obstructing stone, complex (>1cm) acute kidney injury (creatinine 1.5-->1.8 w/ baseline 1.1) flank pain; left renal colic Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>-You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month; this may be related to the passage of stone fragments or, if applicable to you, the indwelling ureteral stent. You may also experience some pain associated with spasm of your ureter. -The kidney stone remains in place; you will follow up with Dr. ___ definitive ___ -Ureteral stents MUST be removed or exchanged and therefore it is IMPERATIVE that you follow-up as directed. -Do not lift anything heavier than a phone book (10 pounds) -You may continue to periodically see small amounts of blood in your urine—this, as noted above, is expected and will gradually improve—continue to drink plenty of fluids to flush out your urinary system -Resume your pre-admission/home medications EXCEPT as noted. -You should ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor. -IBUPROFEN (the active ingredient of Advil, Motrin, etc.) may be taken even though you may also be taking ACETAMINOPHEN (Tylenol). You may alternate these medications for pain control. -For pain control, try TYLENOL FIRST, then the ibuprofen (unless otherwise advised), and then take the narcotic pain medication (if prescribed) as prescribed if additional pain relief is needed. -Ibuprofen should always be taken with food. Please discontinue taking and notify your doctor should you develop blood in your stool (dark, tarry stools) -You MAY be discharged home with a medication called PYRIDIUM that will help with the "burning" pain you may experience when voiding. This medication may turn your urine bright orange. -You may be given “prescriptions” for a stool softener and/or a gentle laxative. These are over-the-counter medications that may be “health care spending account reimbursable.” -Docusate sodium (Colace) may have been prescribed to avoid post-surgical constipation or constipation related to use of narcotic pain medications. Discontinue if loose stool or diarrhea develops. Colace is a stool-softener, NOT a laxative. -Senokot (or any gentle laxative) may have been prescribed to further minimize your risk of constipation. -Do not eat constipating foods for ___ weeks, drink plenty of fluids to keep hydrated</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 50 mg SC Q12H RX *enoxaparin 60 mg/0.6 mL 50 mg sc every twelve (12) hours Disp #*60 Syringe Refills:*2 2. Hydrocortisone (Rectal) 2.5% Cream ___ID:PRN hemorrhoids RX *hydrocorTISone 1 application rectally twice a day Disp #*2 Tube Refills:*3 3. Hydrocortisone Oint 1% 1 Appl TP QID:PRN dry hands RX *hydrocortisone [Cortizone-10] 1 % apply to hands up to 4 times a day as needed four times a day Refills:*2 4. Dexamethasone 1 mg PO DAILY RX *dexamethasone 1 mg 1 tablet(s) by mouth once a day Disp #*14 Tablet Refills:*0 5. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN Pain - Moderate RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every four (4) hours Disp #*72 Tablet Refills:*0 6. Acetaminophen 1000 mg PO Q8H 7. Cepacol (Sore Throat Lozenge) 1 LOZ PO Q4H:PRN dry mouth 8. Creon 12 2 CAP PO TID W/MEALS 9. Creon 12 1 CAP PO TID WITH SNACKS 10. Cyanocobalamin 1000 mcg PO DAILY 11. Diphenoxylate-Atropine 1 TAB PO Q6H:PRN diarrhea RX *diphenoxylate-atropine 2.5 mg-0.025 mg 1 tablet(s) by mouth every six (6) hours Disp #*120 Tablet Refills:*2 12. Levothyroxine Sodium 25 mcg PO DAILY RX *levothyroxine 25 mcg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*2 13. Lidocaine Viscous 2% 15 mL PO TID:PRN mouth pain RX *lidocaine HCl [Lidocaine Viscous] 2 % apply to mouth as needed for mouth sores three times a day Disp #*200 Milliliter Milliliter Refills:*2 14. Lidocaine-Prilocaine 1 Appl TP ASDIR for port access 15. LOPERamide 4 mg PO TID diarrhea 16. LORazepam 0.25 mg PO Q6H:PRN nausea 17. Maalox/Diphenhydramine/Lidocaine ___ mL PO QID:PRN mucositis RX *alum-mag hydroxide-simeth [Maalox Advanced] 200 mg-200 mg-20 mg/5 mL 15 ml by mouth three times a day Refills:*3 18. Omeprazole 40 mg PO DAILY 19. Ondansetron 8 mg PO Q8H:PRN Nausea/Vomiting - First Line 20. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 21. Prochlorperazine 10 mg PO Q6H:PRN Nausea/Vomiting - Second Line NOT relieved by Ondansetron 22. Senna 8.6 mg PO BID:PRN Constipation - First Line 23. Simethicone 125 mg oral QID:PRN gas pain 24. Sodium Chloride Nasal 1 SPRY NU QID:PRN dry nose 25. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hypovolemic shock Diarrhea UGT1A1 deficiency Malignant ascites Hypokalemia Hypophosphatemia Hypomagnesemia Nausea/Vomiting Cancer-related abdominal pain febrile neutropenia Anemia Thrombocytopenia Portal Vein Thrombus SMV thrombosis R peroneal vein DVT Severe Protein Calorie Malnutrition Metastatic Pancreatic Adenocarcinoma Secondary Neoplasm of Liver Secondary Neoplasm of Lung Mucositis GERD Fatigue Pancreatic insufficiency Hypothyroidism 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 our pleasure to care for you at ___. You came to the hospital because of low blood pressure, diarrhea and vomiting. WHAT HAPPENED IN THE HOSPITAL? - you received IV fluids and nutrition via the IV (TPN) with improvement of your blood pressures and electrolytes - you were treated symptomatically for your diarrhea (including supplementing nutrition via the IV) which improved - you were diagnosed with a blood clot in the R leg and were started on a different blood thinner - you had fluid removed from your belly (paracentesis) and received medications to help reduce swelling in your legs - you were diagnosed with an enzyme deficiency (UGT1A1) and as such, received a round of chemotherapy (FOLFOX) without irinotecan WHAT SHOULD YOU DO WHEN YOU LEAVE THE HOSPITAL? - follow up closely with your oncologist Dr. ___ - continue to take your medications as directed - watch closely for signs of bleeding including lightheadedness/dizziness, blood in stool, black stools; please call the oncology office (___) We wish you all the best! Sincerely, Your care team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325 mg PO Q6H:PRN pain 2. Atorvastatin 40 mg PO QPM 3. Bisacodyl 10 mg PR QOD PRN constipation 4. Ferrous Sulfate 325 mg PO DAILY 5. Gabapentin 400 mg PO TID 6. Levothyroxine Sodium 100 mcg PO 6X/WEEK (___) 7. Levothyroxine Sodium 200 mcg PO 1X/WEEK (___) 8. Lidocaine 5% Patch 1 PTCH TD QAM 9. Propafenone HCl 150 mg PO BID 10. Senna 8.6 mg PO BID:PRN constipation 11. TraZODone 50 mg PO QHS:PRN insomnia 12. Vitamin D 800 UNIT PO DAILY 13. Enoxaparin Sodium 70 mg SC QD Dont stop until instructed by health care professional. RX *enoxaparin 150 mg/mL 0.5 (One half) mL SC once a day Disp #*10 Syringe Refills:*0 14. Sulfameth/Trimethoprim DS 1 TAB PO DAILY Duration: 11 Days RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth once a day Disp #*10 Tablet Refills:*0 15. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg(1,500mg) -200 unit oral BID 16. Sorbitol 1 solution PO QD PRN constipation 17. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain 18. Tums Freshers (calcium carbonate) 200 mg calcium (500 mg) oral as needed at bedtime 19. Warfarin 2 mg PO DAILY16 20. Outpatient Lab Work 427.31 Atrial fibrillation INR Check on ___ Please fax results to ___ Attn: Dr ___. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Pyelonephritis Hydroureteronephrosis Transaminitis Secondary Diagnosis: Atrial fibrillation Pulmonary nodules 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>Ms. ___, You were recently hospitalized at ___ for an infection of your kidney, called pyelonephritis. Your pain was treated with medications, and you were given antibiotics through an IV. We additionally gave you medicine to help with your neck pain. We continued your coumadin and gave you heparin to help with your anticoagulation, as your INR was low. Please take all your medications as described below and attend all follow-up appointments as scheduled. You will see the urologist as an outpatient for further workup. You should have your INR checked on ___ and have it faxed to your primary doctor. Do not stop Lovenox until you are told to do so. Again, it was a pleasure taking part in your care. -Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Humalog 2 Units Breakfast Humalog 2 Units Lunch Humalog 2 Units Dinner Tressiba 15 Units Dinner Insulin SC Sliding Scale using HUM Insulin Discharge Disposition: Home Discharge Diagnosis: PRIMARY: =========== Insulin Dependent Diabetes Mellitus Diabetic Ketoacidosis SECONDARY: ========== RASH Acute Kidney Injury Anemia Thrombocytopenia Steatorrhea Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you at the ___ ___. Why did I come to the hospital? - You were unable to take your insulin and your blood sugar was too high, something called Diabetic Ketoacidosis or DKA. What happened while I was in the hospital? - You received insulin until your blood sugars was normal. - You spoke to financial assistance and social work to ensure that you will have better access to medications and insulin in the future. - You left prior to securing you insulin scripts and consequently you left against medical advice What should I do once I leave the hospital? - Take your medications as prescribed, and call your primary doctor if you have trouble accessing insulin. - Follow up with your doctor appointments below. - Check your blood glucose regularly, before meals. 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. Lacosamide 200 mg PO BID RX *lacosamide [Vimpat] 200 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*2 2. Alendronate Sodium 70 mg PO QSUN 3. Citalopram 10 mg PO DAILY 4. Clonazepam 0.5 mg PO BID 5. Haloperidol 1.5 mg PO BID 6. LaMOTrigine 300 mg PO QAM 7. Omeprazole 20 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Acetaminophen 325-650 mg PO Q6H:PRN pain 10. LaMOTrigine 400 mg PO QPM RX *lamotrigine [Lamictal] 100 mg 4 tablet(s) by mouth QPM Disp #*120 Tablet Refills:*2 11. Zonisamide 500 mg PO AT BEDTIME Discharge Disposition: Home Discharge Diagnosis: Intractible epilepsy 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 Epilepsy Monitoring Unit because you were having increased seizures at home, and because you were having problems with unsteadiness on your feet while walking. We felt that these problems were related to the anti-epileptic medications that you take, so we changed them as listed below. We also monitored you on EEG to try and capture your seizures and found that you were not having them. We have made the following changes to your medications: STOP Tegratol START Vimpat 200mg twice per day INCREASE Lamotrigine evening dose to 400mg DECREASE Zonisamide to 500mg at bed time Please attend the outpatient appointment listed below with Dr. ___. It was a pleasure taking care of you, we wish you all the best!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Hydrochlorothiazide 12.5 mg PO DAILY 3. Lisinopril 20 mg PO DAILY 4. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 5. Simvastatin 40 mg PO QPM 6. Glargine 16 Units Bedtime Insulin SC Sliding Scale using REG Insulin 7. Vitamin D ___ UNIT PO WEEKLY 8. Enoxaparin Sodium 100 mg SC Q12H Duration: 24 Doses Start: Today - ___, First Dose: ___ 100mg SC BID until INR therapeutic. RX *enoxaparin 100 mg/mL 100 mg SC twice a day Disp #*24 Syringe Refills:*0 9. Warfarin 7.5 mg PO DAILY Please f/u with Dr/ ___ re: dose adjustments 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: Abdominal wall fluid collection 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 here at ___ ___. You were admitted to our hospital after undergoing exploration of your abdominal wound. You have recovered from surgery and are now ready to be discharged to home. Please follow the recommendations below to ensure a speedy and uneventful recovery. ACTIVITY: - You may climb stairs. - Don't lift more than 10 lbs until otherwise instructed. (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 while the wound vac is in place, however showering is OK with the wound vac in place. Ask your doctor when you can resume tub baths or swimming. - Heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. - You may resume sexual activity unless your doctor has told you otherwise. HOW YOU MAY FEEL: - You may feel weak or "washed out" for 6 weeks. You might want to nap often. Simple tasks may exhaust you. - You may have a sore throat because of a tube that was in your throat during surgery. - You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. - You could have a poor appetite for a while. Food may seem unappealing. - All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: - Your incision where the wound vac sponge is placed may be slightly red around the edges. This is a normal reaction to the sponge material. - You may gently wash away dried material around your incision. - Avoid direct sun exposure to the incision area. - Do not use any ointments on the incision unless you were told otherwise. - You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: - Constipation is a common side effect of medicine such as Percocet or codeine. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. - If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. - After some operations, diarrhea can occur. If you get diarrhea, don't take anti-diarrhea medicines. Drink plenty of fluitds and see if it goes away. If it does not go away, or is severe and you feel ill, please call your surgeon. If you experience any of the folloiwng, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: - Take all the medicines you were on before the operation just as you did before, unless you have been told differently. - 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. PredniSONE 10 mg PO DAILY 2. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 3. Aspirin 81 mg PO DAILY 4. Ferrous Sulfate 325 mg PO DAILY 5. Gabapentin 100 mg PO QHS:PRN insomnia, restless legs 6. Levothyroxine Sodium 75 mcg PO DAILY 7. Mycophenolate Mofetil 1000 mg PO BID 8. Vitamin D 400 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Small Bowel Obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for evaluation of abdominal pain and were found to have a small bowel obstruction. You were treated non-operatively and had a nasogastric tube inserted to help decompress your stomach. You are recovering well and are now ready for discharge. Please follow the instructions below to continue your recovery: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Fish Oil (Omega 3) ___ mg PO DAILY 3. Simvastatin 20 mg PO HS 4. Docusate Sodium 100 mg PO BID Please continue to take while you are still taking narcotics. 5. Famotidine 20 mg PO BID 6. Diazepam 5 mg PO Q6H:PRN back pain RX *diazepam 5 mg 5 mg by mouth Q 6hrs Disp #*28 Tablet Refills:*0 7. OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN pain Please do not drive or operate any machinery while on this medication. RX *oxycodone 10 mg 10 mg tablet(s) by mouth Q 4hrs Disp #*60 Tablet Refills:*0 8. Senna 1 TAB PO BID Please continue to take while you are still taking narcotics. 9. AndroGel (testosterone) 1 %(50 mg/5 gram) Transdermal daily 10. Aspirin 81 mg PO DAILY 11. Viagra (sildenafil) 100 mg Oral daily prn 12. lisinopril-hydrochlorothiazide ___ mg ORAL BID 13. Methylprednisolone 4 mg PO DAILY Take as directed on package, tapered doses. RX *methylprednisolone [Medrol (Pak)] 4 mg 4 tablets,dose pack(s) by mouth As directed on package Disp #*21 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Multiple levels of spinal canal stenosis and L4 on L5 anterolisthesis with spondylosis. 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 have been admitted to ___, on the Neurosurgical team for your recent complaint of back pain and right leg weakness. You have known spondylisthesis and spinal stenosis, and have experienced a recent injury. As your surgeon discussed with you, your recent images showed multilevel canal stenosis, L4 on L5 anterolisthesis with spondylosis without evidence of cord impingement. The need of surgical intervention has been ___ with you by your surgeon, it is our understanding that you will like some time to think about the surgery before consenting for surgery. Our office will contact you to book your appointment within the next two weeks, if you happen not to hear from us, you may contact our office by calling ___. Do not smoke. •No pulling up, lifting more than 10 lbs. or excessive bending or twisting. •Limit your use of stairs. Take your pain medication as instructed; you may find it best if taken in the morning when you wake-up for morning stiffness, and before bed for sleeping discomfort. •Increase your intake of fluids and fiber, as pain medicine (narcotics) can cause constipation. We recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING: •Pain that is continually increasing or not relieved by pain medicine. •Any weakness, numbness, tingling in your extremities. •Any signs of infection at the wound site: redness, swelling, tenderness, and drainage. •Fever greater than or equal to 10.5° F. •Any change in your bowel or bladder habits (such as loss of bowl or urine control).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN dyspnea, wheeze 2. Docusate Sodium 100 mg PO BID 3. Fluticasone Propionate 110mcg 2 PUFF IH BID 4. Fluticasone Propionate NASAL 1 SPRY NU BID 5. OLANZapine 10 mg PO HS 6. Clobetasol Propionate 0.05% Cream 1 Appl TP BID:PRN itch 7. Hydrocortisone Acetate Suppository 1 SUPP PR QHS:PRN hemorrhoids 8. Ibuprofen 800 mg PO Q8H:PRN pain 9. loratadine-pseudoephedrine ___ mg oral daily 10. Mineral Oil ___ mL PO BID:PRN affected area 11. Famotidine 20 mg PO BID:PRN Abdominal Pain RX *famotidine 20 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 12. Prochlorperazine 10 mg PO Q6H:PRN nausea 13. Ondansetron 4 mg PO Q8H:PRN nausea, vomiting RX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*12 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Cannabinoid Hyperemesis Syndrome / Post-Operative Nausea and Vomiting Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to take care of you at ___ ___. You were admitted because you were having nausea/vomiting and couldn't eat anything. We gave you fluids, made sure your electrolytes stay normal, and discharged you once you were eating some food. Best of luck to you in your future health. Please stop consuming marijuana, as we think this is contributing to your nausea. Please take all medications as prescribed, attend all physician appointments as directed, and call a physician with any questions or concerns.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H:PRN pain 2. Aspirin 81 mg PO DAILY 3. Allopurinol ___ mg PO EVERY OTHER DAY 4. Aquaphor Ointment 1 Appl TP TID:PRN itch 5. Carbamide Peroxide 6.5% ___ DROP AD BID 6. Docusate Sodium 100 mg PO BID 7. Dulera (mometasone-formoterol) 100-5 mcg/actuation inhalation BID RX *mometasone-formoterol [Dulera] 100 mcg-5 mcg/actuation 1 puff INH twice daily Disp #*1 Inhaler Refills:*0 8. Exelon (rivastigmine) 9.5 mg/24 hour transdermal daily 9. Ferrous Sulfate 325 mg PO DAILY 10. Finasteride 5 mg PO DAILY 11. Simvastatin 80 mg PO DAILY 12. Sodium Bicarbonate 650 mg PO QID:PRN reflux 13. Vitamin D 1000 UNIT PO DAILY 14. Albuterol Inhaler 1 PUFF IH Q4H:PRN wheezing RX *albuterol sulfate 90 mcg 1 puff INH every 4 hours Disp #*1 Inhaler Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: Chronic obstructive pulmonary disease Hypovolemia Secondary diagnoses: Stage IV Chornic Kidney Disease Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ due to low blood pressure and shortness of breath. You were given intravenous fluids and your blood pressure improved. You were given inhaled medications and your breathing improved. Please ensure that you are using your inhalers and drinking plenty of fluids. Your blood pressure was elevated on discharge. After discussion of the risks of high blood pressure, you and your family decided to go home. Please come to the ED if you have any headaches, vission changes, chest pain, nausea, vomiting. Please check your blood pressure tomorrow at Dr. ___ or at home. If the top number is greater than 170, please call Dr. ___. Please also follow-up with Dr. ___ on ___ at 11:15AM. It was a pleasure taking care of you. We wish you all the best. Sincerely, Your medicine team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Indomethacin 25 mg PO TID 2. Colchicine 0.6 mg PO DAILY RX *colchicine [Colcrys] 0.6 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: chest 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 pleasure to take care of you during this hospitalization. You were admitted to ___ for chest pain that was concerning for pericarditis (inflammation of the sac around your heart). You were treated with oral medications for this (colchicine and indomethacin). Monitoring of your heart did not show any inflammation or damage. The Rheumatology team saw you for this, and they recommended that you continue the oral medications above and that you follow-up with them as an outpatient. You remained stable throughout this hospitalization, and are now safe to go home. You are being discharged on oral medications to treat possible pericarditis. You have follow-up for this hospitalization scheduled with general medicine, Cardiology, and Rheumatology. Please take your medications as prescribed and follow-up with your doctors.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Bisacodyl ___AILY:PRN constipation 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 40 mg SC DAILY 5. Milk of Magnesia 30 ml PO BID:PRN Constipation 6. Multivitamins 1 TAB PO DAILY 7. OxyCODONE (Immediate Release) 2.5-5 mg PO Q6H:PRN pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left tibial plateau fracture, right distal radius fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - touchdown weight bearing left lower extremity in unlocked ___ Brace - nonweightbearing of right upper extremity in case MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take Lovenox daily for 2 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for and any new medications/refills. Physical Therapy: Touchdown weightbearing to left lower extremity Range of motion as tolerated in unlocked ___ brace Treatments Frequency: Please return to clinic in ___ days for incision check Please keep extremity elevated</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital after a fall at home. You had a fractured right clavicle, fractured left ribs, and partial collapse of your left lung. To treat the collapsed lung, surgery placed a chest tube to help the lung re-expand. You were evaluated by Physical Therapy who recommended discharge to a rehab facility to help you get more mobile and get back to normal functioning. Your aspirin and Plavix were stopped while you were in the hospital because you had some bleeding. You should get a lab check at rehab on ___ and if your blood count is stable, then you should restart your home dose of aspirin and Plavix. You were also found to have some kidney injury, which is likely due to dehydration. You received IV fluids and a blood transfusion, which helped your kidney function. Please continue to follow up with Orthopedic Surgery and with your outpatient Vascular Surgeon Dr. ___. It was a pleasure to take care of you while you were in the hospital. We wish you the best! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LeVETiracetam 1000 mg PO BID 2. Levothyroxine Sodium 50 mcg PO DAILY 3. Acetaminophen 650 mg PO Q6H:PRN fever or pain 4. Albuterol 0.083% Neb Soln 1 NEB IH Q4H wheezing 5. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 6. Thiamine 100 mg PO DAILY 7. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID Duration: 14 Days 8. Senna 8.6 mg PO BID:PRN constipation 9. Multiple Vitamins Liq. 5 mL PO QD 10. Lidocaine 1% 2.5 mL IH BID:PRN trach pain/discomfort 11. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 12. LACOSamide 100 mg PO BID 13. Ketoconazole 2% 1 Appl TP BID Duration: 21 Days 14. Heparin 5000 UNIT SC BID 15. FoLIC Acid 1 mg PO DAILY 16. Docusate Sodium (Liquid) 100 mg PO BID 17. Insulin SC Sliding Scale Fingerstick q6h Insulin SC Sliding Scale using REG Insulin Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnoses ================== Status Convulsive Epilepticus Hypoxemic Respiratory Failure Ventilator Associated Stenotrophomonas Pneumonia Acute Respiratory Distress Syndrome Acute Kidney Injury Stress Cardiomyopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a privilege to care for you during your stay at ___. You were admitted to the hospital because of prolonged seizures. You need to be intubated and had a long stay ___ the ICU. Your seizures were well controlled with a new regimen of medications. You needed to have a tracheostomy tube and G-tube (gastrostomy tube) to help you breath and take nutrition. You had an infection of your lungs that was treated with antibiotics. You were doing much better and were transferred out of the ICU to the medical floor. You continued to improve and were doing much better on discharge. You will be going to ___ Rehab ___ to help you regain your strength. You will follow up with the pulmonology doctors there to have your tracheostomy downsized ___ the future. You will also be evaluated while at ___ for a speaking valve for your tracheostomy. You will follow up at ___ ___ the Epilepsy Clinic and with the Infectious Disease clinic. Your appointments are listed below. A list of your medications is included with your discharge paperwork. It is important to bring this list to all of your appointments. 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. Allopurinol ___ mg PO DAILY 2. Aspirin 325 mg PO DAILY 3. Atorvastatin 80 mg PO DAILY 4. Calcium Acetate 667 mg PO TID W/MEALS 5. Lisinopril 20 mg PO DAILY 6. Nephrocaps 1 CAP PO DAILY 7. Omeprazole 20 mg PO DAILY 8. Thiamine 100 mg PO DAILY 9. Vitamin D 400 UNIT PO DAILY 10. Metoprolol Succinate XL 50 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: New onset of bigemny Secondary diagnosis: CHF Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the ___ medical service after it was found during dialysis that your heart rate and blood pressure were low. We think that you had not completely recovered from your congestive heart failure exacerbation over the weekend, making you feel weak. We noticed that you had an abnormal rhythm on your telemetry strip called bigeminy, with one normal strong beat and one weaker beat that was not being picked up on the pulse oximeter, causing it to think that you had a low pulse (which can also make you feel weak). Your pacemaker is functioning normally and the rate of your pacemaker was increased to decrease the frequency of these abnormal beats. We also started metoprolol with should help decrease the number of those abnormal beats. If you experience worsening fatigue, chest pain, shortness of breath, please seek immediate medical care. Please continue all of your home medications as prescribed and continue taking the metoprolol. Please continue your regular dialysis sessions and follow up with your primary care doctor. It was a pleasure taking care of you!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms. ___, It was a pleasure taking care of you during your admission to the hospital. You were admitted to the hospital with sleepiness and low oxygen levels. You were found to have pneumonia. Your condition improved with antibiotics, although you continued to have some low oxygen levels when you walked around for several days. You were also found to have difficulty emptying your bladder which improved. You also reported poorly controlled chronic pain despite the Dilaudid that you take at home. This is an important issue to discuss further with your primary care doctor. In the meantime, it is very important that you take your pain medications only as prescribed. Do not take extra doses of pain medications as this can cause confusion, difficulty breathing, and even death. Please follow up with your PCP at the appointment below. 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. sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times a day). 2. folic acid 1 mg Tablet Sig: Five (5) Tablet PO DAILY (Daily). 3. meclizine 12.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for dizziness. Disp:*30 Tablet(s)* Refills:*0* 4. ranitidine HCl 150 mg Capsule Sig: One (1) Capsule PO twice a day. 5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*0* 6. ondansetron HCl 4 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours) as needed for nausea. 7. methylprednisolone 16 mg Tablet Sig: Two (2) Tablet PO once a day. Disp:*60 Tablet(s)* Refills:*0* 8. ZOFRAN ODT 4 mg Tablet, Rapid Dissolve Sig: ___ Tablet, Rapid Dissolves PO every eight (8) hours as needed for nausea: please do not exceed 32 mg QD. Disp:*30 Tablet, Rapid Dissolve(s)* Refills:*0* 9. loratadine 10 mg Tablet Sig: One (1) Tablet PO twice a day. 10. tramadol 50 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for pain. 11. Outpatient Lab Work please get CBC draw prior to appointment with PCP ___, MD ___ and fax after being drawn Discharge Disposition: Home Discharge Diagnosis: nausea and vomitting likely from methotrexate eosinophillic gastritis 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 nausea and vomitting after getting a dose of methotrexate. You got a EGD and Ct scan which were within normal limits. You were treated with anti-emetics, IV fluids and supportive care. You gradually improved. You also developed unsteadiness which improved with fluids and medications. You will be sent home on steriods. You need to follow up with your Allergist, GI and new PCP. . Medication Changes 1) stop prednisone 2) start methyprednisolone 32 mg PO QD 3) stop budesonide 4) stop nystatin 5) start zofran ___ mg PO Q8H prn for nausea 6) start zofran ___ mg ODT Q8H if unable to tolerate pills for nausea-do not exceed 32 mg po QD 7) meclizine 12.5 PO Q8H prn dizziness</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H 2. Aspirin EC 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Atorvastatin 10 mg PO QPM RX *atorvastatin 10 mg 1 tablet(s) by mouth qpm Disp #*30 Tablet Refills:*0 4. Furosemide 40 mg PO DAILY Duration: 10 Days RX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*10 Tablet Refills:*0 5. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain RX *hydromorphone 2 mg ___ tablet(s) by mouth q3h Disp #*30 Tablet Refills:*0 6. Metoprolol Tartrate 25 mg PO TID RX *metoprolol tartrate 25 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 7. Potassium Chloride 20 mEq PO DAILY Duration: 10 Days RX *potassium chloride 20 mEq 1 tablet(s) by mouth daily Disp #*10 Tablet Refills:*0 8. TraMADOL (Ultram) 50 mg PO Q4H:PRN pain RX *tramadol 50 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 9. Valsartan 80 mg PO DAILY RX *valsartan 80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 10. Warfarin ___ mg PO DAILY16 dose to change daily per Dr. ___ goal INR ___, dx: mech AVR RX *warfarin 1 mg ___ tablet(s) by mouth daily as directed Disp #*60 Tablet Refills:*1 11. Lidocaine 5% Patch 1 PTCH TD QAM lower back pain RX *lidocaine 5 % 1 qam Disp #*30 Patch Refills:*0 12. LORazepam 0.5 mg PO Q8H:PRN anxiety RX *lorazepam 0.5 mg 1 by mouth every eight (8) hours Disp #*20 Tablet Refills:*0 13. Ranitidine 150 mg PO BID RX *ranitidine HCl 150 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: pericardial and pleural effusion, aspergillis in pericardial fluid Discharge Condition: Alert and oriented x3 non-focal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage subxiophoid and lateral (chest tube incicion) sites CDI Trace edema 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 one month or while taking narcotics. Driving 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 cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q4H:PRN Wheeze 2. Amiodarone 200 mg PO BID bid x 7days then decrease to 200mg daily 3. Artificial Tear Ointment 1 Appl BOTH EYES Q8H eye care 4. Artificial Tears ___ DROP BOTH EYES PRN dry eye 5. Aspirin EC 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. Bisacodyl ___AILY:PRN constipation 8. FoLIC Acid 1 mg PO DAILY 9. Furosemide 20 mg PO DAILY 10. GuaiFENesin 5 mL PO Q6H:PRN cough 11. Heparin Flush (10 units/ml) 1 mL IV DAILY and PRN, line flush 12. Lidocaine 5% Patch 1 PTCH TD QPM 13. Pantoprazole 40 mg PO Q12H 14. Potassium Chloride 40 mEq PO DAILY 15. Simethicone 40 mg PO QID:PRN abdominal bloating 16. Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush 17. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line flush 18. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 19. Thiamine 100 mg PO DAILY 20. Vancomycin 1500 mg IV Q 12H 2 week course-Duration to be determined at infectious disease follow up appt. 21. Venlafaxine XR 150 mg PO DAILY 22. ___ MD to order daily dose PO DAILY16 afib goal INR ___ ***very sensitive to Coumadin dosing 23. Metoprolol Tartrate 37.5 mg PO TID 24. Ondansetron 4 mg IV Q8H:PRN nausea 25. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours Disp #*40 Tablet Refills:*0 26. Outpatient Lab Work weekly: CBC, BUN/Creat, vanco through. Fax results to ___ infectious disease ___ 27. amLODIPine 2.5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: ___ chest closure with plating and ties ___ sternal debridement-VAC- OPEN CHEST ___ CABG x2(lima>LAD,SVG>circ) Coronary Artery Disease, MI x2 ___, ___ ___, ___), Hypertension, Hyperlipidemia, Back pain s/p motorcycle accident, Throat Cancer s/p XRT at ___ ___ yrs ago Past Cardiac Procedures: PCI vs angioplasty in the past (pt does not recall which one) Discharge Condition: Incisional pain managed with oxycodone Incisions: Sternal - healing well, no erythema or drainage JP drains intact to bulb suction edema:none Followup Instructions: ___ [/INST] </s><s>Please sponge bath daily. Do not allow chest dressing to get wet. Do not change chest dressing. Empty and keep a record of JP drainage and bring to your follow up appointment with Dr. ___. Look at your incisions daily for redness or drainage 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 until you are told to do so by your surgeon. No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns ___ Labs: ___ for Coumadin – indication afib Goal INR ___ First draw ___ then every ___ until INR stable and on a stable dose of Coumadin. Results to be managed by rehab medical staff then rehab staff to arrange follow up with PCP upon discharge from rehab. **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 2. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 3. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 4. hydrochlorothiazide 12.5 mg Capsule Sig: Fifty (50) mg PO DAILY (Daily). 5. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 6. nicotine 7 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily). 7. acetazolamide 250 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* Discharge Disposition: Home Discharge Diagnosis: Probable episodic ataxia syndrome. Discharge Condition: Condition: Good, improved. Mental status: Intact. Ambulatory status: independent. Only unsteady with tandem gait. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were admitted to the neurology service because of a transient episode of speech difficulty. ___ also informed us that ___ have a history of clumsiness, and your initial examination did show some signs of imprecision and some difficulty with your tandem gait. Your examination improved on its own and ___ are now back to your baseline. We performed head CT, brain MRI, and arterial imaging of your head. We did not find any strokes or vascular abnormalities to explain your symptoms. Your cerebellum, which is the part of the brain that controls the balance, seems to be smaller than usual. Your findings can potentially fit with a rare syndrome, called episodic ataxia syndrome, which is usually familial and is characterized by these intermittent problems with speech or walking, as well as some clumsiness. We would like to start ___ on a medication called diamox, which can help with the symptoms of dizziness and imbalance. This medication can cause carbonated beverages (beers/sodas) to taste flat. We will have ___ follow up with Dr. ___, as well as Dr. ___ runs the ___ clinic in order to consider genetic testing for your condition.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. metoprolol tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 2. simvastatin 10 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 3. metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day. 4. A&D ointment 11.3% Sig: One (1) once a day as needed for Rash. 5. ciclopirox 0.77 % Cream Sig: One (1) Topical once a day. 6. senna 8.6 mg Capsule Sig: Two (2) Capsule PO twice a day. Disp:*120 Capsule(s)* Refills:*2* 7. bisacodyl 10 mg Suppository Sig: One (1) Rectal once a day. Disp:*30 caps* Refills:*2* 8. bisacodyl 5 mg Tablet Sig: One (1) Tablet PO twice a day. Disp:*60 Tablet(s)* Refills:*2* 9. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO QID (4 times a day): give with every glass of milk . Disp:*___ g* Refills:*2* 10. Debrox 6.5 % Drops Sig: One (1) Otic once a day. 11. lactulose 10 gram/15 mL Solution Sig: Two (2) PO twice a day as needed for constipation. Discharge Disposition: Home Discharge Diagnosis: 1. Severe constipation with dilatation of the sigmoid colon Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___ and ___, You were admitted to ___ after worsening abdominal pain and inability to move your bowels. You were found to have a significant amount of constipation. Because of the amount of colon distension noted on imaging, you underwent a sigmoidoscopy to evaluate for potential obstruction. In addition, you had a rectal tube in place to help with constipation. Sigmoidoscopy and CAT scan did not reveal any signs of obstruction. Medication changes: You were started on increasing doses of Miralax to be take with milk. It is also very important for you to be doing the behavioral modifications to help with bowel movements as discussed by Dr. ___. Developing a regular schedule where you are to sit on the toilet to try to have a bowel movement at least three times per day after every meal. Please continue to take Dulcolax suppository as prior and continue to take milk with Miralax as performed in this hospital. If you continue to experience inability to move your bowels please contact your PCP and arrange for a manual disempaction.</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. Clonazepam 0.5 mg PO QHS:PRN anxiety 3. 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 4. Docusate Sodium 100 mg PO BID 5. Furosemide 40 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Incarcerated ventral hernia x2 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 2 hernias that were causing your pain and incarcerated a portion of your small bowel. You were taken to the operating room and had these hernias repaired. You are recovering well and are now being discharged home with the following instructions: Please follow up in ___ clinic at the appointment scheduled for you below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. Heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. HOW YOU MAY FEEL: You may feel weak or "washed out" for 6 weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. You could have a poor appetite for a while. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Your incision may be slightly red around the staples. This is normal. You may gently wash away dried material around your incision. It is normal to feel a firm ridge along the incision. This will go away. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. Ove the next ___ months, your incision will fade and become less prominent. YOUR BOWELS: Constipation is a common side effect of medicine such as Percocet or codeine. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription from your surgeon for pain medicine to take by mouth. It is important to take this medicine as directied. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the folloiwng, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. In some cases you will have a prescription for antibiotics or other medication. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO DAILY 2. Furosemide 40 mg PO DAILY hold for sbp <100 3. Lisinopril 40 mg PO DAILY 4. Pravastatin 20 mg PO DAILY 5. Senna 1 TAB PO BID:PRN constipation 6. Vitamin B Complex 1 CAP PO DAILY 7. Albuterol 0.083% Neb Soln 1 NEB IH Q6H 8. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB/Wheeze 9. Amlodipine 5 mg PO DAILY 10. Aspirin 81 mg PO DAILY 11. Fluticasone Propionate 110mcg 2 PUFF IH BID 12. Metoprolol Succinate XL 150 mg PO DAILY 13. CefePIME 2 g IV Q24H Duration: 10 Days 14. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN wheezing 15. Warfarin 1 mg PO DAILY16 16. Quetiapine Fumarate 6.25 mg PO HS:PRN agitation Should be givenno later than 6pm Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: - diastolic Congestive Heart Failure - Atrial fibrillation - Hx Aortic Dissection ___ - Chronic Kidney disease - Hypertension - Hyperlipidemia - Aortic Stenosis - Migraines - Ulcerative colitis - ___ yrs of symptoms prior to diagnosis. Not currently on any UC medications - Osteoporosis - Hx of upper GI bleed - s/p MVA ___ ago and presumed ___ ___ tear. Took advil and aspirin for fractured sternum. Received 5 unit transfusion. - Fall history - Hyperplastic polyps - Basal and squamous cell carcinomas - Hiatal hernia - Complicated by GERD - Rhinitis - Benign breast cysts - Cataracts surgery - Both eyes Discharge Condition: Mental Status: Confused - sometimes. Activity Status: Out of Bed with assistance to chair or wheelchair. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>You were admitted with respiratory compromise related to a healthcare acquired pneumonia. This was treated with Cefpime and Azitromycin both antibiotics. You also experienced atrial fibrillation with a rapid ventricular response. We initiated you on anticoagulation called Coumadin, which you will take on a daily basis to prevent clot from forming in your heart. We also increased your beta blocker, metorpolol XL to 150 mg dialy. When you came into the hospital it was also thought that you had some evidence of diastolic heart failure which has resolved, we hav eresume dyour home lasix resumed your lisinopril as well as your beta blocker, only at a higher dose given your atrial fibrillation</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Daptomycin 530 mg IV Q24H RX *daptomycin [Cubicin] 500 mg 530 mg IV once a day Disp #*19 Vial Refills:*0 2. Ertapenem Sodium 1 g IV 1X Duration: 1 Dose 1 gram daily until ___ RX *ertapenem [Invanz] 1 gram 1 gram IV daily Disp #*19 Vial Refills:*0 3. Ferrous Sulfate 325 mg PO BID RX *ferrous sulfate [Feosol] 325 mg (65 mg iron) 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 4. Vitamin D 400 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Warfarin 4 mg PO DAILY16 Hold warfarin today (___). Will need to check INR daily to adjust dosing further RX *warfarin [Coumadin] 4 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Albuterol Inhaler 2 PUFF IH Q6H wheezing 7. Atenolol 100 mg PO DAILY 8. Cyclobenzaprine 10 mg PO BID:PRN spasm 9. Leuprolide Acetate 11.25 mg IM Q3MONTHS 10. LORazepam 1 mg PO QHS anxiety 11. QUEtiapine Fumarate 400 mg PO QHS 12. Zolpidem Tartrate 5 mg PO QHS:PRN insomnia 13.Outpatient Lab Work CBC w/ Diff 3 days re: leukopenia and anemia D72.819 ,D64.9 BMP 3 days re: ___ N17.9 LFT's 3 days re: Elevated LFT's R94.5 INR daily until INR therapeutic range (___) re: warfarin anticoagulation Z79.01 Weekly CPK re: Daptomycin use Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: ___ Polymicrobial left septic knee Anemia 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 fever found to have kidney damage, which was likely from your vancomycin. Infectious disease was involved and adjusted your antibiotics. Your orthopedic surgeons were also involved and you had a joint aspiration of your left knee done on ___. You were discharged on IV Daptomycin and Ertapenem It was a pleasure taking care of you. Please be sure that your antibiotics are given on regular intervals.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY RX *aspirin 325 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 2. Atorvastatin 80 mg PO DAILY 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 capsule(s) by mouth every four (4) hours Disp #*20 Capsule Refills:*0 4. Atenolol 100 mg PO DAILY 5. Hydrochlorothiazide 12.5 mg PO DAILY 6. Losartan Potassium 100 mg PO DAILY 7. Tamsulosin 0.4 mg PO HS Discharge Disposition: Home Discharge Diagnosis: Carotid artery stenosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Division of Vascular and Endovascular Surgery Carotid Endarterectomy Surgery Discharge Instructions WHAT TO EXPECT: 1. Surgical Incision: •It is normal to have some swelling and feel a firm ridge along the incision •Your incision may be slightly red and raised, it may feel irritated from the staples 2. You may have a sore throat and/or mild hoarseness •Try warm tea, throat lozenges or cool/cold beverages 3. You may have a mild headache, especially on the side of your surgery •Try ibuprofen, acetaminophen, or your discharge pain medication •If headache worsens, is associated with visual changes or lasts longer than 2 hours- call vascular surgeon’s office 4. It is normal to feel tired, this will last for ___ weeks •You should get up out of bed every day and gradually increase your activity each day •You may walk and you may go up and down stairs •Increase your activities as you can tolerate- do not do too much right away! 5. It is normal to have a decreased appetite, your appetite will return with time •You will probably lose your taste for food and lose some weight •Eat small frequent meals •It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing •To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication MEDICATION: •Take all of your medications as prescribed in your discharge ACTIVITIES: •No driving until post-op visit and you are no longer taking pain medications •No excessive head turning, lifting, pushing or pulling (greater than 5 lbs) until your post op visit •You may shower (no direct spray on incision, let the soapy water run over incision, rinse and pat dry) •Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing over the area CALL THE OFFICE FOR: ___ •Changes in vision (loss of vision, blurring, double vision, half vision) •Slurring of speech or difficulty finding correct words to use •Severe headache or worsening headache not controlled by pain medication •A sudden change in the ability to move or use your arm or leg or the ability to feel your arm or leg •Trouble swallowing, breathing, or talking •Temperature greater than 101.5F for 24 hours •Bleeding, new or increased drainage from incision or white, yellow or green drainage from incisions</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because you were fatigued and had lab abnormalities (low sodium and high bilirubin). WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - We held your diuretic medications and restricted the amount of fluid you can drink because this was causing your low sodium levels. - We updated ___ hospital daily because you are followed by their transplant team. - You had a paracentesis procedure to remove fluid from your stomach for comfort. - You improved and were ready to leave the hospital. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - You must never drink alcohol again or you will die - Please enroll in AA and work with your primary care doctor to determine the best strategy to help you stay sober - Take all of your medications as prescribed (listed below) - Keep your follow up appointments with your doctors - Weigh yourself every morning, before you eat or take your medications. Call your doctor if your weight changes by more than 3 pounds - Please stick to a low salt diet and monitor your fluid intake - 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. Acetaminophen 1000 mg PO Q8H 2. bicalutamide 50 mg oral DAILY RX *bicalutamide 50 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Bisacodyl 10 mg PO DAILY 4. Calcium Carbonate 500 mg PO QID:PRN GI discomfort 5. Lidocaine 5% Patch 1 PTCH TD QPM 6. Multivitamins W/minerals 1 TAB PO DAILY 7. OxyCODONE (Immediate Release) 5 mg PO Q6H Hold for RR<12 or sedation RX *oxycodone 5 mg 1 tablet(s) by mouth q6 hours Disp #*10 Tablet Refills:*0 8. OxyCODONE (Immediate Release) 10 mg PO Q4H:PRN Pain - Severe Hold for RR<12 or sedation RX *oxycodone 10 mg 1 tablet(s) by mouth every four (4) hours Disp #*10 Tablet Refills:*0 9. Polyethylene Glycol 17 g PO DAILY 10. Senna 8.6 mg PO BID 11. Simethicone 40-80 mg PO QID:PRN bloating, gas 12. Thiamine 100 mg PO DAILY 13. TraZODone 12.5 mg PO QHS:PRN insomnia 14. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing 15. nicotine (polacrilex) 4 mg buccal ASDIR 16. Tiotropium Bromide 1 CAP IH DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Metastatic prostate cancer Secondary: Chronic pain COPD Constipation Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>====================== DISCHARGE INSTRUCTIONS ====================== Dear Mr. ___, It was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - You were admitted to the hospital for weight loss and back pain. WHAT HAPPENED TO ME IN THE HOSPITAL? - You were found to have a 7cm mass in back. A biopsy was performed revealing prostate cancer. Oncology started you on bicalutamide treatment for this prostate cancer. - Your pain was treated with Oxycodone, Tylenol, and Lidocaine patches WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 2. Scopolamine Patch 1 PTCH TD ONCE Duration: 72 Hours RX *scopolamine base 1 mg/3 day 1 patch every 3 days Disp #*10 Patch Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis ================= Abdominal pain, nausea, vomiting Depression Bipolar Disease Secondary Diagnosis =================== H. Pylori Gastritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure caring for you at ___ ___! WHY WERE YOU ADMITTED? You were admitted because you had nausea, vomiting and abdominal pain at home and you were not able to keep anything down. WHAT HAPPENED IN THE HOSPITAL? You had an image taken of you abdomen which did not show any problems in your intestinal tract. The image showed you have a cyst in your right ovary which you will need to follow at your upcoming gynecology appointment. We managed your nausea with IV medication, and then we transitioned you to oral medication. We gave you a patch to help with your nausea. You were able to eat small bites and drink before discharge. You were also seen by our social worker and our psychiatry colleagues because you reported some hallucinations. They think it is very important for you to ___ with your psychiatrist on ___ at 2pm. WHAT SHOULD YOU DO AT HOME? You need to stop smoking marijuana as it can cause some of the symptoms of nausea/vomiting/abdominal pain. It is very important you ___ with your psychiatrist to manage your depression and mental health. You need to ___ with gynecology about your ovary cyst. You need to ___ with the gastrointestinal doctor about your nausea, vomiting and abdominal pain symptoms. If you want to continue your care here at ___ our team will be happy to see you. You need to ___ with your PCP - we made an appointment for you with a new PCP at ___. Thank you for allowing us be involved in your care, we wish you all the best! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LORazepam 0.5 mg PO Q4H:PRN anxiety, agitation, chest pain RX *lorazepam [Ativan] 0.5 mg 1 (One) by mouth Q4H PRN Disp #*24 Tablet Refills:*0 2. Morphine Sulfate (Oral Solution) 2 mg/mL ___ mg PO Q4H:PRN Pain - Severe Reason for PRN duplicate override: Alternating agents for similar severity RX *morphine 10 mg/5 mL 2 mg by mouth Q4H PRN Refills:*0 3. Labetalol 300 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: acute coronary syndrome 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 to care for you at ___. You came to the hospital because you developed chest pain at home. We found that you were likely having a heart attack and we considered performing a procedure ("cardiac catheterization") to help treat your heart attack. You and your family decided that you did not want to pursue any procedures in the hospital and will instead be transitioning to comfort care and hospice at home. Please continue to take your prescribed medications and follow-up with your doctors as ___. 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>•Take your pain medicine as prescribed. •Exercise should be limited to walking; no lifting, straining, or excessive bending. •Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. •If you were on a medication such as Coumadin (Warfarin), or Plavix (clopidogrel), or Aspirin prior to your injury, you may safely resume taking this again now. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING •New onset of tremors or seizures. •Any confusion, lethargy or change in mental status. •Any numbness, tingling, weakness in your extremities. •Pain or headache that is continually increasing, or not relieved by pain medication. •New onset of the loss of function, or decrease of function on one whole side of your body.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID 2. Darunavir 800 mg PO DAILY 3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 4. RiTONAvir 100 mg PO DAILY 5. Atovaquone Suspension 750 mg PO BID Duration: 21 Days 21 Day Course (Day #1 ___ RX *atovaquone 750 mg/5 mL 750 mg by mouth twice a day Disp #*210 Milliliter Milliliter Refills:*0 6. Azithromycin 1200 mg PO 1X/WEEK (MO) RX *azithromycin 600 mg 2 tablet(s) by mouth Once a Week Disp #*60 Tablet Refills:*3 7. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q4H:PRN wheeze Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES =================== # Pneumocystic jirovecci pneumonia # Esophageal thrush # Elevated pulmonary pressures SECONDARY DIAGNOSES ==================== # HIV/AIDS (CD4 23 ___ 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 the ___. You were admitted to the hospital with fevers, shortness of breath, and weight loss. We thought your symptoms were most consistent with a pneumonia, specifically a PCP ___ (similar to the episode you have had previously in ___. For concern of a heart or lung etiology of your symptoms, an echocardiogram was performed which revealed moderately elevated pressure in the lung which may be related to your ongoing infection although we can not be 100% certain at this time. You were discharged on ongoing treatment for your PCP pneumonia with atovaquone. Please continue to take atovaquone through ___. Please be sure to call ___ to schedule an appointment with ___. We wish you a speedy recovery and 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. Gabapentin ___ mg PO DAILY 3. Lorazepam 0.5 mg PO Q6H:PRN anxiety 4. Pantoprazole 40 mg PO Q12H 5. Cyanocobalamin 50 mcg PO DAILY 6. Hydrocortisone Cream 2.5% 1 Appl TP DAILY 7. Multivitamins 1 TAB PO DAILY 8. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin 500 mg 1 tablet(s) by mouth twice a day Disp #*20 Tablet Refills:*0 9. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H Duration: 10 Days RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please call Dr ___ and then proceed to the emergency room at ___ if you develop the same pain that brought you into the hospital. Avoid fried foods, and heavy cream sauces, gravies, higher fat meats. Continue all home medications as you were previously taking Follow up appointment with Dr ___ to discuss risks and benefits of removing the gallbladder. Complete antibiotic course. Do NOT drink alcohol while taking these medications. Best to avoid alcohol altogether</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 BREAKTHROUGH PAIN RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*5 Tablet Refills:*0 2. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing RX *albuterol sulfate [ProAir HFA] 90 mcg 2 puffs inhaled every six (6) hours Disp #*1 Inhaler Refills:*0 3. Cetirizine 10 mg PO DAILY 4. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 5. Ranitidine 150 mg PO DAILY 6. Sertraline 50 mg PO DAILY RX *sertraline 50 mg 1 tablet(s) by mouth once a day Disp #*7 Tablet Refills:*0 7. Vitamin E 400 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: stab wound to left chest Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ and underwent chest tube placement and exploratory laparoscopy. You are recovering well and are now ready for discharge. Please follow the instructions below to continue your recovery: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery. Warm regards, Your ___ Surgery Team</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 TID (3 times a day) as needed for pain: max 4g/day. 2. tramadol 50 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours) as needed for pain. 3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 4. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: Five Hundred (500) mg PO TID (3 times a day). 5. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) for 1 weeks. 7. meclizine 12.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for dizziness. 8. hydralazine 20 mg/mL Solution Sig: Ten (10) mg Injection Q6H (every 6 hours) as needed for SBP > 140. 9. ciprofloxacin 0.3 % Drops Sig: One (1) Drop Ophthalmic BID (2 times a day): 1 DROP RIGHT EAR BID give with dexamethasone ear drops . 10. dexamethasone 0.1 % Drops, Suspension Sig: One (1) Drop Ophthalmic BID (2 times a day): give with cipro ear drops to right ear. Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Bifrontal brain contusions Right temporoparietal skull fracture Right Ear external canal laceration 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. •Increase your intake of fluids and fiber. We generally recommend taking an over the counter stool softener, such as Docusate (Colace). •Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Advil, or Ibuprofen etc. •You may safely resume taking Aspirin on ___. •You are being discharged on Keppra (Levetiracetam) for seizure prophylaxis, you will not require blood work monitoring. You will continue this medication for 7 days. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING •New onset of tremors or seizures. •Any confusion, lethargy or change in mental status. •Any numbness, tingling, weakness in your extremities. •Pain or headache that is continually increasing, or not relieved by pain medication. •New onset of the loss of function, or decrease of function on one whole side of your body. ENT DC instructions - do not use hearing aid until canal is clear (this can be verified by her PCP ___ ___ weeks, prior to follow up with ENT) - dry ear precautions until f/u with ENT: use cotton ball coated in Vaseline when showering, no swimming</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. 70/30 45 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 3. Levothyroxine Sodium 112 mcg PO DAILY 4. MetFORMIN (Glucophage) 500 mg PO BID 5. Metoprolol Tartrate 12.5 mg PO BID 6. Simvastatin 40 mg PO DAILY 7. Acetaminophen 1000 mg PO Q8H:PRN pain 8. Docusate Sodium 100 mg PO BID 9. Lisinopril 5 mg PO DAILY 10. Sulfameth/Trimethoprim DS 1 TAB PO BID RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth Twice daily Disp #*30 Tablet Refills:*0 11. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain Do not drink alcohol or drive a car while taking this medication RX *oxycodone 5 mg 1 tablet(s) by mouth Every 4 hours Disp #*20 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Wound dehiscence with fibrinous exudate Discharge Condition: Mental Status: Clear and coherent. Activity Status: Ambulatory - Independent. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ for a dehiscent wound in your right inguinal region from your angioplasty incision. You were treated with operative debridement and placement of a wound vaccuum. You are now stable for discharge. Medications: Please resume your pre-admission medications. You are being discharged on medications to help control the pain associated with having a wound vaccuum. Please take these as prescribed. Do not take greater than 4,000mg tylenol per day and do not drive a car or drink alcohol while taking narcotic pain medications. Your Vaccum: This will provide helpful information in caring for your wound. If you have any questions or concerns please talk with your doctor or nurse. You have an open wound, as opposed to a closed (sutured or stapled) wound. The skin over the wound is left open so the deep tissues may heal before the skin is allowed to heal. Premature closure or healing of the skin can result in infection. Your wound was left open to allow new tissue growth within the wound itself. The wound is covered with a VAC dressing. This will be changed around every three days. The VAC: - helps keep the wound tissue clean - absorbs drainage - prevents premature healing of skin - promotes healing When to Call the Doctor: Watch for the following signs and symptoms and notify your doctor if these occur: -Temperature over 101.5 F or chills -Foul-smelling drainage or fluid from the wound -Increased redness or swelling of the wound or skin around it -Increasing tenderness or pain in or around the wound Your ___ may assist you in showering while your wound vaccuum is in place. Please do not shower with wound vac on as it may harm the seal and prevent your therapy from proceeding appropriately. You have no activity restrictions.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN dyspnea 2. Docusate Sodium 100 mg PO BID:PRN constipation 3. Enoxaparin Sodium 40 mg SC Q12H Start: ___, First Dose: Next Routine Administration Time 4. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 5. Gabapentin 300 mg PO QHS 6. Loratadine 10 mg PO DAILY 7. TraMADol 50 mg PO TID:PRN pain 8. Acetaminophen 650 mg PO Q6H 9. Cephalexin 500 mg PO Q6H RX *cephalexin 500 mg 1 capsule(s) by mouth every six (6) hours Disp #*24 Capsule Refills:*0 10. Sulfameth/Trimethoprim DS 1 TAB PO BID RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Cellulitis Chronic venous stasis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___. You were admitted for foot pain, which we believe is a combination of pain from swelling as well as skin infection. We got an xray that showed no broken bones in your foot. The podiatrists also evaluated your foot and believed that there was no gout, but just swelling and skin infection. We treated you with several doses of intravenous antibiotics with improvement of the infection. We also wrapped your foot/leg to improve the swelling. Please use your compression devices at home to control the swelling, as this was largely contributing to your pain. Remember to take only Tylenol for pain and not ibuprofen/advil or aleve, as these are not allowed after your gastric surgery. Please take all of your antibiotics as prescribed. On behalf of your ___ team, We wish you all the best</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Humalog 35 Units Breakfast Humalog 35 Units Lunch Humalog 35 Units Dinner degludec 120 Units Breakfast Insulin SC Sliding Scale using HUM InsulinMax Dose Override Reason: Discussed with ___ consult RX *blood sugar diagnostic [OneTouch Ultra Test] three times a day Disp #*90 Strip Refills:*2 RX *insulin glargine [Lantus Solostar] 100 unit/mL (3 mL) AS DIR 60 Units before BKFT; 60 Units before BED; Disp #*1 Box Refills:*0 RX *insulin lispro [Humalog KwikPen] 200 unit/mL (3 mL) AS DIR before meals, use 35 units base plus the sliding scale below Disp #*1 Box Refills:*0 RX *lancets [OneTouch UltraSoft Lancets] three times a day Disp #*90 Each Refills:*2 2. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Acetaminophen 1000 mg PO TID:PRN Pain - Mild 4. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath 5. ARIPiprazole 20 mg PO DAILY 6. Aspirin 81 mg PO DAILY 7. BD Insulin Pen Needle UF Short (pen needle, diabetic) 31 gauge x ___ miscellaneous As directed 8. Creon 12 2 CAP PO TID W/MEALS 9. Cyanocobalamin 1000 mcg PO DAILY 10. DULoxetine 20 mg PO BID 11. Fenofibrate 145 mg PO DAILY 12. FreeStyle Lite Strips (blood sugar diagnostic) 1 strip miscellaneous QIDACHS 13. Gabapentin 800 mg PO TID 14. Hydrocerin 1 Appl TP TID 15. Lidocaine 5% Patch 1 PTCH TD QAM 16. Metoprolol Succinate XL 50 mg PO DAILY 17. Nicotine Lozenge 2 mg PO Q2H:PRN cravings 18. OXcarbazepine 300 mg PO BID 19. Pantoprazole 40 mg PO Q12H 20. Ranitidine 150 mg PO DAILY 21. Senna 8.6 mg PO BID:PRN constipation 22. Simethicone 40-80 mg PO QID:PRN gas pain 23. Sucralfate 1 gm PO QID 24. TraMADol 50 mg PO Q6H:PRN Pain - Moderate 25. TraZODone 100 mg PO QHS:PRN insomnia 26. Zolpidem Tartrate 10 mg PO QHS:PRN insomnia Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: DKA Pneumonia Chronic pancreatitis 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 recurrent DKA. You were found to have pneumonia and completed treatment for this. ___ diabetes team co-managed your diabetes and uptitrated your insulin regimen. Please follow their instructions. You were seen by social work, and are encouraged to follow up with your outpatient social worker and therapist.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. oxycodone-acetaminophen ___ mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*100 Tablet(s)* Refills:*0* 2. morphine 30 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO Q12H (every 12 hours). Disp:*60 Tablet Extended Release(s)* Refills:*0* 3. lactulose 20 gram/30 mL Solution Sig: Thirty (30) ML PO TID (3 times a day). Disp:*2700 ML(s)* Refills:*2* 4. cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for spasms. Disp:*90 Tablet(s)* Refills:*0* 5. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). Disp:*60 Adhesive Patch, Medicated(s)* Refills:*2* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Lumbar disc herniation and degeneration Post-op urinary retention Discharge Condition: Good Followup Instructions: ___ [/INST] </s><s>You have undergone the following operation: ANTERIOR/POSTERIOR Lumbar Decompression With 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 getting up and walking around. -Rehabilitation/ Physical Therapy: o2-3 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. oLimit 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 have been given a brace. This brace is to be worn for comfort when you are walking. You may take it off when sitting in a chair or while 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. Call the office. -You should resume taking your normal home medications. No NSAIDs. -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 ___ 2. 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. Please call the office if you have a fever>101.5 degrees Fahrenheit and/or drainage from your wound. Physical Therapy: Activity: as tolerated LSO for ambulation; may be out of bed to chair without. Treatments Frequency: Please continue to change the dressing daily</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levothyroxine Sodium 175 mcg PO DAILY RX *levothyroxine 175 mcg 1 tablet(s) by mouth once a day Disp #*60 Tablet Refills:*0 2. RisperiDONE 1 mg PO BID RX *risperidone 0.5 mg 1 tablet(s) by mouth every evening Disp #*30 Tablet Refills:*0 Discharge Disposition: Extended Care Discharge Diagnosis: Primary: hypothyroidism Secondary: acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were brought to the hospital due to bizarre behavior. We found that your blood alcohol level was very high and that your thyoid level was very low because you had not taken your home levothyroxine in awhile. We cannot stress to you how important it is to take your levothyroxine every single day. You were evaluated by the psychiatry team and they determined that it was unsafe for you to leave the hospital. You were transferred to the inpatient psychiatry floor at ___ ___. You will continue your medications as prescribed. It was a pleasure taking care of you, be well! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levofloxacin 750 mg PO DAILY RX *levofloxacin 750 mg 1 tablet(s) by mouth once a day Disp #*2 Tablet Refills:*0 2. Cyanocobalamin AS DIR mcg PO AS DIR 3. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 4. amLODIPine 2.5 mg PO DAILY 5. Atorvastatin 20 mg PO QPM 6. Hydrochlorothiazide 12.5 mg PO DAILY 7. Losartan Potassium 25 mg PO DAILY 8. Mycophenolate Mofetil 1000 mg PO BID 9. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q4H:PRN 10. Ranitidine 150 mg PO QHS 11. Tacrolimus 5 mg PO Q12H 12. Vitamin D 4000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: #Community Acquired Pneumonia #Urinary tract infection #ESRD s/p transplant #Fibromyalgia #Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___! Why was I admitted to the hospital? -You were admitted because you had fever, sore throat, muscle cramps, a cough and urinary urgency. What happened while I was in the hospital? - You had a chest x-ray which was concerning for pneumonia. You were started on antibiotics, "Levaquin", for 5 days. You will need to continue to take this antibiotic until ___ at home. - You were also found to have a urinary tract infection. The antibiotic you are on right now should also treat your urine infection. Continue this antibiotic until ___ as above. What should I do after leaving the hospital? - Please take your medications as listed in discharge summary and follow up at the listed appointments. Thank you for allowing us to be involved in your care, we wish you all the best! Sincerely, Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 2. Docusate Sodium 100 mg PO BID 3. Enoxaparin (Prophylaxis) 40 mg SC BID RX *enoxaparin 40 mg/0.4 mL 40 mg SC once a day Disp #*28 Syringe Refills:*0 4. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 5. Senna 17.2 mg PO HS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left proximal humerus fracture/dislocation 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>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. REHAB INSTRUCTIONS: Patient was found to be retaining urine on multiple occasions necessitating intermittent catheterization. Please monitor for urinary retention with regular bladder scans with plan for additional intermittent catheterization vs. foley placement if patient continues to retain. ACTIVITY AND WEIGHT BEARING: - NWB LUE ADLs as tolerated - start pendulums in 2 weeks; WBAT RUE - avoid extremes of abduction/external rotation. MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take aspirin 325 daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - Splint must be left on until follow up appointment unless otherwise instructed. - Do NOT get splint wet. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever ___ 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___. You will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for any new medications/refills. THIS PATIENT IS EXPECTED TO REQUIRE ___ DAYS OF REHAB Physical Therapy: NWB LUE ADLs as tolerated - start pendulums in 2 weeks; WBAT RUE - avoid extremes of abduction/external rotation. Treatments Frequency: No surgical dressing in place</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H RX *acetaminophen 325 mg 2 tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*20 Capsule Refills:*0 3. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*16 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY 5. Spironolactone 50 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Acute appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ appendicitis. You had your appendix removed and now you are ready to be discharged home from the hospital. Please read the following instructions to assist with a successful recovery. Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery. Thank you for allowing us to 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. amLODIPine 10 mg PO DAILY 2. Chlorthalidone 25 mg PO DAILY 3. Labetalol 100 mg PO Q6H:PRN SBP >150 4. Lidocaine 5% Patch 1 PTCH TD QAM 5. Lisinopril 40 mg PO DAILY 6. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 7. Omeprazole 20 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Intraparenchymal hemorrhage Discharge Condition: Mental Status: Alert. Good comprehension. No speech. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized due to symptoms of apahasia resulting from an ACUTE HEMORRHAGIC STROKE, a condition where you have bleeding in your brain. 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 adding the following medications for blood pressure control: amlodipine 10mg daily chlorthalidone 25mg daily Lisinopril 40mg daily You will stop taking: Aspirin 81mg daily Losartan Potassium 50mg daily Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body It was a pleasure taking care of you! Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 7 days. Disp:*14 Tablet(s)* Refills:*0* 2. metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) for 7 days. Disp:*21 Tablet(s)* Refills:*0* 3. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*0* 4. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 5. doxycycline hyclate 100 mg Capsule Sig: One (1) Capsule PO Q12H (every 12 hours). 6. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 8. Milk of Magnesia 400 mg/5 mL Suspension Sig: Five (5) ml PO four times a day as needed for constipation. Discharge Disposition: Home Discharge Diagnosis: Ruptured acute appendicitis with suppurative peritonitis 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: 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 6 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. Heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. HOW YOU MAY FEEL: You may feel weak or "washed out" for 6 weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. You could have a poor appetite for a while. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Tomorrow you may shower and remove the gauzes over your incisions. Under these dressings you have small plastic bandages called steristrips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). Your incisions may be slightly red around the stitches. This is normal. You may gently wash away dried material around your incision. It is normal to feel a firm ridge along the incision. This will go away. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. Ove the next ___ months, your incision will fade and become less prominent. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Do not drink alcohol or drive while taking narcotic pain medication. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 2. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 1 tab oral DAILY 3. Ferrous Sulfate 325 mg PO DAILY 4. Fluticasone Propionate NASAL 1 SPRY NU BID 5. GlipiZIDE 5 mg PO BID 6. Losartan Potassium 100 mg PO DAILY 7. Metoprolol Succinate XL 100 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Omeprazole 20 mg PO DAILY 10. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q6H:PRN wheezing 11. Simvastatin 20 mg PO QPM 12. Torsemide 20 mg PO DAILY 13. HELD- amLODIPine 10 mg PO DAILY This medication was held. Do not restart amLODIPine until you speak to your primary care doctor Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Acute Lower GI Bleed (likely diverticular) Acute on Chronic Diastolic CHF Acute Hypoxemic Respiratory Failure Urinary Tract Infection Atrial Fibrillation Fall Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to be a part of your care team at ___ ___. ==================================== Why did you come to the hospital? ==================================== -You had a fall. ==================================== What happened at the hospital? ==================================== - You were found to have low oxygen levels, from fluid build up behind your heart. You were treated with diuretics to help remove the extra fluid and your oxygen levels improved. - You had bleeding from your colon and got 6 units of blood and a colonoscopy. They did not find any active bleeding but could not appropriately screen for colon cancer. They found 1 polyp but did not remove it due to risk of bleeding. Please discuss with your primary care doctor whether you would like to repeat a colonoscopy to screen for colon cancer at your next primary care visit. - You also had a gout flare and you were treated for this. - you had a small mass seen on your lung CT scan, and a special scan called a PET scan is recommended, as the mass increased in size since your last exam where they saw the mass in ___, to make sure the mass is not cancer. Please discuss scheduling this with your primary care doctor. - Your metoprolol was increased to 100mg TWICE A DAY - Your amlodipine was stopeed - You were started on a medication called advair, an inhaler to help with your lungs. ================================================== What needs to happen when you leave the hospital? ================================================== - Take your medications every day and have your blood laboratory level checked as directed by your doctors - Make an appointment to see your primary care doctor within ___ weeks. - Call ___ to schedule an appointment with your cardiologist as soon as possible after you leave the hospital. - Weigh your self daily; if you weight goes up by more than 3 pounds in 1 day or 5 pounds in 3 days, call your doctor. - Please attend all of your doctor appointments. - Discuss with your doctor about having another colonoscopy in the future. Please take all medications as prescribed and keep all scheduled doctor's appointments. Seek medical attention if you develop a worsening or recurrence of the same symptoms that originally brought you to the hospital, experience any of the warning signs listed below, or have any other symptoms that concern you. 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. RisperiDONE 1 mg PO BID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: ================= Command auditory hallucinations SECONDARY DIAGNOSIS: =================== Schizophrenia Depression Asthma 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 caring for you at ___. Please see below for more information on your hospitalization. WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were hearing voices that were possibly telling you to hurt people WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL? - We ensured your safety - Psychiatry evaluated you and helped us with your treatment - We started a medication to treat your auditory hallucinations - We recommend that you try to get back to ___. See below for resources. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Take your new medication-- risperidone. We got you a free 2 week supply of this, which you should take twice daily. - Seek medical attention if you have new or concerning symptoms of auditory or visual hallucination, feelings of paranoia or that you feel that you may want to harm yourself or others. These are the resources in ___ - for psychiatric medication management and substance use counseling: p: ___ ___ Living (Group recovery home) Pt can return to live here for $520/month p: ___ It was a pleasure taking part in your care here at ___! We wish you all the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. QUEtiapine Fumarate 75 mg PO QPM 2. QUEtiapine Fumarate 12.5 mg PO QAM 3. Sertraline 25 mg PO DAILY 4. Simvastatin 40 mg PO QPM 5. Timolol Maleate 0.5% 1 DROP BOTH EYES BID 6. TraZODone 25 mg PO Q6H:PRN agitation RX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth Q6H:PRN Disp #*25 Tablet Refills:*0 7. Vitamin D 1000 UNIT PO DAILY 8. Acetaminophen 650 mg PO TID pain 9. Aspirin 81 mg PO DAILY 10. Docusate Sodium 100 mg PO BID 11. Ferrous GLUCONATE 324 mg PO TID 12. Metoprolol Tartrate 12.5 mg PO BID 13. Multivitamins W/minerals 1 TAB PO DAILY 14. Senna 17.2 mg PO HS 15. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnoses =================== Cervical fracture Anemia Atrial fibrillation Secondary Diagnoses ===================== Colon Cancer status post resection Prostate Cancer Benign prostatic hypertrophy History of pulmonary embolism Glaucoma Hypelipidemia Hypertension Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your stay at ___. You were admitted to the hospital because you had a fall. You were found to have a fracture of one of the bones in your neck. You do not need surgery at this time to fix the fracture, as it will heal on its own, but you will need to wear a neck collar for the next 6 weeks to makes that it is able to heal. Please follow up with Ortho in 2 weeks, with Dr. ___. Please call to make this appointment. You were also found to have a vertebral artery dissection with a blood clot. The vascular surgeons evaluated you and determined that you needed a daily aspirin. You were also found to have anemia (low red blood cell count). You were found to be low in iron, so you were started on iron pills with improvement of your blood counts. You also had some fast heart rates which improved with medications. Your appointments and medications are listed in the discharge paperwork. 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. Allopurinol ___ mg PO DAILY 2. Amlodipine 5 mg PO DAILY 3. Magnesium Oxide 400 mg PO BID 4. Multivitamins 1 TAB PO DAILY 5. TraZODone 150 mg PO QHS:PRN insomnia 6. Cyclobenzaprine 10 mg PO TID:PRN spasm 7. Lorazepam 1 mg PO BID anxiety RX *lorazepam 1 mg 1 mg by mouth twice a day Disp #*10 Tablet Refills:*0 8. Sildenafil 20 mg PO DAILY:PRN erection 9. Nadolol 20 mg PO DAILY 10. Sertraline 50 mg PO DAILY 11. ___ ___ UNIT PO Q8H Last day is ___. Omeprazole 40 mg PO DAILY 13. FoLIC Acid 1 mg PO DAILY 14. Thiamine 100 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: Wernicke's encephalopathy Alcohol intoxication Recurrent falls Lower extremity weakness SECONDARY DIAGNOSES: Cirrhosis Thrombocytopenia Megaloblastic 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. ___, It was a pleasure taking care of you at ___ ___. You came to the hospital because of recurrent falls and excessive alcohol drinking. You were found to be unsteady and confused, a condition called "Wernicke", which is due to vitamin deficiency secondary to excessive alcohol drinking. We treated you with intravenous vitamins and gave you some medications to treat your alcohol withdrawal symptoms. We did imaging for your head and any fractures or bleeding. You were found to have a rib fracture, which only required some pain control. We strongly encourage you to stop drinking alcohol due to the negative effects on your health. Please make sure to take all your medications on time and follow up with your doctors as ___. Best regards, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Carvedilol 25 mg PO BID 2. MetFORMIN (Glucophage) 850 mg PO BID 3. Multivitamins 1 TAB PO DAILY 4. Acetaminophen 650 mg PO Q6H:PRN headache 5. LeVETiracetam 500 mg PO BID RX *levetiracetam 500 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 6. Claritin *NF* 10 mg Oral QD:PRN allergies 7. Magnesium Oxide 400 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Right temporal subarachnoid hemorrhage Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>•Take your pain medicine as prescribed. •Exercise should be limited to walking; no lifting, straining, or excessive bending. •Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. •You have been discharged on Keppra (Levetiracetam) to prevetn seizures, which you should take for a total of 7 days. You will not require blood work monitoring.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325 mg PO Q6H:PRN pain RX *acetaminophen 325 mg 1 tablet(s) by mouth q6hrs Disp #*50 Tablet Refills:*0 2. Gabapentin 300 mg PO TID RX *gabapentin 300 mg 1 capsule(s) by mouth three times a day Disp #*100 Capsule Refills:*1 3. LeVETiracetam 750 mg PO BID RX *levetiracetam 750 mg 1 tablet(s) by mouth twice a day Disp #*100 Tablet Refills:*0 4. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 tablet(s) by mouth qday Disp #*100 Tablet Refills:*0 5. Ketoconazole Shampoo 1 Appl TP ASDIR 6. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth q day Disp #*100 Tablet Refills:*2 7. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Do not drink or drive while taking narcotic pain medications. RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*50 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Left ___ rib fractures Right periorbital injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were hospitalized after falling. * Your injury caused some left rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. * You should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. If the pain medication is too sedating take half the dose and notify your physician. * Pneumonia is a complication of rib fractures. In order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. This will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. * You will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. * Symptomatic relief with ice packs or heating pads for short periods may ease the pain. * Narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. * Do NOT smoke * If your doctor allows, non-steroidal ___ drugs are very effective in controlling pain ( ie, Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. * Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs (crepitus).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 2. Acetylcysteine 20% ___ mL NEB Q4H:PRN SOB 3. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB, wheeze 4. Apixaban 5 mg PO BID 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 80 mg PO QPM 7. Benzonatate 100 mg PO TID:PRN cough 8. BusPIRone 30 mg PO DAILY 9. CloNIDine 0.2 mg PO TID 10. Cyclobenzaprine 5 mg PO HS:PRN spasm 11. Diltiazem Extended-Release 360 mg PO DAILY 12. Ferrous Sulfate 325 mg PO DAILY 13. FLUoxetine 60 mg PO DAILY 14. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 15. glimepiride 2 mg oral DAILY 16. LORazepam 1 mg PO Q8H:PRN breakthrough anxiety 17. Metoprolol Succinate XL 37.5 mg PO DAILY 18. Naproxen 500 mg PO Q12H:PRN Pain - Moderate 19. Pantoprazole 40 mg PO Q24H 20. Pregabalin 75 mg PO TID 21. Torsemide 20 mg PO DAILY 22. TraMADol 50 mg PO DAILY:PRN Pain - Moderate Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis # Dypsnea - likely secondary to acute on chronic diastolic heart failure # Rectal bleeding, likely ___ hemorrhoids Secondary Diagnosis # h/o RUE DVT # COPD/Tracheobronchial Malacia # Afib # Rate-dependent LBBB # Coronary artery disease # Fibromyalgia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to be a part of your care team at ___ ___. You were admitted because you had some more difficulty breathing and weight gain. You also had noticed some rectal bleeding. You were feeling better after getting some Lasix through the IV. We think that the bleeding is from hemorrhoids, and your blood counts were fine. You can take all of your normal medications when you go home. Please see below for your discharge appointments. Again, it was very nice to meet you, and we wish you the best. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>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. 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. amLODIPine 5 mg PO DAILY 2. Vitamin D ___ UNIT PO 1X/WEEK (TH) low vitamin D Duration: 8 Weeks 3. Ascorbic Acid ___ mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 80 mg PO QPM 6. B Complex 1 (vitamin B complex) 1 tablet oral DAILY 7. Clopidogrel 75 mg PO DAILY 8. Finasteride 5 mg PO DAILY 9. Ketoconazole 2% 1 Appl TP BID:PRN itching, fungal infection 10. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 11. Propranolol 10 mg PO BID 12. Ranitidine 150 mg PO BID 13. Simethicone 80 mg PO QID:PRN gas 14. Tamsulosin 0.4 mg PO QHS 15. HELD- Lisinopril 5 mg PO DAILY This medication was held. Do not restart Lisinopril until you follow up with your PCP ___: Home With Service Facility: ___ Discharge Diagnosis: ___ on CKD Generalized weakness Discharge Condition: Independent, Ambulatory Followup Instructions: ___ [/INST] </s><s>Mr ___, You were admitted to the hospital with generalized weakness. At first your symptoms felt similar to your prior strokes. We did an MRI which showed that you did not have a new stroke causing your symptoms. We additionally did an ultrasound of your kidneys to see if you were retaining urine as your symptoms were worsened during that time at home. Your ultrasound was normal. You will need to follow up with the renal doctors for ___ ___ of your kidney disease. You should also follow up with your primary care doctor for management of your blood pressure. Please start taking amlodipine 5 mg daily for your blood pressure and stop taking your lisinopril until follow up with your primary care doctor on ___. You have follow up with your neurologist, Dr ___ today at 12 ___ and follow up with your primary care doctor on ___. The renal doctors ___ for follow up in their clinic as well. We will reactivate your visiting nurse services to help manage and monitor your blood pressure and your symptoms at home. It was a pleasure taking care of you - Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Tacrolimus 0.5 mg PO EVERY OTHER DAY 3. Acyclovir 400 mg PO Q8H 4. amLODIPine 10 mg PO DAILY 5. Ciprofloxacin HCl 500 mg PO Q12H 6. FoLIC Acid 1 mg PO DAILY 7. LORazepam 0.5 mg PO Q8H:PRN nausea 8. Multivitamins 1 TAB PO DAILY 9. OxyCODONE (Immediate Release) 10 mg PO Q4H:PRN Pain - Moderate 10. Posaconazole Delayed Release Tablet 300 mg PO DAILY 11. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 12. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: ---------------- Neutropenic fever Acute Myeloid Leukemia, Relapse SECONDARY: ---------------- Pancytopenia Knee pain, acute on chronic Hypertension Elevated creatinine History of cavernous sinus thrombosis History of left parietal meningioma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to ___ because you were having muscle aches and developed a fever to 100.4 degrees. Because your immune system is low right now, you were given strong intravenous antibiotics just in case you had an infection. Fortunately, no source of infection was found and you did not have any more fevers while you were here. We discontinued these strong antibiotics and started you back on your home Ciprofloxacin. While you were here, you completed the remaining 4 of your 5 days of chemotherapy and tolerated this very well. You were also transfused 1 unit of red blood cells during your hospitalization. As mentioned above, your immune system is very weak right now while you are undergoing treatment. Therefore, please follow a strict diet (called a neutropenic diet). If you need a reminder, please refer to the following website: h t t p : / / w w w . u p m c . c o m/patients-visitors/education/cancer/Pages/neutropenic-diet.aspx Your medication list is essentially the same as when you came in. However, we have decreased the frequency of your Tacrolimus dosing. Please take your Tacrolimus 0.5mg every other day as opposed to 5 days a week. You are due for this medication on ___. Finally, if you develop a fever (100.4F or greater), chills, mouth sores, sinus pain, pain with swallowing, cough (dry or with mucous), shortness of breath, chest pain with deep breathing, abdominal pain, nausea, vomiting, diarrhea, abnormal rashes or any other symptoms that concern you, please call your doctor or return to the emergency room. It was a pleasure taking part in your care. We wish you all the best with your health. Sincerely, The team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LORazepam 0.5-2 mg PO Q4H:PRN anxiety/distress Take as needed every 4 hours for anxiety or agitation RX *lorazepam 2 mg/mL 0.5 to 1 mL by mouth every four (4) hours Refills:*0 2. Morphine Sulfate (Concentrated Oral Solution) 20 mg/mL ___ mg PO Q4H:PRN Pain or respiratory Take ___ Q4H as needed for pain or shortness of breath. ___ use every hour if in crisis. RX *morphine concentrate 100 mg/5 mL (20 mg/mL) 0.25 to 1 mL by mouth every four (4) hours Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left MCA infarct Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were hospitalized due to symptoms of right sided weakness and confusion, 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. While ___ were in the hospital, your family decided to pursue comfort measures only for your care. ___ were given only medications to keep ___ comfortable. It was a pleasure taking care of ___. Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 1 PUFF IH Q6H:PRN sob 2. Vitamin D 3000 UNIT PO DAILY 3. Docusate Sodium 200 mg PO BID 4. Ocuvite *NF* (vit C-vit E-lutein-min-om-3) 150-30-6-150 mg-unit-mg-mg Oral daily 5. Risperidone 0.5 mg PO HS 6. Calcium Carbonate 500 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Anxiety disorder NOS, Depressive disorder NOS, Paranoia Secondary: Uncomplicated urinary tract 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 ___ ___. You came to us due to feelings of paranoia, and you spoke with our medical team, our Pyschiatrists, and our social workers. We did not find any major underlying medical problems, but treated you for a mild urinary tract infection. As a side issue, some lung nodules that were seen on prior chest x-rays from ___ were again seen. You should see your primary care doctor to discuss when you should have these evaluated again in the future. While you were here, some changes were made to your medications: Please START docusate for constipation. Please INCREASE risperidone to 0.5mg every evening.</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. Senna 17.2 mg PO HS 3. Acetaminophen 650 mg PO TID 4. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 7 Days Last dose ___. Diltiazem Extended-Release 120 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY Dementia Acute Kidney Injury E.coli Urinary tract infection SECONDARY 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. ___, You came to the hospital because you were having confusion. We gave you medication to help you calm down. We also did lab testing and imaging, all of which did not show an explanation of your confusion. We believe you have dementia which is a progressive, chronic condition. It is important however, to make sure that you avoid medications like pseudophedrine and Benadryl as these can cause confusion. You later developed a urinary tract infection which we treated with antibiotics. Your discharge medications and follow up appointments are detailed below. 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. Narcan (naloxone) 4 mg/actuation nasal ONCE:PRN RX *naloxone [Narcan] 4 mg/actuation 1 spray nasal once Disp #*1 Spray Refills:*0 2. Polyethylene Glycol 17 g PO BID RX *polyethylene glycol 3350 17 gram 1 powder(s) by mouth twice a day Disp #*30 Packet Refills:*0 3. Senna 17.2 mg PO BID RX *sennosides [senna] 8.6 mg ___ tabs by mouth twice a day Disp #*50 Tablet Refills:*0 4. TraMADol 50 mg PO Q6H:PRN Pain - Moderate Reason for PRN duplicate override: d/c oxy RX *tramadol 50 mg 1 tablet(s) by mouth every six (6) hours Disp #*15 Tablet Refills:*0 5. Nadolol 10 mg PO DAILY RX *nadolol 20 mg 0.5 (One half) tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -400 unit oral Daily 7. Omeprazole 20 mg PO DAILY 8. Ursodiol 500 mg PO BID 9.Outpatient Lab Work Labs: ___ Date: ___ ICD-9 code: ___ Please fax to ___ at ___ Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis ==================== Acute blood loss anemia Rectal varices bleeding Rectal AVM Secondary diagnosis =============== Cirrhosis Primary biliary cholangitis Gastric varices Rectal 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 care of you at the ___ ___! Why was I admitted to the hospital? - You were admitted because you had bleeding from your rectum. What happened while I was in the hospital? - Your blood counts were monitored. You had a procedure done that helped to close the blood vessel that was causing bleeding. You then had imaging which showed ulcers in your colon, for which you will ___ in liver clinic in 1 month. What should I do after leaving the hospital? - Please take your medications as listed in discharge summary and follow up at the listed appointments. - Come back to the emergency room if you have any more bleeding. - Please have labs drawn on ___ Thank you for allowing us to be involved in your care, we wish you all the best! Sincerely, Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*90 Tablet Refills:*1 2. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp #*90 Tablet Refills:*0 3. Warfarin 4 mg PO DAILY16 RX *warfarin 4 mg 1 tablet(s) by mouth qpm Disp #*30 Tablet Refills:*1 4. Albuterol Inhaler 2 PUFF IH Q2H:PRN wheezing, shortness of breath 5. estradiol 0.01 % (0.1 mg/gram) vaginal twice a week 6. Levothyroxine Sodium 75 mcg PO DAILY 7. Vitamin D ___ UNIT PO MONTHLY first day of the month 8. HELD- ibrutinib 420 oral DAILY This medication was held. Do not restart ibrutinib until follow up with your oncoogist Discharge Disposition: Home Discharge Diagnosis: New onset atrial fibrillation with RVR Hypo-osmolar Hyponatremia Essential Hypertension CLL with thrombocytopenia Hypothyroidism 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 during your hospitalization. You were found to have atrial fibrillation which is an abnormal heart rhythm that puts you at increased risk of stroke. You stayed in this rhythm during your hospitalization and we started metoprolol to help control your heart rate. This worked as well when the medication took full effect and we were able to take fluid off of you with a diuretic called Lasix. You no longer need losartan and amlodipine. We checked for a blood clot (pulmonary embolism) in your lung as well as your structural components of your heart and did not find a reason for your atrial fibrillation. It could possibly be caused by your ibrutinib (6% of patients) so your oncology team has asked that you hold this medication until you follow-up with them in clinic. We were unable to control your heart rate with metoprolol and due to interactions of other medications the decision was made to do a cardioversion. You had that procedure prior to discharge and successfully are back in normal sinus rhythm. We have started you on a blood thinner called Coumadin or warfarin. This is a medication that will help prevent strokes which are a 4% risk per year due to your atrial fibrillation. The goal INR (level) for your Coumadin level is ___. You will follow-up with your primary care doctor to monitor your levels this next week. We also need you to hold your Coumadin and call your doctor if you have any bleeding (nose bleed, rectal bleed, etc). Your platelets and blood counts will likely drop after being off ibrutinib and we have asked that you hold your medications per instructions by your PCP if your counts are too low. We have made an appointment with a ___ cardiologist for you to discuss your atrial fibrillation and possible options. Please hold your ibrutinib until follow up with oncology. Please weight yourself daily. If you gain >3 pounds in 3 days please call Dr. ___. Please continue Lasix 40 mg until f/u with your PCP. Then you can change to 20 mg after your PCP has evaluated you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO TID 2. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN pain Do not Drive or consume alcohol while taking this medication RX *oxycodone 5 mg ___ tablet(s) by mouth every ___ hours Disp #*60 Tablet Refills:*0 3. Alprostadil 20 mcg INTRACAVERNOSAL DAILY PRN impotence 4. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -400 unit oral 2 tabslet Daily 5. Vitamin D 50,000 UNIT PO 1X/WEEK (MO) 6. Docusate Sodium 100 mg PO BID COntinue to take while taking oxycodone RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth Twice a day Disp #*60 Capsule Refills:*0 7. Senna 8.6 mg PO BID:PRN constipation Continue to take while taking oxycodone RX *sennosides [senna] 8.6 mg 1 by mouth Twice a day Disp #*60 Capsule Refills:*0 1. Acetaminophen 1000 mg PO TID 2. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN pain Do not Drive or consume alcohol while taking this medication RX *oxycodone 5 mg ___ tablet(s) by mouth every ___ hours Disp #*60 Tablet Refills:*0 3. Alprostadil 20 mcg INTRACAVERNOSAL DAILY PRN impotence 4. Calcium 500 + D (calcium carbonate-vitamin D3) 500 mg(1,250mg) -400 unit oral 2 tabslet Daily 5. Vitamin D 50,000 UNIT PO 1X/WEEK (MO) 6. Docusate Sodium 100 mg PO BID COntinue to take while taking oxycodone RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth Twice a day Disp #*60 Capsule Refills:*0 7. Senna 8.6 mg PO BID:PRN constipation Continue to take while taking oxycodone RX *sennosides [senna] 8.6 mg 1 by mouth Twice a day Disp #*60 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Crohn disease with obstruction. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after a small bowel resection and ileocecectomy for surgical management of your ___ bowel obstruction. You have recovered from this procedure well and you are now ready to return home. Samples from your colon were taken and this tissue has been sent to the pathology department for analysis. You will receive these pathology results at your follow-up appointment. If there is an urgent need for the surgeon to contact you regarding these results they will contact you before this time. You have tolerated a regular diet, passing gas and your pain is controlled with pain medications by mouth. You may return home to finish your recovery. Please monitor your bowel function closely. You may or may not have had a bowel movement prior to your discharge which is acceptable, however it is important that you have a bowel movement in the next ___ days. After anesthesia it is not uncommon for patient’s to have some decrease in bowel function but you should not have prolonged constipation. Some loose stool and passing of small amounts of dark, old appearing blood are expected. However, if you notice that you are passing bright red blood with bowel movements or having loose stool without improvement please call the office or go to the emergency room if the symptoms are severe. If you are taking narcotic pain medications there is a risk that you will have some constipation. Please take an over the counter stool softener such as Colace, and if the symptoms do not improve call the office. If you have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or extended constipation. You have a long vertical incision on your abdomen that is closed with staples. This incision can be left open to air or covered with a dry sterile gauze dressing if the staples become irritated from clothing. The staples will stay in place until your first post-operative visit at which time they can be removed in the clinic, most likely by the office nurse. Please monitor the incision for signs and symptoms of infection including: increasing redness at the incision, opening of the incision, increased pain at the incision line, draining of white/green/yellow/foul smelling drainage, or if you develop a fever. Please call the office if you develop these symptoms or go to the emergency room if the symptoms are severe. You may shower, let the warm water run over the incision line and pat the area dry with a towel, do not rub. No heavy lifting for at least 6 weeks after surgery unless instructed otherwise by Dr. ___ Dr. ___. You may gradually increase your activity as tolerated but clear heavy exercise ________. You will be prescribed a small amount of the pain medication oxycodone. Please take this medication exactly as prescribed. You may take Tylenol as recommended for pain. Please do not take more than 4000mg of Tylenol daily. Do not drink alcohol while taking narcotic pain medication or Tylenol. Please do not drive a car while taking narcotic pain medication. Thank you for allowing us to participate in your care! Our hope is that you will have a quick return to your life and usual activities. Good luck!</s>