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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen (Liquid) 650 mg PO Q6H:PRN Pain - Mild 2. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB, wheezing 3. Gabapentin 800 mg PO TID 4. Metoprolol Tartrate 12.5 mg PO DAILY please hold for SBP<100, HR<60 5. Miconazole Powder 2% 1 Appl TP TID:PRN itching 6. Pyridoxine 50 mg PO DAILY 7. QUEtiapine Fumarate 12.5 mg PO Q8H:PRN agitation 8. Thiamine 100 mg PO DAILY Duration: 5 Days (___) 9. ___ MD to order daily dose PO DAILY16 10. Atorvastatin 10 mg PO QPM 11. Cyanocobalamin 1000 mcg PO DAILY 12. Digoxin 0.125 mg PO DAILY 13. famotidine 20 mg oral DAILY 14. Furosemide 40 mg PO DAILY 15. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: -Small Bowel Obstruction -Malnutrition -Severe Gastroparesis Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___ ___. You were admitted to the hospital for medical and surgical management of your small bowel obstruction. After your original surgery to fix your mechanical obstruction, you were unable to tolerate food by mouth due to slow emptying of your stomach. You required nasogastric tube placement to help decompress your abdomen. You underwent placement of a GJ Feeding Tube due to your continued inability to tolerate an oral diet. You were started on tube feedings to provide you with nutrition. You are now ready to be discharged to a rehabilitation facility to continue your recovery. Please follow the instructions below to ensure a safe recovery while at home: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BuPROPion XL (Once Daily) 150 mg PO DAILY RX *bupropion HCl 150 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Calcium Carbonate 500 mg PO TID:PRN upset stomach over the counter RX *calcium carbonate [Tums] 200 mg calcium (500 mg) 1 tablet(s) by mouth TID:PRN Disp #*30 Tablet Refills:*0 3. ClonazePAM 0.5 mg PO BID Chronic Anxiety Take 1 tab po BID x 2weeks then ___ tab po BID x 2weeks then stop RX *clonazepam 0.5 mg 1 tablet(s) by mouth see taper Disp #*45 Tablet Refills:*0 4. HYDROmorphone (Dilaudid) 8 mg PO BY TAPER 1t po q4hx3d, 1t po q6h x3d, then 1t po q8h 5. LORazepam 2 mg PO Q6H:PRN anxiety 6. DiphenhydrAMINE ___ mg PO Q6H:PRN allerfgies 7. Narcan (nalOXone) 4 mg/actuation nasal ONCE:PRN 8. Vitamin D ___ UNIT PO EVERY OTHER WEEK Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: Enterococcus bacteremia Right buttock abscess Narcotic dependence Chronic pain SECONADRY: Osteoporosis 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 fever and found to have a bloodstream infection. You were evaluated with blood work and imaging to identify the source of the infection. The most likely source of infection was your port-a-cath. We kept the port-a-cath in place to administer IV antibiotics and treated the port itself with antibiotics as well. We monitored your blood for bacteria and it became clear on ___. We then completed your course of antibiotics for 13 more days. Since your blood likely became infected from accessing your port at home for Demerol, we recommended switching to a different medication for your pain that you can take by mouth. We therefore started you on oral Dilaudid pills. Your port was removed by your surgeon given the risk for infections in the future. We also made several other changes to your home medication regimen. For your pain medication, you must not take Demerol any longer. We gave you prescription for a month long taper of dilaudid, to last until you find a new primary care doctor. We started you on a long-acting benzodiazepine called Klonopin. You should keep taking 0.5mg twice a day for 2 weeks, then take 0.25mg twice a day for 2 weeks, in order to taper off of benzodiazepines. You can then stop this medication. We did not give you a prescription for lorazepam since you have this at home; take ___ pills of lorazepam as needed only for very severe anxiety, since you will need to taper off this medication as well. We started you on a medication called Wellbutrin to take once per day to help with anxiety. It is very important that you take these medications as prescribed. There are significant risks to stopping benzodiazepines without a taper including seizures and death. Please discuss any medication changes with your primary care doctor and please see a physician before you run out of any medications. Your buttock abscess was monitored by the surgery team, who also changed your wound VAC as needed. You were seen by the plastic surgery team, who you will follow-up with in clinic. It is very important that you have a primary care doctor to continuing prescribing medications and to monitor you due to the medication changes we've made in the hospital. You should contact ___ for a new primary care physician, if you don't have one there already. We will continue to work on finding a physician for you here at ___ at ___, but please contact ___ on ___ and ask for a new physician in the event that we are unable to find a primary care physician for you. Please return to the ED if you have fever >101, shaking chills, redness or drainage around your port site. It was a pleasure caring for you! Your ___ Care Team.</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). 2. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. losartan 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 6. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 7. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain: Please do not exceed 4000 mg per 24 hour period. 8. hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for pain. Disp:*20 Tablet(s)* Refills:*0* 9. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 14 days. Disp:*14 Tablet(s)* Refills:*0* 10. metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) for 14 days. Disp:*42 Tablet(s)* Refills:*0* 11. Insulin Sliding Scale Humalog Sliding Scale Breakfast 71-100: 2 units 101-150: 4 units 151-200: 8 units 201-250 10 units 251-300: 14 units 301-350: 16 units 351-400: 18 units > 400: Notify Physician ___: 71-100: 2 units 101-150: 4 units 151-200: 8 units 201-250 10 units 251-300: 14 units 301-350: 16 units 351-400: 18 units > 400 notify physician ___: 71-100: 2 units 101-150: 4 units 151-200: 8 units 201-250 10 units 251-300: 14 units 301-350: 16 units 351-400: 18 units >400 notify physician ___: 71-100: 0 units 101-150: 0 units 151-200: 0 units 201-250 6 units 251-300: 8 units 301-350: 10 units 351-400: 12 units > 400 notify physician 12. Humalog 100 unit/mL Solution Sig: One (1) Dose Subcutaneous four times a day: See sliding scale. 13. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 14. insulin glargine 100 unit/mL Solution Sig: ___ (32) units Subcutaneous at bedtime. 15. Vitamin B-12 Injection 16. multivitamin with minerals Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: Intra-abdominal 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 admitted to the hospital with abdominal pain. An abdominal CT scan was suggestive of possible intra-abdominal infection, therefore, antibiotics were initiated. Your pain subsequently improved. Additionally, your blood sugar levels were elevated and you were evaluated by the ___ who managed your insulin regimen while in house and have provided an increased sliding scale. You are now preparing for discharge to home with the following instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications , unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 100 mg PO DAILY 2. Hydrochlorothiazide 25 mg PO DAILY 3. Lisinopril 20 mg PO DAILY 4. Meclizine 12.5 mg PO TID 5. Pravastatin 40 mg PO DAILY 6. Warfarin 7.5 mg PO 5X/WEEK (___) 7. Warfarin 6.25 mg PO 2X/WEEK (___) 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 the hospital with a small bowel obstruction. You have done well, and are now prepared to complete your recovery outside the hospital, with the following instructions: ACTIVITY: Please try to remain active, and ambulate multiple times per day. DIET: Regular diet MEDICATIONS: Take all the medicines you were on before. Please be sure to follow-up as scheduled with your PCP for measuring your INR, as you take coumadin. You have an appointment to have your INR checked at the ___ on ___. 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 Please call the ___ to make an appointment with Dr. ___. The number is ___. This is very important.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H pain 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 #*30 Capsule Refills:*1 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*25 Tablet Refills:*0 4. Senna 8.6 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>You were admitted to the hospital with right lower quadrant pain. You underwent an ultrasound and you were reported to have a dilated appendix. These findings were consistent with appendicitis. You were taken to the operating room to have your appendix removed. You are preparing for discharge home with the following instructions: You were admitted to the hospital with acute appendicitis. You were taken to the operating room and had your appendix removed laparoscopically. You tolerated the procedure well and are now being discharged home with the following instructions: Please follow up at the appointment in clinic listed below. We also generally recommend that patients follow up with their primary care provider after having surgery. We have scheduled an appointment for you listed below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for ___ weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: You may feel weak or "washed out" a couple weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You could have a poor appetite for a couple days. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Tomorrow you may shower and remove the gauzes over your incisions. Under these dressings you have small plastic bandages called steristrips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay. Your incisions may be slightly red around the stitches. This is normal. You may gently wash away dried material around your incision. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Do not drink alcohol or drive while taking narcotic pain medication. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ondansetron ODT 8 mg PO Q8H:PRN Nausea/Vomiting - First Line RX *ondansetron [Zofran ODT] 8 mg 1 tablet(s) by mouth Q8hrs as needed for nausea Disp #*9 Tablet Refills:*0 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 3. ClonazePAM 1 mg PO DAILY:PRN Anxiety 4. Escitalopram Oxalate 20 mg PO DAILY 5. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate 6. Pantoprazole 40 mg PO Q12H Discharge Disposition: Home Discharge Diagnosis: Hematemesis Iron deficiency anemia Abdominal pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you during your recent admission to ___. You were admitted with vomiting blood. You were seen by the gastroenterologists and had an upper GI endoscopy which did not reveal a source of bleeding. It is important that you continue to take your protein pump inhibitor twice daily. Your blood counts were followed and remained stable although you are anemic. It is important that you follow-up with Dr. ___ to resume iron infusions. In terms of your abdominal pain, please follow-up with surgery as previously arranged. 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. Entecavir 0.5 mg PO EVERY OTHER DAY 2. Lactulose 45 mL PO TID 3. Omeprazole 20 mg PO DAILY 4. Propranolol 20 mg PO BID 5. Rifaximin 550 mg PO BID 6. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral BID 7. flaxseed oil .5 mg oral EVERY OTHER DAY 8. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnoses =============== Hepatic encephalopathy HBV cirrhosis Secondary Diagnoses ================== Obstructive Sleep Apnea Chronic Kidney Disease Pancytopenia Portal Vein Thrombosis GERD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital with concern for worsened confusion, which can be a result of your liver disease. We did not find any signs of infection or bleed. Your confusion was likely due to not taking enough lactulose. With more lactulose, you had some bowel movements and your mental status improved, and we feel you are ready for discharge. It is very important that you take all your medications as prescribed, and to take enough lactulose to have ___ bowel movements per day. Please call a doctor if your confusion returns or worsens, if you notice any blood or black color in your stools, if you have fevers or chills, or for any other symptoms that concern you. Thank you, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PR Q6H:PRN pain/ fever 2. Diazepam 20 mg IV X1 PRN. MAY REPEAT AS NEEDED Seizures IV solution to be given per rectum as needed for seizures RX *diazepam 5 mg/mL 20 mg PR x1 PRN. ___ repeat as needed Disp #*12 Syringe Refills:*0 3. LORazepam 1 mg SL Q4H RX *lorazepam 1 mg 1 tablet(s) by mouth q4H PRN Disp #*60 Tablet Refills:*0 RX *lorazepam 1 mg 1 tablet(s) SL every four (4) hours Disp #*60 Tablet Refills:*0 4. LORazepam 1 mg PO Q2H PRN discomfort RX *lorazepam 1 mg 1 mg by mouth q2H PRN Disp #*10 Tablet Refills:*0 RX *lorazepam 1 mg 1 MG SL q2H PRN Disp #*10 Tablet Refills:*0 5. Morphine Sulfate (Concentrated Oral Solution) 20 mg/mL 10 mg PO Q4H RX *morphine concentrate 20 mg/mL 10 mg SL every four (4) hours Disp #*60 Syringe Refills:*0 6. Morphine Sulfate 3 mg SC Q2H:PRN Pain or discomfort RX *morphine 4 mg/mL 3 mg SC q2H PRN Disp #*20 Syringe Refills:*0 7. Scopolamine Patch 1 PTCH TD Q72H PRN secretions Duration: 72 Hours RX *scopolamine base [Transderm-Scop] 1.5 mg (delivers 1 mg over 3 days) 1.5mg Transdermal patch q72 hours PRN Disp #*5 Patch Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: ___ Delirium Discharge Condition: Comfortable with eyes closes. Non verbal. Non-ambulatory. Followup Instructions: ___ [/INST] </s><s>Brain Hemorrhage with Surgery Surgery · You underwent a surgery called a craniotomy to have blood removed from your brain. · After many multidisciplinary discussions including ethics, palliative, and neurosurgery the family decided to make the patient DNR/DNI and then he was transitioned to CMO and under the inpatient hospice service. Activity · No restrictions. Comfort measures. Medications · Your Keppra was discontinued and you were transitioned to scheduled Ativan q4h for comfort measures only. You may have valium per rectal if you have a seizure that does not cease with Ativan. · You may use also be given Morphine for discomfort.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LevETIRAcetam 1500 mg PO BID RX *levetiracetam [Keppra] 500 mg 3 tablet(s) by mouth twice a day Disp #*90 Tablet Refills:*3 2. LORazepam ___ mg IV Q4H:PRN seizure 3. QUEtiapine Fumarate 12.5 mg PO BID Agitation evening dose to be given at bedtime RX *quetiapine 25 mg 0.5 (One half) tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*3 4. Thiamine 100 mg PO DAILY 5. CarBAMazepine 800 mg NG BID RX *carbamazepine 200 mg 4 tablet(s) by mouth twice a day Disp #*240 Tablet Refills:*3 6. LamoTRIgine 300 mg PO BID RX *lamotrigine [Lamictal] 150 mg 2 tablet(s) by mouth twice a day Disp #*120 Tablet Refills:*3 7. Phenytoin Sodium Extended 200 mg PO QHS RX *phenytoin sodium extended 200 mg 1 capsule(s) by mouth at bedtime Disp #*30 Capsule Refills:*3 8. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild 9. FoLIC Acid 1 mg PO DAILY 10. LORazepam 0.5 mg PO QAM 11. LORazepam 2 mg PO QPM 12. Multivitamins 1 TAB PO DAILY 13. PARoxetine 30 mg PO DAILY 14. Vitamin D ___ UNIT PO DAILY 15. HELD- TraZODone 200 mg PO QHS This medication was held. Do not restart TraZODone until you follow up with your primary care provider ___: Home With Service Facility: ___ Discharge Diagnosis: 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 neurology ICU after having convulsive seizures without clear return to your baseline. You were initially intubated and given seizure medications intravenously. We monitored your brain waves for evidence of seizures. We increased your anti-epileptic drugs with resolution of your seizures. Your mental status has been improving daily but you had some periods of agitation for which we have prescribed quetiapine 12.5mg twice per day. We have changed your medications as follows: - carbamazepine 800 mg BID - lamotrigene 300 mg BID - levetiracetam 1500 mg BID - phenytoin 200 mg QHS - seroquel 12.5 mg BID You will need home physical therapy, an urgent appointment with your neurologist Dr. ___, as well as follow up with your primary care one week from discharge. Please do not hesitate to call with questions. It has been a pleasure taking care of you. Your ___ Neurology 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 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 2. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Second Line RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 1 powder(s) by mouth daily as needed Refills:*0 3. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 4. 70/30 30 Units Breakfast 70/30 30 Units Bedtime 5. Albuterol Inhaler 2 PUFF IH Q6H:PRN shortness of breath, wheezing 6. Allopurinol ___ mg PO DAILY 7. Aspirin 81 mg PO DAILY 8. budesonide-formoterol 160-4.5 mcg/actuation inhalation DAILY 9. levothyroxine 50 mcg ORAL DAILY 10. Lisinopril 10 mg PO DAILY 11. Multivitamins 1 TAB PO DAILY 12. Simvastatin 80 mg PO QPM 13. Vitamin D ___ UNIT PO 2X/WEEK (MO,FR) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Failure to thrive Dehydration Weight loss Secondary: Hyponatremia CKD stage III COPD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital with dehydration and constipation. You improved with intravenous fluids and a bowel regimen and are being discharged home with a bowel regimen (Colace and Senna every day, with miralax as needed). Please try to stay hydrated. To avoid extra fluid accumulation, however, be sure to weigh yourself every morning and contact your doctor if your weight increases by more than 3 lbs in 1 day or 5 lbs in 1 week (your weight on discharge is 209.7 lbs). Please continue to take your medications as prescribed. Dr. ___ should contact you within the next few days to schedule a follow-up appointment for next week. If you haven't heard from them by ___, please contact his office. With best wishes, ___ Medicine</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO BID 2. Artificial Tears Preserv. Free ___ DROP RIGHT EYE QID 3. Aspirin 81 mg PO QHS 4. Docusate Sodium 100 mg PO 4X/WEEK (___) 5. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP RIGHT EYE BID 6. Erythromycin 0.5% Ophth Oint 0.5 in LEFT EYE QID 7. Ferrous Sulfate 325 mg PO 2X/WEEK (___) 8. Finasteride 5 mg PO QHS 9. Hydroxyurea 500 mg PO QHS 10. Hydroxyurea 500 mg PO 1X/WEEK (___) 11. Omeprazole 10 mg PO BID 12. simethicone 40 mg/0.6 mL oral QID 13. Tamsulosin 0.4 mg PO QPM 14. Levofloxacin 750 mg PO Q48H Duration: 7 Days Take 1 pill every other day (___). This will complete a 7-day course of antibiotics. RX *levofloxacin 750 mg 1 tablet(s) by mouth every other day Disp #*2 Tablet Refills:*0 15. Lumigan (bimatoprost) 0.01 % ophthalmic QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: Community Acquired Pneumonia SECONDARY: Essential thrombocytosis Chronic abdominal pain Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ because you experienced weakness while walking up the stairs with your son. We were worried you had an infection and a scan identified a multifocal pneumonia (lung infection). You received antibiotics while in the hospital (ceftriaxone and azithromycin). We discharged you with a new antibiotic, levofloxacin, which you should take as prescribed. 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. Donepezil 5 mg PO HS 2. Megestrol Acetate 400 mg PO TID 3. Metoprolol Succinate XL 100 mg PO DAILY 4. Simvastatin 10 mg PO HS 5. Alendronate Sodium 70 mg PO WEEKLY 6. Nitroglycerin SL 0.3 mg SL PRN chest pain 7. Aspirin 81 mg PO DAILY 8. ClonazePAM 0.5 mg PO QHS 9. Amlodipine 5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Cerebral embolism with infarction Discharge Condition: Discharge condition: fair Mental status: awake alert and attentive Ambulatory status: out of bed with assist Neuro exam: left side hemiparesis, left side neglect. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you. You were in the hospital because of gaze deviation to the right and left sided weakness. You were found to have a stroke in multiple areas on the right side of your brain. You were given a thrombolytic (for dissolving clots) in the emergency room. You had a repeat CT scan 24 hours after the thrombolytic and there was not bleeding noted in your brain. Physical therapy recommended rehab. Medication changes: - We ADDED ASPIRIN 81 mg daily to reduce your stroke risk. - We ADDED AMLODIPINE 5mg daily to control your high blood pressure. Please continue to take the rest of your home medications as previously prescribed. Call your doctor or go to the nearest emergency room if you experience any of the danger signs listed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a privilege taking care of you at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? =================================== - You felt weak and dizzy and had black stools at home. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? ========================================== - Your blood counts were closely monitored while you were in the hospital. You received 2 units of blood and tolerated the transfusion well with good improvement in energy. Your blood counts have remained stable since then, indicating that you have not continued to bleed. - You were found to have blood in your stool. We did a scope study of the upper part of your GI tract, which found a potential source of the bleed. Those vessels were cauterized, which should keep them from bleeding again. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? ============================================ - Please continue to take all your medications and follow up with your doctors at your ___ appointments. Please be aware that you should NOT take your carvedilol and losartan at home until you see your doctor at your follow up appointments OR your blood pressure is too high. - Please check your blood pressure at home. If the systolic blood pressure (the number on top) is greater than 140, please resume taking the losartan. We wish you all the best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol 0.083% Neb Soln 1 NEB IH BID 2. Amlodipine 10 mg PO DAILY 3. Calcium Carbonate 600 mg PO DAILY 4. Citalopram 10 mg PO DAILY 5. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH TID 6. FoLIC Acid 1 mg PO DAILY 7. Guaifenesin-CODEINE Phosphate 5 mL PO Q6H:PRN cough 8. Hydroxychloroquine Sulfate 200 mg PO DAILY 9. Ipratropium Bromide Neb 1 NEB IH Q6H 10. Omeprazole 20 mg PO DAILY 11. Ondansetron 4 mg PO Q8H:PRN nausea 12. OxycoDONE (Immediate Release) 10 mg PO Q6H:PRN pain 13. OxyCODONE SR (OxyconTIN) 30 mg PO Q8H 14. Vitamin D 50,000 UNIT PO 1X/WEEK (MO) 15. BuPROPion (Sustained Release) 200 mg PO BID 16. Januvia (sitaGLIPtin) 100 mg oral daily 17. leflunomide 0 mg ORAL DAILY 18. Simvastatin 20 mg PO DAILY 19. Acetaminophen 1000 mg PO Q8H:PRN pain 20. Docusate Sodium 100 mg PO BID:PRN constipation RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 21. Albuterol 0.083% Neb Soln 1 NEB IH Q8 22. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN shortness of breath, wheezing 23. PredniSONE 20 mg PO DAILY Duration: 2 Days RX *prednisone 20 mg 1 tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 24. Benzonatate 100 mg PO TID:PRN cough RX *benzonatate 100 mg 1 capsule(s) by mouth three times a day Disp #*40 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: COPD exacerbation Right lung mass Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at the ___. You came for further evaluation of shortness of breath. It was determined that you likely have a COPD exacerbation, which improved with nebulizers, prednisone, and azithromycin. You symptoms improved. You will continue to take prednisone for the next two days. You will follow up with your oncologist ___ to make sure you continue to improve. You also have a known right lung mass. You were seen by Radiation Oncology while you were admitted - you were seen by radiation oncology for simulation treatment. An appointment was scheduled with your oncologist this week. An appointment was scheduled for radiation oncolgoy this week. It is important that you continue to take your medications as prescribed and follow up with the appointments listed below. Please continue monitor your blood sugars while you are taking prednisone as this can raise blood sugar. If your blood sugars are >400, please contact your primary care physician.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H RX *acetaminophen 500 mg 2 tablet(s) by mouth q 8 hours Disp #*40 Tablet Refills:*2 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. Enoxaparin Sodium 40 mg SC QPM Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 1 injection sq qPM Disp #*28 Syringe Refills:*0 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain Decrease use as pain decreases. Do not drink alcohol or drive. RX *oxycodone 5 mg ___ tablet(s) by mouth q 4 hours Disp #*40 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Left pilon fracture Left fibula fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Non-weightbearing to left lower extremity in external fixator MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take Lovenox 40mg daily for 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. - No dressing is needed if wound continues to be non-draining. Pin Site Care Instructions for Patient and ___ The initial dressing may have Xeroform wrapped at the pin site with surrounding gauze. Often, the Xeroform is used in the immediate post-op phase to allow for control of the bleeding. The Xeroform can be removed ___ days after surgery. If the pin sites are clean and dry, keep them open to air. If they are still draining slightly, cover with clean dry gauze until draining stops. If they need to be cleaned, use ___ strength Hydrogen Peroxide with a Q-tip to the site. Call your surgeon's office with any questions 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 with Dr. ___, NOT PA/NP Please follow up with Dr. ___ in the ___ Trauma Clinic ___ days post-operation for evaluation. Someone from our office should call you to schedule this, but if you do not hear from us within a few days after discharge, please call ___ to schedule appointment. Please follow up with your primary care doctor regarding this admission within ___ weeks and for and any new medications/refills. Physical Therapy: Activity: Activity: Activity as tolerated Left lower extremity: Non weight bearing Treatments Frequency: Site: LLE Description: external fixation, serosang oozing from pin insertion sites Care: pin care: ___ hydrogen peroxide, ___ NS, xeroform, guaze; Monitor s/s infection</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Finasteride 5 mg PO DAILY 2. Gabapentin 300-600 mg PO HS:PRN neuropathic pain 3. Lisinopril 10 mg PO DAILY hold for SBP<100 4. Metoprolol Succinate XL 50 mg PO BID hold for HR<55, SBP<100 5. Pantoprazole 40 mg PO Q24H 6. Tamsulosin 0.4 mg PO HS 7. glimepiride *NF* 4 mg Oral daily 8. TraMADOL (Ultram) 50 mg PO TID:PRN pain Discharge Disposition: Home Discharge Diagnosis: pancreatitis, acute Discharge Condition: Activity as tolerated Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure participating in your care at ___. You were diagnosed with pancreatitis without any complicated cysts on CT scan. We gave you fluids and pain/nausea medications, and slowly advanced your diet, which you tolerated well. As we discussed, please try your best to abstain from alcohol completely, as well as to avoid fatty foods as much as possible, to minimize the chance of future episodes of pancreatitis.</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. Calcium Acetate 1334 mg PO TID W/MEALS 3. Docusate Sodium 100 mg PO BID 4. Levofloxacin 500 mg PO Q48H Duration: 2 Doses For 8 day total course: Please dose on ___ and ___ 5. Polyethylene Glycol 17 g PO DAILY 6. Senna 17.2 mg PO QHS:PRN constipation 7. Sodium Bicarbonate 1300 mg PO BID 8. TraMADol 25 mg PO Q6H:PRN pain RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth every 6 hours Disp #*20 Tablet Refills:*0 9. Glargine 5 Units Bedtime 10. Aspirin 81 mg PO DAILY 11. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q8H 12. Calcitriol 0.25 mcg PO DAILY 13. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID 14. Gabapentin 200 mg PO QHS 15. Lactic Acid 12% Lotion 1 Appl TP DAILY 16. Latanoprost 0.005% Ophth. Soln. 1 DROP LEFT EYE QHS 17. Metoprolol Succinate XL 50 mg PO DAILY 18. NIFEdipine CR 90 mg PO DAILY 19. vardenafil 20 mg oral DAILY:PRN Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS Displaced fracture of proximal femur SECONDARY DIAGNOSES Repeated falls Chronic kidney disease, Stage V Type 2 diabetes mellitus, insulin-dependent Respiratory failure Anemia Metabolic acidosis Hypertension Diabetic retinopathy Glaucoma Hyperkalemia 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 the hospital because you fell and broke your leg. We fixed your leg with surgery. We also gave you some blood to replace the blood that you had lost after you broke your leg. While you were here we also found that your kidney disease has gotten worse, and that you will need to start dialysis soon. We started new medications while you were in the hospital to make sure that your body has the right amount of nutrients and minerals like calcium, phosphate, potassium, and bicarbonate. You improved and were sent to a rehabilitation facility in order to help you regain your strength before going home. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? -Take all of your medications as prescribed (listed below) -Follow up with your doctors as listed below -___ medical atttention 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. Acetaminophen (Liquid) 650 mg PO 5X/DAY 2. CefTRIAXone 2 gm IV Q 24H RX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 2 grams intravenously every 24 hours Disp #*14 Intravenous Bag Refills:*0 3. Ciprofloxacin HCl 500 mg PO Q12H 4. MetroNIDAZOLE 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*28 Tablet Refills:*0 5. Omeprazole 20 mg PO DAILY 6. OxycoDONE Liquid 5 mg PO Q4H:PRN Pain - Severe RX *oxycodone 5 mg/5 mL 5 ML by mouth every four (4) hours Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Perforated diverticulitis 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 and underwent treatment for perforated diverticulitis, which required placement of an abdominal drain and antibiotics. You have recovered in the hospital and are now preparing for discharge to home with the following instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Also, please note the attached hand-out regarding the care of your drain.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>ACDF: You have undergone the following operation: Anterior Cervical Decompression and 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 in a car or chair for more than ~45 minutes without getting up and walking around. • Rehabilitation/ Physical Therapy: ___ ___ times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. ___ Isometric Extension Exercise in the collar: 2x/day x ___xercises as instructed. • Swallowing: Difficulty swallowing is not uncommon after this type of surgery. This should resolve over time. Please take small bites and eat slowly. Removing the collar while eating can be helpful – however, please limit your movement of your neck if you remove your collar while eating. • Cervical Collar / Neck Brace: You have been given a soft collar for comfort. You may remove the collar to take a shower or eat. Limit your motion of your neck while the collar is off. You should wear the collar when walking, especially in public • Wound Care: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually ___ days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Call the office at that time. If you have an incision on your hip please follow the same instructions in terms of wound care. • You should resume taking your normal home medications. • You have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so plan ahead. You can either have them mailed to your home or pick them up at the clinic located on ___. We are not allowed to call in narcotic (oxycontin, oxycodone, percocet) prescriptions to the pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. • Follow up: ___ Please Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. ___ At the 2-week visit we will check your incision, take baseline x rays and answer any questions. ___ We will then see you at 6 weeks from the day of the operation. At that time we will most likely obtain Flexion/Extension X-rays and often able to place you in a soft collar which you will wean out of over 1 week. Please call the office if you have a fever>101.5 degrees Fahrenheit, drainage from your wound, or have any questions.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 100 mg PO Q12H Duration: 5 Days RX *cefpodoxime 100 mg 1 tablet(s) by mouth twice daily Disp #*10 Tablet Refills:*0 2. Aspirin 81 mg PO DAILY 3. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q12H 4. Cetirizine 10 mg PO DAILY 5. Digoxin 0.125 mg PO DAILY 6. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 7. LevETIRAcetam 500 mg PO Q12H 8. Losartan Potassium 25 mg PO DAILY 9. Metoprolol Succinate XL 25 mg PO DAILY 10. Omeprazole 20 mg PO DAILY 11. Phenytoin Infatab 50 mg PO BID 12. Simvastatin 10 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: Right sided weakness Neuropathy 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 because your right arm and leg were weak, and you were having worsening of the tingling in your hands and feet. Given your history of subdural hemorrhages, atrial fibrillation, and prior stroke, we wanted to make sure that you did not have a new stroke as the cause of your weakness. You had a MRI of your brain and your cervical spine, which did not show a new stroke or any problems with your spinal cord. Although we do not know exactly why your right side is weaker and why the tingling is worse, it is not because of a new anatomic problem such as a stroke or a tumor. As an outpatient, you will need another test called an EMG, which Dr. ___ order. If the tingling in your hands worsen, you can also start some gabapentin 100mg at night to see if that will help. You were also found to have a urinary tract infection. Please take cefpodoxime twice per day for an additional 5 days. It was such a pleasure taking care of you, and 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. Furosemide 20 mg PO DAILY RX *furosemide 20 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 2. Metoprolol Succinate XL 12.5 mg PO DAILY RX *metoprolol succinate 25 mg 0.5 (One half) tablet(s) by mouth Daily Disp #*15 Tablet Refills:*0 3. Warfarin 5 mg PO DAILY16 RX *warfarin 5 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 4. Warfarin 2.5 mg PO DAILY16 Only take this if instructed to by the ___ clinic or ___ ___ *warfarin [Coumadin] 2.5 mg 1 tablet(s) by mouth Daily Disp #*15 Tablet Refills:*0 5. Aspirin 81 mg PO DAILY 6. Hydroxychloroquine Sulfate 200 mg PO DAILY 7. Letrozole 2.5 mg PO DAILY 8. potassium citrate 15 mEq oral BID 9. Ranitidine 300 mg PO BID 10. HELD- Lisinopril 10 mg PO DAILY This medication was held. Do not restart Lisinopril until your PCP or cardiologist tells you 11.Outpatient Lab Work 428.21 Heart Failure w/ reduced EF ___ - INR + Chem-7 ___ ___ clinic to follow up results ___ - ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: ================= PRIMARY DIAGNOSIS ================= Deep Vein thrombosis =================== SECONDARY DIAGNOSIS =================== Heart Failure with Reduced Ejection Fraction Acute Kidney Injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___. Why was I here? -You were because your left arm was swollen. What was done for me while I was here? -You had an ultrasound and a CT that showed blood clots in your left arm, left neck, and left chest. -You were given a medicine through an IV, called heparin, to stop the blood clots from growing -You were started on warfarin, to keep the blood clots from growing when you go home. -You were started on a water pill (furosemide, also known as Lasix) because fluid was backed up from your heart What should I do when I go home? -You should take your medications as prescribed. -You should go to all of your doctor's appointments. -You should weight yourself everyday and call your cardiologist if your weight increases more than 3 lbs (229lbs) in a day or 5 lbs (231) in a week. We wish you the best in the future! Sincerely, Your ___ Care Team Discharge Diuretic - Lasix 20mg Daily Discharge Weight - 226 lbs Discharge Cr - 1.2 New Medications - Warfarin, Lasix, and Metoprolol</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Senna 8.6 mg PO BID:PRN constipation 2. Midodrine 15 mg PO TID 3. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 4. Docusate Sodium 100 mg PO BID 5. Atorvastatin 40 mg PO DAILY 6. Acetaminophen (Liquid) 1000 mg PO Q6H:PRN pain 7. Enoxaparin Sodium 80 mg SC BID Start: Today - ___, First Dose: Next Routine Administration Time 8. Warfarin 4 mg PO DAILY16 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Posterior circulation infarcts Basilar artery thrombosis Vertebral artery occlusion 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 the Stroke Service at ___ ___ after presenting with nausea, slurred speech, diplopia, ataxia and flucuating right-sided weakness. Emergent imaging showed strokes in multiples areas at the base of your brain and clots in the arteries that supply the base of your brain. An attempt was made to remove the clot; however, the clot could not be reached. You were therefore started on a blood thinner. You were admitted initially to the ICU for close monitoring. You required medications to keep your blood pressure high enough to allow blood to flow past the clots in the arteries supplying your brain. You were eventually able to wean off the medications that required intravenous administration. At that point you were transferred to the floor. You were switched from an intravenous blood thinner to an oral blood thinner which you will continue long-term. You had significant difficulty with swallowing while in the ICU. You therefore had a feeding tube placed. You were re-evaluated after transfer to the floor and it was felt that you were safe for ground solids and thickened liquids. You were also treated twice for urinary tract infections during your admission. In addition, you required an enema the day of discharge due to a significant amount of stool in your bowels.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clindamycin 300 mg PO Q8H RX *clindamycin HCl 300 mg 1 capsule(s) by mouth every 8 hours Disp #*22 Capsule Refills:*0 2. Acetaminophen 500 mg PO Q6H:PRN pain 3. Allopurinol ___ mg PO DAILY 4. Amiodarone 200 mg PO DAILY 5. Amlodipine 2.5 mg PO BID 6. Atorvastatin 40 mg PO DAILY 7. Calcitriol 0.25 mcg PO DAILY 8. Omeprazole 40 mg PO DAILY 9. Torsemide 40 mg PO QAM 10. Valsartan 320 mg PO DAILY 11. Warfarin 2.5 mg PO DAILY16 12. Zolpidem Tartrate 10 mg PO HS 13. Vitamin D 1000 UNIT PO DAILY 14. GenTeal Mild (artificial tear (hypromellose)) 0.2 % ophthalmic Q4h PRN itching RX *artificial tear (hypromellose) [GenTeal Mild] 0.2 % 1 drop eye every hour Disp #*1 Bottle Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnoses: Cellulitis Secondary Diagnoses: Atrial Fibrillation Diastolic Congestive Heart Failure Diabetes mellitus Coronary Artery Disease Gout Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted for cellulitis (an infection of your skin and soft tissue) of your face and treated with IV antibiotics. Your cellulitis improved and you will go home with antibiotics for 7 more days to complete a 10 day course. You should stop your antibiotics on ___. Please refrain from using any new topical creams or ointments on your face, and continue to see your dermatologist. Please refrain from scratching your skin, as it makes you more prone to infection.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO/PR Q4H:PRN Pain 2. Diltiazem Extended-Release 180 mg PO DAILY 3. Escitalopram Oxalate 10 mg PO DAILY 4. Multivitamins 1 TAB PO DAILY 5. Psyllium 1 PKT PO TID:PRN for bulk 6. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: # s/p fall # urinary tract infection # urinary retention Secondary diagnoses: # advanced dementia # hypertension # anxiety 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>You were admitted s/p fall. You were seen by ___ and did well and now you will go to rehab for further strength. A ___ has been left in place to help with your difficulty urinating. Please follow-up with Uro-Gyneocology next week, as planned.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg NG Q8H:PRN pain 2. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB 3. Aspirin 81 mg PO DAILY 4. Furosemide 20 mg NG DAILY 5. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN SOB 6. Lansoprazole Oral Disintegrating Tab 30 mg J TUBE DAILY 7. Levothyroxine Sodium 75 mcg NG DAILY 8. Sertraline 50 mg PO DAILY 9. Atorvastatin 10 mg NG DAILY 10. Insulin SC Sliding Scale Insulin SC Sliding Scale using REG Insulin 11. Vitamin D 1000 UNIT NG DAILY 12. Warfarin 3 mg PO DAILY16 13. Hydrocortisone Oint 2.5% 1 Appl TP TID 14. Clotrimazole Cream 1 Appl TP TID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: GJ-tube dislodgement Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You presented to the hospital after removing your GJ-tube. You had the GJ-tube replaced successfully. Due to bleeding from the GJ-tube site, you received 3 units of red blood cells with good effect. You were successfully restarted on tube feeds. You had some diarrhea, but there was no evidence of C. diff infection. The diarrhea is likely due to the tube feeds and improved with addition of banana flakes. You also developed a new rash, which is most likely a fungal rash. The rash is improving with a steroid ointment and an antifungal ointment. .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN pain 2. Atorvastatin 10 mg PO QPM 3. Docusate Sodium 100 mg PO DAILY 4. Donepezil 10 mg PO QHS 5. Lisinopril 2.5 mg PO DAILY 6. Memantine 10 mg PO BID 7. Ondansetron 4 mg PO Q8H:PRN nausea 8. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth Once a day Disp #*30 Tablet Refills:*0 9. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 2 Days To start on ___, continue through ___. RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*4 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: ------------------ Syncope UTI SECONDARY DIAGNOSES: ------------------- Orthostatic hypotension Discharge Condition: Oriented to self, and partly oriented to place, but not to date. 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 pleasure caring for you at ___ ___. You were admitted for fainint in the bathroom. We assessed conduction system of your heart with EKG, and it was normal. We also put you on telemetry to continously monitor your heart, and you had no undesirable event. You were found to have low blood pressure when you were standing relative to when you were sitting. We call this orthostasis hypotension, and it could have been a reason that caused you to faint. We treated this by giving you some intravenous fluid. You were also found to have an infection of your urinary tract, which could also have contributed to your passing out. We started you on a 5-day course of antibiotics (first day ___. We are glad you are feeling better, and we wish you the best of luck! Regards, ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Mycophenolate Mofetil 250 mg PO BID 2. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 3. Acetaminophen 1000 mg PO BID:PRN pain 4. Amlodipine 5 mg PO DAILY 5. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral DAILY 6. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID 7. Eplerenone 25 mg PO BID 8. Gabapentin 300 mg PO QHS 9. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 10. MetFORMIN (Glucophage) 1000 mg PO BID 11. Metoprolol Tartrate 25 mg PO TID 12. Omeprazole 20 mg PO BID 13. Rosuvastatin Calcium 20 mg PO QPM 14. Vitamin D 400 UNIT PO DAILY ___ purchase over the counter 15. Glargine 24 Units Breakfast Glargine 6 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 16. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 17. liraglutide 1.2 mg subcutaneous DAILY 18. Tacrolimus 3 mg PO Q12H you should have twice weekly levels for now Discharge Disposition: Home Discharge Diagnosis: Small bowel mass s/p small bowel resection DM Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You have been transitioned from Rapamycin (Sirolimus) to Tacrolimus to help with wound healing. Please call the transplant clinic at ___ for fever > 101, chills, nausea, vomiting, diarrhea, constipation, inability to tolerate food, fluids or medications, increased abdominal pain, incisional redness, drainage or bleeding, dizziness or weakness, decreased urine output or dark, constipation or diarrhrea or any other concerning symptoms. You will have labwork drawn as arranged by the transplant clinic, with results to the transplant clinic (Fax ___ . CBC, Chem 10, AST, T Bili, Trough Tacro level, Urinalysis. On the days you have your labs drawn, do not take your Tacrolimus until your labs are drawn. Bring your Tacro with you so you may take your medication as soon as your labwork has been drawn. You may shower. Allow the water to run over your incision and pat area dry. No rubbing, no lotion or powder near the incision. You may leave the incision open to the air. The staples are removed approximately 3 weeks following your surgery No tub baths or swimming No driving if taking narcotic pain medications Drink enough fluids to keep your urine light in color. Your appetite will return with time. Eat small frequent meals, and you may supplement with things like carnation instant breakfast or Ensure. Check your blood sugars and blood pressure at home. Report consistently elevated values to the transplant clinic. Follow insulin scale as ordered Do not increase, decrease, stop or start medications without consultation with the transplant clinic at ___. There are significant drug interactions with anti-rejection medications which must be considered in medication management following transplant Consult transplant binder, and there is always someone on call at the transplant clinic with any questions that may arise</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 2. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). 3. ___ -60,000 unit Capsule, Delayed Release(E.C.) Sig: Two (2) Cap PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 4. fluticasone 50 mcg/actuation Spray, Suspension Sig: Two (2) Spray Nasal DAILY (Daily). 5. metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day. 6. mirtazapine 15 mg Tablet Sig: Three (3) Tablet PO HS (at bedtime). 7. divalproex ___ mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO BID (2 times a day). 8. divalproex ___ mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 9. metoprolol tartrate 50 mg Tablet Sig: 2.5 Tablets PO BID (2 times a day). 10. alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 11. oxycodone 5 mg Tablet Sig: ___ Tablets PO every six (6) hours as needed for pain/headache. 12. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 13. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 14. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 15. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 16. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 17. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation. 18. Vitamin D3 2,000 unit Capsule Sig: One (1) Capsule PO once a day. 19. cyclobenzaprine 5 mg Tablet Sig: ___ Tablets PO three times a day as needed for muscle pain. 20. amlodipine 10 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Occlusion of cerebral arteries, cerebral embolism, with cerebral infarction (middle cerebral artery) SECONDARY DIAGNOSIS: Hypertension, Hyperlipidemia, Tobacco use Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neurologic: Some unsteadiness of gait without ataxia or weakness. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were hospitalized due to symptoms of SLURRED SPEECH. This is likely due to your new Alprazolam medication. However, you were found to have a small ACUTE ISCHEMIC STROKE for which you fortunately have not developed severe symptoms. This stroke developed while you were not taking Clopidogrel regularly. In order to prevent stroke, you need to take this medication to prevent the formation of clots. We are changing your medications as follows: 1. We are increasing your ATORVASTATIN to 40 MG (from the prior 10 MG dose) to better control your cholesterol. 2. Please take CLOPIDOGREL 75 mg daily as prescribed to prevent future stroke. 3. Please take your other medications as prescribed. Please followup with your Neurologist as listed below as well as your PCP. If you experience any of the symptoms below, please seek medical attention. It was a pleasure providing you with medical care during this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Citalopram 20 mg PO DAILY 2. Doxepin HCl 100 mg PO BID 3. Famotidine 20 mg PO DAILY 4. Clindamycin 300 mg PO Q8H RX *clindamycin HCl 300 mg 1 capsule(s) by mouth q8 Disp #*21 Capsule Refills:*0 5. Hydrocortisone Cream 1% 1 Appl TP BID:PRN Itching RX *hydrocortisone 1 % apply to affected areas twice a day Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Lymphangitis 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 a rash. This rash is likely an infection that affected the lymph (drainage system) for your arm. We started you on an IV antibiotic, and would like you to continue to take oral antibiotics for the next 7 days. The medication we would like you start is called Clindamycin. Please take this three times a day for the full 7 days, and follow up with your primary care doctor. If you develop worsening redness, pain, or weakness, please return to the hospital.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*28 Tablet Refills:*0 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 3. Allopurinol ___ mg PO DAILY 4. Chlorpheniramine-Hydrocodone 5 mL PO Q12H:PRN Cough 5. Desonide 0.05% Cream 1 Appl TP DAILY PRN skin rash 6. Donepezil 10 mg PO QHS 7. Levothyroxine Sodium 100 mcg PO DAILY 8. Loratadine 10 mg PO DAILY 9. Niaspan Extended-Release (niacin) 500 mg oral DAILY 10. Omeprazole 20 mg PO DAILY 11. Triamcinolone Acetonide 0.025% Cream 1 Appl TP BID PRN eczema 12. HELD- Furosemide 20 mg PO DAILY This medication was held. Do not restart Furosemide until told to start by your doctor 13.Home Oxygen ___, DOB ___, Diagnosis: Pyothorax without fistula ICD-10 J86.9, Length of need: Indefinite, Concentrator and portable, Via n/c, Liter flow 2L/min Oxygen Saturation: Rest on RA (88%), Amb on RA (87%), Amb on O2 (92-95%) Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: - Empyema - Sepsis - Hypoxemia SECONDARY DIAGNOSIS: - Elevated INR (coagulopathy) - Gout - Peripheral edema Discharge Condition: Mental Status: at his baseline. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you! You came to the hospital because you were feeling unwell and having difficulty breathing. You were found to have fluid around your lungs, which was infected. A tube was placed in your chest to drain the infected fluid. You were also given medicine to treat the infection. You improved with the medicine and tube in your chest. The tube was removed and you did very well. You were able to go home with a medicine that will help you continue to treat your infection. You will also be using supplemental oxygen at home during the day started during your hospitalization. It is very important that you finish all of the medicine that we have prescribed you. It is also very important that you follow-up with your primary doctor and the lung doctors. ___ have scheduled the appointments for you and you can see the details below. It was a pleasure caring for you! Sincerely, Your Medical Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID RX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*11 2. CARVedilol 6.25 mg PO BID RX *carvedilol 6.25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*11 3. Lidocaine 5% Ointment 1 Appl TP DAILY RX *lidocaine 5 % Apply twice daily As needed for foot pain Refills:*1 4. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule(s) by mouth once a day Disp #*56 Capsule Refills:*0 5. Vancomycin Oral Liquid ___ mg PO QID RX *vancomycin 50 mg/mL 125 mg by mouth four times a day Refills:*0 6. Glargine 12 Units Bedtime Humalog 4 Units Breakfast Humalog 4 Units Lunch Humalog 4 Units Dinner 7. Acamprosate 333 mg PO TID 8. Aspirin 81 mg PO DAILY 9. Atorvastatin 80 mg PO QPM 10. FoLIC Acid 1 mg PO DAILY 11. HydrALAZINE 12.5 mg PO BID 12. Isosorbide Dinitrate 10 mg PO TID 13. Multivitamins 1 TAB PO DAILY 14. Sodium Bicarbonate 650 mg PO TID 15. Thiamine 100 mg PO DAILY 16. Torsemide 40 mg PO DAILY 17. Vitamin D 4000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: GI bleed Acute on chronic renal failure Cirrhosis Atrial fibrillation Discharge Condition: Stable AAOx3; No distress Ambulatory Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted at ___ for management of bloody stools. We transfused blood products and performed endoscopy (EGD) to look for a source of the bleeding. While we found some enlarged blood vessels in your esophagus (varices) and a nodular area in the duodenum, we did not find a definite source of your bleeding. Because of this, we would like to look again in ___ months. We recommend changing your blood thinner due to the difficulties of warfarin.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you at ___. WHY WERE YOU ADMITTED? ======================== You were brought to the hospital with confusion. We believe that the confusion was caused by your trouble breathing from all of the fluid in your lungs. WHAT HAPPENED WHILE I WAS HERE? ================================= We treated you for pneumonia, in case you also have a pneumonia. We gave you medications to help eliminate the fluid from your lungs. You were discharged back to ___ where you have been living. We wish you the very best, Your ___ Care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Gabapentin 100 mg PO BID 2. Hydrocodone-Acetaminophen (5mg-500mg) ___ TAB PO Q6H:PRN pain 3. Allopurinol ___ mg PO DAILY RX *allopurinol ___ mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Possible CLL Splenomegaly Leukocytosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You have been admitted with an enlarged spleen and increased white blood count that could be chronic lymphocytic leukemia. You have been seen by an oncologist who has recommended further testing that will be followed up as an outpatient. You will be contacted by ___ oncology for a follow-up appointment this week.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Alendronate Sodium 70 mg PO TAKE 1 TABLET EVERY WEEK IN THE MORNING ___ HOUR BEFORE FIRST MEAL 2. Betamethasone Dipro 0.05% Cream 1 Appl TP BID:PRN itching 3. Carvedilol 25 mg PO BID 4. Donepezil 5 mg PO QHS 5. Gabapentin 100 mg PO QHS 6. Losartan Potassium 100 mg PO DAILY 7. Omeprazole 20 mg PO DAILY 8. HELD- Furosemide 40 mg PO DAILY This medication was held. Do not restart Furosemide until you are taking in enough liquid and your PCP tells you it's okay 9. HELD- Pravastatin 40 mg PO QPM This medication was held. Do not restart Pravastatin until 3-months post bleed Discharge Disposition: Home with Service Facility: ___ Discharge Diagnosis: Acute hemorrhagic stroke Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized due to symptoms of confusion resulting from an ACUTE HEMORRHAGIC STROKE, a condition where a blood vessel bleeds into 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. Please take your other medications as prescribed. We have stopped your cholesterol medication pravastatin as this can increase your risk of bleeding for the next three months. We will re-start this medication in 3-months when you come to see us in the neurology clinic. We have scheduled you for a neurology appointment with Dr. ___ on ___. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB 2. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL Q6H 3. BusPIRone 10 mg PO TID 4. Duloxetine 60 mg PO DAILY 5. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 6. Gabapentin 1200 mg PO TID 7. Haloperidol ___ mg PO TID:PRN agitation 8. Heparin Flush (10 units/ml) 5 mL IV PRN line flush RX *heparin lock flush (porcine) [heparin lock flush] 10 unit/mL inject 5mL twice a day Disp #*60 Syringe Refills:*0 9. Heparin Flush (100 units/ml) 5 mL IV PRN DE-ACCESSING port 10. Nicotine Patch 21 mg TD DAILY 11. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 12. Quetiapine extended-release 200 mg PO QHS 13. traZODONE 50 mg PO HS RX *trazodone 50 mg ___ tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 14. Cyanocobalamin 1000 mcg IM/SC MONTHLY 15. Compro *NF* (prochlorperazine) 25 mg Rectal q6h nausea 16. Methocarbamol 750 mg PO Q6H:PRN muscle cramps 17. Sucralfate 1 gm PO QID RX *sucralfate 1 gram/10 mL 10mL Suspension(s) by mouth four times a day Disp #*1 Bottle Refills:*0 18. ferumoxytol *NF* 510 mg/17 mL (30 mg/mL) Injection once Duration: 1 Doses Reason for Ordering: Wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: Failure to thrive Secondary diagnoses: esophageal and anastomotic ulcers anxiety depression COPD Iron deficiency anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospitalization at ___. You were admitted for abdominal pain and decreased oral intake. You were treated with IV fluids, bowel rest and pain medication and your symptoms improved. You had an endoscopy and a colonoscopy which found an ulcer in your esophagus as well as at the site of your previous gastric bypass. This may be contributing to your abdominal pain and decreased ability to eat. You were started on twice daily Protonix and sucralfate slurry four times a day which are new medications for you to treat your ulcers. Please add these to the medications you take daily. You were given an iron infusion before you left the hospital to help with your anemia. Please continue to take your other medications as you have been doing. Attend all follow up appointments as below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Hydrochlorothiazide 25 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: chest pain not otherwise specified 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. You were admitted to the ___ for chest discomfort and shortness of breath. We performed a stress test to evaluate the condition of your heart which came back normal. Your chest discomfort resolved and you were well enough to be discharged home. You will follow up with your primary care doctor within the next week. Please continue to take all of your medications as previously prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin EC 81 mg PO DAILY 2. Atorvastatin 80 mg PO QPM 3. Calcipotriene 0.005% Cream 1 Appl TP DAILY 4. Clopidogrel 75 mg PO DAILY 5. Docusate Sodium 100 mg PO DAILY 6. Lisinopril 2.5 mg PO DAILY 7. Magnesium Oxide 400 mg PO BID 8. Metoprolol Tartrate 25 mg PO BID 9. Pantoprazole 40 mg PO Q12H 10. Tamsulosin 0.4 mg PO QHS 11. Vitamin D ___ UNIT PO DAILY 12. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID:PRN psoriasis 13. Glargine 13 Units Breakfast Glargine 10 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 14. Ciprofloxacin HCl 500 mg PO Q12H Duration: 9 Days RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*18 Tablet Refills:*0 15. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 6 Days RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: RLE Cellulitis and abscess IDDM 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 cellulitis of your fight foot and leg. You were also found to have an abscess which was drained by podiatry. You were treated with antibiotics. Your blood sugars were also very high and your insulin dosing was adjusted.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth twice a day Disp #*16 Tablet Refills:*0 2. Enoxaparin Sodium 80 mg SC Q12H Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 80 mg/0.8 mL 80 mg SC twice a day Disp #*60 Syringe Refills:*0 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 20 mg PO DAILY 5. Amitriptyline 150 mg PO HS 6. Ferrous Sulfate 325 mg PO BID 7. FoLIC Acid 1 mg PO DAILY 8. Gabapentin 800 mg PO TID 9. Lisinopril 2.5 mg PO DAILY 10. Metoprolol Tartrate 25 mg PO BID 11. Omeprazole 20 mg PO DAILY 12. Oxycodone-Acetaminophen (5mg-325mg) 2 TAB PO TID 13. TraZODone 150 mg PO HS 14. Cyclobenzaprine 10 mg PO TID:PRN pain 15. HydrOXYzine 50 mg PO BID:PRN itching 16. Topiramate (Topamax) 150 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS ================= RIGHT SIDED PULMONARY EMBOLUS CAVITARY LUNG LESION DYSPHAGIA SECONDARY DIAGNOSIS =================== RHEUMATOID ARTHRITIS CORONARY ARTERY DISEASE CHRONIC PAIN GASTROESOPHAGEAL REFLUX DISEASE OBSTRUCTIVE SLEEP APNEA Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ after experiencing shortness of breath and cough. You underwent imaging of you chest (CT Scan) which showed a blood clot ___ your lungs (pulmonary embolus). ___ order to treat the blood clot we will send you home on a medicine called enoxoparin. You will need to give yourself injections twice a day. This helped stabilize the blood clot ___ your lung. Your breathing improved significantly with this medication. Please continue with the injections of the enoxoparin twice a day. During the hospitalization we also treated you for an infection ___ your lung or pneumonia. ___ order to treat the pneumonia you were started on intravenous antibiotics and transitioned you to oral antibiotics why the time you left. You were seen by the lung doctors (___) as well as infectious disease specialists. They recommended you continue augmentin twice a day. We would like you to continue this medication with end date ___. Additionally to determine what was the cause of the cavitary lesion, the interventional pulmonologists would like you to undergo another imaging of your chest (CT imaging) ___ approximately three weeks. They would also like to follow-up with you ___ the interventional pulmonology clinic following the repeat imaging of your chest. They will help schedule the CT imaging as well as the clinic appointment. They would also like you to follow-up with the general lung doctor (___) ___ approximately 5 weeks. It is very important that you obtain the repeat imaging and attend every follow-up appointment as the cause of the cavitary lesion ___ the lung is currently not known without an interventional procedure. Possible causes include infection versus a cancer. Thus it is very important to follow-up with these appointments ___ the coming weeks. We stopped your prednisone as well as enbrel for your rheumatoid arthritis as you were suspected to have had an infection. Please follow up with your rheumatologist and primary care physician to determine if it is appropriate to restart these medications. It was a pleasure taking care of you during your hospitalization! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Clopidogrel 75 mg PO DAILY 3. LevETIRAcetam Oral Solution 1000 mg PO BID 4. Calcium Carbonate 500 mg PO BID 5. Carbidopa-Levodopa (___) 2 TAB PO TID 6. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID 7. Docusate Sodium 100 mg PO BID 8. FoLIC Acid 1 mg PO DAILY 9. LamoTRIgine 200 mg PO BID 10. Levothyroxine Sodium 50 mcg PO 6X/WEEK (___) 11. Levothyroxine Sodium 100 mcg PO 1X/WEEK (___) 12. Miconazole Powder 2% 1 Appl TP QPM 13. Pataday (olopatadine) 0.2 % ophthalmic (eye) BID 14. Sertraline 200 mg PO DAILY 15. Tamsulosin 0.4 mg PO QHS 16. Topiramate (Topamax) 100 mg PO BID 17. Vitamin D ___ UNIT PO 1X/WEEK (MO) 18. ZIPRASidone Hydrochloride 20 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute Ischemic Stroke Seizures Discharge Condition: Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of left sided weakness resulting from an ACUTE ISCHEMIC STROKE, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. You underwent a procedure called thrombectomy where a catheter was used to unclog the clot blocking the blood supply in your brain. Your symptoms significantly improved following the procedure. 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: Atrial septal defect/PFO After the above procedure for your stroke, you were found to have seizures involving your left side of face and arm. Seizures are abnormal electrical activity in your brain for which you were taking medication at home. We suspected that this was due to you missing a dose of your seizure medications prior to arrival and in the setting of a new stroke. You required assistance with breathing and a breathing tube was placed and were closely monitored in an ICU. You were started on your home medications Lamotrigine, Topamax and a medication called Leviteracetam (KEPPRA) was added. Your seizures were well controlled with these medications. We are changing your medications as follows: Added: Keppra 1000mg oral twice daily Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluoxetine 20 mg PO DAILY 2. GenTeal Mild to Moderate *NF* (artificial tear (hypromellose)) 0.3 % ___ daily:PRN 3. Memantine 10 mg PO BID 4. Pataday *NF* (olopatadine) 0.2 % ___ daily:PRN 5. Vitamin D 1000 UNIT PO DAILY 6. Enoxaparin Sodium 40 mg SC DAILY Duration: 4 Weeks RX *enoxaparin 40 mg/0.4 mL 40 mg sc daily Disp #*28 Syringe Refills:*0 7. Calcium Citrate + D *NF* (calcium citrate-vitamin D3) 315-200 mg-unit Oral daily 8. Centrum Silver *NF* (multivitamin-minerals-lutein;<br>mv with min-lycopene-lutein;<br>mv-min-folic acid-lutein) 1 tablet Oral daily 9. GLUCOTEN *NF* (glucosamine &chondroit-mv-min3) ___-0.5 mg Oral daily Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: right tibial plateau and proximal femur fracture Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>discharge instructions MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 4 weeks WOUND CARE: - You can get the wound wet/take a shower starting 3 days after your surgery. You may wash gently with soap and water, and pat the incision dry after showering. - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. ACTIVITY AND WEIGHT BEARING: - Touch down weight bearing in unlocked ___ Physical Therapy: touch down weight bearing in unlocked ___ Treatments Frequency: Dressing changes BID until wound is dry and clean</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ledipasvir/Sofosbuvir 1 TAB PO DAILY 2. Omeprazole 20 mg PO DAILY 3. Potassium Chloride 20 mEq PO DAILY 4. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*2 5. Hydrochlorothiazide 25 mg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. shark cartilage 1000 mg oral DAILY Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: TIA Secondary diagnosis: Hepatitis C cirrhosis Hypertension GERD with ___ esophagus Gastric bypass surgery Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were hospitalized due to symptoms of speech difficulty resulting from an TRANSIENT ISCHEMIC ATTACK, a condition where a blood vessel providing oxygen and nutrients to the brain is temporarily 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 ___ 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 -Artery plaque We are changing your medications as follows: -Starting aspirin 81mg daily for prevention of future stroke (we have contacted your hepatologist and PCP about the addition of this medication) Please also: -Attempt to eat low fat and salt foods to prevent artery plaque formation Please take your other medications as prescribed. Please follow-up with Neurology and your primary care physician. If ___ 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 ___ - sudden weakness of one side of the body - sudden drooping of one side of the face - sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Fish Oil (Omega 3) 1000 mg PO DAILY 3. Gemfibrozil 900 mg PO BID 4. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q6H:PRN pain RX *oxycodone-acetaminophen 5 mg-500 mg ___ capsule(s) by mouth every four (4) hours Disp #*60 Capsule Refills:*0 5. Gabapentin 100 mg PO TID RX *gabapentin 100 mg 1 capsule(s) by mouth three times a day Disp #*120 Capsule Refills:*1 6. Warfarin 5 mg PO DAILY16 RX *warfarin 2.5 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*3 7. MetFORMIN (Glucophage) 1000 mg PO BID 8. HumaLOG KwikPen *NF* (insulin lispro) 100 unit/mL Subcutaneous QID <250=0, 250-300=1 unit, 300-350=2 unit, >350=3 unit RX *insulin lispro [Humalog KwikPen] 100 unit/mL per sliding scale QID four times a day Disp #*5 Box Refills:*0 9. insulin admin supplies *NF* BD insulin pen needles Subcutaneous QID RX *insulin admin supplies BD insulin pen needles four times a day Disp #*100 Syringe Refills:*0 Discharge Disposition: Home Discharge Diagnosis: 1. Right ICA thrombus 2. Diabetic amyotrophy 3. Right sixth nerve palsy Secondary diagnosis: 1. Uncontrolled DM Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neuro Exam at Discharge: right sixth nerve palsy. Right deltoid, triceps, pectoralis weakness with dropped triceps reflex on right. Remainder of exam nonfocal. Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, You were admitted with symptoms of double vision and after a clot was found in your right internal carotid artery. We tried to get an MRI of your head and your neck arteries for further evaluation, but since you were unable to lay flat for this, we decided to perform an ultrasound of your carotid arteries instead. This showed there was a soft plaque vs. thrombus in the right internal carotid artery. You were started on Coumadin, which you should take for 3 months, to help lower the stroke risk from this clot. You will then need a repeat CT scan of the arteries in your neck to see if the clot has stabilized. Your double vision is due to ___ nerve palsy, which is likely due to diabetes. You can use an eye patch, alternating between eyes to help with the double vision. Dr. ___ neuro-ophthalmologist may also give you prism glasses. Your shoulder pain and right sided proximal weakness is likely from your diabetes resulting in a condition called diabetic amytrophy. You were started on Percoet and Gabapentin to help with pain control. You may need an EMG/NCS (nerve conduction study) to help with diagnosis (though this should be done when you are not on Coumadin). Your diabetes is very poorly controlled and you will need to make lifestyle, and likely medication changes as well. You were started on insulin while in the hospital and you should schedule ___ follow-up as outpatient.</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. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 3. clonidine 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*60 Tablet(s)* Refills:*2* 4. citalopram 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). Disp:*45 Tablet(s)* Refills:*2* 5. lisinopril 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. tramadol 50 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours) as needed for pain. 7. spironolactone 100 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). Disp:*120 Tablet(s)* Refills:*2* 8. glyburide 2.5 mg Tablet Sig: One (1) Tablet PO once a day. 9. amlodipine 10 mg Tablet Sig: One (1) Tablet PO at bedtime. 10. trazodone 300 mg Tablet Sig: One (1) Tablet PO at bedtime. 11. simvastatin 20 mg Tablet Sig: One (1) Tablet PO at bedtime. 12. labetalol 200 mg Tablet Sig: Two (2) Tablet PO every eight (8) hours. 13. gabapentin 400 mg Capsule Sig: One (1) Capsule PO every eight (8) hours. Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Hypertensive emergency Right adrenal adenoma Secondary Diagnosis: Resistant hypertension Chronic kidney disease Anxiety Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted to the hosptial with very high blood pressures. We have been able to better control your blood pressures using the current medication regimen we have prescribed for you. It is important that you continue to take your medications on a daily basis. We found that you have a mass in your right adrenal gland. This is likely contributing to your high blood pressure. We have scheduled follow up appointments for you with the Endocrine and Kidney doctors that ___ have been seeing in the hosptial. Dr. ___ (the surgeon you met while in the hospital) will be contacting you with a follow up appointment as well as scheduling you for an appointment with a cardiologist for pre-operative clearance. The following changes have been made to your medications: NEW medications: - Clonidine 0.1mg by mouth twice per day for blood pressure control CHANGES: - Increased spironolactone to 200mg by mouth twice per day for blood pressure control It is very important that you keep your follow up appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluticasone Propionate NASAL 1 SPRY NU DAILY 2. Vitamin D ___ UNIT PO DAILY 3. Vitamin D ___ UNIT PO 1X/WEEK (MO) 4. PredniSONE 10 mg PO DAILY Duration: 18 Days Take 5 pills x1day, Then 4 pills x3day; 3 pills x3day,2 pill x3day,1 pill ___ pill x3 days. Tapered dose - DOWN RX *prednisone 10 mg 1 tablet(s) by mouth daily starting ___ Disp #*37 Tablet Refills:*0 5. Lisinopril 10 mg PO DAILY 6. Colchicine 0.6 mg PO DAILY RX *colchicine 0.6 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 7. Allopurinol ___ mg PO DAILY RX *allopurinol ___ mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis Gout Secondary Diagnosis C3 glomerulopathy and proteinuria Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (crutches). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your hospitalization. Briefly, you were admitted with swelling in your left foot and pain in your right foot. You were given steroids and your symptoms improved. The Rheumatologists sampled the fluid in your ankle and this showed signs consistent with gout. Please continue taking the Prednisone according to the following taper: ___: 50mg (5 pills) ___: 40mg (4 pills) ___: 30mg (3 pills) ___: 20mg (2 pills) ___: 10mg (1 pill) ___: 5mg ___ pill) ___: Stop You will also start taking the medications Colchicine and Allopurinol daily, which will help to prevent gout attacks in the future. Please follow up with your nephrologist on ___ and discuss whether or not it is safe to resume taking your NSAIDs. If you are in pain, it is safe to take Tylenol. We wish you the best, Your ___ Treatment Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PR QHS RX *bisacodyl [Bisac-Evac] 10 mg 1 suppository(s) rectally every day as needed Disp #*30 Suppository Refills:*0 2. Magnesium Citrate 300 mL PO ONCE Duration: 1 Dose 3. Senna 8.6 mg PO BID RX *sennosides [Evac-U-Gen (sennosides)] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 4. Ferrous Sulfate 325 mg PO DAILY 5. Allopurinol ___ mg PO DAILY 6. CloNIDine 0.1 mg PO BID 7. Cyclobenzaprine 20 mg PO TID:PRN pain, back spasm 8. Fentanyl Patch 100 mcg/h TD Q72H 9. FoLIC Acid 1 mg PO DAILY 10. Gabapentin 300 mg PO BID 11. HYDROmorphone (Dilaudid) 4 mg PO Q6H:PRN Pain - Severe 12. Hydroxychloroquine Sulfate 200 mg PO DAILY 13. Labetalol 600 mg PO TID 14. Lisinopril 40 mg PO DAILY 15. Nicotine Patch 21 mg TD DAILY 16. Omeprazole 20 mg PO DAILY 17. Polyethylene Glycol 17 g PO DAILY 18. Pravastatin 20 mg PO QPM 19. Restasis 0.05 % ophthalmic (eye) Q12H 20. Tamsulosin 0.4 mg PO QHS 21. Torsemide 20 mg PO DAILY 22. Venlafaxine XR 112.5 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Acute on chronic abdominal pain Constipation Acute on chronic testicular pain 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 with severe abdominal pain after not taking your stool softeners for two days. As you are taking opioid pain medications, you are at significant risk of getting constipated. Please follow up with your primary care provider to continue to address this problem. Please take your stool softeners daily. If you start to have constipation, speak with your primary care doctor before stopping your stool softeners. It was a pleasure taking care of you, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild Duration: 24 Hours RX *acetaminophen 500 mg 2 capsule(s) by mouth every six (6) hours Disp #*40 Capsule Refills:*0 2. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN Pain - Moderate RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth Q3H Disp #*40 Tablet Refills:*0 3. LORazepam 0.5 mg PO Q6H:PRN anxiety or insomnia RX *lorazepam [Ativan] 0.5 mg 1 tablet by mouth every six (6) hours Disp #*20 Tablet Refills:*0 4. Multivitamins 1 TAB PO DAILY RX *multivitamin [Daily Multiple] 1 tablet(s) by mouth DAILY Disp #*20 Tablet Refills:*0 5. OxycoDONE Liquid ___ mg PO Q4H:PRN Pain - Moderate do not drive or drink alcohol while taking this medication RX *oxycodone 5 mg/5 mL 5 ml by mouth every six (6) hours Refills:*0 6. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*20 Tablet Refills:*0 7. Simethicone 40-80 mg PO QID:PRN gas pain RX *simethicone [Bicarsim] 80 mg 1 tablet by mouth four times a day Disp #*30 Tablet Refills:*0 8. Omeprazole 40 mg PO DAILY 9. Polyethylene Glycol 17 g PO DAILY:PRN constipation 10. Sucralfate 1 gm PO QID Discharge Disposition: Home Discharge Diagnosis: abdominal pain, hernia 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 the treatment of your abdominal pain. You have underwent treatment and are now safe to continue your recovery at home. You were found to have hernias during this admission. A surgical correction of the hernia is recommended and you have been scheduled for surgery on ___. Please remain on bariatric stage 5 diet through your surgery. Please resume all of your medications unless specifically told by your doctor to do otherwise. Please call your surgeon or return to the Emergency Department if you develop a fever greater than ___ F, shaking chills, chest pain, difficulty breathing, pain with breathing, cough, a rapid heartbeat, dizziness, severe abdominal pain, pain unrelieved by your pain medication, a change in the nature or severity of your pain, severe nausea, vomiting, abdominal bloating, severe diarrhea, inability to eat or drink, foul smelling or colorful drainage from your incisions, redness, swelling from your incisions, or any other symptoms which are concerning to you. Diet: Stay on Stage 5 diet until your follow up appointment; please refer to your work book for detailed instructions. Do not self- advance your diet and avoid drinking with a straw or chewing gum. To avoid dehydration, remember to sip small amounts of fluid frequently throughout the day to reach a goal of approximately ___ mL per day. Please note the following signs of dehydration: dry mouth, rapid heartbeat, feeling dizzy or faint, dark colored urine, infrequent urination.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. DAPTOmycin 600 mg injection Q24H Plan for 4-week course (Day ___, to be completed ___. RX *daptomycin 500 mg Take 600mg IV every 24 hours. Disp #*22 Vial Refills:*0 2. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate Do not drive. ___ cause sedation. RX *oxycodone 5 mg Take 1 tablet by mouth every 6 hours Disp #*14 Tablet Refills:*0 3. Simvastatin 10 mg PO QPM 4. Albuterol Inhaler 2 PUFF IH Q6H:PRN sob 5. Azithromycin 500 mg PO DAILY:PRN dental work 6. Enoxaparin Sodium 90 mg SC Q12H 7. Levothyroxine Sodium 88 mcg PO DAILY 8. Loratadine 10 mg PO QHS 9. LORazepam 0.5 mg PO QHS:PRN insomnia 10. Multivitamins W/minerals 1 TAB PO DAILY 11. Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting 12. safflower oil-linoleic acid,co 1,000 mg oral DAILY 13.Outpatient Lab Work Please check weekly: CBC with differential, BUN, Cr, CPK. Please fax results to: ___ CLINIC at ___. ICD-10: T80.212. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: - Right Internal Jugular Thrombus - Port Infection - Myelodysplastic 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 taking care of you at ___ ___. You were admitted with fever and worsening neck pain shortly after diagnosis of a blood clot in your right jugular vein. We started you on IV antibiotics because of concern the clot was infected and continued you on anticoagulation medication. After your your port was removed you had significant improvement in your symptoms. There was growth of bacteria on your port so will you be treated for a total of 4 weeks of IV antibiotics. You had a PICC line placed so this could be done at home. Please continue your home medications. Your simvastatin dose was reduced to 10mg due to potential interaction with the antibiotic (daptomycin). Please follow up with your primary care doctor and your oncologist. Sincerely, 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. Benzonatate 100 mg PO TID:PRN cough 3. ClonazePAM 1 mg PO BID:PRN anxiety 4. ClonazePAM 1 mg PO QHS:PRN insomnia 5. Cyanocobalamin 50 mcg PO DAILY 6. DiCYCLOmine ___ mg PO QID:PRN bowel spasm 7. Ferrous Sulfate 325 mg PO DAILY 8. Fish Oil (Omega 3) 1000 mg PO BID 9. Furosemide ___ mg PO DAILY:PRN leg edema 10. Gabapentin 900 mg PO TID 11. HYDROmorphone (Dilaudid) 8 mg PO Q3H:PRN Pain - Moderate 12. Levothyroxine Sodium 100 mcg PO DAILY 13. Lidocaine 5% Ointment 1 Appl TP Q8H:PRN pain 14. Metoclopramide 5 mg PO TID:PRN nausea 15. Midodrine 5 mg PO BID 16. Multivitamins 1 TAB PO DAILY 17. Nitrofurantoin Monohyd (MacroBID) 100 mg PO Q12H 18. Omeprazole 20 mg PO DAILY 19. Ondansetron 4 mg PO Q8H:PRN nausea, vomiting 20. Sertraline 100 mg PO DAILY 21. Vitamin D 1000 UNIT PO DAILY 22. Zenpep (lipase-protease-amylase) 5,000-17,000 -27,000 unit oral TID W/MEALS 23. Zolpidem Tartrate 5 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Recurrent right prosthetic hip dislocation Discharge Condition: Activity Status: Ambulatory - requires assistance or aid (walker or cane). Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for a right dislocated hip. It is normal to feel tired or "washed out" after hospitalization, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Weight bearing as tolerated always with hip abduction brace on, in 30 degrees of abduction and ___ degrees of flexion 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: - N/A 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 - 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. ___ in the ___ Clinic in ___ weeks for evaluation, see ___ ___ for first follow up visit. 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: Weight bearing as tolerated in the right lower extremity, always with hip abduction brace on, 30 degrees of abduction and ___ degrees of flexion Treatments Frequency: No wound care needed.</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. Clopidogrel 75 mg PO DAILY 3. Levothyroxine Sodium 150 mcg PO DAILY 4. Metoprolol Succinate XL 100 mg PO BID 5. Atorvastatin 80 mg PO DAILY 6. Scopolamine Patch 1 PTCH TD ONCE Duration: 1 Dose 7. Warfarin 2.5 mg PO DAILY16 first dose ___ 8. Fluoxetine 10 mg PO DAILY 9. ALPRAZolam 0.25 mg PO TID:PRN anxiety Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Penetrating aortic ulcer with intrathoracic rupture. Non ST elevation myocardial infarction Pulmonary Edema Discharge Condition: Activity Status: Ambulatory - requires assistance or aid (walker or cane). Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>Division of Vascular and Endovascular Surgery Endovascular Aneurysm Repair Discharge Instructions MEDICATIONS: •Take Aspirin 81mg (enteric coated) once daily •Do not stop Aspirin unless your Vascular Surgeon instructs you to do so. •You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort WHAT TO EXPECT AT HOME: It is normal to have slight swelling of the legs: •Elevate your leg above the level of your heart (use ___ pillows or a recliner) every ___ hours throughout the day and at night •Avoid prolonged periods of standing or sitting without your legs elevated It is normal to feel tired and have a decreased appetite, your appetite will return with time •Drink plenty of fluids and eat small frequent meals •It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing •To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication ACTIVITIES: •When you go home, you may walk and 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, gradually increase your activities and distance walked as you can tolerate •No driving until you are no longer taking pain medications</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. trazodone 100 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 2. cyclobenzaprine 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. cyclobenzaprine 10 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0* 5. ibuprofen 400 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 hours). Disp:*30 Tablet(s)* Refills:*0* 6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 7. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 8. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q3H (every 3 hours) as needed for pain. Disp:*90 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Ligamentous Injury to the left thigh and knee ___ Syndrome 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 L knee and thigh pain, complete workup was negative for clots, bleeding, infection, but it was felt you have a sprain. You will wear a brace, use ibuprofen and oxycodone for pain, and follow up with orthopedics.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Aspirin 81 mg PO DAILY 3. Atenolol 50 mg PO DAILY 4. Atorvastatin 10 mg PO DAILY 5. Cinacalcet 60 mg PO DAILY 6. HydrOXYzine 25 mg PO DAILY 7. Lisinopril 20 mg PO BID 8. Mirtazapine 30 mg PO HS 9. Nephrocaps 1 CAP PO DAILY 10. NIFEdipine CR 60 mg PO DAILY 11. Valsartan 160 mg PO BID 12. Zolpidem Tartrate 10 mg PO HS 13. sevelamer CARBONATE 800 mg PO TID W/MEALS Follow up at dialysis as to whether you should continue this medication RX *sevelamer carbonate [Renvela] 800 mg 1 tablet(s) by mouth three times daily with meals Disp #*21 Tablet Refills:*0 14. Renagel *NF* 1600 Other TID 15. Humalog ___ 15 Units Breakfast Humalog ___ 15 Units Dinner 16. OxycoDONE (Immediate Release) ___ 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 17. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice daily Disp #*20 Capsule Refills:*0 18. Sodium Polystyrene Sulfonate 30 gm PO ONCE Please continue taking as you did prior to admission Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Infected below the knee amputation site Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Will require discharge to rehab to improve functional status. Followup Instructions: ___ [/INST] </s><s>You are being discharged from ___ ___ after undergoing an above the knee amputation of your right leg for an infected below the knee amputation site incision. You have recovered from your surgery well and are now being discharged to rehab. This information is designed as a guideline to assist you in a speedy recovery from your surgery. Please follow these guidelines unless your physician has specifically instructed you otherwise. Please call our office nurse if you have any questions. Dial 911 if you have any medical emergency. ACTIVITY: There are restrictions on activity. On the side of your amputation you are non weight bearing until cleared by your Surgeon. You should keep this amputation site elevated when ever possible. You may use the other leg to assist in transferring and pivots. But try not to exert to much pressure on the amputation site when transferring and or pivoting. Please keep knee immobilizer on at all times to help keep the amputation site straight. No driving until cleared by your Surgeon. PLEASE CALL US IMMEDIATELY FOR ANY OF THE FOLLOWING PROBLEMS: Redness in or drainage from your leg wound(s) . Watch for signs and symptoms of infection. These are: a fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site. If you experience any of these or bleeding at the incision site, CALL THE DOCTOR. Exercise: Limit strenuous activity for 6 weeks. Do not drive a car unless cleared by your Surgeon. Try to keep leg elevated when able. BATHING/SHOWERING: You may shower immediately upon coming home. No bathing. A dressing may cover you’re amputation site and this should be left in place for three (3) days. Remove it after this time and wash your incision(s) gently with soap and water. You will have sutures, which are usually removed in 4 weeks. This will be done by the Surgeon on your follow-up appointment. WOUND CARE: Sutures / Staples may be removed before discharge. If they are not, an appointment will be made for you to return for staple removal. When the sutures are removed the doctor may or may not place pieces of tape called steri-strips over the incision. These will stay on about a week and you may shower with them on. If these do not fall off after 10 days, you may peel them off with warm water and soap in the shower. Avoid taking a tub bath, swimming, or soaking in a hot tub for four weeks after surgery. MEDICATIONS: Unless told otherwise you should resume taking all of the medications you were taking before surgery. You will be given a new prescription for pain medication, which can be taken every three (3) to four (4) hours only if necessary. Remember that narcotic pain meds can be constipating and you should increase the fluid and bulk foods in your diet. (Check with your physician if you have fluid restrictions.) If you feel that you are constipated, do not strain at the toilet. You may use over the counter Metamucil or Milk of Magnesia. Appetite suppression may occur; this will improve with time. Eat small balanced meals throughout the day. CAUTIONS: NO SMOKING! We know you've heard this before, but it really is an important step to your recovery. Smoking causes narrowing of your blood vessels which in turn decreases circulation. If you smoke you will need to stop as soon as possible. Ask your nurse or doctor for information on smoking cessation. Avoid pressure to your amputation site. No strenuous activity for 6 weeks after surgery. PLEASE FEEL FREE TO CALL THE OFFICE WITH ANY OTHER CONCERNS OR QUESTIONS THAT MIGHT ARISE</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY RX *lansoprazole 30 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 2. Calcium Carbonate 1000 mg PO DAILY RX *calcium carbonate 500 mg calcium (1,250 mg) 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 3. FoLIC Acid 2 mg PO DAILY RX *folic acid 1 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 4. lamiVUDine *NF* 100 mg Oral Daily RX *lamivudine [Epivir HBV] 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Vitamin D 800 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 6. Artificial Tears ___ DROP BOTH EYES PRN dryness RX *dextran 70-hypromellose [Artificial Tears] ___ drops in each eye every four hours Disp #*1 Bottle Refills:*0 7. Atovaquone Suspension 1500 mg PO DAILY RX *atovaquone [Mepron] 750 mg/5 mL 1500 mg(s) by mouth daily Disp #*30 Unit Refills:*0 8. Cyanocobalamin 1000 mcg PO DAILY RX *cyanocobalamin (vitamin B-12) 1,000 mcg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 9. CycloSPORINE (Neoral) MODIFIED 75 mg PO Q12H RX *cyclosporine modified 25 mg 3 capsule(s) by mouth every twelve hours Disp #*180 Capsule Refills:*0 10. Dexamethasone 5 mg PO DAILY RX *dexamethasone 1 mg 5 tablet(s) by mouth daily Disp #*150 Tablet Refills:*0 11. Fluconazole 200 mg PO Q24H RX *fluconazole 200 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 12. Furosemide 20 mg PO DAILY RX *furosemide 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 13. NPH 20 Units Breakfast Insulin SC Sliding Scale using HUM Insulin RX *insulin lispro [Humalog] 100 unit/mL Up to 13 Units per sliding scale four times a day Disp #*1 Vial Refills:*0 RX *NPH insulin human recomb [Humulin N] 100 unit/mL inject subcutaneously 20 Units before BKFT; Disp #*6 Vial Refills:*0 14. Oseltamivir 75 mg PO Q24H RX *oseltamivir [Tamiflu] 75 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 15. ValGANCIclovir 900 mg PO Q12H RX *valganciclovir [Valcyte] 450 mg 2 tablet(s) by mouth every twelve hours Disp #*120 Tablet Refills:*0 16. MetFORMIN XR (Glucophage XR) 500 mg PO BID Do Not Crush RX *metformin 500 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 17. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every eight hours Disp #*15 Tablet Refills:*0 18. Diltiazem 90 mg PO QID RX *diltiazem HCl 90 mg 1 tablet(s) by mouth four times a day Disp #*120 Tablet Refills:*0 19. Fexofenadine 60 mg PO BID RX *fexofenadine 60 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hemophagocytic lymphohistiocytosis Macrophage Activating Syndrome Secondary diagnoses: Type 2 Diabetes mellitus Paroxysmal atrial fibrillation CMV viremia Enterococcal bacteremia Hepatitis B Hepatitis C 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 ___, ___ were seen in the hospital because of recurrent fevers likely associated with a recurrence of your Macrophage Activating Sydrome. ___ underwent chemotherapy for this and your hospitalization was complicated by a bacteria called enterococcus and a virus called CMV in your blood, treated with antibiotics and antiviral medications. ___ also had an irregular heart rhythm called atrial fibrillation which resolved. Your sugars were very high because of the steroids in your chemotherapy regimen, so ___ will need insulin at least while still on steroids at home. Also, ___ were started on a pill called lasix for your leg swelling. Please have your home nurse draw the following labs on ___: Cyclosporine level, CMV Viral load, CBC with Diff, Na, K, Cl, HCO3, BUN, Cr, Glucose, Ca, Mg, Phosphate, AST, ALT, Alk phos, LDH, total protein, albumin, ___, PTT. We have made the following changes to your medications: START artificial tears as needed START atovaquone START cyanocobalamin START cyclosporin START dexamethasone START diltiazem START fexofenadine START fluconazole START furosemide START NPH insulin START humalog START lansoprazole START oseltamivir START oxycodone as needed START valgancyclovir INCREASE folic acid INCREASE metformin STOP valsartan STOP etodolac</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcitriol 0.25 mcg PO DAILY 2. Ferrous Sulfate 325 mg PO DAILY 3. Metoprolol Succinate XL 25 mg PO DAILY 4. Sodium Bicarbonate 650 mg PO BID 5. Furosemide 20 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: - Acute on chronic kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You came in because your creatinine, a blood test that tells us about the function of your kidneys was abnormal. It improved when we gave you fluids. You will be going to ___ for inpatient physical therapy. There you can have your blood drawn so that doctors ___ continue to watch your kidneys. You will follow up with your nephrologist and 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: 1. Methadone 60 mg PO DAILY 2. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 3. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 4. FLUoxetine 20 mg PO BID RX *fluoxetine 20 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Tricuspid valve endocarditis complicated by septic emboli SECONDARY DIAGNOSES: Septic pulmonary emboli, improved Asymptomatic bacteriuria Opioid use disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___. WHY WERE YOU ADMITTED? You were admitted for evaluation and management of chest pain, shortness of breath, and an episode of losing consciousness, in addition to wanting to receive another opinion on management of your tricuspid valve endocarditis. WHAT DID WE DO FOR YOU? - To manage your endocarditis, we continued the antibiotics (Augmentin, Rifampin, and Bactrim) that you had left ___ with. We then switched you to intravenous Cefazolin after speaking with our infectious disease team. Our infectious disease team determined that you had completed your antibiotic course, and did not need other antibiotics at home. - We managed your chest pain with an IV anti-inflammatory drug, and then continued you on methadone to manage both pain and your previous opioid use. You were discharged on a dose of 60mg once daily. The last dose of your methadone was given at 9:52AM on ___. - We obtained an echo image of your heart to evaluate whether surgery (tricuspid valve replacement) would be appropriate at this point. Our cardiac surgery team agreed with your operative plan at ___, that you would need to demonstrate 6 months of not using drugs in order to be re-considered for valve replacement WHAT SHOULD YOU DO FOR FOLLOW-UP? - Set up follow-up with a primary care physician at ___: ___, or online ___/ - Follow up with the ___ clinic (Habit Opco) as scheduled below. - Follow up with Dr. ___ office as scheduled below. - Follow up with our infectious disease team as scheduled below. It was a pleasure taking care of you. 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. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 2. Acetaminophen 1000 mg PO Q8H 3. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain RX *oxycodone 5 mg 1 capsule(s) by mouth 1 capsule every 4 hours Disp #*60 Capsule Refills:*0 4. Warfarin 4 mg PO DAILY16 Titrate as necessary 5. Atorvastatin 80 mg PO QPM 6. Calcitonin Salmon 200 UNIT NAS DAILY alternating nostrils 7. Docusate Sodium 100 mg PO BID 8. Lisinopril 40 mg PO DAILY 9. Metoprolol Succinate XL 50 mg PO DAILY 10. Nicotine Patch 14 mg TD DAILY 11. Senna 8.6 mg PO BID:PRN constipation 12. Torsemide 10 mg PO DAILY 13. TraZODone 25 mg PO QHS:PRN insomnia 14. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left femoral neck fracture now s/p left hip hemiarthroplasty 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: - Weight bearing as tolerated LLE with anterior hip precautions 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 Coumadin 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. - Please remain in your dressing and do not change unless it is visibly soaked or falling off. 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 Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Physical Therapy: WBAT LLE Anterior hip precautions Treatments Frequency: WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Dressing change as needed daily starting ___, after POD 7, may leave open to air if not draining - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Please remain in your dressing and do not change unless it is visibly soaked or falling off.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild Do not take more than 4 grams (4 tablets) per 24 hours. RX *acetaminophen 500 mg 2 tablet(s) by mouth every 6 hours Disp #*40 Tablet Refills:*0 2. Ibuprofen 800 mg PO Q8H:PRN Pain - Moderate Duration: 5 Days Take with food or your stomach will get upset. RX *ibuprofen 800 mg 1 tablet(s) by mouth every 8 hours Disp #*15 Tablet Refills:*0 3. Methylprednisolone 4 mg PO ASDIR Duration: 21 Doses see attached patient instructions for taper. Pharmacist, taper is same as Medrol dose pack. This is dose # of tapered doses RX *methylprednisolone 4 mg ___ tablets(s) by mouth as directed Disp #*1 Dose Pack Refills:*0 4. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Please continue for 10 full days (last dose ___. Do not skip any doses. RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every 12 hours Disp #*20 Tablet Refills:*0 5. bimatoprost 0.03 % Other Other 6. BuPROPion XL (Once Daily) 300 mg PO DAILY 7. dextroamphetamine-amphetamine 10 mg oral BID:PRN 8. Levothyroxine Sodium 75 mcg PO DAILY 9. Lisinopril 20 mg PO DAILY 10. Metoprolol Succinate XL 100 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: supraglottitis/pharyngitis 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 hoarseness and difficulty swallowing. You were found to have an infection of your tonsillar cavity. You were treated with steroids and antibiotics. Your symptoms improved and should continue to improve over the next several days. You can alternate taking Tylenol and ibuprofen for pain. You also need to take the steroids and antibiotic you were prescribed. Please finish all doses of those. You need to follow-up with your PCP on ___ ___ at 9:30am. Please call Dr. ___ office on ___ to make a follow-up appointment for ___ weeks from now.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at ___ ___. You were admitted because you were having a harder time breathing and were coughing more. You were given antibiotics and more steroids to treat a pneumonia. Interventional Pulmonology saw you, rescheduled your surgery, and you were discharged to rehab to make you stronger before the surgery. Best of luck to you in your future health. Discharge weight 93kg or 205 lbs. Please weigh yourself every day and call a physician if you gain more than 3 pounds in one day. Please take all medications and therapies as directed, attend all physician appointments as directed, follow a diabetic heart healthy diet, and call a doctor if you have any questions or concerns.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever 2. Ibuprofen 400 mg PO Q6H:PRN Pain - Mild please take with food 3. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp #*4 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 5. Senna 8.6 mg PO BID:PRN Constipation - First Line 6. Aspirin 81 mg PO DAILY 7. FoLIC Acid 1 mg PO DAILY 8. Furosemide 30 mg PO DAILY 9. Gabapentin 900 mg PO TID 10. Omeprazole 20 mg PO BID 11. Spironolactone 100 mg PO DAILY 12. Sucralfate 1 gm PO TID 13. Verapamil SR 180 mg PO Q24H 14. prednisolone acetate 1 gtt right eye BID (use until f/u exam with Optho) 15. ciprofloxacin 0.3% 1 gtt qid right eye (use until f/u exam with Optho) 16. cyclopentolate 1% 1 gtt BID right eye ( to d/c) Eye meds as per Dr. ___ ___ Disposition: Home Discharge Diagnosis: left 3rd rib fracture right orbital swelling Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after you were assaulted. Your received swelling around your left eye and a left 3rd rib fracture. You have received pain medication for your injuries. You were seen by the Social Worker and you have been cleared for discharge home with the following instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. You sustained a left sided rib fracture, which puts you at risk for pneumonia, please use the incentive spirometer, every 4 hours. If you develop fever, cough, chills, night sweats please call the clinic at ___. If you have other questions, do not hesitate to call the clinic # ___ Please schedule an appointment with the Opthomology service so you can be seen in 1 week. The telephone number is # ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. HELD- Amphetamine-Dextroamphetamine XR 20 mg PO DAILY This medication was held. Do not restart Amphetamine-Dextroamphetamine XR until decided by psychiatry 2. HELD- QUEtiapine Fumarate 12.5 mg PO DAILY This medication was held. Do not restart QUEtiapine Fumarate until decided by psychiatry 3. HELD- Sertraline 100 mg PO DAILY This medication was held. Do not restart Sertraline until decided by psychiatry Discharge Disposition: Extended Care Discharge Diagnosis: Suicide attempt Drug overdose Tachycardia 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 drug overdose in a suicide attempt. You were stabilized initially in the intensive care unit and monitored closely. Toxicology was involved and monitored you until the drugs had left your system. Initially were having high heart rate but over your hospitalization you improved and now your heart rate has remained normal. You are being discharged to an inpatient psychiatric facility for further help. We wish you the best in your recovery Your medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 2. LeVETiracetam 1000 mg PO BID 3. Docusate Sodium 100 mg PO BID 4. Bisacodyl 10 mg PO/PR DAILY 5. Acetaminophen 650 mg PO Q6H:PRN fever, pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: L frontal AVM L frontal IPH L ___ Cerebral edema 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>•Have a friend/family member check your incision daily for signs of infection. •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, and Ibuprofen etc. •**You have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. •Clearance to drive and return to work will be addressed at your post-operative office visit. •Make sure to continue to use your incentive spirometer while at home, unless you have been instructed not to.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325 mg PO Q4H:PRN pain/fever 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing 3. Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN indigestion 4. Amlodipine 7.5 mg PO DAILY hold for SBP<100 5. Ascorbic Acid ___ mg PO DAILY 6. Calcium Carbonate 500 mg PO BID 7. Docusate Sodium 200 mg PO HS 8. Donepezil 10 mg PO HS 9. Escitalopram Oxalate 5 mg PO DAILY 10. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN wheezing 11. Milk of Magnesia 30 mL PO Q6H:PRN constipation 12. Omeprazole 20 mg PO DAILY 13. Oxybutynin 5 mg PO DAILY 14. Sulfameth/Trimethoprim DS 1 TAB PO BID 15. Benzonatate 100 mg PO TID 16. Guaifenesin 10 mL PO Q6H:PRN cough 17. Vitamin D 50,000 UNIT PO QMON next dose ___ Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: Urinary Tract Infection Secondary Diagnosis: HTN, Breast cancer Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, you were admitted to the ___ ___ with confusion, fevers and tremors. You were found to have a urinary tract infection and were treated with antibiotics to complete a seven day course. It was a pleasure caring for you and we wish you a speedy recovery!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cetirizine 10 mg PO DAILY 2. Citalopram 20 mg PO DAILY 3. Cyanocobalamin 1000 mcg PO DAILY 4. Donepezil 5 mg PO QHS 5. LevETIRAcetam 500 mg PO BID 6. Metoprolol Succinate XL 12.5 mg PO DAILY 7. Tamsulosin 0.4 mg PO DAILY 8. Tolterodine 4 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Brief episodes of unresponsiveness not due to seizures 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 Mr. ___, You were admitted to ___ for evaluation of two episodes of unresponsiveness. Monitoring of your EEG did not show signs of ongoing seizure activity, and you did not have further episodes during your stay. Testing did not show signs of infection. No medication changes needed to be made. It was a pleasure taking care of you at ___. Sincerely, ___ Neurology</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 Discharge Disposition: Home Discharge Diagnosis: Left spontaneous pneumothorax Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>* You were admitted to the hospital for observation as you developed another left pneumothorax. Your pain has improved and your chest xray has remained about the same. * You will likely need to have this problem corrected with surgery, when you are ready. You have a follow up appointment with Dr. ___ to review your xrays and discuss firther plans. * If you develop any increase in chest pain, shortness of breath please return to the Emergency Room. If you have any new symptoms that concern you, call Dr. ___ at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q6H:PRN pain 2. FoLIC Acid 1 mg PO DAILY 3. Furosemide 20 mg PO BID 4. Lactulose 30 mL PO BID 5. Multivitamins W/minerals 1 TAB PO DAILY 6. Pantoprazole 40 mg PO Q12H 7. Rifaximin 550 mg PO BID 8. Thiamine 100 mg PO DAILY 9. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 10. Amoxicillin-Clavulanic Acid ___ mg PO Q8H RX *amoxicillin-pot clavulanate 500 mg-125 mg 1 tablet(s) by mouth every 8 hours Disp #*24 Tablet Refills:*0 11. OxycoDONE (Immediate Release) ___ mg PO Q6H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 6 hours Disp #*25 Tablet Refills:*0 12. Lorazepam 0.5 mg PO Q12 HR PRN anxiety RX *lorazepam [Ativan] 0.5 mg 1 tab by mouth every 12 hours Disp #*10 Tablet Refills:*0 13. Spironolactone 50 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: Umbilical Hernia s/p repair Cellulitis Secondary: EtOH abuse EtOH cirrhosis ___ LVPs as outpatient, negative for SBP ___ MRI abdomen with cholelithiasis, sclerosed hemangioma segment VIII ___ 3 admissions with decompensation due to ascites At least two visits to ___ in ___ with paracenteses ___ EGD with biopsies of esophagus and stomach reportedly negative, no comment on presence or absence of varices HCV negative ___ HBV non-immune ___ Autoimmune hep negative ___ 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 ___. You were admitted to the hospital with worsening abdominal pain. You had an umbilical hernia, which was repaired by surgery, and also excessive fluid in your abdomen, which required two paracentesis procedures to remove the fluid. You also developed a fever and some redness around your surgical site, and you received antibiotics for a skin infection. It is very important that you avoid salt in your diet and do not take in too much fluid. We also recommend that you stop drinking alcohol and seek assistance in ways to do this safely if you choose to do it. Please make sure you complete all of your antibiotics so your infection thoroughly improves. Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear ___ ___ was a pleasure taking care of you at ___. You were admitted for abdominal pain with poor appetite, nausea, and a few episodes of diarrhea in the emergency department. We performed imaging of your abdomen, which showed inflammation of your colon. We treated you with fluids given through your veins and antibiotics in case your pain was from an infection. You improved during your stay, and we discharged you after you were able to eat. Please continue to take the antibiotics as prescribed through ___. We would like you to follow-up with you primary care doctor to further discuss whether you should undergo colonoscopy to evaluation your colon more closely.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fish Oil (Omega 3) 1000 mg PO BID 2. Rosuvastatin Calcium 10 mg PO QPM RX *rosuvastatin [___] 10 mg 1 tablet(s) by mouth nightly Disp #*30 Tablet Refills:*2 3. Aspirin 81 mg PO DAILY 4. Multivitamins 1 TAB PO DAILY Discharge Disposition: Home Discharge Diagnosis: TIA Prediabetes Hyperlipidemia Obesity Discharge Condition: Patient was alert and oriented. Stable gait. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of left leg weakness resulting from a TRANSIENT ISCHEMIC ATTACK, oxygen and nutrients temporarily do not get to the brain because the vessel 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 cholesterol snoring with concern for sleep apnea Obesity Pre-diabetes Poor diet with low fiber, high simple sugar intake Lack of exercise We are changing your medications as follows: Start ___ 10 mg nightly Start Fish Oil 1000 mg BID Please take your other medications as prescribed. Please follow up with your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 1 dose by mouth daily as needed Refills:*0 2. Senna 17.2 mg PO DAILY RX *sennosides [senna] 8.6 mg 2 tabs by mouth once a day Disp #*60 Tablet Refills:*0 3. Aspirin 81 mg PO DAILY 4. Omeprazole 20 mg PO BID 5. RisperiDONE 2 mg PO QHS 6. Tamsulosin 0.4 mg PO QHS 7. HELD- MetFORMIN (Glucophage) 500 mg PO DAILY This medication was held. Do not restart MetFORMIN (Glucophage) until instructed by primary care doctor 8. HELD- Simvastatin 40 mg PO QPM This medication was held. Do not restart Simvastatin until instructed by PCP ___: Home Discharge Diagnosis: Acute metabolic encephalopathy Dementia Rhabdomyolysis Discharge Condition: Mental Status: Confused - always Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - occasionally requires assistance of family but does not use walker Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital for confusion and hallucinations. You underwent an extensive infectious workup which was unremarkable. You also underwent a CT head which did not reveal any acute process. Your confusion ultimately resolved and your are being discharged home. Please do NOT take the following medications until told to do so by your primary care doctor: - metformin - simvastatin Please call your primary care doctor tomorrow to try and move up your appointment scheduled for ___. With best wishes, ___ Medicine</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 2. Erythromycin 500 mg PO Q12H RX *erythromycin 500 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 3. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID 4. Gabapentin 800 mg PO QID 5. LevETIRAcetam 1500 mg PO DAILY Discharge Disposition: Home with Service Discharge Diagnosis: R dorsal wrist abscess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Patient Instructions - Please do the following after discharge: - Continue daily showers/rinses with warm soapy water three times a day - Continue daily packing of the wound after each shower rinse Physical Therapy: - WBAT ROMAT RUE Treatments Frequency: Please do the following wound care: - continue daily showers/rinses for 10 min three times a day - continue packing your wound after each showering - continue to dress your wound in dry gauze after each shower/rinse</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 1500 mg PO DAILY 2. Multivitamins 1 TAB PO DAILY 3. Omeprazole 20 mg PO QAM 4. Sertraline 50 mg PO DAILY 5. Albuterol Inhaler ___ PUFF IH Q4H:PRN wheezing 6. Fluticasone Propionate 110mcg 2 PUFF IH BID 7. Nasal CPAP w/PSV (BIPAP) Indication: Neuromuscular d/o Inspir pressure: 13 cm/h2o Expir pressure: 5 cm/h2o Supp O2: 4 L/min 8. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB, wheeze Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnosis: Hypoxia Viral syndrome . Secondary diagnoses: Neuromuscular disorder Restrictive lung disease 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 admitted with shortness of breath and decreased oxygen saturation. We think your symptoms are likely due to a viral infection worsened by your underlying lung disease, but pneumonia could not be ruled out. You were treated with antibiotics as well as various medications and chest therapy to improve your breathing. You were transferred to the ICU for a brief period for difficulty breathing. You were also started on BiPAP at night given the results of previous sleep studies. . Please follow-up with your PCP, an appointment has been made on your behalf. You should also follow-up with your outpatient pulmonologist. . Your medication reconcilliation can be found as part of this discharge packet -- it has been updated to include your new and old medications. . It was a pleasure participating in your care, thank you for choosing ___!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 10 mg PO BID Take 10mg twice a day for 7 days, then 5mg twice a day. RX *apixaban [Eliquis] 5 mg 2 tablet(s) by mouth twice a day Disp #*75 Tablet Refills:*0 2. Baclofen 10 mg PO TID 3. Bisacodyl ___AILY 4. Cephalexin 500 mg PO TID 5. Diazepam 4 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: ================= Bilateral DVTs SECONDARY DIAGNOSES: ==================== Quadriplegia UTI Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___. WHY WERE YOU IN THE HOSPITAL? ============================== - You had blood clots in your legs. WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL? ============================================== - You were given a blood thinner though the IV. - You had imaging of your abdomen/pelvis which showed that the blood clots extend to the large veins of your abdomen. - You were seen by the vascular surgeons, who recommended a follow-up appointment in the clinic if you have additional symptoms. There is no need for immediate surgery at this time. - We started you on a new medication called Eliquis (Apixiban) that helps to thin your blood and prevent stroke. We discussed the side effects of Apixaban and symptoms that would be concerning. Please call your primary care physician or come to the emergency department if you have: - Changes in your mental status (e.g. increased sleepiness or confusion) - Headaches worse than usual - Severe skin bruising - Abnormal bleeding - Blood in stool or dark/black tarry stool - Blood in your urine WHAT YOU NEED TO DO WHEN YOU GO HOME? ====================================== - Please continue to take all of your medicines as prescribed. - Follow up with your primary care doctor ___ avoid taking aspirin or ibuprofen for pain, as these will further increase your bleeding risk. Tylenol (up to 3 grams per day) is acceptable. It was a pleasure taking care of you! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Dabigatran Etexilate 150 mg PO BID 2. Levothyroxine Sodium 75 mcg PO 6X/WEEK (___) 3. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 4. Oxybutynin 10 mg PO DAILY 5. Pantoprazole 20 mg PO Q12H 6. Rosuvastatin Calcium 20 mg PO QPM 7. Sotalol 120 mg PO BID 8. HELD- Ramipril 5 mg PO DAILY This medication was held. Do not restart Ramipril until you see you primary care doctor Discharge Disposition: Home Discharge Diagnosis: # Hypotension # Atrial fibrillation # Transaminitis # Hypothyroidism # GERD # HLD # Complex sleep apnea # Muscular dystrophy # Hypertension # Bladder spasm Discharge Condition: Mental Status: Clear and coherent. Activity Status: Ambulatory - Independent. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Ms. ___: It was a pleasure caring for you at ___. You were admitted with low blood pressure after drinking alcohol and smoking marijuana. Your blood pressure was so low that you needed to be in the ICU, where you received medications to increase your blood pressure. You were seen by cardiologists and toxicologists who were reassured that this was not caused by a problem with your heart or by a medication overdose. You were monitored and improved. You are now ready for discharge home. Of note, during your hospital stay, your liver tests were mildly elevated, but they improved. We think this was due to your alcohol and drug use. We recommend that you have your liver tests rechecked at your primary care appointment. We recommend avoiding alcohol and additional drug use.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Nystatin Cream 1 Appl TP BID 2. Metoprolol Succinate XL 50 mg PO DAILY 3. Simvastatin 40 mg PO DAILY 4. Acetaminophen 1000 mg PO Q8H 5. ALPRAZolam 0.5 mg PO QHS 6. Apixaban 5 mg PO BID 7. Ciprofloxacin HCl 500 mg PO Q12H 8. Docusate Sodium 100 mg PO BID 9. Escitalopram Oxalate 20 mg PO DAILY 10. Lactobacillus acidophilus 1 billion cell oral DAILY 11. MetFORMIN (Glucophage) 1500 mg PO QHS 12. Milk of Magnesia 30 mL PO Q6H:PRN Constipation - First Line 13. Multivitamins 1 TAB PO DAILY 14. Omeprazole 20 mg PO DAILY 15. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 16. selenium 200 mcg oral DAILY 17. Senna 8.6 mg PO BID 18. Tamsulosin 0.4 mg PO QHS 19. Triamcinolone Acetonide 0.025% Cream 1 Appl TP BID L upper chest 20. Vancomycin 1250 mg IV Q 12H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: prosthetic joint infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You were admitted to the hospital because your heart was beating fast and your knee was hurting more and swelling a little more. WHAT HAPPENED TO ME IN THE HOSPITAL? - In the hospital we continued your antibiotic regimen and increased the medication which slows your heart rate. The orthopedic surgeons saw you and did not think you needed to have a sample of your knee fluid as it was healing as expected. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue working hard in rehab. - Continue to take all your medicines and keep your appointments. We wish you the ___! Sincerely, Your ___ 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. daptomycin 500 mg Recon Soln Sig: One (1) 460mg Intravenous every ___ hours. 4. citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 5. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day. 6. Flagyl 500 mg Tablet Sig: One (1) Tablet PO three times a day. 7. metoclopramide 10 mg Tablet Sig: One (1) Tablet PO twice a day: with meals . 8. diclofenac potassium 25 mg Capsule Sig: Three (3) Capsule PO twice a day as needed for pain. 9. insulin lispro 100 unit/mL Cartridge Sig: One (1) 10 units Subcutaneous three times a day: please inject 10 units with breakfast, lunch and dinner and use sliding scale as directed. 10. insulin NPH & regular human 100 unit/mL (70-30) Suspension Sig: One (1) units Subcutaneous twice a day: inject 38 units with breakfast and 40 units with dinner as directed. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: ___ site infection Secondary Diagnosis: Chronic Calcaneal Osteomyelitis Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, It was a pleasure caring for you at the ___ ___. You were admitted for a fever. We performed blood cultures that showed no bateria in your blood. We feel your fever was due to a small infection around your ___ site. We removed your PICC and replaced it with a new line. We feel you are safe to return home on antibioitcs. During this admission, we made no changes to your medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Simvastatin 20 mg PO QPM 2. Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush 3. Senna 8.6 mg PO BID:PRN constipation 4. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 5. Lisinopril 10 mg PO DAILY 6. Omeprazole 40 mg PO DAILY 7. Ondansetron 4 mg IV Q8H:PRN nausea/vomiting 8. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN pain Hold for sedation, drowsiness or RR <12. RX *oxycodone 5 mg 1 tablet(s) by mouth every 4 hours Disp #*20 Tablet Refills:*0 9. Hydrochlorothiazide 12.5 mg PO DAILY 10. Docusate Sodium 100 mg PO BID 11. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 12. Aspirin 325 mg PO DAILY RX *aspirin 325 mg 1 tablet(s) by mouth daily. Disp #*30 Tablet Refills:*3 13. Acetaminophen 325-650 mg PO Q6H:PRN Pain Do not exceed greater than 4g Acetaminophen in a 24-hour period. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Type II dens fracture. C1 anterior arch fractures. Left skull base fracture. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •No contact sports until cleared by your neurosurgeon. *** You must wear the hard cervical collar at all times. Medications •Please do NOT take any blood thinning medication (Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. •It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. *** Continue to take Aspirin 325mg by mouth daily for concern for arterial injury to the V3 segment. When to Call Your Doctor at ___ for: •Fever greater than 101.5 degrees Fahrenheit. •New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 2. Bisacodyl 10 mg PR HS:PRN constipation 3. Calcium Carbonate 1000 mg PO BID 4. Docusate Sodium 50 mg PO BID 5. FoLIC Acid 1 mg PO DAILY 6. Multivitamins W/minerals 1 TAB PO DAILY 7. Nystatin Ointment 1 Appl TP QID:PRN rash in skin folds 8. Polyethylene Glycol 17 g PO DAILY:PRN constipation 9. Senna 1 TAB PO BID 10. Triamcinolone Acetonide 0.025% Cream 1 Appl TP DAILY 11. Vitamin D ___ UNIT PO EVERY OTHER DAY 12. Fleet Enema ___AILY:PRN constipation 13. Milk of Magnesia 30 mL PO QHS:PRN constipation 14. LaMOTrigine 300 mg PO BID Administer at 9AM and 9PM. Name brand only 15. Phenytoin (Suspension) 200 mg PO QAM 16. Phenytoin (Suspension) 250 mg PO QPM Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Aspiration Pneumonia Delirium Discharge Condition: Mental Status: difficult to assess since nonverbal. Level of Consciousness: Awake, alert, eyes open. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for a change in your mental status. We also found that you were likely aspirating oral contents and that this led to a pneumonia. We treated you with antibiotics and your mental status is currently improving. We have also continued your Lamictal and changed your Dilantin dosages as recommended by your outpatient neurologist Dr. ___. Please have your rehab center check your Dilantin level on ___ and report the results to Dr. ___ ___. You will see ___ (nurse in Dr. ___ on ___, and will see Dr. ___ on ___ (see below). Please call your doctor or go to an emergency room if you have another change in your mental status, develop a new fever, or have trouble breathing.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Tamsulosin 0.4 mg PO QHS 3. Glargine 20 Units Bedtime Insulin SC Sliding Scale using REG Insulin 4. Diltiazem Extended-Release 180 mg PO DAILY 5. GlipiZIDE 10 mg PO BID 6. Isosorbide Dinitrate 10 mg PO TID 7. Metoprolol Succinate XL 50 mg PO DAILY 8. HELD- Lisinopril 10 mg PO DAILY This medication was held. Do not restart Lisinopril until you see your primary care doctor Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Abdominal aortic aneurysm Lumbar stenosis Community acquired pneumonia Hyponatremia Toxic metabolic encephalopathy Urinary retention Discharge Condition: Mental Status: Clear and coherent, though anxious and tangential Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___. Please see below for information on your time in the hospital. WHY WAS I IN THE HOSPITAL? You were transferred to ___ because your abdominal aortic aneurysm appeared bigger on scans you had, and you needed to see vascular surgery. WHAT HAPPENED IN THE HOSPITAL? -You were seen by vascular surgery for your aneurysm. This will need to further management by vascular surgery, and we have arranged a clinic appointment for you -You were seen by neurosurgery for your weakness. This was felt to be due to narrowing of your spinal cord and you have an appointment for further follow-up -You were treated for antibiotics for a pneumonia -Physical therapy recommended rehab to help you get stronger -You had a catheter placed because you were having difficulty urinating WHAT SHOULD I DO AFTER LEAVING THE HOSPITAL: -Work with the therapists at your rehab to help regain your strength -Please follow-up with your vascular surgery and neurosurgery appointments as scheduled below -Please see your primary doctor after leaving rehab ___ wish you the best! -Your Care Team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Divalproex (DELayed Release) 500 mg PO BID 2. Enoxaparin Sodium 70 mg SC Q12H Start: Today - ___, First Dose: Next Routine Administration Time 3. Nicotine Patch 14 mg TD DAILY 4. OLANZapine 5 mg PO QHS 5. Gabapentin 300 mg PO TID 6. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 7. Aspirin 81 mg PO DAILY 8. Atorvastatin 80 mg PO QPM 9. Cyanocobalamin 1000 mcg PO DAILY 10. Docusate Sodium 100 mg PO BID 11. Fetzima (levomilnacipran) 120 mg oral DAILY 12. Fluticasone Propionate NASAL 1 SPRY NU DAILY:PRN congestion 13. Lidocaine 5% Ointment 1 Appl TP DAILY 14. Lisinopril 5 mg PO DAILY 15. melatonin 3 mg oral QHS:PRN 16. Metoprolol Succinate XL 100 mg PO DAILY 17. Morphine SR (MS ___ 100 mg PO Q12H RX *morphine 100 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 18. Multivitamins W/minerals 1 TAB PO DAILY 19. Nicotrol (nicotine) 10 mg inhalation Q2H:PRN 20. OxyCODONE--Acetaminophen (5mg-325mg) 1 TAB PO TID RX *oxycodone-acetaminophen 5 mg-325 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 21. Senna 8.6 mg PO BID:PRN constipation 22. HELD- Diazepam ___ mg PO TID:PRN anxiety This medication was held. Do not restart Diazepam until discussed with PCP or psychiatry 23. HELD- LaMIVudine-Zidovudine (Combivir) 1 TAB PO BID This medication was held. Do not restart LaMIVudine-Zidovudine (Combivir) until Discuss at outpatient ___ clinic 24. HELD- Nevirapine 200 mg PO BID This medication was held. Do not restart Nevirapine until discuss with oupatient ID clinician Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS Hospital Acquired Pneumonia Toxic Metabolic Encephalopathy Chronic Back Pain Atrial fibrillation Transaminitis Hypertension Type II Non- ST Elevation MI SECONDARY DIAGNOSIS Deep Vein Thrombosis Malnutrition Depression/Anxiety 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 Mr. ___, It was a pleasure to be part of your care. You were admitted to the hospital because you were found to be very confused at home. In the hospital you were found to have a lung infection which was likely contributing to this change, and which was treated with antibiotics. The sudden confusion improved with antibiotics, however you remained confused about some facts during your stay and both your family and the doctors were concerned based on this confusion that you wouldn't be able to take care of yourself at home. We also adjusted your anticoagulation drugs, used to prevent new drug clots in your legs. Please follow up with your appointments as listed below. We found a longer-term care facility that can help take care of you while you are still confused. 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. Amlodipine 5 mg PO DAILY 2. Indapamide 2.5 mg PO DAILY 3. Aspirin 325 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Right hypoglossal nerve palsy 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 presented to the hospital with tongue weakness and you were found to have a nerve problem (a hypoglossal nerve palsy). It is unclear what caused this; brain imaging did not show a stroke or vascular abnormality. We checked a variety of bloodwork that was pending at the time of your discharge; please follow-up as an outpatient to go over these results. 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. Fluticasone Propionate NASAL 2 SPRY NU BID 3. Furosemide 80 mg PO EVERY OTHER DAY first dose in am 4. HydrALAzine 100 mg PO Q8H Please hold for SBP < 100 5. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY hold for SBP < 100 6. Labetalol 150 mg PO BID Hold for SBP < 100, HR < 50 7. Lorazepam 1 mg PO HS:PRN sleep 8. Nephrocaps 1 CAP PO DAILY 9. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 10. Sertraline 50 mg PO QAM 11. Sertraline 100 mg PO HS 12. sevelamer CARBONATE 800 mg PO TID W/MEALS 13. Simvastatin 40 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Complications from fistula Discharge Condition: Mental Status: Clear and coherent. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you while you were admitted ___. You were admitted because of complications with hemodialysis yesterday. Your AV fistula was evaluated here and found to be working well. You should resume your home cycle of dialysis on ___. There were no changes made to your medications. You should follow up with your PCP and nephrologist at your scheduled appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Nitrofurantoin Monohyd (MacroBID) 100 mg PO BID RX *nitrofurantoin monohyd/m-cryst [Macrobid] 100 mg 1 capsule(s) by mouth once a day Disp #*8 Capsule Refills:*0 2. Creon 12 1 CAP PO TID W/MEALS 3. Dexamethasone 4 mg PO ASDIR 4. Diphenoxylate-Atropine ___ TAB PO Q8H:PRN diarrhea 5. LORazepam 0.5 mg PO Q6H:PRN nausea, vomiting, anxiety 6. Ondansetron ODT 8 mg PO Q8H:PRN Nausea/Vomiting - First Line 7. Potassium Chloride 20 mEq PO DAILY 8. Prochlorperazine 10 mg PO Q6H:PRN Nausea/Vomiting - First Line 9. HELD- Atorvastatin 40 mg PO QPM This medication was held. Do not restart Atorvastatin until you see your primary care doctor 10. HELD- Rivaroxaban 20 mg PO DAILY This medication was held. Do not restart Rivaroxaban until ___ Discharge Disposition: Home Discharge Diagnosis: Primary: Biliary obstruction s/p ERCP UTI Pancreatic cancer Secondary: PE Vaginal bleeding 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 WAS I IN THE HOSPITAL? - You were admitted for abnormal liver tests. WHAT HAPPENED TO ME IN THE HOSPITAL? - You had a CT scan that showed worsening of biliary dilatation due to an obstruction that we believe is secondary to your pancreatic cancer. - You underwent an ERCP and had a stent placed in your common bile duct. - You were given IV fluids after the procedure and then transitioned to a clear liquid diet. - The CT scan also showed an infection in your bladder, and we gave you antibiotics. - Given your vaginal bleeding, you had a vaginal ultrasound that showed that you could have an abnormal connection between your vagina and intestinal tract or inflammatory changes. This finding requires further workup as an outpatient by your primary care provider. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. - Followup with your primary care doctor and your oncologist. 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. Prenatal Vitamins 1 TAB PO DAILY Discharge Disposition: Home Discharge Diagnosis: L dural AV fistula Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>•Continue all other medications you were taking before surgery, unless otherwise directed •You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort. What 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 until you are no longer taking pain medications 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! • Please remember that you received contrast during your angiogram and that you should pump and throw away the breast milk x 48 hours.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H RX *acetaminophen 500 mg 2 tablet(s) by mouth every eight (8) hours Disp #*50 Tablet Refills:*0 2. Albuterol Inhaler ___ PUFF IH Q4H:PRN dyspnea 3. amLODIPine 5 mg PO DAILY 4. Atorvastatin 40 mg PO QPM 5. BuPROPion XL (Once Daily) 150 mg PO BID 6. EPINEPHrine (EpiPEN) 0.3 mg IM ONCE MR1 7. Fexofenadine 60 mg PO BID 8. Ipratropium-Albuterol Neb 1 NEB NEB Q4H:PRN SOB 9. Lisinopril 40 mg PO DAILY 10. MetFORMIN XR (Glucophage XR) ___ mg PO DAILY Do Not Crush 11. Montelukast 10 mg PO DAILY 12. Terazosin 2 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: ___ abscess Multiple complex fistulas Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital with rectal pain. You underwent an MRI in the emergency department which demonstrated a perirectal abscess. This abscess spontaneously drained and you did not require surgical intervention. You are tolerating a regular diet, passing gas and your pain is controlled with pain medications by mouth. If you have any of the following symptoms, please call the office 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. Thank you for allowing us to participate in your care, we wish you all the best!</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. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 3. ClonazePAM 2 mg PO QHS:PRN insominia 4. Docusate Sodium 100 mg PO BID 5. Famotidine 20 mg PO BID 6. Finasteride 5 mg PO DAILY 7. Gabapentin 100 mg PO TID 8. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 9. Lithium Carbonate SR (Lithobid) 300 mg PO QHS 10. Milk of Magnesia 30 mL PO Q6H:PRN constipation 11. Multivitamins 1 TAB PO DAILY 12. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*12 Tablet Refills:*0 13. Polyethylene Glycol 17 g PO DAILY 14. Senna 8.6 mg PO BID 15. Simvastatin 10 mg PO QPM 16. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ ___) Discharge Diagnosis: Trauma: MVC Left ___ rib fx grade II splenic laceration subcapsular splenic hematoma small left hemo-pneumothorax Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after the car in which you were driving was t-boned by another car. You sustained rib fractures as well as a collection of blood around your spleen. You were admitted to the intensive care unit for monitoring. Because of your rib fractures, you had a catheter placed in your back for pain management which has since been removed. You have been transitioned to oral medication with control of your pain. You have been evaluated by physical therapy and cleared for discharge to a rehabilitation facility to futher regain your strength.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ___ 200-25-400-40 mg/30 mL mucous membrane as needed RX ___ [FIRST-Mouthwash BLM] 400 mg-400 mg-40 mg-25 mg-200 mg/30 mL Take as directed Daily Disp #*1 Bottle Refills:*0 2. DiCYCLOmine 20 mg PO TID 3. Omeprazole 20 mg PO DAILY 4. Ondansetron 4 mg PO Q8H:PRN nausea 5. Oxycodone-Acetaminophen (5mg-325mg) 2 TAB PO BID:PRN pain Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis - Hematemsis - Chronic RUQ Pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ with abdominal pain and vomiting up blood. Please continue to take all of your medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Hydrocortisone (Rectal) 2.5% Cream 1 Appl PR PRN hemorrhoids 3. LOPERamide 2 mg PO QID diarrhea 4. Ondansetron ___ mg PO Q8H:PRN nausea 5. OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN moderate pain RX *oxycodone 10 mg 1 tablet(s) by mouth q4h:prn Disp #*30 Tablet Refills:*0 6. OxyCODONE SR (OxyconTIN) 40 mg PO Q8H RX *oxycodone [OxyContin] 40 mg 1 tablet(s) by mouth every eight (8) hours Disp #*40 Tablet Refills:*0 7. Simethicone 80 mg PO QID:PRN gas pain 8. Sotalol 80 mg PO BID 9. Diphenoxylate-Atropine 1 TAB PO Q6H:PRN diarrhea 10. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 13 Days 11. Acetaminophen 650 mg PO Q8H:PRN pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Urinary Tract Infection Non-infectious diarrhea Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, It was a pleaseure taking care of you at ___ ___! You were admitted for abdominal pain. You were found to have a urinary tract infection, that was initially treated with IV antibiotics and converted to antibiotics by mouth. Your foley catheter was also replaced while admitted. Your pain improved. While here, your port was clotted and was treated with fibrinolytics and successfuly reaccessed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 70 mg SC Q12H Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 60 mg/0.6 mL 60 mg sc every twelve (12) hours Disp #*60 Syringe Refills:*0 2. Albuterol Inhaler 2 PUFF IH Q4H:PRN Wheezing, shortness of breath 3. Allopurinol ___ mg PO DAILY 4. anastrozole 1 mg oral DAILY 5. Docusate Sodium 100 mg PO BID 6. LaMOTrigine 50 mg PO BID 7. LeVETiracetam 1500 mg PO BID 8. Loratadine 10 mg PO DAILY 9. Simvastatin 20 mg PO DAILY 10. Tiotropium Bromide 1 CAP IH DAILY 11. Valproic Acid ___ mg PO Q12H 12. Milk of Magnesia 30 mL PO Q4H:PRN constipation 13. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 14. Polyethylene Glycol 17 g PO DAILY:PRN constipation 15. Senna 8.6 mg PO BID constipation 16. Vitamin D ___ UNIT PO DAILY 17. Alendronate Sodium 70 mg PO QMON 18. Vancomycin 750 mg IV Q 12H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: 1. Breast Cancer: pT1bN0Mx ER+/PR+/Her 2 neg, LVI (-) 2. CLL/SLL (unfavorable cytogenetics) 3. NSCLC, adenocarcinoma (T1aN2Mx, at least stage IIIa) NEW DIAGNOSIS: 1. MRSA Central Line Associated Blood Stream Infection 2. Chronic Lower Extremity Edema 3. Distal DVT Discharge Condition: Improved in stable condition Followup Instructions: ___ [/INST] </s><s>- continue daily weights and lasix as needed for gain of more than 1 kg - continue monitoring hg/hct weekly and transfuse blood PRN for Hg <7.0 - cont IV vancomycin to 750 mg q 12 h thru ___ with trough am ___, goal trough ___ - Please obtain weekly cbc w/diff, BMP, LFTs while on vancomycin</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Anastrozole 1 mg PO DAILY RX *anastrozole 1 mg 1 tablet(s) by mouth daiy Disp #*30 Tablet Refills:*12 3. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 4. FoLIC Acid 1 mg PO DAILY 5. HydrOXYzine 10 mg PO Q6H:PRN anxiety 6. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 7. Multivitamins 1 TAB PO DAILY 8. Naproxen 500 mg PO Q12H:PRN Pain - Moderate 9. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Metastatic breast cancer Right femoral neck fracture, pathologic Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital after having a fracture of your right femur which was caused by cancer that has spread to your bones. We'd like to keep you in the hospital to treat you for the cancer, the fracture, and pain. However, you wanted to leave against medical advice. We recommend that you follow up with your own doctors as ___ as you leave the hospital and that you come back to the hospital if at any point you develop worsening symptoms or any concerning symptoms to you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO EVERY OTHER DAY 2. Cinacalcet 30 mg PO DAILY 3. Heparin Flush (1000 units/mL) ___ UNIT IV PRN line flush for dialysis nurse use only 4. HydrOXYzine 25 mg PO TID 5. Lactulose 30 mL PO Q6H:PRN constipation 6. Nephrocaps 1 CAP PO DAILY 7. sevelamer CARBONATE 3200 mg PO TID W/MEALS 8. sevelamer CARBONATE 1600 mg PO TID W/SNACKS 9. Nephro-Vite *NF* (B complex-vitamin C-folic acid) 0.8 mg Oral daily 10. Ciprofloxacin HCl 500 mg PO Q24H Duration: 9 Days dose after HD 11. Vancomycin 1000 mg IV HD PROTOCOL Duration: 13 Days 12. Outpatient Lab Work Blood cultures after completion of antibiotics Discharge Disposition: Extended Care Discharge Diagnosis: Primary: Sepsis Secondary: End stage renal disease on hemodialysis Anemia Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure caring for you at ___. You were admitted because you had a blood stream infection. Your infection was most likely caused by your dialysis line, and you were treated with IV antibiotics. Because your infection appeared to be associated with your line, we removed your dialysis line. You instead received dialysis through your right thigh AV graft. Because of your infection, your blood pressures have been lower than normal so we have not given you your blood pressure medications (amlodipine and metoprolol). You will continue taking ciprofloxacin through ___. Please continue taking vancomycin through ___. Thank you for allowing us to participate in your care. All best wishes for your recovery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild/Fever Do not exceed 4000mg in a day RX *acetaminophen 500 mg ___ tablet(s) by mouth Q6H PRN Disp #*50 Tablet Refills:*0 2. Ibuprofen 600 mg PO Q8H:PRN Pain - Mild Do not exceed over 2400mg in a day. RX *ibuprofen 600 mg 1 tablet(s) by mouth Q6H PRN Disp #*50 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the gynecology oncology service for a small bowel obstruction. Over the course of your stay, your small bowel obstruction was treated with bowel rest, nasogastric tube placement for stomach decompression and antiemetics. At this time, you have recovered well and the team now feels it is safe for you to be discharged home. Please follow these instructions: * Take your home medications as prescribed. * You may alternate between Tylenol and ibuprofen for your pain. * Do not combine narcotic and sedative medications or alcohol. * Do not take more than 4000mg acetaminophen (tylenol) in 24 hrs. * Please continue on your low residual diet until ___. Please follow up with Dr. ___ in ___ weeks. An appointment has been made for you for ___. Do not hesitate to call the Gynecology ___ clinic if you have any questions.</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 SOB 2. Fluticasone Propionate 110mcg 2 PUFF IH BID 3. Polyethylene Glycol 17 g PO DAILY constipation 4. Fluconazole 200 mg PO Q24H RX *fluconazole 200 mg 1 tablet(s) by mouth once a day Disp #*18 Tablet Refills:*0 5. Omeprazole 40 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Abdominal pain Vomiting Anxiety 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 abdominal pain and vomiting. It is not clear what caused your symptoms but they may be due to a problem with the motility of your gastrointestinal tract or irritation in your stomach. You were treated symptomatically and your symptoms improved. You were evaluated by the GI service and had an endoscopy that showed a fungal infection which is being treated with anti-fungal. Brain MRI showed nothing that would cause your symptoms. You had a swallow study which was normal and without spasm of your esophagus. You should follow up with your PCP and gastroenterologist. You were evaluated by social work as well. Please speak with your PCP to see ___ Psychologist to help treat your anxiety. Your anxiety may not be the sole cause, but may be contributing to your physical symptoms of abdominal pain and vomiting.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Artificial Tear Ointment 1 Appl LEFT EYE BID 2. Bisacodyl ___X/WEEK (MO,TH) 3. Omeprazole 20 mg PO DAILY 4. Senna 17.2 mg PO HS 5. Sertraline 50 mg PO DAILY 6. Ertapenem Sodium 1 g IV ONCE Duration: 1 Dose last dose ___ ___ dose already provided prior to discharge) RX *ertapenem [Invanz] 1 gram 1 gram IV once daily Disp #*8 Vial Refills:*0 7. Acetaminophen 650 mg PO Q8H 8. Gas-X (simethicone) 80 mg oral tid 9. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN wheeze 10. Victoza 3-Pak (liraglutide) 0.2 mg subcutaneous daily 11. Warfarin 2 mg PO DAILY16 12. Glargine 5 Units Bedtime Insulin SC Sliding Scale using HUM Insulin Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: UTI Supratherapeutic INR Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were sent from your nursing home to the hospital with fever, elevated white blood cell count and concern for pneumonia. You were started on broad-spectrum antibiotics. You were found to have a urinary tract infection. Your Foley catheter was exchanged. You antibiotics were tapered to the results of your urine culture. You had a PICC line placed so that you can receive antibiotics at home. . We noted that your sodium levels are high sometimes, suggesting you don't drink enough water. We recommend that you increase your water intake.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth Q12 Disp #*6 Tablet Refills:*0 2. Docusate Sodium 100 mg PO DAILY as needed 3. MetroNIDAZOLE 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*9 Tablet Refills:*0 4. Simvastatin 10 mg PO QPM 5. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: perforated appendicitis with abscess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you here at ___ ___. You were admitted to our hospital because you were found to have an appendix abscess. You had a drain placed by Interventional Radiology on ___ without complications. You tolerated the procedure well and are ambulating, stooling, tolerating a regular diet, and your pain is controlled by pain medications by mouth. You are taking antibiotics to help with the abscess infection. You are now ready to be discharged to home. Please follow the recommendations below to ensure a speedy and uneventful recovery. IMPORTANT: CONTINUE YOUR ABTIBIOTICS TILL ___ ACTIVITY: - Do not drive until you have stopped taking pain medicine and feel you could respond ___ an emergency. - You may climb stairs. You should continue to walk several times a day. - You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. - You may start some light exercise when you feel comfortable. Slowly increase your activity back to your baseline as tolerated. HOW YOU MAY FEEL: - You may feel weak or "washed out" for several weeks. You might want to nap often. Simple tasks may exhaust you. YOUR BOWELS: - Constipation is a common side effect of narcotic pain medicine such as oxycodone. 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. - With antibiotics, diarrhea can occur. If you get diarrhea, don't take anti-diarrhea medicines. Drink plenty of fluids and see if it goes away. If it does not go away, or is severe and you feel ill, please call your surgeon. PAIN MANAGEMENT: - You may take Tylenol as directed, not to exceed 3500mg ___ 24 hours. Take regularly for a few days after surgery but you may skip a dose or increase time between doses if you are not having pain until you no longer need it. - Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - chest pain, pressure, squeezing, or tightness - cough, shortness of breath, wheezing - pain that is getting worse over time or pain with fever - shaking chills, fever of more than 101 - a drastic change ___ nature or quality of your pain - nausea and vomiting, inability to tolerate fluids, food, or your medications - if you are getting dehydrated (dry mouth, rapid heart beat, feeling dizzy or faint especially while standing) -any change ___ your symptoms or any symptoms that concern you 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. Drain Care: ============== You are being discharged with drains ___ place. Drain care is a clean procedure. Wash your hands with soap and warm water before performing your drain care, which you should do ___ times a day. Try to empty the drain at the same time each day. Pull the stopper out of the bottle and empty the drainage fluid into the measuring cup. Record the amount of fluid on the record sheet, and reestablish drain suction. **--A visiting nurse ___ help you with your drain care.--** - Clean around the drain site(s) where the tubing exits the skin with soap and water. Be sure to secure your drains so they don't hang down loosely and pull out. -Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). -Note color, consistency, and amount of fluid ___ the drain. Call the doctor, ___, or ___ nurse if the amount increases significantly or changes ___ character. -Be sure to empty the drain bag or bulb frequently. Record the output daily. You should have a nurse doing this for you. -You may shower; wash the area gently with warm, soapy water. -Keep the insertion site clean and dry otherwise. -Avoid swimming, baths, hot tubs; do not submerge yourself ___ water. - If you develop worsening abdominal pain, fevers or chills please call Interventional Radiology at ___ at ___ and page ___. -When the drainage total is LESS THAN 10cc/ml for 2 days ___ a row, please have the ___ call Interventional Radiology at ___ at ___ and page ___. This is the Radiology fellow on call who can assist you. Please call with any questions or concerns. Thank you for allowing us to participate ___ your care. We hope you have a quick return to your usual life and activities. -- Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB, wheezing 2. Aspirin 81 mg PO DAILY 3. Atenolol 25 mg PO DAILY 4. Betamethasone Dipro 0.05% Cream 1 Appl TP BID 5. brinzolamide 1 % ___ TID 6. Clotrimazole Cream 1 Appl TP BID 7. Hydrochlorothiazide 50 mg PO DAILY 8. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 9. Losartan Potassium 100 mg PO DAILY 10. Potassium Chloride 40 mEq ORAL DAILY 11. Timolol Maleate 0.5% 1 DROP BOTH EYES BID 12. Vitamin D 400 UNIT PO DAILY 13. Fluticasone Propionate 110mcg 2 PUFF IH BID 14. Fluticasone Propionate NASAL 2 SPRY NU DAILY 15. Acetaminophen 500 mg PO Q6H:PRN pain RX *acetaminophen 500 mg 1 tablet(s) by mouth Every 6 hours Disp #*50 Tablet Refills:*0 16. Ciprofloxacin HCl 500 mg PO Q12H Duration: 11 Days RX *ciprofloxacin 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*22 Tablet Refills:*0 17. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H Duration: 11 Days RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*33 Tablet Refills:*0 RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*33 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Diverticulitis Secondary: Endometrial Cancer on chemotherapy 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 ___ at the ___. ___ were admitted for diverticulitis - an inflammation of the outpouchings along your colon. ___ were given antibiotics for this condition which ___ should continue after discharge. Please continue to eat soft foods for another few days after discharge (bananas, boiled rice, apple sauce and toast), then advance your diet as ___ can tolerate without pain. During your stay, ___ had a CT scan that showed a cyst in your pancreas and a thickened area along your left pelvic wall. We talked to your oncologist's office about these findings, who feels they can be followed up as an outpatient. Please be sure to ask your oncologist about a MRI study to evaluate these findings. MEDICATION CHANGES - Start ciprofloxacin - Start metronidazole (Flagyl)</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 400 mg PO/NG Q12H RX *cefpodoxime 200 mg 2 tablet(s) by mouth every twelve (12) hours Disp #*24 Tablet Refills:*0 2. MetroNIDAZOLE 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*18 Tablet Refills:*0 3. Glargine 35 Units Breakfast Glargine 35 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 4. Warfarin 3 mg PO DAILY16 Please take this dose until notified by your PCP ___ *warfarin [Coumadin] 3 mg 1 tablet(s) by mouth daily Disp #*10 Tablet Refills:*0 5. Aspirin 81 mg PO DAILY 6. azelastine 137 mcg (0.1 %) nasal DAILY 7. BuPROPion XL (Once Daily) 300 mg PO DAILY 8. DULoxetine 60 mg PO DAILY 9. Levothyroxine Sodium 100 mcg PO DAILY 10. Losartan Potassium 100 mg PO DAILY 11. Pantoprazole 20 mg PO Q24H 12. Rosuvastatin Calcium 20 mg PO QPM 13. Sotalol 120 mg PO BID 14. Vitamin D 5000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Ischemic colitis Type 2 DM Diabetic ketoacidosis Afib HTN Hypothyroid Peripheral neuropathy HLD Mood Post-menopausal bleeding Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized for an episode of ischemic colitis likely brought about by diabetic ketoacidosis. While in the hospital, you received intravenous fluids and antibiotics. Once your digestive tract had rested for a day, we resumed your diet to facilitate its healing. We were reassured that your blood levels were stable and did not think a colonoscopy would be needed at this time. When you leave the hospital, please continue to take your medications, including the antibiotics we have prescribed for you this hospitalization, and please follow-up with your primary care physician. If you have increased amounts of bleeding, we would recommend that you return to the emergency room! It was a pleasure to take part in your care! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Escitalopram Oxalate 20 mg PO DAILY 2. Gabapentin 400 mg PO TID 3. Levofloxacin 750 mg PO DAILY Duration: 4 Days RX *levofloxacin [Levaquin] 750 mg 750 mg PO Daily Disp #*4 Tablet Refills:*0 4. Creon 12 4 CAP PO QIDWMHS 5. HYDROmorphone (Dilaudid) 6 mg PO Q4H:PRN pain 6. Lorazepam 1 mg PO BID:PRN nausea 7. Ondansetron 8 mg PO Q8H:PRN nausea Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: ___ line drainage ? Pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>As you know, you were admitted with concern of drainage from the R PICC line. This PICC line was evaluated by an IV nurse here and repositioned. There was no evidence of infection or drainage. Please continue with the TPN as scheduled. There was question of pneumonia on a CXR, although this was not a definitive diagnosis - since there was no fever or significant rise in white blood cell count in the blood. You may continue to take the antibiotics (Levoflox) for a short course of treatment. There are no changes to your medication otherwise.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: None Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Vertigo NOS Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mrs. ___, ___ were admitted for evaluation of dizziness and left leg weakness. MRI of your brain did not show any evidence of stroke or structural abnormalities as potential causes of your symptoms. We recommend that ___ follow-up with your PCP, ___ can also return to the Neurology Clinic ___ may call Dr. ___ ___ below) for evaluation if symptoms persists. We are not ordering any new prescriptions for ___ at this time. It was a pleasure providing care for ___ during this hospitalization.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. HydrALAZINE 50 mg PO TID 3. Glargine 44 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 4. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 5. Lisinopril 20 mg PO DAILY 6. Torsemide 80 mg PO BID 7. AcetaZOLamide 125 mg PO QHS 8. Allopurinol ___ mg PO DAILY 9. Digoxin 0.0625 mg PO DAILY 10. Levothyroxine Sodium 112 mcg PO DAILY 11. Rosuvastatin Calcium 40 mg PO QPM 12. Warfarin 7.5 mg PO 3X/WEEK (___) 13. Warfarin 5 mg PO 4X/WEEK (___) 14.Outpatient Lab Work Please obtain repeat labs on ___. ICD-9 code: ___ Name/Contact Information: ___. Phone: ___ Fax: ___ Labs: Chem 10, INR Discharge Disposition: Home Discharge Diagnosis: PRIMARY ======= Acute HFrEF Exacerbation SECONDARY ========= LV Thrombus Acute on Chronic 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. ___, It was a pleasure participating in your care. Please read through the following information. WHY WAS I ADMITTED TO THE HOSPITAL? Your admitted to the hospital due to worsening shortness of breath and increased fluid buildup. We were concerned he was had an exacerbation of your heart failure. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? – We gave you medications to help her move excess fluid from the body. Originally you required intravenous medications, however as your symptoms started to improve, we switched you to oral medications. – We were also concerned that you may have developed a mild upper respiratory infection. Given that you did not have any fevers and your lab work otherwise looked fine, we did not feel that you needed antibiotics. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Get labs drawn on ___ - Take all of your medications as prescribed (listed below) - Follow up with your doctors as listed below - Weigh yourself every morning. Your weight on discharge is 212.96 lbs (96.6 kg). Please seek medical attention if your weight goes up more than 3 lbs (increases to a weight of 215 lbs). - Seek medical attention if you have new or concerning symptoms or you develop swelling in your legs, abdominal distention, or shortness of breath at night. 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 TID 2. Digoxin 0.125 mg PO DAILY 3. Divalproex (DELayed Release) 250 mg PO BID 4. Docusate Sodium 100 mg PO DAILY 5. Finasteride 5 mg PO DAILY 6. Metoprolol Tartrate 100 mg PO Q6H 7. MetRONIDAZOLE (FLagyl) 500 mg PO Q 8H Last dose: ___ 8. Mirtazapine 7.5 mg PO HS 9. OxycoDONE (Immediate Release) 5 mg PO BID:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 10. Senna 1 TAB PO HS 11. Tamsulosin 0.4 mg PO BID 12. Verapamil 80 mg PO Q8H 13. Ciprofloxacin HCl 500 mg PO Q12H Last dose: ___. 14. Albuterol-Ipratropium ___ PUFF IH Q4H:PRN SOB 15. Divalproex Sod. Sprinkles 125 mg PO PRN agitation 16. Florastor *NF* (saccharomyces boulardii) 250 mg Oral BID 17. OLANZapine 2.5 mg PO PRN agitation 18. Potassium Chloride 10 mEq PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Right gluteal hematoma Dementia Atrial fibrillation Urinary tract infection 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 Mr. ___, It was a pleasure taking part in your care at ___. You were admitted after your fall and were found to have bleeding in to your thigh. You were monitored closely and given blood transfusions. Your blood levels have remained stable and thus appears that you have stopped bleeding. You were also treated for a urinary tract infection. You will need to restart your anticoagulation in about 2 weeks, but will need to speak to a physician regarding the risks and benefits of this type of medications. We hope you continue to improve.</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. Heparin 5000 UNIT SC TID 3. Midodrine 10 mg PO Q6H 4. Scopolamine Patch 1 PTCH TD Q72H 5. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 6. Neutra-Phos 1 PKT PO TID 7. Nystatin Oral Suspension 5 mL PO QID:PRN thrush 8. QUEtiapine Fumarate 25 mg PO QHS 9. Sulfameth/Trimethoprim Suspension 20 mL PO BID 10. Tamsulosin 0.4 mg PO HS 11. Albuterol 0.083% Neb Soln 1 NEB IH Q6H 12. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 13. Furosemide 20 mg PO DAILY 14. TraZODone 25 mg PO HS:PRN insomnia Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. C7 fracture dislocation. 2. T1 fracture dislocation. 3. Spinal cord injury. 4. Ankylosing spondylitis. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You have undergone the following operation: Posterior Cervical Decompression and 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 in a car or chair for more than ~45 minutes without getting up and walking around. • Rehabilitation/ Physical Therapy: ___ ___ times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. ___ Isometric Extension Exercise in the collar: 2x/day x ___xercises as instructed. • Cervical Collar / Neck Brace: You need to wear the brace at all times until your follow-up appointment which should be in 2 weeks. You may remove the collar to take a shower. Limit your motion of your neck while the collar is off. Place the collar back on your neck immediately after the shower. • Wound Care: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually ___ days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Call the office at that time. If you have an incision on your hip please follow the same instructions in terms of wound care. • You should resume taking your normal home medications. • You have also been given Additional Medications to control your pain. . Please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. You can either have them mailed to your home or pick them up at the clinic located on ___. We are not allowed to call in narcotic prescriptions (oxycontin, oxycodone, percocet) to the pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. • Follow up: ___ Please Call the office ___ and make an appointment for 2 weeks after the day of your operation if this has not been done already. ___ At the 2-week visit we will check your incision, take baseline x rays and answer any questions. ___ We will then see you at 6 weeks from the day of the operation. At that time we will most likely obtain Flexion/Extension X-rays and often able to place you in a soft collar which you will wean out of over 1 week. Please call the office if you have a fever>101.5 degrees Fahrenheit, drainage from your wound, or have any questions. Physical Therapy: Activity as tolerated w/ C-collar on. Treatments Frequency: Location: Sacrum Type: unstageable pressure ulcer Size: 1.0 X 0.8cm Wound Bed: 100% yellow slough Exudate: minimal Odor: none Wound Edges: pink, new epithelial tissue, intact Periwound Tissue: intact, no issues Wound Pain: ___ Wound Progress: Wound is decreasing in size with healthy new epithelial tissue around borders. Wound center appears to be superficial in depth. patient is incontinent of stool and his perineal area was erythematous with scattered rashy areas. Recommendations: Continue pressure relief measures per pressure ulcer guidelines. ( X )Continue with current wound care as per previous note. Commercial wound cleanser or normal saline cleanse all open wounds. Pat the tissue dry. Apply DuoDerm wound gel to wound Cover with 4 X ___ Mepilex Border Change every 3 days Apply thin layer of Critic Aid Anti-fungal moisture barrier lotion to perineal area with every ___ cleaning of perineal area. Support nutrition/hydration. ___ MD or wound care nurse if wound or skin deteriorates</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium 500 + D (D3) (calcium carbonate-vitamin D3) 500 mg(1,250mg) -125 unit oral DAILY 2. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID RX *clobetasol 0.05 % Apply to affected area twice daily Refills:*0 3. Clobetasol Propionate 0.05% Soln 1 Appl TP QHS RX *clobetasol 0.05 % Apply to scalp before bed Refills:*0 4. econazole 1 % topical BID 5. FoLIC Acid 1 mg PO DAILY 6. Furosemide 40 mg PO DAILY 7. Hydrocortisone Oint 2.5% 1 Appl TP BID 8. Lactulose 30 mL PO TID 9. Levothyroxine Sodium 50 mcg PO DAILY 10. Multivitamins 1 TAB PO DAILY 11. Omeprazole 20 mg PO DAILY 12. Ondansetron 4 mg PO Q8H:PRN NAUSEA 13. Rifaximin 550 mg PO BID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIANGOSES ================= HEPATIC ENCEPHALOPATHY LATENT TUBERCULOSIS INFECTION SECONDARY DIAGNOSES ================== ___ CIRRHOSIS Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, You were admitted to ___ for confusion. We think you had build-up of toxins from your liver disease. We gave you some extra doses of your lactulose medicine. While you were here, we ruled out active tuberculosis infection. However it appears you have a latent infection with tuberculosis. You also underwent a biopsy of a lesion in your lung. The results of this are pending at the time of discharge. Dr. ___ will follow up with you with the results. Please continue you to take this and your other medicines at home. You should have ___ bowel movements per day at home. It was a pleasure taking care of you! Wishing you the best, Your care team at ___</s>