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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY RX *allopurinol ___ mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 3. Apixaban 2.5 mg PO BID 4. Atorvastatin 40 mg PO QPM 5. Levothyroxine Sodium 50 mcg PO DAILY 6. Omeprazole 20 mg PO DAILY 7. Senna 17.2 mg PO HS 8. Torsemide 60 mg PO BID 9. Verapamil 160 mg PO Q8H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Pleural effusion Congestive heart failure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. Why did you come to the hospital? -You came to the hospital because you were having shortness of breath. What was done for you while you were here? -You were evaluated by the interventional pulmonology team and they decided that your lung does not have enough fluid to remove and the benefits of this would not outweigh the risks. -You underwent a CT scan of your chest which confirmed fluid in the lung and some collapsed lung tissue. What should you do when you go home? -Please continue weighing yourself every day and call your primary care doctor if your weight goes up more than 3 pounds. -Please continue using your incentive spirometer to help keep your lungs open. We wish you the best. Sincerely, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID 2. Aspirin 81 mg PO DAILY 3. Bisacodyl 10 mg PR HS:PRN constipation 4. Calcium Carbonate 500 mg PO DAILY 5. Citalopram 20 mg PO DAILY 6. Docusate Sodium 100 mg PO BID 7. Donepezil 10 mg PO HS 8. Famotidine 20 mg PO Q24H 9. Furosemide 80 mg PO DAILY hold if SBP<100 10. Gabapentin 300 mg PO Q12H 11. Levothyroxine Sodium 100 mcg PO DAILY 12. Lisinopril 40 mg PO DAILY 13. Multivitamins 1 TAB PO DAILY 14. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN pain hold RR<12 or sleeping or sedated 15. Polyethylene Glycol 17 g PO DAILY:PRN constipation 16. Senna 1 TAB PO BID senna 17. Simvastatin 10 mg PO DAILY 18. ValACYclovir 1000 mg PO Q12H Duration: 6 Days 19. ASPART 12 Units Dinner NPH 32 Units Breakfast NPH 14 Units Bedtime 20. Miconazole Powder 2% 1 Appl TP BID:PRN yeast rash 21. Mupirocin Cream 2% 1 Appl TP BID any broken skin on legs Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Primary Diagnosis: urinary tract infection shingles mechanical unwitnessed fall Secondary Diagnosis: Dementia hypertension diabetes Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for a urinary tract infection. You have been treated with antibiotics and will not need to take antibiotics after you leave the hospital. We also found that you have shingles of your arm, upper chest, and back. Anyone that has not had chickenpox or the chickenpox vaccine should not visit with you. You will need to continue to take medication to reduce the pain associated with shingles. You fell at home. There is no evidence of fractures from this fall. You will be discharged to rehab for further treatment after this fall. Please follow up with you primary care provider after being discharged from rehab. Medication changes: START taking gabapentin 300mg twice daily for pain control of you shingles START taking Valacyclovir 1000 mg by mouth every 12 hours for an additional 6 days START taking oxycodone 2.5-5mg every 4 to 6 hours as needed for pain control Continue to take all other medication as prescribed</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Naproxen 500 mg PO Q12H Duration: 2 Days RX *naproxen [Naprosyn] 500 mg 1 tablet(s) by mouth twice a day Disp #*4 Tablet Refills:*0 2. albuterol sulfate 90 mcg/actuation inhalation ___ PUFFS Q4-6HR PRN shortness of breath 3. atomoxetine 100 mg oral DAILY 4. Atorvastatin 20 mg PO QPM 5. BuPROPion (Sustained Release) 75 mg PO QAM 6. ClonazePAM 1 mg PO QHS 7. Docusate Sodium 100 mg PO BID:PRN pain 8. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 9. Lansoprazole Oral Disintegrating Tab 30 mg PO BID 10. Levothyroxine Sodium 100 mcg PO DAILY 11. Methocarbamol 500 mg PO Q8H 12. Nortriptyline 10 mg PO QHS 13. Polyethylene Glycol 17 g PO DAILY:PRN constipation 14. Senna 8.6 mg PO BID 15. Sertraline 75 mg PO DAILY 16. Topiramate (Topamax) 100 mg PO DAILY 17. TraMADol 200 mg PO DAILY 18. TraZODone 50 mg PO QHS:PRN insomnia 19. Vitamin D 1000 UNIT PO DAILY 20. HELD- MetFORMIN XR (Glucophage XR) 1000 mg PO DAILY This medication was held. Do not restart MetFORMIN XR (Glucophage XR) until your primary care doctor tells you to restart it. Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses ========================= Orthostatic hypotension Hypoglycemia Costochondritis Migraine headaches Secondary diagnoses ==================== Type 2 diabetes Hypothyroidism Hyperlipidemia GERD Insomnia Depression Anxiety Fibromyalgia Asthma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, WHY WERE YOU ADMITTED TO THE HOSPITAL? -You were having chest pain, difficulty breathing and you were feeling lightheaded. WHAT HAPPENED WHILE YOU WERE HERE? -All of the testing on your heart came back normal. The pain you were having is likely from a condition called costochondritis and you got better with a medicine called naproxen. -Because of your headaches we did some imaging of your brain. You had a cat scan of your head that didn't show any abnormalities. -We sampled some fluid from your toe and there was no evidence of infection. -You were dehydrated so we gave you some fluids through the IV. -Your iron levels were low so you got an iron infusion through the IV. WHAT SHOULD YOU DO WHEN YOU LEAVE THE HOSPITAL? -Do not take metformin until you speak with your PCP -___ taking naproxen for your chest pain through ___, but not longer -Follow up with your primary care doctor. -___ up with the neurologists to discuss your headaches further. We made you an appointment at the Headache Clinic. See below for more details. It was a pleasure taking care of you, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Simethicone 80 mg PO TID:PRN indegestion 2. Acetaminophen 325 mg PO Q4H:PRN Pain - Mild 3. Cyclobenzaprine 10 mg PO BID:PRN pain 4. Diltiazem Extended-Release 120 mg PO DAILY 5. Fluticasone Propionate 110mcg 2 PUFF IH BID 6. Levothyroxine Sodium 50 mcg PO DAILY 7. Metoprolol Tartrate 25 mg PO BID 8. Nystatin Ointment 1 Appl TP BID:PRN rash 9. Prochlorperazine 5 mg PO Q8H:PRN nausea 10. Senna 8.6 mg PO QHS 11. Sertraline 125 mg PO DAILY 12. TraZODone 25 mg PO QHS:PRN insomnia Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY Partial small bowel obstruction Hypotension Atrial fibrillation with rapid ventricular rate ___ SECONDARY Cauda Equina syndrome Hypothyroidism Depression Bacterial Conjunctivitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized because of abdominal pain and vomiting. This led to worsening of your atrial fibrillation. You needed to be taken care of in the intensive care unit because your blood pressure was low. You were given IV fluids and your blood pressure improved. We think you may have had a partial blockage of your bowels and this caused nausea and poor fluid intake and you became dehydrated. Once your symptoms improved you restarted all of your home medications and we were able to send you to rehab. Please continue to take all your medications as directed and attend all of your follow up appointments. It was a pleasure taking 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. Amlodipine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Aspirin 325 mg PO DAILY 3. Atorvastatin 20 mg PO QPM 4. Calcitriol 0.25 mcg PO DAILY 5. Clopidogrel 75 mg PO DAILY 6. Gabapentin 400 mg PO BID RX *gabapentin 400 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 7. Metoprolol Tartrate 100 mg PO BID 8. Oxybutynin 5 mg PO BID:PRN URINARY SPASM 9. OxycoDONE (Immediate Release) 10 mg PO Q6H:PRN PAIN 10. OxyCODONE SR (OxyconTIN) 40 mg PO Q12H 11. Polyethylene Glycol 17 g PO DAILY:PRN CONSTIPATION 12. PredniSONE 5 mg PO DAILY 13. Senna 8.6 mg PO DAILY 14. Prograf (tacrolimus) 3 mg oral Q12H 15. Bisacodyl 10 mg PO/PR DAILY RX *bisacodyl 5 mg 2 tablet(s) by mouth daily Disp #*28 Tablet Refills:*0 16. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*28 Capsule Refills:*0 17. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron 4 mg 1 tablet(s) by mouth q8h PRN Disp #*42 Tablet Refills:*0 18. Prochlorperazine 10 mg PO Q6H:PRN nausea RX *prochlorperazine maleate [Compazine] 10 mg 1 tablet(s) by mouth q6h prn Disp #*56 Tablet Refills:*0 19. nizatidine 150 mg oral BID 20. Glargine 17 Units Breakfast Glargine 17 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 21. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Nausea ___ on CKD Secondary: PVD ESRD s/p transplant HTN CAD s/p CABG Neuropathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were seen at ___ for evaluation of nausea and for decreased urine output. You received fluids, and your urine output improved. You had an elevated creatinine, which is a marker of your kidney function. This improved closer to your baseline with fluids as well. Your nausea improved with an antinausea medicines called Zofran and compazine which you will take at home. Your nausea is most likely multifactorial. It may be due to constipation in part. You had an XRay that showed significant stool in your colon, and you were started on an aggressive bowel regimen to improve you constipation. You then had a follow up XRay that showed improvement. Some of your medications that are cleared by the kidney could also be causing your nausea as well, specifically gabapentin. Your oxycodone and oxycontin can also contribute to nausea. Finally, your kidney injury could also cause nausea. Over the hospital course, you were able to tolerate food with oral medication, and you will go home on these. You should follow up with GI to manage your nausea if it does not continue to improve. Please take all the medications as prescribed and please follow up with the appointments we have arranged. It was a pleasure taking care of you at ___. Your ___ care team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB 3. Docusate Sodium 100 mg PO BID 4. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 5. Metoprolol Tartrate 50 mg PO BID 6. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN mild pain 7. OxyCODONE SR (OxyconTIN) 40 mg PO QAM 8. OxyCODONE SR (OxyconTIN) 20 mg PO QPM 9. Prochlorperazine 10 mg PO Q6H:PRN nausea 10. Senna 8.6 mg PO BID:PRN constipation 11. Sertraline 100 mg PO BID 12. Tiotropium Bromide 1 CAP IH DAILY 13. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath 14. Atropine Sulfate 1% 2 DROP SL ASDIR 15. Haloperidol 1 mg PO Q6H:PRN agitation 16. Lorazepam 1 mg PO QHS:PRN anxiety 17. Lorazepam 1 mg PO Q6H:PRN anxiety 18. Morphine Sulfate (Oral Soln.) 5 mg PO Q4H:PRN shortness of breath 19. NexIUM (esomeprazole magnesium) 40 mg oral DAILY 20. OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN severe pain 21. OxycoDONE Liquid 5 mg PO Q4H:PRN pain 22. OxyCODONE SR (OxyconTIN) 40 mg PO QHS 23. Prochlorperazine 25 mg PR Q12H:PRN nausea 24. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: Presyncope from dehydration Secondary diagnoses: Chronic obstructive pulmonary disease Hypertension Hyperlipidemia Irritable bowel syndrome Low back pain Renal cell carcinoma Spinal stenosis Discharge Condition: Mental status: alert, oriented Ambulatory status: independent Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital for dizziness, light-headedness, and some difficulty breathing. Because of your shortness of breath, you were treated with steroids, antibiotics, and a nebulizer in case you had a COPD exacerbation. These medications were stopped in the morning, once your symptoms improved. Most likely, you were dizzy because you dehydrated after not eating or drinking well over the past few days. We gave you some fluids through the IV and encouraged you to drink and eat normally. It was a pleasure to take care of you. Best wishes for the future, your care team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Tylenol ___ mg Q8H prn pain Discharge Disposition: Home Discharge Diagnosis: Small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the surgery service at ___ for evaluation of the new onset abdominal pain. Abdominal CT revealed small bowel obstruction. You bowels were rested with NPO and IV fluids. When you started to pass flatus, diet was progressively advanced to regular and was well tolerated. You are now safe to return home to complete your recovery with the following instructions: . Please call ACS service at ___ if your symptoms return, or if you have any question or concerns. . Please call your doctor or nurse practitioner if you experience the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain is not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 200 mg PO DAILY 2. Atorvastatin 80 mg PO DAILY 3. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 4. Levothyroxine Sodium 50 mcg PO DAILY 5. Lidocaine 5% Patch 1 PTCH TD QAM 6. Nitroglycerin SL 0.3 mg SL PRN Chest Pain 7. Warfarin 0.5 mg PO DAILY16 8. Mirtazapine 7.5 mg PO HS sleep 9. Omeprazole 20 mg PO DAILY 10. Simethicone 40-80 mg PO QID:PRN Bloating 11. darbepoetin alfa in polysorbat 25 mcg/mL injection q14 days 12. Fluocinolone Acetonide 0.025% Ointment 1 Appl TP BID: PRN Rash 13. Metoprolol Succinate XL 25 mg PO DAILY 14. Morphine Sulfate (Oral Soln.) 5 mg PO Q2H:PRN Chest Pain PRN chest pain not relieved by nitro. 15. Outpatient Lab Work Patient needs INR drawn ___ Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: - Toxic-metabolic encephalopathy with recrusdescence of stroke sx - Angina pectoris Secondary: - CKD stage IV - Paroxysmal atrial fibrillation - Left MCA CVA with mild expressive aphasia (___) - CAD w/ totally occluded RCA with L->R collaterals (cath ___ - Ischemic systolic HF with LVEF 40-45% - GERD - Hypothyroidism - Hyperlipidemia - Hypertension - COPD - Pernicious Anemia - Gout - Leg/pelvic fractures due to MVA in ___. - s/p cholecystectomy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospitalization. You were diagnosed with stroke recrudescence and angina pectoris. You were treated for your angina and your neurologic exam has improved. You also have a new baseline in your kidney disease. You will be discharge to rehab and should follow up with a kidney doctor/nephrologist regarding your chronic kideny disease. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cyanocobalamin 1000 mcg PO DAILY 2. Levothyroxine Sodium 112 mcg PO DAILY 3. Multivitamins 1 TAB PO DAILY 4. Vitamin E 800 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Syncope: Secondary diagnoses: Hypothyroidism Osteoporosis Hyperlipidemia Dementia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, Why did I come to the hospital? -You came to the hospital because you fainted What happened while I was in the hospital? -We checked your blood work, which was normal. We looked at the rhythm of your heart using an EKG, which did not show any arrhythmia. -You were fitted for a heart monitor, which will monitor the activity of your heart for a month. This will help us see if your heart is causing you to pass out. -We are not sure why you have had these fainting episodes but there is a small risk of fainting with donepezil so we have stopped this medication. What should I do when I leave the hospital? -Please make sure you attend all of your doctor appointments -___ taking donepezil 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 DAILY:PRN constipation RX *bisacodyl 5 mg 2 tablet(s) by mouth daily PRN Disp #*30 Tablet Refills:*1 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*1 3. Enoxaparin Sodium 120 mg SC DAILY Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 120 mg/0.8 mL 0.___aily Disp #*30 Syringe Refills:*0 4. Fludrocortisone Acetate 0.1 mg PO DAILY RX *fludrocortisone 0.1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 5. Ondansetron ODT 4 mg PO Q8H:PRN nausea RX *ondansetron 4 mg 1 tablet(s) by mouth q8h prn Disp #*30 Tablet Refills:*0 6. Polyethylene Glycol 17 g PO DAILY 7. Senna 8.6 mg PO BID:PRN Constipation RX *sennosides [Senna Laxative] 8.6 mg 1 tablet PO BID PRN Disp #*60 Tablet Refills:*1 8. Morphine SR (MS ___ 60 mg PO TID RX *morphine [MS ___ 60 mg 1 tablet(s) by mouth three times a day Disp #*21 Tablet Refills:*0 9. Morphine Sulfate ___ 30 mg PO Q4H:PRN BREAKTHROUGH PAIN RX *morphine 30 mg 1 tablet(s) by mouth every 4 hours PRN Disp #*42 Tablet Refills:*0 10. Atorvastatin 40 mg PO QPM 11. Cyanocobalamin 1500 mcg PO DAILY 12. Glucosamine (glucosamine sulfate) 500 mg oral DAILY 13. Hydrochlorothiazide 12.5 mg PO DAILY 14. LORazepam 0.25 mg PO Q6H:PRN anxiety, nausea 15. Losartan Potassium 25 mg PO DAILY 16. Mirtazapine 50 mg PO QHS 17. Omeprazole 40 mg PO DAILY 18. Potassium Chloride 20 mEq PO DAILY 19. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q6H:PRN 20. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Bilateral punctate ischemic strokes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of left facial droop, slurred speech and 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. 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: -pancreatic cancer -high blood pressure -high cholesterol We are changing your medications as follows: -started lovenox (injectable blood thinner medication) -started florinef, a medication to treat orthostatic hypotension (when blood pressure drops upon standing) -Discontinued your aspirin in favor of lovenox 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: [/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: - nonweightbearing on the left upper extremity, range of motion as tolerated in elbow, wrist, shoulder and fingers; sling for comfort as needed MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take aspirin daily for 4 weeks 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. - Leave soft dressing on</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 500 mg PO BID 2. Ferrous Sulfate 325 mg PO DAILY 3. Furosemide 80 mg PO DAILY 4. Lactulose 15 mL PO BID 5. Nadolol 40 mg PO DAILY give after EGD, hold for hr<55 sbp<90 6. Omeprazole 20 mg PO BID 7. Rifaximin 550 mg PO BID 8. Spironolactone 100 mg PO BID 9. Sucralfate 1 gm PO QID 10. Vitamin D 800 UNIT PO DAILY 11. Vancomycin Oral Liquid ___ mg PO Q6H Duration: 10 Days RX *vancomycin [Vancocin] 125 mg 1 capsule(s) by mouth every 6 hours Disp #*36 Capsule Refills:*0 12. Sulfameth/Trimethoprim SS 1 TAB PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: clostridium difficile SECONDARY DIAGNOSES: Secondary biliary cirrhosis Anemia Diabetes mellitus 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 to take care of you. You were admitted to the ___ because of fevers. We treated you with antibiotics and performed many studies to evaluate you for potential sources of fever and you were found to have an infection called Clostridium difficile which was causing diarrhea. We treated this with an antibiotic called vancomycin, which you should continue to take for a total of 10 days. Weigh yourself every morning, and call your primary care doctor if your weight goes up more than three pounds. Please start: VANCOMYCIN 125 mg by mouth every 6 hours, take through ___ *Prescription has been faxed to ___ pharmacy on ___.* Please see below for your follow-up appointments. Wishing you all the best!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Docusate Sodium 100 mg PO QHS 3. Levothyroxine Sodium 125 mcg PO DAILY 4. Losartan Potassium 100 mg PO DAILY 5. OLANZapine 2.5 mg PO QAM 6. OLANZapine 5 mg PO QHS 7. Senna 8.6 mg PO QHS 8. Sertraline 200 mg PO DAILY 9. Metoprolol Succinate XL 50 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Mechanical Fall Secondary: Delirium Hypertension Acute Kidney Injury Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of ___ at ___. ___ first came to the hospital after a mechanical fall. A CT scan of your head and neck was normal. Fortunately, we do not think ___ had any serious injury from that fall. We had physical therapy come to see ___ to evaluate for problems with your walking. They recommend ___ get ___ more sessions of physical therapy to get stronger on your feet. ___ may need to use a walker for getting around after leaving the hospital. Your thyroid medication was not at the right dose, which we adjusted. ___ will have to go see your regular doctor in about 6 weeks to get your thyroid checked again. We stopped some of the medicines ___ were on so that ___ will have to take fewer pills. We wish ___ the best of future health, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY RX *amlodipine 5 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*1 2. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*1 3. Docusate Sodium 100 mg PO DAILY 4. Outpatient Occupational Therapy 5. Outpatient Physical Therapy 6. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID 7. Omeprazole 20 mg PO DAILY 8. Restasis (cycloSPORINE) 0.05 % ophthalmic bid 9. MetFORMIN (Glucophage) 500 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Acute Ischemic Stroke Diabetes Mellitus Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. LLE>LUE weakness Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of L 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. 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: Diabetes Hypertension We are changing your medications as follows: INCREASE AMLODIPINE TO 5 MG DAILY START ASPIRIN 81 MG DAILY Please discuss increasing your dose of Metformin with your PCP ___ take your other medications as prescribed. Please followup with Neurology and your primary care physician as listed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to the Internal Medicine service at ___ ___ on ___ regarding management of your healthcare-associated pneumonia. You had evidence of mental status changes and this improved with antibiotics. Please call your doctor or go to the emergency department if: * You experience new chest pain, pressure, squeezing or tightness. * You develop new or worsening cough, shortness of breath, or wheezing. * You are vomiting and cannot keep down fluids, or your medications. * If you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit, or have a bowel movement. * You experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * Your pain is not improving within 12 hours or is not under control within 24 hours. * Your pain worsens or changes location. * You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. * You develop any other concerning symptoms.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: Four (4) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 3. furosemide 40 mg Tablet Sig: ___ Tablets PO once a day. 4. isosorbide dinitrate 10 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 5. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. nifedipine 30 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO DAILY (Daily). 7. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet Sublingual once a day as needed for chest pain: ___ repeat every 5 minutes for 3 doses total. 8. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 9. Detrol LA 4 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO once a day. 10. valsartan 160 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. warfarin 5 mg Tablet Sig: One (1) Tablet PO ___ (). 12. warfarin 3 mg Tablet Sig: One (1) Tablet PO once a day: On ___. 13. B Complex Tablet Extended Release Sig: One (1) Tablet Extended Release PO once a day. 14. Vitamin D 1,000 unit Tablet Sig: One (1) Tablet PO once a day. 15. docusate sodium 100 mg Capsule Sig: Two (2) Capsule PO once a day. 16. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 17. Benefiber (guar gum) 1 gram Tablet Sig: One (1) Tablet PO ___ times daily. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: Failure to Thrive Secondary Diagnosis: Depression Type 2 diabetes mellitus Atrial fibrillation, on coumdin Hypertension 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 ___, ___ was a pleasure taking care of you at ___ ___. You were admitted because there was concern that you may not be able to take care of yourself at home. You are going to go to a rehabilitation facility to try to get back to your baseline. Please continue to take all of your medications as prescribed. No changes have been made. Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Aspirin EC 325 mg PO DAILY RX *aspirin [Enteric Coated Aspirin] 325 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Atorvastatin 20 mg PO DAILY RX *atorvastatin 20 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 4. Carvedilol 25 mg PO BID RX *carvedilol 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 5. Fluoxetine 20 mg PO BID RX *fluoxetine 20 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 6. MetFORMIN XR (Glucophage XR) 500 mg PO DAILY RX *metformin [Glucophage XR] 500 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 7. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*0 8. Warfarin 2 mg PO DAILY16 RX *warfarin [Coumadin] 2 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 9. Lisinopril 40 mg PO BID RX *lisinopril [Zestril] 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 10. ALPRAZolam 1 mg PO BID:PRN anxiety 11. Zolpidem Tartrate 10 mg PO HS:PRN insomnia Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: AAA followed by Dr. ___ on coumadin, MVP, HTN, COPD, DM2, Stage II lung CA s/p radiation and chemo completed 1 month ago, swallowing difficulty Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait edema- trace Followup Instructions: ___ [/INST] </s><s>DISCHARGE INSTRUCTIONS: Please have your INR checked on ___ and contact Dr. ___ coumadin instructions Please call with any questions or concerns ___ **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN pain 2. Cephalexin 500 mg PO Q6H 3. Gabapentin 300 mg PO TID 4. Loratadine 10 mg PO DAILY 5. Omeprazole 20 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: right knee wound dehiscence Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. 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 in right lower extremity MEDICATIONS: - Please continue and complete the two week course of oral antibiotic (Keflex ___ by mouth four times per day). - Continue all home medications unless specifically instructed to stop by your surgeon. WOUND CARE: - A visiting nurse ___ come to help you with daily dressing changes for your knee wound. Please keep the area clean and dry. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns Physical Therapy: WBAT RLE, ROMAT Treatments Frequency: Right knee wound needs daily wet-to-dry dressing changes. Please monitor for signs and symptoms of infection (ie: increased redness, warmth, swelling or drainage of pus).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. HydrOXYzine 50 mg PO 4X DAILY PRN Anxiety 2. guanFACINE 1 mg oral DAILY 3. TraZODone 50 mg PO QHS 4. Fluoxetine 20 mg PO DAILY 5. Oxcarbazepine 300 mg PO BID 6. Acetaminophen 650 mg PO Q6H:PRN pain or fever > 101.3 do not take more than 4000mg (4 grams) of acetaminophen Daily. Do not take while drinking alcohol. 7. Docusate Sodium 100 mg PO BID 8. LeVETiracetam 1500 mg PO BID RX *levetiracetam 750 mg 2 tablet(s) by mouth twice a day Disp #*120 Tablet Refills:*3 9. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: Left frontal SDH Bifrontal contusions Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Hemorrhage without Surgery Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. •NO DRIVING for 6 months, until you have been cleared to drive by neurology and neurosurgery. If you experienced a seizure while admitted, you are NOT allowed to drive by law. •DO NOT DRINK ALCOHOL until you have been cleared by neurology and neurosurgery; alcohol increases your risk of having another seizure. •No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications •Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instructions. It is important that you take this medication consistently and on time. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •You may have difficulty paying attention, concentrating, and remembering new information. •Emotional and/or behavioral difficulties are common. •Feeling more tired, restlessness, irritability, and mood swings are also common. •Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Headaches: •Headache is one of the most common symptom after a brain bleed. •Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. •Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. •There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •Nausea and/or vomiting •Extreme sleepiness and not being able to stay awake •Severe headaches not relieved by pain relievers •Seizures •Any new problems with your vision or ability to speak •Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: •Sudden numbness or weakness in the face, arm, or leg •Sudden confusion or trouble speaking or understanding •Sudden trouble walking, dizziness, or loss of balance or coordination •Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 5 mg PO DAILY 2. Multivitamins W/minerals 1 TAB PO DAILY 3. Polyethylene Glycol 17 g PO DAILY 4. Acetaminophen 325-650 mg PO Q4H:PRN Pain - Mild/Fever 5. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN Cough/SOB 6. Artificial Tears ___ DROP BOTH EYES Q4H:PRN Dry eyes 7. Aspirin 81 mg PO DAILY 8. Citalopram 20 mg PO DAILY 9. Fluticasone Propionate 110mcg 1 PUFF IH BID 10. Losartan Potassium 50 mg PO DAILY 11. Pantoprazole 20 mg PO DAILY 12. Psyllium Powder 1 PKT PO TID:PRN Constipation 13. Rosuvastatin Calcium 40 mg PO QPM 14. Tacrolimus 0.1 % topical BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: lumbar radiculopathy dysphagia polyneuropathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were hospitalized due to symptoms of right leg numbness, right leg pain and weakness, and difficulty swallowing. These symptoms were concerning for a possible stroke, however the head CT and MRI which did not show any evidence of stroke. You also had a muscle and nerve study which showed some injury. We sent blood work and tests of your spinal fluid to see what is causing your nerve problems and these tests are pending. You were seen by the GI doctors who looked at your esophagus and stomach using a camera. They did not find any reason for your difficulty swallowing. They will contact you regarding the results of the biopsy. You should follow-up with neurology for ongoing work-up of your sensory neuropathy and dysphagia. Please take your medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Mirtazapine 15 mg PO QHS 2. Vancomycin Oral Liquid ___ mg PO Q6H 3. amLODIPine 5 mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. FoLIC Acid 1 mg PO DAILY 7. Metoprolol Succinate XL 50 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Thiamine 100 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnosis: UTI Toxic Metabolic Encephalopathy Acute Kidney Injury Hypernatremia Secondary diagnoses: Prior subdural hematoma and subarachnoid hemorrhage Mood disorder Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to take care of you during your stay at ___ ___. You had to stay in the hospital for a UTI which was treated with antibiotics. You then had diarrhea and you were found to have an infection called C diff. Please follow up with your regular doctor. Please return to the hospital for fevers > 100.4F, worsening confusion that doesn't improve, shortness of breath, or chest pain. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Furosemide 80 mg PO BID RX *furosemide 80 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. PredniSONE 50 mg PO DAILY Tapered dose - DOWN RX *prednisone 10 mg ASDIR tablets(s) by mouth once a day Disp #*105 Tablet Refills:*0 3. ValGANCIclovir 450 mg PO Q24H 4. Acetaminophen 650 mg PO Q6H:PRN pain 5. Aspirin 81 mg PO DAILY 6. Carvedilol 6.25 mg PO BID 7. CycloSPORINE (Neoral) MODIFIED 200 mg PO Q12H 8. Hydroxychloroquine Sulfate 200 mg PO DAILY 9. Mycophenolate Sodium ___ 1080 mg PO BID 10. Vitamin D 1000 UNIT PO DAILY 11. Zinc Sulfate 220 mg PO DAILY Discharge Disposition: Extended Care Discharge Diagnosis: Primary Diagnosis ================= Acute kidney injury secondary to acute kidney rejection Secondary Diagnosis =================== Systemic lupus erythematosus Transaminitis Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ because you were having worsening kidney function along with swelling in your lower legs. The worsening in your kidney function was concerning for acute rejection versus a lupus flare. We sent antibodies to test for rejection and although these were negative, we still believe that the worsening in your creatinine is most likely due to rejection. We placed you a medication called furosemide intravenously to eliminate this additional fluid. You were able to get rid of 5L of fluid and your leg swelling improved. We then started you on a higher dose of oral furosemide to keep the fluid off. You should continue to take this medication daily. We also gave you a dose of IVIG to treat rejection on ___. You tolerated this medication without issues. You will need to complete your course of rituximab on ___. You should follow up with your kidney doctor to continue to monitor your kidney function. You liver enzymes were slightly elevated during the hospitalization. Your primary doctor ___ continue to monitor this. It was a privilege 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. Ertapenem Sodium 1 g IV ONCE Duration: 1 Dose RX *ertapenem 1 gram 1 g IV once a day Disp #*10 Vial Refills:*0 2. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever 3. Dakins ___ Strength 1 Appl TP ASDIR 4. Furosemide 40 mg PO DAILY 5. HYDROmorphone (Dilaudid) ___ mg PO BID:PRN for dressing changes 6. melatonin 6 mg oral QPM:PRN insomnia 7. MetFORMIN (Glucophage) 500 mg PO BID 8. Miconazole Powder 2% 1 Appl TP QID:PRN scrotal site 9. Mirtazapine 7.5 mg PO QHS 10. Multivitamins W/minerals 15 mL PO DAILY 11. Nystatin Cream 1 Appl TP BID groin fungus 12. Polyethylene Glycol 17 g PO DAILY 13. Ramelteon 8 mg PO QPM:PRN sleep as needed Should be given 30 minutes before bedtime 14. Senna 8.6 mg PO BID 15. Sertraline 100 mg PO DAILY 16. Simvastatin 10 mg PO QPM 17. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation BID 18. Tamsulosin 0.4 mg PO QHS 19. Tiotropium Bromide 1 CAP IH DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY ======== CAUTI Scrotal cellulitis SECONDARY ========== CODP DMII Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted to the hospital because you had a urinary tract infection and an infection of your scrotum. While you were here you were given antibiotics to treat your infections. Urology evaluated you and felt that the scrotal infection was superficial and limited to the skin, meaning that antibiotics were the only treatment needed. A foley was placed to keep the area clean and dry. When you go home you should continue all your medications as prescribed. Please follow up with your outpatient doctors as listed below. We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Latanoprost 0.005% Ophth. Soln. 1 DROP LEFT EYE QHS 2. Vitamin D ___ UNIT PO DAILY 3. Calcium Carbonate 500 mg PO DAILY 4. Atenolol 25 mg PO BID 5. Losartan Potassium 50 mg PO DAILY 6. Torsemide 10 mg PO 2X/WEEK (MO,FR) 7. Torsemide 5 mg PO 5X/WEEK (___) 8. Amlodipine 2.5 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Gastrointestinal bleeding Acute blood loss anemia Likely diverticular bleeding 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 with bloody stools. You received 2 units blood transfusion. Your bleeding self-resolved. CT scan suggests underlying diverticulosis, which ___ have caused diverticular bleeding. You were seen by the GI doctors, but they did not recommend pursuing a colonoscopy at this time. Of note, there were 2 incidental findings seen on your CT scan: a renal lesion and a lung nodule. You will need a dedicated MRI to further evaluate the renal lesion and you can consider a follow-up chest CT in 12 months. Please discuss with your PCP to obtain these further imaging studies. You should also follow-up with your GI physician at ___ to decide if you should pursue further work-up with an elective outpatient colonoscopy. . You also developed left arm superficial thrombophlebitis at the antecubital fossa where a peripheral IV had been sited. This improved with hot packs alone. You should continue to apply warm compresses three times daily for the next three days. 20 min at a time. Continue to monitor the site for resolution of the redness, and IF there is expanding redness, pain, or any drainage from the site, or if you experience any fevers - call Dr. ___ present to our emergency department immediately for repeat evaluation as we discussed. I expect that the area will improve to normal within the next several days with warm compresses alone.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. hydromorphone 2 mg Tablet Sig: ___ Tablets PO every ___ hours as needed for pain. 3. olanzapine 2.5 mg Tablet Sig: ___ Tablets PO every six (6) hours as needed for Agitation or Insomnia. 4. prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. potassium chloride 20 mEq Tablet, ER Particles/Crystals Sig: Two (2) Tablet, ER Particles/Crystals PO once a day. 6. Calcium 500 + D 500 mg(1,250mg) -400 unit Tablet Sig: One (1) Tablet PO once a day. 7. lidocaine-prilocaine 2.5-2.5 % Cream Sig: 0.5 Inch Topical every four (4) hours as needed for Pain over port site. 8. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 4 days. Disp:*8 Tablet(s)* Refills:*0* 9. magnesium oxide 400 mg Tablet Sig: One (1) Tablet PO Every other day. Disp:*30 Tablet(s)* Refills:*2* 10. Outpatient Lab Work Please have a blood count (CBC) and chemisty panel including calcium, magnesium and phospahte (chem-10) checked on ___, ___ and have results faxed to ___ ATTN: ___, ___ 11. loperamide 2 mg Tablet Sig: One (1) Tablet PO every four (4) hours as needed for Diarrhea: Please take every 4 hours as long as diarrhea persists. Disp:*60 Tablet(s)* Refills:*0* 12. Macrobid ___ mg Capsule Sig: One (1) Capsule PO once a day: Do not start this medication until AFTER completing your course of Ciprofloxacin. Discharge Disposition: Home Discharge Diagnosis: Radiation Proctitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you at ___! You were admitted due to excessive diarrhea and a change in your mental status. In the hospital you were also found to have a urinary tract infection (UTI). You were given intravenous fluids and treated with antibiotics for your UTI. Your mental status improved although you continued to have diarrhea and, on occasion, blood in your stool. You underwent colonoscopy that showed changes consistent with radiation proctitis. You are now ready for discharge with close outpatient ___. See below for changes made to your home medication regimen: - Please CONTINUE Ciprofloxacin 500mg twice daily for an additional 4 days - Please STOP Macrobid until after completing the course of Ciprofloxacin - Please INCREASE your dose of Loperamide (Immodium) to 2mg every 6 hours while diarrhea persists - Please START Magnesium supplementation 400mg every other day - Please CONTINUE Potassium supplementation 40meq daily Please visit your primary doctor's office to have blood work done this ___. You were also having bad headaches while in the hospital. If these persist after discharge please call your primary doctor for further instructions. See below for instructions regarding ___ care:</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) 5 mg PO Q8H:PRN Pain RX *oxycodone 5 mg 1 tablet(s) by mouth every 8 hour as needed for pain Disp #*20 Tablet Refills:*0 2. Albuterol Inhaler ___ PUFF IH Q4H:PRN Wheeze 3. ClonazePAM 0.5 mg PO QHS:PRN Anxiety 4. Cyanocobalamin 1000 mcg PO BID 5. Omeprazole 40 mg PO BID 6. Escitalopram Oxalate 20 mg PO DAILY 7. Cystex (methenamine & sod sal) (methenamine-sodium salicylate) 162-162.5 mg Oral daily Discharge Disposition: Home Discharge Diagnosis: PRIMARY chronic suprapubic and testicular pain SECONDARY interstitial cystitis s/p ileal neobladder GERD Anxiety Depression Asthma Vitamin B12 Deficiency Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your stay at ___ ___. You were admitted to the hospital because of pain around your bladder. You were first started on antibiotics, but the antibiotics was stopped because your urine did not show any signs of infection. You have an appointment with your urologist, Dr. ___ ___. Please make sure you make it to this appointment.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms. ___, It was a pleasure treating you during this hospitalization. You were admitted to ___ because of increasing confusion and forgetfullness at home. Infectious and metabolic work up did not show any specific cause for your encephalopathy. Neurology was consulted and you completed an electroencephalograpm, which showed that you were not having any seizures. Our neurologists felt that your confusion was likely caused by a combination of excess sedating medication, which we have stopped, and sleep apnea, a medical condition that causes you to stop breathing briefly many times a night during sleep. The following changes to your medications were made: - STOP Clonazepam (Klonopin) as this may worsen your confusion - STOP Benadryl (diphenhydramine) as this may worsen your confusion - REDUCE your Tetrabenazine from 25mg to 12.5 mg (one half tablet) every night - START using your CPAP machine every night, as much as possible, when you sleep. - No other changes were made to your medications, please continue taking as previously prescribed</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Quetiapine extended-release 150 mg PO QHS 2. Testim *NF* (testosterone) 50 mg/5 gram (1 %) Transdermal daily 3. Clindamycin 300 mg PO Q6H RX *clindamycin HCl 300 mg 1 capsule(s) by mouth four times a day Disp #*56 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: --Pneumonia Secondary: --falls --anemia --altered mental status Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of ___ at ___ ___. ___ came into the hospital because ___ had a fall approximately a week before ___ were admitted and then the day before ___ were admitted ___ had a motor vehicle accident. ___ performed a CT scan of your head and did not find any bleed. While ___ were here, ___ had a CXR that was consistent with pneumonia. ___ had a CT scan of your chest and abdomen, which showed a mass that was most likely pneumonia, but there was the possibility that the mass could be cancer. ___ had a bronchoscopy on ___ that showed a lot of mucus in your lungs. The biopsy results from that time are pending and will be followed up by pulmonology (lung) doctors. ___ were also found to be anemic. Your blood counts were lower than what they were in ___ at Dr. ___. We were worried about ___ bleeding. ___ had a CT scan of your chest and abdomen that did not show that ___ had a bleed. On the CT scan, we discovered an aneurism (dilation) of the aorta, the largest blood vessel in the body. ___ should follow up with your primary care physician regarding management of this condition. We are concerned that your memory deficits may be impairing your ability to drive. It is not safe for ___ to drive until ___ have undergone formal neuropsychologic testing. We have booked an appointment for ___ with cognitive neurology to initiate this process. In the mean time, we have alerted the ___ who will be contacting ___ to coordinate the steps to regaining driving privileges. The following changes were made to your medications: Clindamycin 450mg Three times a day for a total of 3 weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Donepezil 10 mg PO HS 3. Lisinopril 2.5 mg PO DAILY 4. Memantine 10 mg PO BID 5. Sertraline 100 mg PO DAILY 6. Triamterene-HCTZ (37.5/25) 1 CAP PO DAILY 7. Ursodiol 250 mg PO TID 8. Cyanocobalamin 500 mcg PO DAILY 9. Fexofenadine 180 mg PO DAILY 10. Levofloxacin 500 mg PO EVERY OTHER WEEK 11. Viactiv (calcium-vitamin D3-vitamin K) 500-500-40 mg-unit-mcg oral BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: gait instability chronic left basal ganglia stroke Discharge Condition: Mental Status: Confused - sometimes. She is oriented to herself,but limited orientation to place and time. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - dependent on assistance, will benefit from ___ assistance. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking care of you while you were admitted to ___. You were admitted with gait instability and were evaluated by physical therapy who recommends that you will need continued ___ at home. You were also evaluated by our Neurology team who recommended you have a carotid ultrasound prior to your outpatient clinic appointment with our stroke specialists on ___. This study showed that there is no narrowing if your carotid vessels. No changes were made to your medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild/Fever Do not exceed 4000mg in 24 hours. 2. Dexamethasone 3 mg PO Q8H Duration: 6 Doses Step 1. This is dose # 3 of 5 tapered doses Tapered dose - DOWN 3. Dexamethasone 2 mg PO Q8H Duration: 6 Doses Step 2. This is dose # 4 of 5 tapered doses Tapered dose - DOWN 4. Dexamethasone 1 mg PO Q8H Duration: 6 Doses Step 3. This is dose # 5 of 5 tapered doses Tapered dose - DOWN 5. Docusate Sodium 100 mg PO BID Hold for loose stools. ___ discontinue if not constipated. 6. Famotidine 20 mg PO BID ___ discontinue once off dexamethasone. 7. Heparin 5000 UNIT SC BID ___ discontinue once mobilizing consistently. 8. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 9. Metoprolol Tartrate 25 mg PO BID Hold for HR < 60, SBP < 110 10. Ramelteon 8 mg PO QHS:PRN Insomnia 11. Simvastatin 40 mg PO QPM Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Posterior fossa lesion Discharge Condition: Mental Status: Sometimes confused. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory with assistance. Followup Instructions: ___ [/INST] </s><s>Surgery: - You underwent surgery to remove a brain lesion from your brain. - The final pathology was consistent with meningioma. - Please keep your surgical incisions dry until your sutures and staples are removed. - You may shower at this time, but keep your surgical incisions dry. - It is best to keep your surgical incisions open to air, but it is okay to cover them when outside. - Call your neurosurgeon if there are any signs of infection, such as fever, redness, swelling, or drainage. Activity: - We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up. - You may take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. - No driving while taking narcotics or any other sedating medications. - No contact sports. Medications: - Please do NOT take any blood thinning medications such as clopidogrel (Plavix), ibuprofen, warfarin (Coumadin) until cleared by your neurosurgeon. - You were taking aspirin 81mg once daily at home, which you may resume on ___. - You may use acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: - You may experience headaches and pain at the surgical incisions. - Feeling more tired or restlessness is also common. - Constipation is common. Be sure to drink plenty of fluids and eat a high fiber diet. You may also try an over the counter stool softener if needed. When To Call Your Neurosurgeon At ___: - Severe pain, redness, swelling, or drainage from the surgical incisions. - Fever greater than 101.5 degrees Fahrenheit. - Nausea or vomiting. - Extreme sleepiness and not being able to stay awake. - Severe headaches not relieved with pain medications. - Seizures. - Any new problems with your vision or ability to speak. - Weakness or changes in sensation in your face, arms, or legs. Call ___ And Go To The Nearest Emergency Department If You Experience Any Of The Following: - Sudden numbness or weakness in the face, arms, or legs. - Sudden confusion or trouble speaking or understanding. - Sudden trouble walking, dizziness, or loss of balance or coordination. - Sudden severe headaches with no known reason.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. Disp:*40 Tablet(s)* Refills:*1* 2. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours). Discharge Disposition: Home Discharge Diagnosis: Spontaneous right 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 with right sided chest pain and your xray showed a small pneumothorax laterally. A small pigtail catheter was placed to evacuate the air and you then underwent chemical pleurodesis with talc. Your chest tube is now out and your right lung is..... Call Dr. ___ ___ if you experience: -Fevers > 101 or chills -Increased shortness of breath, chest pain or any other symptoms that concern you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day for 30 doses. Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: pneumothorax Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came to the hospital because you were told that you had a pneumothorax (air that escaped from the lung into the chest cavity) after a thoracentesis. You were admitted to the Medical ICU because you needed a special oxygen delivery device (non-rebreather), which helped to resorb some of the air. You still have a pneumothorax, and it is STRONGLY ADVISED for you to stay in the hospital for a procedure known as a bronchoscopy. You stated that you understood this but still wished to leave. At this time, although we recommend that you have this procedure, you are stable to be discharged home with Interventional Pulmonary clinic follow-up. It is strongly recommended that you attend the pulmonary clinic. . In addition to your pneumothorax, you have a fast heart rate which could be contributing to some fluid in the lungs. You were started on a medication (Metoprolol) to slow the heart rate. . We made the following changes to your medications: -START Metoprolol Please do not hesitate to return to the hospital if you have any worrisome symptoms.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Capsaicin 0.025% 1 Appl TP TID neuropathic pain ___ left BKA RX *capsaicin [Arthritis Pain Relief(capsaic)] 0.075 % Apply to leg for pain apply to leg as needed for pain Refills:*0 3. DULoxetine 30 mg PO DAILY RX *duloxetine 30 mg 1 capsule(s) by mouth Daily Disp #*30 Capsule Refills:*0 4. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN Pain - Severe RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth Q4HRS PRN for pain Disp #*25 Tablet Refills:*0 5. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine [Lidoderm] 5 % Apply patch to leg once a day As needed for pain Disp #*30 Patch Refills:*0 6. Naproxen 500 mg PO BID Duration: 5 Days RX *naproxen 500 mg 1 tablet(s) by mouth Twice a day Disp #*10 Tablet Refills:*0 7. Glargine 10 Units Breakfast Glargine 12 Units Bedtime Humalog 2 Units Breakfast Humalog 5 Units Lunch Humalog 4 Units Dinner Insulin SC Sliding Scale using HUM Insulin 8. Daptomycin 24 mg IV Q24H RX *daptomycin 500 mg 450 mg IV Daily Disp #*30 Vial Refills:*0 9. Ferrous Sulfate 325 mg PO DAILY 10. Metoprolol Succinate XL 37.5 mg PO DAILY 11. Multivitamins 1 TAB PO DAILY 12. Polyethylene Glycol 17 g PO DAILY 13. Warfarin 7.5 mg PO DAILY16 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis ================== Left BKA abscess and osteomyelitis Phantom Limb pain Secondary Diagnosis =================== DM1 HTN Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure to take care of you at ___. WHY WAS I HERE? You were admitted to the hospital because you had increased pain ___ your left leg. WHAT WAS DONE WHILE YOU WERE ___ THE HOSPITAL - While you were ___ the hospital you had imaging done that showed new fluid collection ___ your left leg. - This fluid was drained and sent for culture - You were given medications to help control your pain - You were continued on your home antibiotics - A new medication was started to help with your phantom limb pain. WHAT SHOULD I DO WHEN I GET HOME? 1) Follow up with your Primary Care Doctor. 2) Follow up with Infectious Disease 3) Follow up with Chronic Pain 4) Follow up with Vascular surgery 5) Continue your IV antibiotics 6) You will have ___ help you with your antibiotics and your incision 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. Simethicone 40-80 mg PO QID:PRN GI upset / gas 2. TraMADOL (Ultram) 50 mg PO Q4H:PRN Pain 3. Multivitamins 1 TAB PO DAILY 4. Calcium Carbonate 500 mg PO QID:PRN heartburn 5. Clonazepam 1 mg PO TID:PRN anxiety per home dosing 6. Cyanocobalamin 50 mcg PO DAILY 7. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Lower extremity pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, ___ were evaluated at ___ your issue with lower extremity pain which progressed into your left lumbar back and abdomen, with subsequent Left leg weakness. We performed a abdominal X-ray to rule out any intra-abdominal process, and performed an MRI study of your head and cervical spine. Both of these studies did not demonstrate any new exacerbation of your MS. ___ should follow up with your PCP regarding your vaginal discomfort if it continues to be an issue.</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. Sulfameth/Trimethoprim DS 1 TAB PO BID RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*20 Tablet Refills:*0 3. Miconazole Powder 2% 1 Appl TP BID:PRN abdominal rash Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: 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 nausea and vomiting. You were found to have a wound infection and a uninary tract infection. A VAC was placed on the abdomen and you were also treated with antibiotics. You did well and your lab tests improved and you were able to go home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 10 mg PO QPM 2. GlipiZIDE XL 2.5 mg PO DAILY 3. lansoprazole 30 mg oral BID 4. Atenolol 25 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Primary: Aspiration pneumonitis Secondary: Esophageal stricture and cancer, HTN, T2DM 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 recently admitted to the ___. Why were you admitted to the hospital? - You were admitted to the hospital because you developed shaking and chills after your outpatient EGD and stent removal. - We think that you developed rigors and chills because you aspirated some stomach acid into your lungs. What was done in the hospital? - You were given 1 dose of antibiotics, some IV fluids, and some Tylenol. - You were monitored and did not show any signs of infection. What should you do when you leave the hospital? - You should continue taking all your medications as prescribed - You should follow up with your primary care physical within a week after discharge - You should seek medical attention if you develop rigors/chills or fevers It was a pleasure taking care of you in the hospital. We wish you the best of health. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 2. Artificial Tears ___ DROP BOTH EYES PRN irritation Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left Ring Finger Middle Phalanx Dislocation Left Periorbital Hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, you were brought to ___ ED by ambulance ___ after being struck by a car. You underwent complete physical exam as well as multiple imaging studies and blood tests. You were found to have left periorbital hematoma and left ring finger middle phalanx dislocation, which was reduced in the emergency department and splint was applied: Please follow these instructions: -your finger should remain in extension blocking splint that limits extension at proximal interphalangeal joint to 30 degrees until your follow up instruction with hand doctors. Please, call the Hand Clinic to arrange follow up appointment in ___ days. Please, find the information below -please, lubricating eye drops for your left eye irritation as needed,, if you have an eye doctor follow up with him in ___ weeks. If you don't have regular eye doctor you can call this number ___ to arrange follow up appointment at ___ ___ -you can use ice to your left forehead and left periorbital area for the next 3 days as tolerated Please, also follow these general instructions Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *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. Surgery team in ___ days. ___ flex freely at DIP/PIP</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/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 in the right lower extremity MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 3 hours as needed x 1 day, then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take Lovenox 40mg SC daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE <30 DAYS OF REHAB Physical Therapy: weight bearing as tolerated in the right lower extremity Treatments Frequency: Any staples or superficial sutures you have are to remain in place for at least 2 weeks postoperatively. Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. You may shower and allow water to run over the wound, but please refrain from bathing for at least 4 weeks postoperatively.</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 fever or pain Do not exceed greater than 4g Acetaminophen. Do not consume alcohol when taking Acetaminophen. 2. Docusate Sodium 100 mg PO BID 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Do not drive while taking. RX *oxycodone 5 mg ___ tablet(s) by mouth Q4hrs Disp #*60 Tablet Refills:*0 4. LeVETiracetam 1000 mg PO BID RX *levetiracetam [Keppra] 1,000 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 5. Cephalexin 500 mg PO Q6H Duration: 3 Days RX *cephalexin 500 mg 1 tablet(s) by mouth Q6hrs Disp #*12 Tablet Refills:*0 6. Outpatient Physical Therapy Continued strenghthening. Discharge Disposition: Home Discharge Diagnosis: Depressed Skull fracture. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Craniotomy for Hemorrhage • 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. • Your wound was closed with staples. You may wash your hair only after the staples have been removed. • You may shower before this time using a shower cap to cover your head. • 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. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING • New onset of tremors or seizures. • Any confusion or change in mental status. • Any numbness, tingling, weakness in your extremities. • Pain or headache that is continually increasing, or not relieved by pain medication. • Any signs of infection at the wound site: redness, swelling, tenderness, or drainage. • Fever greater than or equal to 101.5° F.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr ___, Why was I admitted to the hospital? You presented to ___ for a scheduled procedure; however, the surgery was not done because your blood pressure was found to be too low. What was done for me while I was in the hospital? While in the hospital, we were concerned that you were bleeding from somewhere in your belly or intestines. You received blood and got better with this treatment. We looked at your digestive tracts with cameras (colonoscopy, EGD) and did not find any source of bleeding. You also have bruising of your left arm, we had our Neurology and Orthopedic team evaluate you. This got better with Tylenol and an arm splint. Please continue to take your home medications and follow-up with your doctors as ___ and ___ yourself daily. If you gain more than 3lb, please call your doctor. We wish you all the best, Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 10 mg PO BID RX *apixaban [Eliquis] 5 mg (74 tabs) 10 mg by mouth twice a day Disp #*1 Dose Pack Refills:*0 2. LevoFLOXacin 750 mg PO Q24H RX *levofloxacin 750 mg 1 tablet(s) by mouth once a day Disp #*2 Tablet Refills:*0 3. Novarel (chorionic gonadotropin, human) 2500 units injection 2X/WEEK Discharge Disposition: Home Discharge Diagnosis: Community-acquired pneumonia L leg DVT 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 pneumonia and blood clot in your left leg. Your pneumonia improved with antibiotics, which you should continue through ___ (levofloxacin). Your blood clot was treated with a medicine called apixaban, which you will need to take at a dose of 10mg twice a day until ___, after which you should reduce the dose to 5mg twice a day. Continue this medication until instructed to stop by your primary care doctor. In addition, you were found to have small nodules in your lungs, likely to be of no importance. Please address the possibility of follow up imaging with your primary care doctor. It is critically important that you quit smoking, if possible, to reduce your risk of further blood clots. Please also monitor closely for worsening of the blood in your sputum, which - if evident - should prompt return to the emergency room. With best wishes, ___ Medicine</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Torsemide 40 mg PO BID RX *torsemide 20 mg 2 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. aMILoride 5 mg PO BID 3. Cholestyramine 2 gm PO DAILY 4. Ciprofloxacin HCl 500 mg PO Q24H 5. HydrOXYzine 25 mg PO Q6H:PRN Itching RX *hydroxyzine HCl 25 mg 1 tablet(s) by mouth q6 Disp #*28 Tablet Refills:*0 6. Lactulose 15 mL PO BID 7. magnesium chloride 71.5 mg oral DAILY 8. Omeprazole 20 mg PO DAILY 9. Potassium Chloride 20 mEq PO BID Hold for K >5 10. rifAXIMin 550 mg PO BID 11. Thiamine 100 mg PO DAILY 12. Venlafaxine XR 75 mg PO DAILY 13. Vitamin D ___ UNIT PO DAILY 14. Vitamin D ___ UNIT PO 1X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: #Decompensated cirrhosis Secondary diagnoses: Anasarca Ascites Malnutrition Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because you had too much fluid in your body. WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - We removed fluid from your abdomen (called "paracentesis"). We took off 1.75 liters of fluid from your abdomen on ___. - We gave you IV medications to remove excess fluid from your body. - Before you left the hospital, we switched to an oral medication to keep fluid off your body. - We continued studies for your liver transplant. - We placed a feeding tube to help with nutrition - You improved and were ready to leave the hospital. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Take all of your medications as prescribed (listed below) - Keep your follow up appointments with your doctors - Weigh yourself every morning, before you eat or take your medications. Call your doctor if your weight changes by more than 3 pounds - Please stick to a low salt diet and monitor your fluid intake - If you experience any of the danger signs listed below please call your primary care doctor or come to the emergency department immediately. It was a pleasure participating in your care. We wish you the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - You can get the wound wet/take a shower starting 3 days after your surgery. You may wash gently with soap and water, and pat the incision dry after showering. - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. ACTIVITY AND WEIGHT BEARING: - TDWB</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Referral for Meals on Wheels Patient requires 2g low sodium, cardiac diet 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. allopurinol ___ mg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day). 5. mycophenolate mofetil 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 6. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. tacrolimus 1 mg Capsule Sig: Two (2) Capsule PO Q12H (every 12 hours). 8. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 11. fenofibrate micronized 145 mg Tablet Sig: One (1) Tablet PO daily (). 12. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 13. torsemide 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). 15. repaglinide 0.5 mg Tablet Sig: One (1) Tablet PO TIDAC (3 times a day (before meals)). 16. insulin glargine 100 unit/mL Solution Sig: Twelve (12) units Subcutaneous at bedtime. 17. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO TID (3 times a day). 18. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day). 19. CPAP Please provide CPAP while sleeping: Autoset ___ Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnosis: # Congestive heart failure exacerbation # Obstructive sleep apnea Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you during your recent admission. You were admitted with shortness of breath, related to too much fluid. You were given medications to help you urinate to take off the fluid, and your breathing improved. Please weigh yourself daily to ensure that you are not gaining weight. Your weight on the day of discharge was 63.7 kg (140lbs). If you gain more than 3 lbs, please call your doctor. You also were seen by the pulmonologists, who felt that some of your breathing issues were related to sleep apnea, or not breathing properly while asleep. You were started on a CPAP machine, and you felt much more rested during the day. You should continue this at rehab, and Dr. ___ pulmonologist, will help arrange for you to have a machine at home prior to discharge from rehab. The following changes were made to your medications: - STOP amlodipine - STOP carvedilol - START metoprolol twice a day for your heart - START imdur once a day for your heart - START torsemide once daily for help removing fluid - STOP metolazone - DECREASE tacrolimus to 2mg twice a day (from 3mg twice a day)</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. Docusate Sodium 100 mg PO BID 3. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*15 Tablet Refills:*0 4. Senna 8.6 mg PO BID constipation 5. ALPRAZolam 1 mg PO QHS 6. Amiodarone 200 mg PO DAILY 7. Digoxin 0.125 mg PO DAILY 8. Methimazole 5 mg PO DAILY 9. Warfarin 2 mg PO ONCE Duration: 1 Dose Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Displaced percutaneous cholecystostomy tube Sepsis Uncontrolled arial fibrillation with rapid ventricular response Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ when your gallbladder drain stopped draining bile. On CT scan, the drain was noted to be dislodged and was no longer within the gallbladder. Interventional Radiology attempted to reposition this drain but they were unable to. You were becoming increasingly sick and had to be transferred to the ICU for close monitoring and medications to control your heart rate and treat your blood pressure. You were taken to the operating room for an exploratory laparotomy, extensive lysis of adhesions, washout, removal and replacement of gallbladder drain. Post-operatively, cardiology was consulted to help manage your uncontrolled atrial fibrillation. They have made adjustments to your medications. You were then taken for cardioversion, as the medications alone were not working. You tolerated cardioversion well, and you have remained in sinus rhythm. It is crucial for your INR to remain therapeutic. Please check your INR at least twice/week and follow-up with your home Cardiologist. Physical therapy has worked with you and you have been cleared for a discharge home with ___ services to help with the drain and VAC dressing. You are now tolerating a regular diet, your pain is well controlled, and your heart rate is controlled. You are ready for discharge. Please note the following: 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. Drain Care: *Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *Maintain suction of the bulb. *Note color, consistency, and amount of fluid in the drain. Call the doctor, ___, or ___ nurse if the amount increases significantly or changes in character. *Be sure to empty the drain frequently. Record the output, if instructed to do so. *You may shower; wash the area gently with warm, soapy water. *Keep the insertion site clean and dry otherwise. *Avoid swimming, baths, hot tubs; do not submerge yourself in water. *Make sure to keep the drain attached securely to your body to prevent pulling or dislocation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Simethicone 40-80 mg PO QID:PRN gas RX *simethicone 80 mg ___ tab by mouth three times a day Disp #*30 Tablet Refills:*0 2. Sucralfate 1 gm PO TID Duration: 3 Months Please dispense liquid, and not pill or capsule RX *sucralfate 1 gram/10 mL 10 ml by mouth three times a day Disp #*1 Bottle Refills:*2 3. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*2 4. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild 5. Calcium Carbonate 600 mg PO DAILY 6. Docusate Sodium 100 mg PO BID 7. Multivitamins 1 TAB PO DAILY 8. Omeprazole 20 mg PO DAILY 9. OxycoDONE (Concentrated Oral Soln) ___ mg PO Q4H:PRN MODERATE PAIN (___) 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation 11. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: Internal Hemorrhoids Abdominal pain possibly secondary to a retained stitch after 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>You were admitted to the hospital with abdominal pain. It was initially thought that a stone may have been blocking a duct in the pancreas, which caused your pain, but the MRCP showed that this was not the case. You had a colonoscopy out of concern for GI bleeding; this showed internal hemorrhoids, but was otherwise normal. Upper endoscopy (scope of the stomach) showed that there was a stitch that was 5-6cm left from the previous surgery. In discussion with your outside bariatric surgeon, this was removed as a possible culprit of the pain. If the pain recurs, it would likely be because of an internal hernia, which is when the bowel gets "stuck" from time to time as a result of the previous surgery. The treatment for this is to have an operation to fix it. If you experience ongoing pain, we advise to go to ___ where your primary surgeon is in order to figure out the next steps . It was a pleasure to participate in your care, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Docusate Sodium 100 mg PO BID 3. Lactulose 30 mL PO TID 4. Omeprazole 20 mg PO DAILY 5. Oxycodone SR (OxyconTIN) 30 mg PO Q12H 6. Rifaximin 550 mg PO BID 7. Ursodiol 600 mg PO QAM 8. Ursodiol 300 mg PO QPM 9. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 10. Calcium Citrate + D *NF* (calcium citrate-vitamin D3) 315-200 mg-unit Oral 2 tabs BID 11. Glargine 10 Units Bedtime Insulin SC Sliding Scale using HUM Insulin RX *insulin lispro [Humalog KwikPen] 100 unit/mL ___ units subcutaneously QID per sliding scale Disp #*1 Pack Refills:*1 12. Dexamethasone 2 mg PO AS PER TAPER Please stick to taper specified on discharge instructions. Tapered dose - DOWN RX *dexamethasone 2 mg ___ tablet(s) by mouth in the mornings and evenings Disp #*44 Tablet Refills:*0 13. test strips Please use to check sugars three times daily 14. Glucometer Please use to check fingersticks three times daily (please provide glucometer covered by patients insurance) 15. Glargine 14 Units Bedtime RX *insulin glargine [Lantus Solostar] 100 unit/mL (3 mL) 14 u SC Before BED; Disp #*1 Unit Refills:*0 16. Outpatient Physical Therapy To optimize strength and mobility 17. Glargine 14 Units Bedtime Insulin SC Sliding Scale using HUM Insulin Discharge Disposition: Home Discharge Diagnosis: Esophageal Adenocarcinoma with bone and pulmonary metastases Back Pain New vertebral lesion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane).- to wear back brace while out of bed. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for your during your most recent admission. You were admitted for back pain. You had a Ct scan of your lumbar spine which showed L4 vertebral lesion with pathologic fracture and epidural mass causing severe spinal canal narrowing. You were evaluated by orthopedic surgery and per discussion with them decided to forgoe surgical intervention at this time. You were given a back brace which you should continue to wear it at all times while out of bed. You were instructed to limit lefting objects no more than 10 lbs. Steroid taper: 8 mg in the morning and 4 mg in the evenings- ___ 8 mg in the morning ___ 6 mg in the morning ___ 4 mg in the morning ___ 2 mg in the morning ___ No more steroids starting ___. Once your morning sugars are running below 150, please stop using nightime lantus. Please note given your elevated blood sugars, you should have a hemoglobin A1C in the future drawn by your primary care physician to make sure that your hyperglycemia has resolved.</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 650 mg 1 tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*28 Capsule Refills:*0 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain This medication is HIGHLY addictive. DECREASE dose/frequency as pain improves. RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*120 Tablet Refills:*0 4. Aspirin 325 mg PO DAILY Duration: 30 Days RX *aspirin 325 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Left proximal humerus fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Non-weight-bearing, left upper extremity MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take Aspiring 325 MG daily for 4 weeks to help prevent blood clots that may occur after orthopedic surgery. WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. - Splint must be left on until follow up appointment unless otherwise instructed Physical Therapy: Non-weight-bearing LUE in sling, gentle pendulums to shoulder ONLY Active ROM elbow, wrist, fingers Treatments Frequency: Non-weight-bearing LUE in sling, gentle pendulums to shoulder ONLY Active ROM elbow, wrist, fingers</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN leg pain 2. Amlodipine 2.5 mg PO HS 3. Aspirin 81 mg PO DAILY 4. Atenolol 25 mg PO DAILY 5. Calcium Carbonate 500 mg PO BID 6. Guaifenesin-CODEINE Phosphate 10 mL PO HS:PRN cough 7. Levothyroxine Sodium 50 mcg PO DAILY 8. Lisinopril 20 mg PO DAILY 9. Pravastatin 20 mg PO DAILY 10. Vitamin D 1000 UNIT PO DAILY 11. Alendronate Sodium 70 mg PO QSAT 12. GlipiZIDE 5 mg PO DAILY 13. MetFORMIN (Glucophage) 850 mg PO BID 14. Sulfameth/Trimethoprim DS 2 TAB PO BID Duration: 9 Days RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 2 tablet(s) by mouth twice a day Disp #*34 Tablet Refills:*0 15. Cephalexin 500 mg PO Q8H Duration: 9 Days RX *cephalexin 500 mg 1 capsule(s) by mouth every eight (8) hours Disp #*26 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Cellulitis without joint involvement Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, Thank you for choosing us for your care. You were admitted for a cellulitis (infection of the skin) on your hand. We treated you with a day of the intravenous antibiotic Vancomycin before switching you to the oral antibiotic Bactrim. Please continue to take Bactrim and keflex as prescribed for a total 10 days of antibiotics. Please follow with your primary care physician as illustrated below. Please keep your arm elevated and keep the splint until you are evaluated by your primary care physician.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PO/PR DAILY 2. CefTAZidime 1 g IV Q12H Duration: 5 Days 3. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol 4. Famotidine 20 mg PO DAILY 5. Furosemide 120 mg PO BID 6. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 7. Glucose Gel 15 g PO PRN hypoglycemia protocol 8. GuaiFENesin ___ mL PO Q6H:PRN cough 9. Glargine 40 Units Breakfast Insulin SC Sliding Scale using REG Insulin 10. Lactulose 30 mL PO PRN constipation 11. Lidocaine 5% Patch 1 PTCH TD QAM L knee pain 12. Lisinopril 5 mg PO DAILY 13. Multivitamins W/minerals 15 mL PO DAILY 14. Potassium Chloride (Powder) 40 mEq PO BID Hold for K >3.5 15. Ramelteon 8 mg PO QHS:PRN insomnia Should be given 30 minutes before bedtime 16. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line flush 17. ___ MD to order daily dose PO DAILY16 target INR 2.5-3.5 18. Docusate Sodium 100 mg PO TID 19. Metoprolol Succinate XL 12.5 mg PO DAILY 20. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every six (6) hours Disp #*50 Tablet Refills:*0 21. Senna 8.6-17.2 mg PO QHS:PRN constipation 22. Acetaminophen 650 mg PO Q6H 23. amLODIPine 10 mg PO DAILY 24. Aspirin 81 mg PO DAILY 25. FoLIC Acid 1 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Small Bowel Obstruction s/p ex lap PE s/p thrombectomy, Bilat DVT s/p IVC filter Cardiogenic shock/Right heart failure s/p VA ECMO hypoxic respiratory failure rt ankle ORIF HIT positive Pseudomonas UTI Secondary: PMHx: cirrhosis, EtOH abuse, up to a pint of rum daily, HYPERTENSION, HEPATITIS C, KNEE PAIN, SEXUAL DYSFUNCTION, OSTEOARTHRITIS, H/O ELEVATED BLOOD SUGAR Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Alert and oriented x3, non-focal Full assist for OOB, touch down weight bearing on right foot Sternal pain managed with oxycodone and tylenol Sternal Incision - healing well, no erythema or drainage Edema trace Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for evaluation of abdominal pain and were diagnosed with a small bowel obstruction. Please follow the instructions below to continue your recovery: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please take any new medications as prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. FoLIC Acid 1 mg PO DAILY 2. Loperamide 4 mg PO BID 3. Mirtazapine 15 mg PO HS 4. Multivitamins 1 TAB PO DAILY 5. Omeprazole 20 mg PO BID 6. PredniSONE 5 mg PO DAILY with Zytega 7. Psyllium Wafer 6 WAF PO BID 8. Sucralfate 1 gm PO BID 9. Tamsulosin 0.4 mg PO HS 10. Zytiga *NF* (abiraterone) 1000 mg Oral daily 11. Zinc Sulfate 220 mg PO DAILY 12. Cyanocobalamin 100 mcg PO DAILY 13. Enoxaparin Sodium 60 mg SC DAILY RX *enoxaparin 60 mg/0.6 mL apply subcutaneously daily Disp #*30 Syringe Refills:*1 Discharge Disposition: Home With Service Facility: ___ ___: Hematuria, likely traumatic DVT of left leg Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you during your hospitalization. You were admitted to the hospital after having blood in your urine. While here your Foley catheter was continuously flushed in order to help clean out the blood from your bladder. The amount of bleeding in your urine continued to improve and was clear of blood prior to your discharge. The most likely cause of this bleeding was minor trauma from the presence of the Foley catheter. While in the hospital, you developed a clot in your left leg (Deep Vein Thrombosis; DVT). This DVT is the cause of your leg swelling. Certain risk factors for developing a DVT include having cancer and being immobile. You are being treated with a drug called Lovenox, which is injected underneath the skin in your abdomen. This will help to keep your blood thin so that your body can dissolve the clot. You will remain on this for at least 6 months and possibly longer, but this will be decided at a later time by your PCP. It is important that you follow-up with the doctor's appointments listed below. Please call your doctor or come to the Emergency Department if you develop any concerning symptoms such as chest pain, shortness of breath, pain with breathing, or more blood in your urine.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 2.5 mg PO BID 2. FoLIC Acid 1 mg PO DAILY 3. LevETIRAcetam 500 mg PO BID 4. Multivitamins 1 TAB PO DAILY 5. Thiamine 100 mg PO DAILY 6. Atenolol 25 mg PO DAILY 7. Valsartan 160 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Acute Ischemic Stroke Atrial fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized due to language difficulties 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. Your stroke was treated with a medication that breaks up blood clots, and this likely helped resolve your symptoms. You also had a seizure, which can sometimes result from a stroke. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: - Atrial fibrillation We are changing your medications as follows: - START apixaban (Eliquis) 2.5mg DAILY. This is a blood thinner and will reduce your risk of blood clots leading to a stroke. - START levetiracetam (Keppra) 500mg DAILY. This is an anti-seizure medication to prevent future seizures like the one you had after your stroke. This will likely be stopped upon follow-up with Dr. ___. Please take your other medications as prescribed. Please followup with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body As you had a seizure, it is state law in MA for you to not drive for 6 months starting from the date of your seizure. After this time, if you have not had another seizure you can resume driving providing other factors are also stable.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Outpatient Physical Therapy Evaluatation and treatment for right hip and right knee pain. 2. Enablex *NF* 15 mg Oral daily Reason for Ordering: Wish to maintain preadmission medication while hospitalized, as there is no acceptable substitute drug product available on formulary. 3. Haloperidol 10 mg PO HS 4. Lacosamide 250 mg PO BID 5. Zonisamide 100 mg PO TID 6. Acetaminophen 650 mg PO Q6H:PRN pain RX *8 HOUR PAIN RELIEVER 650 mg 1 tablet(s) by mouth every six (6) hours Disp #*60 Capsule Refills:*0 7. Docusate Sodium 100 mg PO BID:PRN constipation 8. Fluticasone Propionate NASAL ___ SPRY NU DAILY 9. Hydrocortisone Acetate Suppository ___ID:PRN rectal pain Discharge Disposition: Home Discharge Diagnosis: Right groin muscle strain Epilepsy 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 great pleasure to take care of you at ___. You were admitted to the hospital because of right groin and thigh pain. You also had a seizure while you were at the hospital. The neurology team saw you and determined that you can continue with the same dosage of your seizure medications. Orthopedics also saw you and reviewed your right leg x-rays. You do not have a fracture or infection. Your right groin/leg pain is most likely a muscle strain and should get better with physical therapy.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Diphenoxylate-Atropine 1 TAB PO Q4H diarrhea Please stop if patient is experiencing constipation. 2. Methadone 10 mg PO Q8H RX *methadone 10 mg 10 mg by mouth every 8 hours Disp #*54 Tablet Refills:*0 3. Metoprolol Tartrate 25 mg PO BID Please hold medication if heart rate is less than 60 or blood pressure less than 100. RX *metoprolol tartrate 25 mg 1 Tablet(s) by mouth every 12 hours Disp #*36 Tablet Refills:*0 4. Acetaminophen 650 mg PO Q6H RX *acetaminophen 650 mg 1 Tablet(s) by mouth three times a day Disp #*40 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Bowel obstruction- malignant Tachycardia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted for management of a bowel obstruction. During your hospitalization you first underwent a colonoscopy with ileocolic dilitation. You continued to experience emesis( vommiting) and a repeat CT scan showed continuing bowel obstruction. You then underwent a jejunocolostomy on ___ for the obstruction. You tolerated the operation well with a return of bowel function. You tolerated a regular diet and are now ready to return home. General Discharge Instructions: Please resume all regular home medications. Please take any new medications as prescribed.Please take the prescribed analgesic medications as needed. You may not drive or operate heavy machinery while taking narcotic analgesic medications. You may also take acetaminophen (Tylenol) as directed,but do not exceed 4000 mg in one day. Please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. Avoid strenuous physical activity and refrain from heavy lifting greater than 10 lbs., until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Please also follow-up with your primary care physician. Incision Care: *Please call your surgeon or go to the emergency department if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until cleared by your surgeon. *You may shower and wash incisions with a mild soap and warm water. Gently pat the area dry. Your staples will be removed at your followup appointment with Dr. ___ on ___ at 2pm. You received an injection of B12 during this hospitalization. You are to continue receiving B12 injections monthly as an outpatient. If you fail to tolerate your diet at home, become febrile, or fail to have bowel movements you are to call your physician immediately or report to the local emergency deparment. If you are having too frequent bowel movements (more than 2 bowel movements per day), notify your physician. Take your Lomotil as prescribed. Stop taking it if you experience constipation. Your PICC line will be removed at your follow up appointment on ___ ___. Note your heart rate was elevated during this hospitalization, you were started on Metoprolol 25 mg BID. You are to continue this medication until you follow up with your primary care physician and have your medications reconciled. You are stop taking this medication if your heart rate measures less than 60 beats per minute or your blood pressure is less than 100/60 at the time of your scheduled dose. Your pain medications were changed to Methadone 8 mg orally every 8 hours. This is your new pain medication regimen. You are to STOP taking any other narcotics while on this regimen. Follow up with your primary care physician to have your pain medications reconciled.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl 10 mg PO DAILY:PRN constipation 2. Acetaminophen 1000 mg PO Q8H RX *acetaminophen [Acetaminophen Extra Strength] 500 mg 2 tablet(s) by mouth every eight (8) hours Disp #*60 Tablet Refills:*0 3. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 [ClearLax] 17 gram/dose 1 powder(s) by mouth once a day Refills:*0 4. Ranitidine 150 mg PO DAILY Duration: 3 Days RX *ranitidine HCl [Acid Control (ranitidine)] 150 mg 1 tablet(s) by mouth once a day Disp #*3 Tablet Refills:*0 5. Senna 8.6 mg PO BID constipation RX *sennosides [___] 8.6 mg 1 tablet by mouth twice a day Disp #*20 Tablet Refills:*0 6. Aspirin 81 mg PO DAILY 7. Cyclobenzaprine 10 mg PO HS:PRN muscle spasm 8. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain Duration: 7 Days RX *oxycodone [Oxecta] 5 mg 1 tablet(s) by mouth every six (6) hours Disp #*28 Tablet Refills:*0 9. Outpatient Physical Therapy Physical Therapy. Evaluation and treatment. 10. Gabapentin 100 mg PO BID pain RX *gabapentin 100 mg 1 capsule(s) by mouth twice a day Disp #*20 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: lumbosacral radiculopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized at ___ because of your back and hip pain. In the emergency room, you had X-rays taken of your hip and pelvis that was normal except for some changes associated with arthritis. Orthopedic spine doctors also ___ images of your back taken before you came to the hospital and a physical therapist assessed your injury. You were given medications to manage your pain. We recommend that follow up as an outpatient with physical therapy, pain clinic, and your primary care doctor to continue treatment of your back and hip pain. It was a pleasure taking care of you. Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Bisacodyl ___AILY:PRN Constipation - Second Line Reason for PRN duplicate override: Alternating agents for similar severity 2. Dexamethasone 8 mg PO QAM 3. Ketorolac 15 mg IV Q8H:PRN Pain - Mild 4. OxyCODONE Liquid 10 mg PO Q6H:PRN Pain - Moderate Reason for PRN duplicate override: Patient is NPO or unable to tolerate PO 5. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 6. LevETIRAcetam 1000 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY ======= - Metastatic neuroendocrine tumor - Intraparenchymal hemorrahge - Subarachnoid hemorrhage SECONDARY ========= - Oropharyngeal candidiasis - Hypoglycemia in the setting of steroid taper Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You came into the hospital because you were having headaches. WHAT HAPPENED TO ME IN THE HOSPITAL: - You received radiation therapy for your cancer - You received steroids - Your blood glucose was monitored closely and you were given insulin accordingly - You were confused at times during the hospitalization When you leave the hospital you should: - Take all of your medications as prescribed. It was a pleasure taking care of you, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*4 2. Naproxen 500 mg PO Q12H:PRN Pain - Moderate RX *naproxen 500 mg 1 tablet(s) by mouth twice daily as needed Disp #*30 Tablet Refills:*0 3. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 [Miralax] 17 gram 1 powder(s) by mouth daily as needed Disp #*30 Packet Refills:*4 4. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tab by mouth twice daily Disp #*60 Tablet Refills:*4 5. Albuterol Inhaler 2 PUFF IH Q6H:PRN sob 6. Diazepam 10 mg PO QHS 7. Divalproex (EXTended Release) 500 mg PO QHS 8. Gabapentin 300 mg PO TID 9. Levothyroxine Sodium 112 mcg PO DAILY 10. Lisinopril 30 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Constipation Musculoskeletal back pain Secondary: Hypothyroidism Bipolar disorder Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital with constipation. You were given bowel medications and disimpacted in the Emergency Department. You can to the medical floor and continued to have bowel movements. You are now ready to go home. Please take the bowel regimen as prescribed and *please avoid opiate medications as these will worsen constipation.* For your musculoskeletal back pain, you can take naproxen (prescribed) and follow up with your PCP. 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. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 2. Gabapentin 1200 mg PO HS 3. Levothyroxine Sodium 50 mcg PO DAILY 4. Lorazepam 1.5 mg PO HS 5. modafinil 50 mg oral QAM 6. QUEtiapine Fumarate 350 mg PO QHS 7. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP DAILY 8. zafirlukast 20 mg oral BID 9. Tacrolimus 0.1 % TOPICAL WEEKLY 10. Cephalexin 500 mg PO Q6H Duration: 9 Days RX *cephalexin 500 mg 1 tablet(s) by mouth every 6 hours Disp #*36 Capsule Refills:*0 11. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 9 Days RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice per day Disp #*18 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: primary diagnosis: cellulitis eczema Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for a skin infection. You were treated with antibiotics and you should complete a ___ day course of the two antibiotics as you have been prescribed. We wish you the best.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth Qdaily Disp #*30 Tablet Refills:*0 2. Multivitamins W/minerals 1 TAB PO DAILY RX *Multi-Vitamin HP/Minerals 1 capsule(s) by mouth Qdaily Disp #*30 Tablet Refills:*0 3. Omeprazole 40 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth Q daily Disp #*30 Tablet Refills:*0 4. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 3 Days RX *Bactrim DS 800 mg-160 mg 1 tablet(s) by mouth Q daily Disp #*3 Tablet Refills:*0 5. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth Q daily Disp #*30 Tablet Refills:*0 6. Outpatient Physical Therapy Eval and treat balance disorder Discharge Disposition: Home Discharge Diagnosis: Urinary Tract Infections Alcohol withdrawl seizures gait instability Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure to care for you in the hospital. . You were admitted because of alcohol withdrawl seizures. Your symptoms improved with supportive care. You were found to have a urinary tract infection.Please complete 3 days of antibiotics for this. You were also unsteady on your feet and physical therapy recommended outpatient physical therapy. Please stop drinking alcohol. . You were started on: Multivitamins 1 tab daily Thiamine 1 tab daily Folic acid 1 Tab daily Omperazole 40mg daily Bactrim 1 Tab daily for 3 days.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ibuprofen 800 mg PO Q8H:PRN pain 2. Acetaminophen 650 mg PO Q8H:PRN fever 3. Cephalexin 500 mg PO Q6H 4. Sulfameth/Trimethoprim DS 2 TAB PO BID 5. Docusate Sodium 100 mg PO BID constipation 6. sildenafil 50 mg oral prn sexual intercourse Discharge Disposition: Home Discharge Diagnosis: Primary: Cellulitis Secondary: hepatitis C virus Discharge Condition: Clear and coherent. Ambulating independently without assistance. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted with a cellulitis (infection) of your right leg. This occurred after an injury sustained during your motorcycle accident. You also had a small abscess of your anlke that was incised and drained. You were treated with several days of IV antibiotics and will be discharged to complete a 14 day course of oral antibiotics. You should change your bandage daily and ensure that your wound remains clean and dry. It has been a pleasure taking care of you at the ___ and we wish you the best of luck.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild 2. Cephalexin 500 mg PO Q6H Duration: 9 Days RX *cephalexin 500 mg ONE capsule(s) by mouth Q6HRS Disp #*36 Capsule Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg ONE capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Phenazopyridine 200 mg PO TID:PRN bladd pain Duration: 3 Days RX *phenazopyridine 100 mg ONE TAB by mouth Q8HRS Disp #*9 Tablet Refills:*0 5. Senna 8.6 mg PO BID 6. Tamsulosin 0.4 mg PO DAILY RX *tamsulosin 0.4 mg ONE capsule(s) by mouth DAILY Disp #*30 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: SIRS: fever, + Urinalysis, leukocytosis, pain, tachycardia Surgeon's Preop Diagnosis: Left Ureteral Calculus, obstructing Findings: large left proximal ureteral stone Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>-You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month; this may be related to the passage of stone fragments or the indwelling ureteral stent. -The kidney stone may or may not have been removed AND/or there may fragments/others still in the process of passing. -You may experience some pain associated with spasm of your ureter.; This is normal. Take the narcotic pain medication as prescribed if additional pain relief is needed. -Ureteral stents MUST be removed or exchanged and therefore it is IMPERATIVE that you follow-up as directed. -Do not lift anything heavier than a phone book (10 pounds) -You may continue to periodically see small amounts of blood in your urine--this is normal and will gradually improve -Resume your pre-admission/home medications EXCEPT as noted. You should ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor. HOLD ASPIRIN and aspirin containing products for one week unless otherwise advised. -IBUPROFEN (the ingredient of Advil, Motrin, etc.) may be taken even though you may also be taking Tylenol/Acetaminophen. You may alternate these medications for pain control. For pain control, try TYLENOL FIRST, then ibuprofen, and then take the narcotic pain medication as prescribed if additional pain relief is needed. -Ibuprofen should always be taken with food. Please discontinue taking and notify your doctor should you develop blood in your stool (dark, tarry stools) -You MAY be discharged home with a medication called PYRIDIUM that will help with the "burning" pain you may experience when voiding. This medication may turn your urine bright orange. -You may be given “prescriptions” for a stool softener and/or a gentle laxative. These are over-the-counter medications that may be “health care spending account reimbursable.” -Colace (docusate sodium) may have been prescribed to avoid post-surgical constipation or constipation related to use of narcotic pain medications. Discontinue if loose stool or diarrhea develops. Colace is a stool-softener, NOT a laxative. -Senokot (or any gentle laxative) may have been prescribed to further minimize your risk of constipation. -Do not eat constipating foods for ___ weeks, drink plenty of fluids to keep hydrated -No vigorous physical activity or sports for 4 weeks and while Foley catheter is in place.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Carvedilol 12.5 mg PO BID 2. Docusate Sodium 100 mg PO DAILY:PRN constipation 3. Gabapentin 100 mg PO IN AFTERNOON 4. Gabapentin 200 mg PO QHS 5. Lisinopril 40 mg PO DAILY 6. Omeprazole 20 mg PO BID 7. Ciprofloxacin HCl 250 mg PO Q12H 8. Dexamethasone 4 mg PO Q12H RX *dexamethasone 4 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*60 Tablet Refills:*1 9. Ondansetron 4 mg PO Q8H:PRN nausea Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: metastatic breast cancer UTI Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. 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 with weakness and a fall. These symptoms were atttibuted a urinary tract infection. You were also started on steroids to help your weakness and to treat the small amount of swelling near the known lesion in your brain. Dr. ___ will see you next week and be able to discuss the results of the MRI and PET CT scan that you will have today. Please see below for your follow up appointments. Medication changes: dexamethasone 4 mg twice a day ciprofloxacin 250 mg twice a day, last day ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Guaifenesin ER 1200 mg PO Q12H 3. Glargine 90 Units Breakfast Glargine 90 Units Bedtime Humalog 24 Units Breakfast Humalog 24 Units Lunch Humalog 24 Units Dinner Insulin SC Sliding Scale using HUM InsulinMax Dose Override Reason: home dose 4. OxycoDONE (Immediate Release) 30 mg PO Q4H:PRN pain 5. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H 6. PredniSONE 2.5 mg PO DAILY 7. Sulfameth/Trimethoprim DS 1 TAB PO BID RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 8. Tacrolimus 2 mg PO QAM 9. Tacrolimus 1 mg PO QPM 10. Torsemide ___ mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: 1. T tube revision by interventional pulmonology Secondary Diagnosis: 2. Hyperglycemia from Diabetes Mellitus 3. Tracheitis 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 medical care during your stay at the ___. You came to the hospital after your custom T-tube migrated down your trachea. It was revised by Interventional Pulmonology. You were monitored overnight in the ICU. A Passy-Muir valve was placed and you were subsequently evaluated and cleared. **Please schedule the following appointments (phone numbers are listed below), including: ** - For an echocardiogram (within 1 week) - For pulmonary function tests (within 2 months) - A chest x-ray (within 2 months) - With your renal transplant team and for Prograf monitoring (within ___ months) - With cardiologist Dr. ___ (within ___ weeks, ___ Thank you for letting us participate in your care. We wish you all the best, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms. ___, It was a pleasure taking care of you at ___ ___. You were admitted with new neurological deficits including left sided weakness and a left facial droop. You also developed seizure and were started on new medications for this. Your seizures are now controlled and your weakness greatly improved.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Gabapentin 300 mg PO TID 3. TraMADOL (Ultram) 50 mg PO Q8H:PRN pain 4. Zolpidem Tartrate 5 mg PO QHS 5. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB, wheeze 6. MetFORMIN (Glucophage) 1000 mg PO BID 7. Lisinopril 20 mg PO DAILY RX *lisinopril 20 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 8. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 9. Carvedilol 12.5 mg PO BID RX *carvedilol 12.5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 10. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: - Diastolic Heart Failure - Coronary Artery Disease - Hypertensive Urgency Secondary Diagnosis - Hyperlipidemia - Diabetes - Asthma - Obstructive Sleep Apnea - Low back pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ due to lower extremity swelling and some new shortness of breath with walking. You were found to have signs of fluid overload and heart failure on exam and were treated with a medication called Lasix. You will need to continue this medication at home. You were also found to have very high blood pressure. You were started on carvedilol, a medication that helps treat your heart disease and high blood pressure. You were also started on Lisinopril for blood pressure control. You were also started on Lipitor for your heart disease. A stress echocardiogram was done to evaluate your heart for worsening heart disease and for heart pumping function. This showed no major abnormalities. We have set up an appointment for you with ___ cardiology (see below). You need to take these medications every day. Please weigh yourself daily and call your doctor if your weight goes up by more than 3 lbs in one day. It was a pleasure taking care of you. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Benztropine Mesylate 0.5 mg PO BID 2. BusPIRone 10 mg PO BID 3. Gabapentin 600 mg PO DAILY 4. Gabapentin 900 mg PO QHS 5. OLANZapine 10 mg PO DAILY 6. RISperidone 3 mg PO QHS 7. RISperidone 2 mg PO DAILY 8. Rivaroxaban 15 mg PO BID take until ___ RX *rivaroxaban [___] 15 mg (42)- 20 mg (9) 1 tablets(s) by mouth BID to daily Disp #*1 Dose Pack Refills:*0 9. Rivaroxaban 20 mg PO DAILY begin on ___ Discharge Disposition: Home Discharge Diagnosis: ================= PRIMARY DIAGNOSES ================= - massive pulmonary embolus (unprovoked) - Deep vein thrombosis of lower extremity =================== SECONDARY DIAGNOSES =================== - Cognitive impairment with developmental delay - Bipolar disorder - Hypertriglyceridemia - Congenital heart disease - Pectus excavatum 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. ___, You came to ___ from ___ ___ after you had trouble breathing and passed out. You were found to have a big blood clot in your lungs, which was making the right side of your heart work poorly. This likely came from a blood clot that we found in your leg. You received medication through your veins to break up the blood clots, and more medicine to keep your blood thin so that your body can get rid of the rest of your blood clots. Your breathing improved afterward. You have been started on a new blood thinner to be taking by mouth, and you will have appointments to continue to follow this as an outpatient. We wish you the very best of health! - Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lidocaine Viscous 2% 15 mL PO DAILY:PRN Mouth pain RX *lidocaine HCl [Lidocaine Viscous] 2 % Take 15 mL daily once a day Refills:*0 2. Ondansetron 4 mg PO Q8H:PRN Nausea/Vomiting - First Line Reason for PRN duplicate override: swtiching from IV to PO RX *ondansetron 4 mg one tablet(s) by mouth every eight (8) hours Disp #*12 Tablet Refills:*0 3. Clindamycin 300 mg PO QID RX *clindamycin HCl 300 mg one capsule(s) by mouth four times a day Disp #*21 Capsule Refills:*0 4. Acetaminophen-Caff-Butalbital ___ TAB PO Q8H:PRN Pain - Moderate Do not exceed 6 tablets/day 5. ALPRAZolam 1 mg PO TID 6. DULoxetine ___ 20 mg PO BID 7. HYDROmorphone (Dilaudid) 4 mg PO Q4H:PRN Pain - Severe 8. Levothyroxine Sodium 175 mcg PO DAILY 9. LOPERamide 2 mg PO TID:PRN diarhrea 10. Metoprolol Succinate XL 50 mg PO DAILY 11. Midodrine 5 mg PO TID On HD days 12. Pantoprazole 40 mg PO Q24H 13. PHENObarbital 100 mg PO TID 14. Pregabalin 100 mg PO QHS 15. sevelamer CARBONATE 800 mg PO TID W/MEALS 16. Spironolactone 25 mg PO BID 17. Zolpidem Tartrate 10 mg PO QHS insomnia 18. HELD- Warfarin 16 mg PO DAILY16 This medication was held. Do not restart Warfarin until you have your INR checked ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Left mandibular 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 privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You were in the hospital for facial swelling and jaw pain. WHAT HAPPENED TO ME IN THE HOSPITAL? - In the hospital a CT scan of your neck revealed that you had an infection surrounding the teeth that you were planned to have pulled. An incision and drainage was done around this area to manually clear some of the infection. Afterwards you were started on an antibiotic, clindamycin, to help clear the remainder of the infection. - You saw our oral maxillofacial team, who set you up to have your teeth extracted on ___, at ___, ___ Floor Oral and Maxillofacial Surgery Clinic. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? -Please continue to take all of your medications and follow-up with your appointments as listed below. -If you notice any of the danger signs listed below, please contact your PCP or go to an emergency room immediately. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Docusate Sodium 100 mg PO BID please hold for loose stool 3. Ibuprofen 400 mg PO Q8H:PRN Pain - Mild please take with food 4. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate do NOT drink alcohol or drive while taking this medication RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Acute appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You were admitted to the hospital with acute appendicitis (inflammation of your appendix). You were taken to the operating room and had your appendix removed laparoscopically. This procedure went well, you are now tolerating a regular diet and your pain is better controlled. You are now ready to be discharged home to continue your recovery. Please follow the discharge instructions below to ensure a safe recovery while at home: Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM 2. Warfarin 4 mg PO 6X/WEEK (___) Take ___ and ___ 3. Warfarin 2 mg PO 1X/WEEK (___) 4. Aspirin 162 mg PO DAILY 5. Finasteride 5 mg PO DAILY 6. Lisinopril 2.5 mg PO DAILY 7. Metoprolol Succinate XL 50 mg PO DAILY 8. Metoprolol Succinate XL 25 mg PO QHS 9. Ranitidine 150 mg PO DAILY 10. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Transient Ischemic Attack (TIA) Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Dr. ___, ___ were hospitalized due to symptoms of aphasia resulting from a TRANSIENT ISCHEMIC ATTACK, a condition where a blood vessel providing oxygen and nutrients to the brain is transiently 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: -atrial fibrillation -history of heart disease -high blood pressure -high cholesterol We are changing your medications as follows: -Increasing your warfarin dose, and considering changing to Apixaban after discussion with your cardiologist. Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. 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 Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ropinirole 1 mg Tablet Sig: Two (2) Tablet PO QPM (once a day (in the evening)). 2. diazepam 5 mg Tablet Sig: Two (2) Tablet PO Q12H (every 12 hours) as needed for anxiety. 3. pramipexole 0.25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 4. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain. 7. ranitidine HCl 150 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 8. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 9. rosuvastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 10. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 11. azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 4 days. Disp:*4 Tablet(s)* Refills:*0* 12. divalproex ___ mg Tablet Extended Release 24 hr Sig: Three (3) Tablet Extended Release 24 hr PO QAM (once a day (in the morning)). Disp:*90 Tablet Extended Release 24 hr(s)* Refills:*2* 13. divalproex ___ mg Tablet Extended Release 24 hr Sig: Four (4) Tablet Extended Release 24 hr PO QPM (once a day (in the evening)). Disp:*120 Tablet Extended Release 24 hr(s)* Refills:*2* 14. Outpatient Lab Work valproic acid level . Please fax lab results to ___ Discharge Disposition: Home 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>You were transfered to ___ for concern regarding increased seizure frequency. We believe you had increased seizures because of a respiratory infection. Your urine also tested positive for cocaine. Although this might be a lab error, it is essential that you avoid any illicit drugs or narcotics as these increase the likelihood of seizures. Please note that you should continue taking two new medications: - Azithromycin (continue taking for 4 days for respiratory infection) - Depakote ER (extended release, twice every day 1500mg in the morning and 2000mg in the evening) You should get your Depakote level checked as an outpatient, 1 week from today. Please do not stop taking your anti-epileptic medication as this increases the likelihood of seizure.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO TID 2. Allopurinol ___ mg PO DAILY 3. Betamethasone Dipro 0.05% Oint 1 Appl TP BID 4. Fish Oil (Omega 3) 1000 mg PO BID 5. Fluticasone Propionate NASAL 1 SPRY NU BID 6. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 7. Multivitamins W/minerals 1 TAB PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Pravastatin 40 mg PO QPM 10. Sulfameth/Trimethoprim DS 1 TAB PO 3X/WEEK (___) 11. Triamcinolone Acetonide 0.025% Cream 1 Appl TP BID:PRN rash 12. Vitamin B Complex 1 CAP PO DAILY 13. Vitamin D 400 UNIT PO DAILY 14. Sotalol 40 mg PO BID RX *sotalol 80 mg 0.5 (One half) tablet(s) by mouth twice a day Disp #*90 Tablet Refills:*1 15. TiCAGRELOR 90 mg PO BID PCI RX *ticagrelor [BRILINTA] 90 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 16. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheeze/dyspnea 17. Warfarin 2 mg PO DAILY16 RX *warfarin 2 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 18. Aspirin 81 mg PO DAILY RX *aspirin [Adult Low Dose Aspirin] 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnoses: - Atrial fibrillation - NSTEMI Secondary Diagnoses: - Asthma - Hypertension - Hyperlipidemia - Hypogammaglobulinemia - 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. ___, It was a pleasure to take care of ___ during your recent admission to ___. ___ came to the hospital because ___ were having palpitations. We found that ___ were having an irregular heart rhythm, and we gave ___ medications to help with this. We also found that ___ had a heart attack. We performed a procedure to help open one of the blood vessels of your heart. We discharged ___ on several new medications for your heart. We wish ___ a fast recovery. Sincerely, Your ___ Team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth Twice a day Disp #*40 Capsule Refills:*0 2. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 by mouth Twice a day Disp #*40 Capsule Refills:*0 3. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain Do not Drive or consume alcohol while taking this medication RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every 4 hours Disp #*50 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Right Gluteal Hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after a fall onto steps. You were found to have a large right sided gluteal hematoma. You had a CT scan which showed active bleeding at the time of your presentation. You were evaluated with frequent hematocrit checks. They were found to be stable and you are now ready for discharge. This hematoma will take sometime to completely resolve. You may continue to have pain, and you will be discharged with pain medication and a stool softener to continue to take while on the narcotic medication. You may also continue to take advil and tylenol as directed. You will follow up in the Acute Care Surgery clinic.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ClonazePAM 2 mg PO TID:PRN agitation 2. FoLIC Acid 1 mg PO DAILY 3. LeVETiracetam 1000 mg PO BID 4. Tamsulosin 0.4 mg PO DAILY 5. Multivitamins 1 TAB PO DAILY 6. Thiamine 100 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: Hypotension; Altered Mental Status Secondary Diagnosis: Acute kidney injury; Schizophrenia 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 a low blood pressure that you had at your psychiatric facility. You also were very confused on presentation. In the Emergency Department you were given fluids for dehydration, and your blood pressure improved. You were admitted to the floor to further work up your confusion. Your dextroamphetamine-amphetamine was discontinued as well as your bupropion as it may have been contributing to your confusion. Labs were checked which did not show any signs of infection. Labs did show that you had an injury to your kidneys, but this resolved with fluids. You were started on multivitamins as well as thiamine to help with your nutrition. Your mental status improved and you were deemed medically cleared for discharge to crisis stabilization. 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. Aspirin 325 mg PO DAILY 2. Calcium Carbonate 1500 mg PO DAILY 3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 4. Omeprazole 20 mg PO DAILY 5. Pregabalin 200 mg PO TID 6. Sirolimus 1 mg PO DAILY 7. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 8. Vitamin D 1000 UNIT PO DAILY 9. Albuterol Inhaler ___ PUFF IH Q4H:PRN cough/SOB RX *albuterol sulfate [ProAir HFA] 90 mcg ___ puffs inhaled every six hours Disp #*1 Inhaler Refills:*1 10. Guaifenesin-CODEINE Phosphate ___ mL PO Q6H:PRN cough RX *codeine-guaifenesin 100 mg-10 mg/5 mL 5 mL by mouth every six hours Refills:*1 11. Levofloxacin 750 mg PO DAILY Last day of antibiotics: ___ RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*4 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Community-acquired pneumonia, dyseqillibrium Secondary: Chronic hepatitis B virus infection complicated by hepatocellular carcinoma status post liver transplant, osteopenia, neuropathy, fibromyalgia, gastroesophageal reflux disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was our pleasure caring for you at ___ ___. You were admitted to the hospital with a persistent cough. Because you had a liver transplant and are on an immunosuppressive medication, we performed a CT scan of your chest, which showed evidence of a small pneumonia. This is the most likely cause of your symptoms. It is also possible that you have bronchitis ___ addition to this, but ___ any case, we think you should be treated for pneumonia and are sending you home with a prescription for antibiotics, which you will take until ___. We are also discharging you home on a stronger anti-cough medication and an inhaler for symptomatic relief. Regarding your dizziness, we were not able to determine the cause of this. There was no evidence that you were dehydrated, and we performed tests to determine if your dizziness was due to a problem with your balance system (called vertigo), and there was no evidence of this. Overall, we did not think that there was anything dangerous causing your dizziness. You should follow-up with your primary care physician if your dizziness continues. Thank you for allowing us to participate ___ your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. Disp:*60 Capsule(s)* Refills:*0* 2. senna 8.6 mg Tablet Sig: ___ Tablets PO BID (2 times a day) as needed for constipation. Disp:*60 Tablet(s)* Refills:*0* 3. diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for anxiety: do not drive, drink or operate heavy machinary. Disp:*30 Tablet(s)* Refills:*0* 4. quetiapine 200 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). Disp:*30 Tablet(s)* Refills:*0* 5. bupropion HCl 100 mg Tablet Extended Release Sig: One (1) Tablet Extended Release PO BID (2 times a day). Disp:*60 Tablet Extended Release(s)* Refills:*0* 6. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain. 7. hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain: do not drive, drink or operate heavy machinary. Disp:*30 Tablet(s)* Refills:*0* 8. morphine 15 mg Tablet Extended Release Sig: Three (3) Tablet Extended Release PO Q12H (every 12 hours): do not drive, drink or operate heavy machinary. Disp:*30 Tablet Extended Release(s)* Refills:*0* 9. linezolid ___ mg Tablet Sig: One (1) Tablet PO twice a day for 11 days: unless otherwise directed by infectious disease on follow up. Disp:*22 Tablet(s)* Refills:*0* 10. voriconazole 200 mg Tablet Sig: One (1) Tablet PO twice a day for 6 days: unless otherwise directed by infectious disease on follow up. Disp:*12 Tablet(s)* Refills:*0* 11. ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, Rapid Dissolve PO Q8H (every 8 hours) as needed for nausea. Disp:*30 Tablet, Rapid Dissolve(s)* Refills:*0* 12. morphine 15 mg Tablet Sig: 0.5 Tablet PO Q6H (every 6 hours) as needed for pain: do not drive, drink or operate heavy machinary. Disp:*30 Tablet(s)* Refills:*0* 13. gabapentin 300 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). Disp:*30 Capsule(s)* Refills:*0* 14. furosemide 40 mg Tablet Sig: One (1) Tablet PO once a day. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS Wound infection Difficulty with ambulation SECONDARY DIAGNOSIS suicidal ideation substance abuse 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 ___, It was a pleasure participating ___ your care while you were admitted to ___. You initially came into the hospitial because you were depressed and had some thoughts of harming yourself. As you know you were admitted because it was felt you were not safe ___ the shelter and would benefit from a stay at a nursing facility. The incision site on your foot was infected and you also had blood stream infections with bacteria and yeast. We treated you with antibiotics and anti-fungals and you need to follow up with Podiatry at ___, your PCP, and infectious diseases at ___. We advised you stay with us until we have more information from your blood work, but you decided to leave against medical advise. We made the following changes to your medications 1. START Linezolid twice daily till ___ (unless directed otherwise on follow up) 2. START Voriconazole twiece daily till ___ (unless directed otherwise on follow up) 3. START Lasix 40mg PO daily</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ertapenem Sodium 1 g IV 1X Duration: 1 Dose PLEASE DOSE EVERY 24 HOURS. PROJECTED END DATE IS ___. 2. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 3. Vancomycin 1000 mg IV Q 8H skin infection PROJECTED END DATE ___ 4. Acetaminophen 650 mg PO Q4H:PRN Pain - Mild 5. Docusate Sodium 100 mg PO BID 6. Ferrous Sulfate 325 mg PO BID 7. HYDROcodone-Acetaminophen (5mg-325mg) 1 TAB PO Q6H:PRN Pain - Moderate RX *hydrocodone-acetaminophen 5 mg-325 mg 1 tablet(s) by mouth EVERY SIX HOURS Disp #*30 Tablet Refills:*0 8. lansoprazole 30 mg oral Q24H 9. Polyethylene Glycol 17 g PO DAILY:PRN constipatoin 10. Warfarin 8 mg PO DAILY16 11. Zolpidem Tartrate 5 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Pulmonary Embolism Skin and soft tissue infection under flap of right lower leg Hardware infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair ___ wheelchair (not weight bearing right leg) Followup Instructions: ___ [/INST] </s><s>You were admitted after developing chest pain ___ the ___ Emergency Room where you were found to have a blood clot (pulmonary embolus) that travelled to your lungs. You were seen by the hematologists who feel that this likely happened on account of your coumadin and lovenox doses being lower than they should be and we have made the necessary arrangements. You were also taken to the operating room by plastic surgery where they cleaned out the area under your flap, which was infected. The orthopedic hardware you have is also felt to be infected. You were started on antibiotics for this infection as well.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cyanocobalamin 100 mcg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Omeprazole 20 mg PO DAILY 4. Acetaminophen 650 mg PO Q8H:PRN pain 5. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth Q6hr prn: pain Disp #*12 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Biliary colic Sarcoidosis Cryptogenic cirrhosis, compensated Pancytopenia, neutropenia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at ___. You went to the emergency room with recurrent abdominal pain, which is likely from another stone in your gallbladder. You were seen by nutrition and should eat a low fat diet at home to help reduce the risk of recurrent pain in your gallbladder. While in the emergency room, your oxygen saturation dropped into the ___. You had a CT of your chest which did not show any clot. It did show concerning consolidations which may be related to your sarcoid and you should follow up with your pulmonologists about this. You had no clinical signs of pneumonia. While inpatient, your white blood cells dropped to a dangerous level indicating that your immune system is suppressed and you are at high risk of infection. You were seen by the blood specialists (hematology/oncology) and had a biopsy of your bone marrow. We advised that you stay in the hospital due to the risk of infection. However, you insisted on leaving so we made you an appointment with hematology/oncology on ___. You also have an appointment with your liver doctor on ___. It is very important that you keep these appointments. You may continue to have problems with your gallbladder. We suggest that you speak with your hepatologist about getting on the liver transplant list in case you have a complication. At the time of discharge, your bilirubin was improving and your white blood cell count was still very low but slightly improved. Your oxygen saturation dropped to 82% when you were walking. This is dangerous and could be damaging to your lungs. We strongly suggest that you wear oxygen when walking around. You were discharged with a small amount of oxycodone for pain from your bone marrow biopsy site. You should not drive, operate heavy machinery, fly an airplane, drink alcohol, or take other sedating medication while taking this medication. You should not fly a plane with your low oxygen saturation. Please follow up with your pulmonologist regarding this. As we discussed, you are at high risk of infection and need to return to the ED with any signs of infection such as fever, chills, cough, or not feeling well in general. We wish you the best! Sincerely, Your ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Diltiazem Extended-Release 180 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Multivitamins 1 TAB PO DAILY 4. Oxybutynin 5 mg PO BID 5. Ranitidine 75 mg PO BID 6. TraZODone 50 mg PO HS:PRN insomnia 7. Zinc Sulfate 50 mg PO DAILY 8. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*2 9. Senna 1 TAB PO BID constipation RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*1 10. esomeprazole magnesium 40 mg oral bid 11. Magnesium Oxide 400 mg PO DAILY RX *magnesium oxide 400 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Acute Kidney Injury Secondary Diagnosis: Dysphagia, dysthymia with superimposed adjustment disorder in the setting of recent stressors and medical issues 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 you have been eating poorly at home and your kidney has been functioning less well than before. You were seen by nutritionists, neurologist and psychiatrist during this stay, and we are glad to see that we have come up with a plan to help you eat better at home. You will continued to be followed by your primary care doctor and we have asked your primary care doctor to provide referral to a nutritionist</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours Disp #*60 Tablet Refills:*0 2. Ibuprofen 400 mg PO Q8H:PRN pain Discharge Disposition: Home Discharge Diagnosis: Abdominal pain Liver tumor Thoracic spine tumor Hepatitis C 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 workup of a new liver mass. You had a biopsy, CT scans, and labs. We feel this is most likely a cancerous liver tumor due to longstanding hepatitis C infection. However, we will not know for sure until the final pathology results return. You will need to be seen in the Liver Tumor Clinic on ___. Instructions are below. Take oxycodone as needed for pain. Be sure to take over-the counter laxatives like Colace, senakot, and miralax as needed for constipation while taking oxycodone. Avoid alcohol and Tylenol.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain do not exceed 4000mg (4g) per day. available over the counter. 2. Docusate Sodium 100 mg PO BID:PRN constipation available over the counter if needed 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain continue to use prescription given in ED two days ago Discharge Disposition: Home Discharge Diagnosis: left distal radius fracture, acute carpal tunnel syndrome Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - No need for anticoagulation WOUND CARE: - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. -Splint must be left on until follow up appointment unless otherwise instructed -Do NOT get splint wet ACTIVITY AND WEIGHT BEARING: -non-weight-bearing left upper extremity</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BuPROPion 200 mg PO BID 2. Duloxetine 30 mg PO DAILY 3. Fentanyl Patch 50 mcg/h TP Q72H 4. Fish Oil (Omega 3) 300 mg PO TID 5. Gabapentin 600 mg PO QID 6. HYDROmorphone (Dilaudid) 2 mg PO Q8H:PRN pain 7. Midodrine 5 mg PO TID 8. Mirtazapine 30 mg PO DAILY 9. Multivitamins 1 TAB PO DAILY 10. Pantoprazole 40 mg PO Q12H 11. Piperacillin-Tazobactam 3.375 g IV Q8H RX *piperacillin-tazobactam 3.375 gram Administer 3.375g through PICC every eight (8) hours Disp #*27 Bag Refills:*0 12. biotin *NF* 1000 mg Oral daily 13. cranberry *NF* 3600 mg Oral daily 14. Klor-Con *NF* (potassium chloride) 20 Oral BID 15. potassium citrate *NF* 10 mEq ORAL BID 16. Senexon *NF* (sennosides) 8.6 mg Oral BID 17. Super B-50 Complex *NF* (B complex vitamins) ORAL DAILY 18. Sodium Chloride 0.9% Flush 3 mL IV BEFORE AND AFTER ZOSYN INFUSION Peripheral IV - Inspect site every shift RX *sodium chloride 0.9 % [Normal Saline Flush] 0.9 % please give before and after zosyn infusion Disp #*72 Syringe Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: recurrent urinary tract infection SECONDARY: Medullary sponge kidneys, nephrolithiasis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your stay at ___ ___. You were admitted to the hospital because of an urinary tract infection. Your urine culture taken by your primary care physician grew pseudomonas and you were treated with IV zosyn for your infection. You will need to continue with this antibiotic for a total of 10 days. Imaging of your kidneys by ultrasound showed that your kidneys look the same as before. Please hold off taking monurol until you complete your 10 days of zosyn (last day on ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Benzonatate 100 mg PO TID:PRN cough RX *benzonatate 100 mg 1 capsule(s) by mouth three times a day Disp #*90 Capsule Refills:*0 2. Enoxaparin Sodium 100 mg SC Q12H RX *enoxaparin 100 mg/mL 1 mL SQ twice a day Disp #*60 Syringe Refills:*0 3. Guaifenesin-Dextromethorphan ___ mL PO Q6H:PRN cough RX *dextromethorphan-guaifenesin 100 mg-10 mg/5 mL 5 mL by mouth every six (6) hours Refills:*0 4. Cetirizine 10 mg PO DAILY:PRN allergies 5. Docusate Sodium 100 mg PO BID:PRN constipation 6. Ondansetron ODT ___ mg PO Q8H:PRN nausea/vomiting 7. Prochlorperazine ___ mg PO Q6H:PRN nausea/vomiting 8. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: Acute Pulmonary Embolism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking part in your care here at ___! Why was I admitted to the hospital? - You came in with shortness of breath especially with exertion and we found several blood clots in the blood supply to your lungs which explains your symptoms. What was done for me while I was in the hospital? - We started you on a blood thinner (Lovenox, also called Enoxaparin or Low Molecular Weight Heparin) to stabilize your blood clot. We also performed an ultrasound of your heart to rule out significant strain on your heart caused by the clot burden, this was normal. Given your recent calf pain we performed ultrasound testing of your legs as well and did not find evidence of any blood clots on either side. What should I do when I leave the hospital? - Over time your body will break down the clot on its own but it's important to continue the blood thinner for at least 6 months to reduce the risk of clot expansion or migration. Sincerely, Your ___ Care Team It was a pleasure to participate in your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day. 2. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. buspirone 30 mg Tablet Sig: One (1) Tablet PO TID (3 times a day) as needed for anxiety: as prescribe by your doctor. 4. alprazolam 2 mg Tablet Sig: ___ Tablets PO once a day as needed for anxiety. 5. trazodone 300 mg Tablet Sig: One (1) Tablet PO at bedtime. 6. gabapentin 600 mg Tablet Sig: One (1) Tablet PO three times a day. 7. prazosin 2 mg Capsule Sig: One (1) Capsule PO once a day. 8. oxycodone 10 mg Tablet Sig: One (1) Tablet PO q3h as needed for pain: Do not drive or operate on machinery when you take this medication in order to prevent accidents. 9. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO three times a day as needed for pain. Disp:*60 Tablet(s)* Refills:*0* 10. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily): on for 12 hours and off for 12 hours. Disp:*15 Adhesive Patch, Medicated(s)* Refills:*0* 11. atenolol 50 mg Tablet Sig: One (1) Tablet PO once a day. 12. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day. Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: - Left knee pain Secondary diagnoses: - Hypertension - Chronic back pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It is a pleasure to take care of you at ___ ___. You were admitted to the hospital for evaluation of your left knee pain after a fall. You said you hit your head after the fall. The CT of your head does not show any bleeding. Physical therapy evaluated you and thought that it is safe for you to return home. Your pain is better controlled. You will need to have further outpatient work-up for your knee pain as it is already arranged for you. Please note the following changes to your medications: - START tylenol ___ mg, every 8 hours as needed for pain - START lidocaine patch, 1 patch to the affected area, on for 12 hours and off for 12 hours. - You can take stool softener such as colace and laxative such as senna if you experience constipation. - You can use ice pack to help with the discomfort in your knee You should not drink, drive, or operate machinery while taking oxycodone. This can make you drowsy and can potentially lead to accidents.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Warfarin 2 mg PO DAILY16 3. Metoprolol Tartrate 50 mg PO BID 4. Amlodipine 10 mg PO DAILY 5. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron HCl 4 mg 1 tablet(s) by mouth three times a day Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis - hiatal hernia - gastritis - gastric polyp Secondary diagnosis - hypertension - osteoarthritis 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 here at ___ for difficulty swallowing. As part of the workup, you underwent an upper endoscopy, which did not show obstructing lesions, but instead showed a hiatal hernia, inflammation in the stomach and a polyp in the stomach. Biopsy was taken and results were still pending. You were also seen by the speech and swallow specialists, who felt that you are safe to continue eating. You were also found to have significantly elevated coumadin level, which has been reversed during this admission. Please note the following changes in your medication. - Please START to take pantoprazole 40 mg twice a day - You may take one tablet of zofran after meal for nausea. - Please HOLD lisinopril and hydrochlorothiazide before you see your PCP. Please discuss when to restart these medication with your PCP. We also made followup appointments with your PCP and ___ gastroenterologist.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ondansetron 8 mg PO PRN nausea and vomiting RX *ondansetron 8 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Furosemide 20 mg PO DAILY 3. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate 4. Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting RX *prochlorperazine maleate [Compazine] 10 mg 1 tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 5. Simvastatin 20 mg PO QPM 6. Vitamin D ___ UNIT PO 1X/WEEK (SA) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: ================== Gastric Outlet Obstruction Metastatic poorly differentiated neuroendocrine carcinoma Leukocytosis Secondary Diagnosis: =================== Hypertension Hyperlipidemia Diarrhea 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 had a blockage of your stomach that was not allowing food to pass through your gut properly. Because of this, you had nausea, vomiting, and abdominal pain. We believe that your cancer was compressing your gut. WHAT HAPPENED TO ME IN THE HOSPITAL? - We did a procedure to fix the obstruction by placing a stent in your gut. - We gave you chemotherapy. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Azithromycin 250 mg PO Q24H Duration: 1 Day RX *azithromycin 250 mg 1 tablet(s) by mouth once a day Disp #*1 Tablet Refills:*0 2. Cefpodoxime Proxetil 200 mg PO Q24H RX *cefpodoxime 200 mg 1 tablet(s) by mouth once a day Disp #*1 Tablet Refills:*0 3. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheeze 4. Aspirin 325 mg PO DAILY 5. Desmopressin Acetate 0.1 mg PO QHS 6. Docusate Sodium 100 mg PO DAILY 7. Ferrous Sulfate 325 mg PO DAILY 8. Fluticasone Propionate NASAL 1 SPRY NU BID 9. Hydrocortisone (Rectal) 2.5% Cream ___ID:PRN itch 10. Hydrocortisone 10 mg PO QAM 11. Hydrocortisone 2.5 mg PO QPM 12. Ipratropium Bromide MDI 2 PUFF IH BID:PRN wheeze 13. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 14. Levothyroxine Sodium 75 mcg PO DAILY 15. Montelukast 10 mg PO QHS 16. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 17. Nystatin Oral Suspension 5 mL PO QID:PRN thrush 18. Pantoprazole 40 mg PO Q24H 19. Rectiv (nitroglycerin) 0.4 % (w/w) rectal QHS 20. Senna 8.6 mg PO DAILY 21. Sertraline 100 mg PO DAILY 22. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation INHALATION BID 23. HELD- Torsemide 20 mg PO DAILY This medication was held. Do not restart Torsemide until seeing your PCP ___: Home With Service Facility: ___ Discharge Diagnosis: Primary: Failure to thrive Transaminitis secondary to amiodarone use UTI Community acquired pneumonia Secondary: Paroxysmal atrial fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, You were admitted to ___ because you lost weight and had abdominal pain. We found that your liver enzyme levels were abnormally high. This is likely due to a medication (amiodarone) that you have been taking. We stopped that medication and your liver enzymes downtrended. You also started eating more in the hospital. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Please follow up with your PCP as scheduled. It was a pleasure caring for you. 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. Aspirin 81 mg PO DAILY 3. Latanoprost 0.005% Ophth. Soln. 1 DROP RIGHT EYE HS 4. Pravastatin 40 mg PO DAILY 5. Tamsulosin 0.4 mg PO HS 6. Vitamin D 1000 UNIT PO DAILY 7. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth twice daily Disp #*10 Tablet Refills:*0 8. lisinopril-hydrochlorothiazide ___ mg ORAL DAILY Discharge Disposition: Home with Service Discharge Diagnosis: Mechanical fall, atraumatic Hematuria, possibly related to benign prostatic hyperplasia Chest pain, musculoskeletal versus a bout of stable angina Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - walks with a cane. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after a mechanical fall. The reason you were admitted was actually a bout of chest pain, but you had a negative workup and your chest pain has resolved. You were seen by the urologists for hematuria, and they plan to send you home with the foley catheter and then see you as an outpatient next week. You worked with ___ and they felt you were safe for discharge home with home physical therapy.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 20 mg PO BID 2. Pravastatin 40 mg PO QPM 3. Keppra (levETIRAcetam) 1,000 mg oral 2 tablets by mouth twice a day 4. Lorazepam 0.5 mg PO BID:PRN seizure/anxiety 5. Clobazam 5 mg PO BID RX *clobazam [Onfi] 10 mg 0.5 (One half) tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Generalized Epilepsy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted for slurred speech, unsteadiness and myoclonic jerks, which were concerning for Fycompa toxicity. Your brain imaging was normal. Your Fycompa and Vimpat were tapered off. You had no seizure. You were started on clobazam (Onfi) a new medication which you are tolerating well. You will take Onfi ___ tablet in the morning and at night. Dr. ___ will uptitrate this if you are having further seizures. Please continue to take lorazepam (Ativan) if you are have seizures at home. If you need to take lorazepam, please call Dr. ___ office as she may want to adjust your medications. Please follow up with Neurology and take your medications as prescribed. Sincerely, YOUR ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN fever 2. Docusate Sodium 100 mg PO BID:PRN Constipation 3. Enoxaparin Sodium 80 mg SC Q12H Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 80 mg/0.8 mL 0.8 ml subcut twice a day Disp #*28 Syringe Refills:*0 4. travoprost 0.004 % ophthalmic QD 5. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *polyethylene glycol 3350 [Laxative PEG 3350] 17 gram 1 packet by mouth daily prn Disp #*30 Packet Refills:*0 6. Warfarin 5 mg PO DAILY16 RX *warfarin [Coumadin] 5 mg 1 tablet(s) by mouth daily Disp #*50 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: primary diagnosis: pulmonary embolism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to participate in your care here at the ___ ___. You were admitted for chest pain and found to have large blood in your lungs. We started you on blood thinners to treat this. You will need to be on Lovenox (injectable blood thinners) while we transition you to the pill form (coumadin or warfarin). You will need to follow up with your PCP to adjust the dose. Please follow-up with your outpatient providers as outlined below. We wish you the best, Your ___ team transitional issues: - please make sure your visiting nurse checks your blood on ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levofloxacin 750 mg PO DAILY RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*5 Tablet Refills:*0 2. Acyclovir 400 mg PO Q12H 3. Amitriptyline 10 mg PO QHS 4. Atovaquone Suspension 1500 mg PO DAILY 5. Fluconazole 400 mg PO Q24H 6. Isosorbide Dinitrate 10 mg PO TID 7. Melatin (melatonin) 1 mg oral QHS:PRN 8. Metoprolol Succinate XL 200 mg PO DAILY 9. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 10. Omeprazole 20 mg PO DAILY 11. Ondansetron 8 mg PO Q8H:PRN nausea 12. Tamsulosin 0.4 mg PO QHS 13. Vancomycin Oral Liquid ___ mg PO BID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES ACUTE HEMOLYTIC REACTION FEBRILE NEUTRAPENIA PNEUMONIA AFIB WITH RVR RELAPSED AML Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted for a platelet transfusion reaction. We did a work up and found you were allergic to certain type of blood products and will not get this type from here on out. You were also treated with antibiotics because you developed fever and was found to have pneumonia. You will follow up with Dr. ___ as stated below. It was a pleasure taking care of you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Docusate Sodium 100 mg PO BID constipation 3. LeVETiracetam 750 mg PO BID RX *levetiracetam 750 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 4. Nimodipine 60 mg PO Q4H RX *nimodipine 30 mg 2 capsule(s) by mouth every four (4) hours Disp #*144 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Subarachnoid hemorrhage Left MCA aneurysm Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Surgery/ Procedures: •You had a cerebral angiogram to coil your MCA aneurysm. You may experience some mild tenderness and bruising at the puncture site (groin). Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. •You make take a shower. •No driving while taking any narcotic or sedating medication. •If you experienced a seizure while admitted, you must refrain from driving. Medications •Resume your normal medications and begin new medications as directed. •Please do NOT take any blood thinning medication (Aspirin, Plavix, Coumadin) until cleared by the neurosurgeon. •You have been discharged on a medication called Nimodipine. This medication is used to help prevent cerebral vasospasm (narrowing of blood vessels in the brain). Finish all doses of this medication. •You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication until follow-up. It is important that you take this medication consistently and on time. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •Mild to moderate headaches that last several days to a few weeks. •Difficulty with short term memory. •Fatigue is very normal •Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site or puncture site. •Fever greater than 101.5 degrees Fahrenheit •Constipation •Blood in your stool or urine •Nausea and/or vomiting •Extreme sleepiness and not being able to stay awake •Severe headaches not relieved by pain relievers •Seizures •Any new problems with your vision or ability to speak •Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: •Sudden numbness or weakness in the face, arm, or leg •Sudden confusion or trouble speaking or understanding •Sudden trouble walking, dizziness, or loss of balance or coordination •Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg every four (4) hours Disp #*80 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID 4. Senna 1 TAB PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: grade 1 open Left both bone forearm fracture Discharge Condition: stable alert and oriented independent ambulation Followup Instructions: ___ [/INST] </s><s>******SIGNS OF INFECTION********** Please return to the emergency department or notify MD if you should experience severe pain, increased swelling, decreased sensation, difficulty with movement; fevers >101.5, chills, redness or drainage at the incision site; chest pain, shortness of breath or any other concerns. -Wound Care: You can get the wound wet/take a shower starting from 3 days post-op. 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 continued to be non-draining. ******WEIGHT-BEARING******* NWB LUE; ok to come out of splint for supervised gentle PROM but otherwise wear splint while ambulating / sleeping ******MEDICATIONS*********** - Resume your pre-hospital medications. - You have been given medication for your pain control. Please do not operate heavy machinery or drink alcohol when taking this medication. As your pain improves please decrease the amount of pain medication. This medication can cause constipation, so you should drink ___ glasses of water daily and take a stool softener (colace) to prevent this side effect. -Medication refills cannot be written after 12 noon on ___. *****ANTICOAGULATION****** -No anticoagulation needed. You should be ambulating a normal amount. ******FOLLOW-UP********** Please follow up with ___ in ___ days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your PCP regarding this admission and any new medications/refills.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 40 mg PO QPM 3. Cyanocobalamin 1000 mcg PO DAILY 4. Losartan Potassium 25 mg PO DAILY 5. MetFORMIN (Glucophage) 850 mg PO BID 6. rOPINIRole 0.5 mg PO QPM 7. TraMADol 50 mg PO QHS 8.Outpatient Occupational Therapy Evaluate and treat Dx: R26.89 9.Outpatient Physical Therapy Evaluate and treat Dx: R26.89 Discharge Disposition: Home Discharge Diagnosis: Encephalopathy, transient, of undetermined etiology (possibly hypertensive) 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>Mr. ___, You were admitted after you had an episode during which you were 'stuck' and couldn't move, particularly your legs. You were also very pale during this time. We did tests including a CT scan that showed there was no bleeding in the brain, a CT scan with dye showing that the blood vessels going to your brain have cholesterol plaques, but are all open, and an MRI scan showing you did NOT have a stroke. It is difficult to say for sure what it was that happened yesterday. We will need to continue testing after you leave the hospital to look into this. Though we don't know for sure what caused this event, we have been able to rule out many dangerous causes with the testing we did in the hospital. We did an EEG test (a brain wave test) while you were here, and the results are pending. You were also seen by physical and occupational therapy, who recommended continuing to see both physical and occupational therapy as an outpatient. We did not change any of your medications. You are already taking the right medications to treat the cholesterol plaques in your blood vessels. It is very important to follow up with your Primary Care Physician to continue to look into potential causes of this episode. Talk to them about whether or not it could have been related to your heart. It is also very important to follow up with Neurology. Your Primary Care Physician ___ refer you to a Neurologist at ___ (___), or to one here at ___. ___ will work with you to figure out why you have had memory problems and falls over the past months-years, and also continue to think about whether or not the episode yesterday may have been from a brain problem. Please do not hesitate to call us at ___ if you have any questions/concerns. Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain RX *acetaminophen 650 mg 1 tablet(s) by mouth every 8 hiours Disp #*30 Tablet Refills:*0 2. Amlodipine 10 mg PO DAILY 3. Atenolol 25 mg PO DAILY 4. Erythromycin 0.5% Ophth Oint 0.5 in BOTH EYES QID RX *erythromycin 5 mg/gram (0.5 %) 1 drop four times a day Refills:*0 5. Hydrochlorothiazide 12.5 mg PO DAILY 6. LeVETiracetam 500 mg PO BID RX *levetiracetam 500 mg 1 tablet(s) by mouth twice a day Disp #*70 Tablet Refills:*0 7. Quinapril 40 mg PO DAILY 8. Simvastatin 20 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: Left maxillary sinus fracture, left posteriorlateral orbital wall fracture, non-displaced left sphenoid fracture, left sided subdural hematoma, focal right lateral ventricular hemorrhage, and small left frontal subcortical hemorrhage 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 at ___ after your fall. You suffered multiple injuries including a left maxillary sinus fracture, left posteriorlateral orbital wall fracture, non-displaced left sphenoid fracture, left sided subdural hematoma, focal right lateral ventricular hemorrhage, and small left frontal subcortical hemorrhage. You are now ready for discharge from the hospital. Please follow-up with your scheduled outpatient appointments. Please also see the following discharge instructions for post-hospitalization care. 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. Sincerely, ___ Surgery</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN pain 2. Mirtazapine 15 mg PO HS 3. TraMADOL (Ultram) 50 mg PO BID:PRN pain 4. CeftriaXONE 1 gm IV Q24H Duration: 3 Days continue 3 days after discharge, through ___ 5. Senna 17.2 mg PO DAILY:PRN constipation 6. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush 7. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line flush 8. Bisacodyl 10 mg PR HS:PRN constipation 9. Fleet Enema ___AILY:PRN constipation 10. LOPERamide 2 mg PO QID:PRN diarrhea 11. Ondansetron 4 mg PO Q8H:PRN nausea 12. TraZODone 25 mg PO BID 13. Zinc Sulfate 220 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Urinary tract infection SECONDARY DIAGNOSES: Dementia, Stage IV decubitus ulcer, hypertension, hearing loss, L3 compression fracture Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital because of a urinary tract infection and confusion. You received fluids and antibiotics and your blood pressure recovered. You were treated with antibiotics and your infection showed signs of improvement. An special IV ("midline") was placed to allow you to continue your antibiotics after you leave the hospital. You will receive a total of one week of antibiotics, which will require three more days after discharge. The wound care team saw your bed sore ("decubitus ulcer") and made recommendations on the best way to treat it and prevent further progression.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You came to the hospital with abdominal pain and nausea. You underwent testing including imaging studies and a sigmoidoscopy which raised concern for a likely crohns disease flare with resultant bowel obstruction and pouchitis. At the recommendation of the GI doctors and ___, a rectal tube was placed to decompress your bowels and you were started on IV steroids with improvement in your symptoms. You should continue on steroids by mouth (prednisone) every day to complete a ___s well as antibiotics by mouth every day to complete a 7 day course. It is very important that you reach out to your outpatient GI doctors to ___ follow up in ___ weeks and consider re-initiating humira at their discretion. We will be in touch with their staff to ensure a safe transition of your care. It was a pleasure taking care of you. We wish you all the best!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Metoprolol Tartrate 6.25 mg PO BID hold for SBP <100, HR<60 2. Pantoprazole 40 mg PO Q24H Duration: 30 Days 3. Senna 8.6 mg PO BID:PRN Constipation - First Line 4. Sulfameth/Trimethoprim DS 1 TAB PO BID take through ___. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild 6. Acetaminophen ___ mg PO QNOON:PRN Pain - Mild 7. Aspirin 81 mg PO DAILY 8. Atorvastatin 80 mg PO QPM 9. Citalopram 20 mg PO DAILY 10. Docusate Sodium 100 mg PO DAILY:PRN Constipation - First Line 11. Furosemide 40 mg PO DAILY 12. HELD- Ferrous Sulfate 325 mg PO DAILY This medication was held. Do not restart Ferrous Sulfate until you finish Bactrim 13. HELD- Metoprolol Succinate XL 25 mg PO DAILY This medication was held. Do not restart Metoprolol Succinate XL until your blood pressure and heart rate is better 14. HELD- Zestoretic (lisinopril-hydrochlorothiazide) ___ mg oral DAILY This medication was held. Do not restart Zestoretic until you finish Bactrim Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: acute blood loss anemia secondary to GI bleed acute on chronic systolic heart failure NSTEMI complicated UTI delirium nighttime hypoxia Secondary: dementia CKD chronic lymphedema severe AS pleural plaques 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. ___, You came to the hospital because you were not feeling well at home and your granddaughter was worried about you. Your stool was darker than normal. You went to the emergency room and your blood count was found to be low, probably because of a GI bleed. You were transferred to ___ and received 2 units of blood. You felt better after that. You had an endoscopy to look in your stomach which did not show any bleeding. Your lungs got backed up with fluid from getting a blood transfusion. You got better with IV medicine to help pee out the fluid. You had fevers. We found out that you have a urinary tract infection. You need to finish antibiotics at rehab. You had low oxygen at night. This might be because of sleep apnea. A CPAP machine helped you. You will need a sleep study as an outpatient in order to see if you have sleep apnea. When you leave the hospital, please: - go to rehab to get stronger - take all of your medicines as prescibed - see below for your followup appointments It was a pleasure caring for you and 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. Lisinopril 10 mg PO DAILY 2. Hydrochlorothiazide 12.5 mg PO DAILY 3. Docusate Sodium 100 mg PO BID hold for loose stool 4. Ciprofloxacin HCl 500 mg PO Q12H last dose ___ RX *ciprofloxacin 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*26 Tablet Refills:*0 5. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H last dose ___ RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*39 Tablet Refills:*0 6. Acetaminophen 650 mg PO Q6H:PRN pain 7. Sodium Chloride 0.9% Flush ___ mL IV Q8H please flush JP drain RX *sodium chloride 0.9 % [Normal Saline Flush] 0.9 % ___ cc via ___ drain every eight (8) hours Disp #*30 Syringe Refills:*0 8. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN pain may cause dizziness RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: perforated appendix 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 then developed a fever and you were seen by your primary care provider. You underwent a cat scan which showed a perforated appendix with an abscess. You went to ___ drainage where a drain was placed into the collection. Your vital signs have been stable. You are now preparing for discharge home with the following instructions: Please call your doctor or return to the emergency room if you have any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep ___ fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change ___ your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. Activity: No heavy lifting of items ___ pounds for 6 weeks. You may resume moderate exercise at your discretion, no abdominal exercises. You will be discharged with the drain ___ place with the following instructions: General Drain Care: *Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *If the drain is connected to a collection container, please note color, consistency, and amount of fluid ___ the drain. Call the doctor, ___, or ___ nurse if the amount increases significantly or changes ___ character. Be sure to empty the drain frequently. Record the output, if instructed to do so. *Wash the area gently with warm, soapy water. *Keep the insertion site clean and dry otherwise. *Avoid swimming, baths, hot tubs; do not submerge yourself ___ water. *Make sure to keep the drain attached securely to your body to prevent pulling or dislocation</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Lisinopril 5 mg PO DAILY 3. PHENObarbital 48.6 mg PO QAM 4. PHENObarbital 64.8 mg PO QPM 5. Phenytoin Sodium Extended 300 mg PO QHS 6. QUEtiapine Fumarate 400 mg PO BID 7. RISperidone 2 mg PO BID 8. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Epilepsy Intellectual Disabilities Chronic Kidney Disease Schizophrenia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the Neurology Inpatient Service because you had 2 seizures. We have increased your phenobarbital dose. Your EEG did not show any seizures however we did not capture your typical episode. Your MRI showed a chronic injury in the left parietal area of your brain. It also showed 6 x 3 x 8mm, 2 x 1 x 2mm, and 2 x 2x 2 mm nonenhancing intraventricular nodules, arising from the lateral and superior margins of left lateral ventricle with no definite associated ventriculomegaly and no definite blood products or mineralization. However, these findings do not explain why you may have headaches. There is no sign of increased pressure in your head.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q8H:PRN pain or headache 2. Fulvestrant 250 mg IM Q 28 DAYS Duration: 1 Doses Next dose due ___. Azithromycin 250 mg PO Q24H Duration: 3 Doses RX *azithromycin 250 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 4. Albuterol Inhaler ___ PUFF IH Q4H:PRN shortness of breath or wheeze RX *albuterol ___ puffs every 4 hours Disp #*1 Inhaler Refills:*0 5. PredniSONE 60 mg PO DAILY RX *prednisone 20 mg 3 tablet(s) by mouth daily Disp #*9 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: COPD exacerbation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you at ___ ___. You were admitted with shortness of breath. This was caused by cigarette smoking and a viral upper respiratory infection. We started you on medications to help open the airways and reduce the irritation in your lungs. It is important that you quit smoking to prevent these events from occurring again in the future.</s>