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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H 2. Bisacodyl ___AILY 3. Citalopram 20 mg PO BID 4. Cyanocobalamin 100 mcg PO DAILY 5. Docusate Sodium 100 mg PO BID:PRN constipation 6. Fludrocortisone Acetate 0.1 mg PO DAILY 7. Fludrocortisone Acetate 0.05 mg PO QHS 8. Gabapentin 800 mg PO QHS 9. Levothyroxine Sodium 137 mcg PO DAILY 10. Omeprazole 20 mg PO DAILY 11. Polyethylene Glycol 17 g PO DAILY 12. Senna 8.6 mg PO BID 13. Vitamin D 3000 UNIT PO DAILY 14. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every ___ hours Disp #*30 Tablet Refills:*0 15. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 5 Days RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice daily Disp #*6 Tablet Refills:*0 16. Cal-Citrate (calcium citrate-vitamin D2) ___ mg oral TID 17. grape seed oil (bulk) 100 mg PO DAILY 18. Melatin (melatonin) 10 mg oral QHS 19. Multivitamins 1 TAB PO DAILY 20. Medipore H (adhesive tape) 3 X 10 topical DAILY Please dispense 1 Roll RX *adhesive tape 1" X ___ yard Apply dressing daily Disp #*1 Package Refills:*2 21. Gauze Pad (gauze bandage) 4 X 4 topical DAILY RX *gauze bandage 4" X 4" Apply dressing daily Disp #*2 Package Refills:*2 22. Tech Split Drain Sponge ICD 10: 87.51 Duration: Ongoing Please dispense split-drain sponge, 1 Box to apply daily Refill: 2 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: 1. Ampullary Stricture with PTBD Drain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___ was a pleasure taking care of you during your hospital stay at ___. You were hospitalized for concern of your biliary drain, and underwent a procedure by the Interventional Radiology Team to dilate and help this drain more effectively. While here, we were able to control your pain with pain relievers, and started you on antibiotics because we were concerned for a skin infection near your drain entry site. Please continue to take all of your home medications as prescribed. Please follow-up with your primary care physician, and the interventional radiology team as an outpatient. Take Care, Your ___ Team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cephalexin 500 mg PO Q6H RX *cephalexin 500 mg 1 tablet(s) by mouth every 6 hours Disp #*25 Tablet Refills:*0 2. Clotrimazole Cream 1 Appl TP BID:PRN rash RX *clotrimazole 1 % one application under breasts and abdominal skin twice daily as needed for fungal skin rash Disp #*30 Gram Gram Refills:*0 3. Miconazole Powder 2% 1 Appl TP TID:PRN rash under breasts and pannus 4. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 5. Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB/wheeze 6. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL TID 7. BuPROPion XL (Once Daily) 300 mg PO DAILY 8. Chantix (varenicline) 1 mg oral BID 9. ChlorproMAZINE 50 mg PO QAM 10. ChlorproMAZINE 100 mg PO QPM 11. Cyanocobalamin 100 mcg PO DAILY 12. DiphenhydrAMINE 50 mg PO QHS:PRN insomnia 13. Docusate Sodium 100 mg PO BID 14. Fluticasone Propionate 110mcg 1 PUFF IH BID 15. Gabapentin 800 mg PO TID 16. Ibuprofen 600 mg PO Q6H:PRN Pain - Mild Reason for PRN duplicate override: Patient is NPO or unable to tolerate PO 17. LamoTRIgine 25 mg PO DAILY 18. Latuda (lurasidone) 40 mg oral DAILY 19. Pyridoxine 50 mg PO DAILY 20. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Erysipelas Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, What brought you to the hospital? ================================ You came to the hospital because of abdominal pain, rash, fever/chills. What happened while you were in this hospital? ============================================= -You were found to have a skin infection on your abdomen -You receiving imaging of your abdomen and pelvis, which found: -No evidence of an infected collection or "abscess" -You were started on antibiotics and the skin infection was monitored and improved. -You were discharged on a course of antibiotics. What should you do when you leave the hospital? ============================================== -You should take the Cephelaxin 500mg 4x/day (every 6 hours) for another 6 days, last full day ___. You should take the full course of antibiotics as prescribed. -You should carefully clean the skin around the infection, making sure not to be too rough when cleaning to cause cuts or abrasions to the skin. -Please follow up with your ___ clinic provider on ___. You can walk into the ___ clinic. -Please bring your discharge paperwork to your follow up visit with your suboxone provider and your primary care doctor. -You should have a follow up appointment with your primary care physician, ___, on ___ at 2:15. 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. Glargine 18 Units Breakfast Novolog 2 Units Breakfast Novolog 2 Units Lunch Novolog 2 Units Dinner Insulin SC Sliding Scale using Novolog Insulin 2. Lidocaine 5% Patch 1 PTCH TD QAM 3. Spiriva Respimat (tiotropium bromide) 2.5 mcg/actuation inhalation 2 puffs daily 4. PredniSONE 5 mg PO DAILY 5. ___ MD to order daily dose PO DAILY16 6. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever 7. Aspirin 81 mg PO DAILY 8. Docusate Sodium 100 mg PO BID 9. Dulera (mometasone-formoterol) 200-5 mcg/actuation inhalation BID 10. Ezetimibe 10 mg PO DAILY 11. FoLIC Acid 1 mg PO DAILY 12. Furosemide 40 mg PO DAILY 13. Levalbuterol Neb 0.63 mg NEB BID:PRN shortness of breath 14. Losartan Potassium 100 mg PO DAILY 15. Metoprolol Succinate XL 100 mg PO QHS 16. Metoprolol Tartrate 25 mg PO TID:PRN palpitations 17. Milk of Magnesia 30 mL PO Q8H:PRN Constipation - First Line 18. Montelukast 10 mg PO DAILY 19. Nitroglycerin SL 0.4 mg SL ASDIR chest pain 20. Omeprazole 20 mg PO BID 21. Ondansetron 4 mg PO Q8H:PRN Nausea/Vomiting - First Line Reason for PRN duplicate override: Discontinuing IV zofran 22. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate 23. Polyethylene Glycol 17 g PO DAILY 24. riTUXimab 1000 mg IV EVERY 3 MONTHS 25. Senna 8.6 mg PO BID:PRN Constipation - First Line 26. Tiotropium Bromide 1 CAP IH AT BEDTIME 27. Zoledronic Acid (Reclast) (zoledronic acid-mannitol-water) 5 mg/100 mL injection ANNUALLY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Pelvic abscess / hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted with bleeding from your pelvic fluid collection. You had a drain placed under CT guidance and were started on antibiotics to treat the infected fluid collection. You are recovering well and are now ready for discharge. Please follow the instructions below to continue your recovery: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q6H:PRN respiratory distress 2. Atazanavir 300 mg PO DAILY 3. Calcium Carbonate 600 mg PO BID 4. ClonazePAM 1 mg PO TID 5. Divalproex (DELayed Release) 250 mg PO TID 6. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY 7. Escitalopram Oxalate 40 mg PO QHS 8. Fenofibrate 145 mg PO DAILY 9. Methadone 170 mg PO DAILY 10. Metoprolol Tartrate 50 mg PO BID 11. Multivitamins W/minerals 1 TAB PO DAILY 12. OxycoDONE (Immediate Release) 5 mg PO Q4-6H PRN Pain RX *oxycodone 5 mg 1 tablet(s) by mouth q4hr Disp #*50 Tablet Refills:*0 13. Pregabalin 50 mg PO BID 14. Ranitidine 150 mg PO BID 15. RiTONAvir 100 mg PO DAILY 16. Hydrochlorothiazide 25 mg PO DAILY 17. dextroamphetamine-amphetamine 20 mg ORAL TID 18. Gabapentin 100 mg PO TID 19. Ibuprofen 600 mg PO Q6H:PRN Pain 20. Bisacodyl 10 mg PO DAILY:PRN constipation 21. Docusate Sodium 100 mg PO BID:PRN Constipation 22. Enoxaparin Sodium 40 mg SC QPM Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 40 mg sc qpm Disp #*30 Syringe Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: right femoral avascular necrosis Secondary: Hep C, HIV, HTN, HLD, bipolar disorder, panic disorder, ADHD 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 take part in your care at ___ ___. You were admitted for right hip pain. An xray revealed that your hip has avascular necrosis (bone collapse) and you underwent orthopedic hip surgery. 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: - Touch down weight bearing right lower extremity MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take Lovenox 40mg daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns FOLLOW UP: Please follow up with your surgeon's team (Dr. ___, with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for and any new medications/refills. Physical Therapy: Touch down weight bearing right lower extremity Posterior precautions of right hip Treatments Frequency: - 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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cephalexin 500 mg PO/NG Q8H Duration: 5 Days 2. Losartan Potassium 25 mg PO DAILY 3. Rivaroxaban 20 mg PO DINNER 4. Spironolactone 25 mg PO DAILY 5. Torsemide 20 mg PO DAILY 6. Aspirin 81 mg PO DAILY 7. Atorvastatin 40 mg PO QPM 8. Escitalopram Oxalate 20 mg PO DAILY 9. Metoprolol Succinate XL 12.5 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: - Acute heart failure reduced ejection fraction from ventricular dyssynchrony SECONDARY: - Atrial fibrillation - Acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because of your heart failure. Please see below for more information on your hospitalization. It was a pleasure participating in your care! We wish you the best! - Your ___ Healthcare Team What happened while you were in the hospital? - You were given medication to help reduce the amount of fluid in your body to help improve your breathing and leg swelling. - You were evaluated for a double pacemaker to help both sides of your heart beat more synchronously. This was done on ___. You had some bleeding around the device afterwards which was causing some pain, but the device specialists said this should improve with time. - You were improved significantly and were ready to leave the hospital. What should you do after leaving the hospital? - Weight yourself daily. On the day of discharge, your weight is 231 pounds. Call your doctor if your weight increases by more than three pounds. You might need - Please take your medications as listed in discharge summary and follow up at the listed appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for pain. 2. amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 3. ascorbic acid ___ mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO QHS (once a day (at bedtime)). 5. cetirizine 10 mg Tablet Sig: One (1) Tablet PO once a day. 6. cholecalciferol (vitamin D3) 1,000 unit Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. ferrous sulfate 300 mg (60 mg iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. levothyroxine 88 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). 10. multivitamin,tx-minerals Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 12. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) Powder in Packet PO DAILY (Daily). 13. prednisone 5 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). 14. senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day. 15. Aloe Vesta 2 % Ointment Sig: One (1) Topical twice a day. 16. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Chronic Deep Venous Thrombosis Secondary: Hypertension Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a sincere pleasure taking care of you during your hospitalization at ___. You were admitted with swelling of your left leg. We found that the clot in your leg was likely old or "chronic." After discussions of the risks and benefits of treatment with you and your family, it was decided that you would not restart coumadin. If you are to develop any worsening redness, pain or swelling in your leg, or shortness of breath/chest pain, you should report immediately to the emergency department. PLEASE NOTE THE FOLLOWING MEDICATION CHANGES: RESTARTED ASPIRIN 81 MG DAILY</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 50 mg PO DAILY 2. Lisinopril 10 mg PO DAILY 3. Paroxetine 30 mg PO DAILY 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 5. Docusate Sodium 100 mg PO BID 6. Acetaminophen 650 mg PO Q6H:PRN pain Discharge Disposition: Home Discharge Diagnosis: 1. Choledocholithiasis 2. Cholelithiasis 3. Pancreatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you on this admission. You came to the hospital because you were having abdominal pain, nausea, and dark urine. You were found to have an obstruction of your bile duct. This caused your pancreas to get inflammed. You were treated with IV fluids and pain control. You underwent an ERCP to remove some stones, and then you had your gallbladder removed to ensure the problem wouldn't recur. You tolerated the procedure well and are now being discharged home to continue your recovery with the following instructions. Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o 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. Aspirin 81 mg PO DAILY 2. Atorvastatin 80 mg PO DAILY 3. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 4. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 5. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS 6. Levothyroxine Sodium 75 mcg PO DAILY 7. Multivitamins 1 TAB PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Vitamin D 1000 UNIT PO DAILY 10. Albuterol Inhaler 2 PUFF IH Q8H:PRN sob 11. Alendronate Sodium 70 mg PO QMON 12. Os-Cal 500 + D3 (calcium carbonate-vitamin D3) 500 mg(1,250mg) -200 unit oral daily 13. Acetaminophen 325-650 mg PO Q6H:PRN pain 14. Metoprolol Succinate XL 25 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY: Aortic stenosis status post valvuloplasty SECONDARY: Acute Kidney Injury. Retroperitoneal hematoma. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking care you during your hospitalization. You were admitted because you were having lightheadedness and shortness of breath with activity that we felt was caused by your aortic stenosis. You were scheduled for a repeat balloon valvuloplasty in ___ but we decided to do it on this admission because of your symptoms. The valvuloplasty was successful but it was complicated by bleeding which caused you to have low blood pressures and your kidneys to be damaged. Your blood pressure, blood counts and kidney function had all improved and were stable by the time your discharge. Your lasix was stopped. You should followup with your cardiologist. 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. Finasteride 5 mg PO DAILY 2. Tamsulosin 0.4 mg PO BID 3. Bethanechol 25 mg PO TID 4. Acetaminophen 650 mg PO TID 5. Docusate Sodium 100 mg PO TID 6. Senna 17.2 mg PO HS 7. Potassium Chloride 10 mEq PO DAILY 8. Levothyroxine Sodium 88 mcg PO DAILY 9. Ascorbic Acid ___ mg PO DAILY 10. cranberry 405 mg oral daily 11. Magnesium Oxide 400 mg PO DAILY 12. CloniDINE 0.3 mg PO BID 13. Metoprolol Tartrate 25 mg PO BID 14. Mirtazapine 7.5 mg PO HS 15. Pantoprazole 40 mg PO Q24H 16. BuPROPion 75 mg PO HS 17. Amlodipine 7.5 mg PO DAILY 18. Bisacodyl ___VERY 3 DAYS 19. Polyethylene Glycol 17 g PO DAILY 20. Multivitamins 1 TAB PO DAILY 21. Vitamin D 50,000 UNIT PO QMONTH 22. Warfarin 4 mg PO DAILY16 Duration: 3 Days Needs INR check on ___ to determine dosing 23. ertapenem 1 gram injection every 24 hours Duration: 7 Days RX *ertapenem [Invanz] 1 gram 1 gram iv every 24 hours Disp #*7 Vial Refills:*0 24. Collagenase Ointment 1 Appl TP DAILY 25. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: ESBL E. coli UTI Anemia, likely anemia of chronic disease 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>You were sent from your nursing home with confusion and fever, due to inadequately treated UTI. You were given IV antibiotics with good improvement in your symptoms. You will need to complete a course of IV antibiotics via midline IV. Because your Coumadin levels were high, your Coumadin was held and you were given some Vitamin K to reverse the Coumadin. You will need to resume your Coumadin and have your INR monitored. . Please take your medications as listed. . Please see your physicians as listed. .</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 - Moderate 2. Atorvastatin 40 mg PO QPM 3. Ibuprofen 600 mg PO Q8H:PRN Pain - Moderate 4. Glargine 18 Units Bedtime 5. LORazepam 1 mg PO Q6H:PRN nausea, anxiety 6. Nystatin Oral Suspension 15 mL PO QID 7. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Severe 8. Prochlorperazine 10 mg PO Q6H:PRN nausea 9. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY - recurrent small bowel obstruction SECONDARY - metastatic rectal cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___. You were admitted because of your nausea and vomiting, which was secondary to a recurrent small bowel obstruction. Your symptoms improved after advancing your diet very slowly and giving fluids through the IV. It is very important for you to continue advancing your diet very slowly. It is also very important for you to follow up with your physicians as scheduled (see below for your upcoming appointments). Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___. You were admitted on ___ with a 2-day history of nausea/vomiting, diffuse abdominal pain and constipation. In the emergency room, most of your laboratory work-up was negative except for elevated inflammatory markers. You also had a CT scan to look at your abdomen and pelvis, which was concerning for inflammation at the end of your small intestine as well as a partial obstruction of your small intestine. You were evaluated by the surgical service, who thought that there was no surgical concern at that time. On admission to the medicine floor, you had significant abdominal pain and was very dehydrated. You were hydrated with intravenous fluid since drinking made your pain worse. We also started you on two antibiotics named ciprofloxacin and flagyl to decrease the inflammation and improve your symptoms. You were also seen by our gastroenterologists who thought you may be suffering from inflammatory bowel disease given your history. Your symptoms continue to improve over 48 hours and by the ___ day of your stay, you were able to tolerate a regular diet with no abdominal pain or nausea. Also, your blood culture grew some bateria so we switched you antibiotic to cover for the microbes. By the time of discharge, you were able to walk on your own, your pain was significantly improved, you have transitioned successfully to oral pain medication and you have been tolerating a regular diet. We sent some labs as requested by our gastroenterologist in preparation, should you need any treatment in the future based on further analysis as outpatient. We strongly suggested you follow-up with the appointment with the gastroenterologist and on getting a colonoscopy, which you understand is not only important for screening for colon cancer but also may help in making the final diagnosis. Please take all your medications as prescribed. You will be on a steroid which you will be taking every morning. You will also be on oxycodone for pain so avoid driving while on this medication. PLEASE BE SURE TO HAVE YOUR PPD READ ON ___ BY A NURSE OR DOCTOR AT YOUR PRIMARY CARE DOCTOR'S OFFICE. Thank you for choosing the ___. We wish you the very best. Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 1,000 mg-62.5 mg 1 tablet(s) by mouth twice a day Disp #*42 Tablet Refills:*0 2. Lisinopril 5 mg PO DAILY 3. Calcitriol 0.5 mcg PO DAILY 4. Calcium Carbonate 500 mg PO TID 5. Metoclopramide 10 mg PO QHS 6. Pantoprazole 40 mg PO Q12H 7. Simvastatin 10 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: Diverticulitis with pericolonic 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. ___, You were admitted to ___ for diverticulitis causing a small intra-abdominal abscess. You were treated with antibiotics. You are being discharged on antibiotics to complete a 3-week course. After that, you will have a repeat CT scan and follow up with Dr. ___ in clinic. Please read and follow the following instructions for discharge. General Discharge Instructions: -Please resume all regular home medications, unless specifically advised not to take a particular medication. Please take any new medications as prescribed. Take Augmentin for a total 3-week antibiotic course (___). -Please take the prescribed analgesic medications as needed. You may not drive or heavy machinery while taking narcotic analgesic medications. You may also take acetaminophen (Tylenol) as directed, but do not exceed 3000 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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 2. Fluticasone Propionate NASAL 2 SPRY NU DAILY Discharge Disposition: Home Discharge Diagnosis: -Right PCA territory stroke -R ICA occluded from common carotid to intracranial portion where it reconstitutes - unknown chronocity 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 unsteady walking and visual changes 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: Prior smoking We are changing your medications as follows: Take aspirin 81mg daily Please take your other medications as prescribed. Please followup with Neurology and your primary care physician. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - sudden partial or complete loss of vision - sudden loss of the ability to speak words from your mouth - sudden loss of the ability to understand others speaking to you - sudden weakness of one side of the body - sudden drooping of one side of the face - sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Pantoprazole 40 mg PO Q24H 3. Xeljanz (tofacitinib) 5 mg oral DAILY 4. Citalopram 40 mg PO DAILY 5. Calcium 500 + D (D3) (calcium carbonate-vitamin D3) 500 mg(1,250mg) -125 unit oral DAILY 6. Lactobacillus acidophilus ___ colonies ORAL DAILY 7. Ondansetron 4 mg PO Q8H:PRN nausea 8. OxycoDONE (Immediate Release) ___ mg PO Q4-6H PRN pain 9. Promethazine 12.5 mg PO Q6H:PRN nausea 10. Warfarin 3 mg PO 3X/WEEK (___) 11. Warfarin 2 mg PO 4X/WEEK (___) 12. Outpatient Lab Work ___ (DOB ___ ICD Code ___.40 Please draw INR on ___ and fax results to ___, MD to ___ 13. OxycoDONE (Immediate Release) ___ mg PO Q4-6H:PRN pain RX *oxycodone 10 mg ___ tablet(s) by mouth Q4-6H:PRN Disp #*21 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Pancreatitis Perirectal abscess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, It was a pleasure taking care of you at ___. You were admitted because you had worsening abdominal pain for several days associated with nausea and vomiting, with difficulty being able to eat food and liquids, and decreased ostomy output. You were evaluated by the GI and colorectal services. Imaging did not reveal any perforation (as had occurred in the past), and we monitored you for any signs of obstruction or blockage. It was found on the CT image that you had a perirectal abscess, and per colorectal surgery, interventional radiology aspirated the fluid (culture pending). After the procedure, you had a fever, and we gave you IV antibiotics (cefepime and flagyl) to treat for a suspected infection. However, there was lower suspicion for infection at this point, and we discontinued the antibiotics. You will be discharged on your home oxycodone (Immediate Release) ___ mg PO Q4-6H PRN pain for a total of 21 pills. Please see your PCP on ___ to obtain refills. For your midline incision with two areas of yellow drainage: place wet gauze and let dry, and change dressing daily. Please follow up with your PCP on ___ at 9:30 AM. 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. Amitriptyline 10 mg PO HS 2. Docusate Sodium 100 mg PO BID 3. Fentanyl Patch 100 mcg/h TP Q72H 4. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Post-Op pain 5. Multivitamins W/minerals 1 TAB PO DAILY 6. Senna 2 TAB PO HS:PRN constipation 7. Aspirin 81 mg PO DAILY 8. One-A-Day Mens (multivit with min-FA-lycopene) 0.4-600 mg-mcg Oral daily 9. Psyllium 1 PKT PO TID 10. Sulindac 150 mg PO BID 11. Famotidine 20 mg PO BID:PRN epigastric pain RX *famotidine [___] 20 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 12. Calcium Carbonate 500 mg PO TID RX *calcium carbonate [Calcium 500] 500 mg calcium (1,250 mg) 1 tablet(s) by mouth three times daily Disp #*90 Tablet Refills:*0 13. LeVETiracetam 500 mg PO BID RX *levetiracetam 500 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 14. Vitamin D 800 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 15. Dexamethasone 4 mg PO Q8H Tapered dose - DOWN RX *dexamethasone 4 mg 1 tablet(s) by mouth three times daily Disp #*60 Tablet Refills:*0 16. Omeprazole 40 mg PO DAILY RX *omeprazole 40 mg 1 capsule,delayed ___ by mouth daily Disp #*30 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Metastatic melanoma Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You came to the hospital because of confusion and worsening mental status. This is secondary to advanced melanoma. You had a brain biopsy which revealed the tumor's response to treatment with surrounding swelling. You were started on steroids to decrease the swelling in your brain, and on seizure medication called keppra for possible seizure activity. You will not continue on your current treatment for the melanoma, but will be started on a new medication (a BRAF inhibitor). This will arrive in the mail. Please follow up with your outpatient oncologists as below regarding further management of your melanoma. Thank you for allowing us to take part in your care, Your ___ team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. famotidine 20 mg Tablet Sig: One (1) Tablet PO twice a day. 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 3. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 4. oxycodone-acetaminophen ___ mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain. 5. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain, fever: Do not exceed 4000mg acetaminophen over any 24-hour period. . 6. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day. 7. digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 9. levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 10. cefpodoxime 100 mg Tablet Sig: Two (2) Tablet PO Q24H (every 24 hours) for 2 days: last day is ___. 11. dexamethasone 6 mg Tablet Sig: One (1) Tablet PO twice a day. 12. insulin aspart 100 unit/mL Solution Sig: per sliding scale units Subcutaneous QACHS: Please give insulin per sliding scale depending on fingerstick blood glucose readings. 13. insulin glargine 100 unit/mL Solution Sig: Ten (10) units Subcutaneous QAM. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Cerebellar mass Carcinoma of the lung Urinary tract infection . Secondary: Diabetes Hypertension 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 Mr. ___, . You were admitted to the hospital with left sided facial droop and slurring of your words. A CAT scan of your head was done which showed that the mass in your head was stable to minimally larger in size. You also had imaging of your shunt which was in proper position and not kinked. An EEG was done which showed that you did NOT have any seizure activity. The cause of your left facial droop and slurred speech was thought to be secondary to swelling in your brain. We treated you for this with steroids. We also started you on Keppra, a medicine to prevent seizures. Of note, you also had a urinary tract infection which we treated with antibiotics. . We have made the following changes to your medications: -START Keppra 500mg twice daily -CHANGE Dexamethasone to 6mg PO bid -START Cefpodoxime 200mg daily, last day on ___ . On discharge, please follow up with Dr. ___ Dr. ___ ___ Dr. ___ as scheduled below. . 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. acyclovir 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours). Disp:*90 Tablet(s)* Refills:*0* 2. levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). Disp:*30 Tablet(s)* Refills:*0* 3. fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours). Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: acute myeloid leukemia left upper extremity deep vein thrombosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mrs. ___, ___ were admitted to the hospital for treatment of your leukemia with chemotherapy. ___ developed a blood clot of your right upper arm, likely due to the IV line that was used to infuse your medication. This line was removed, and ___ were treated with a blood thinner until your platelets (the cells that help your body form clots) dropped to a low level. . ___ were kept in the hospital until your white blood cells (the cells that fight infection) recovered from the chemotherapy treatment. . We have made the following changes to your medications: -START fluconazole (to prevent infection) -START levofloxacin (to prevent infection) -START Acyclovir (to prevent infection) -STOP lisinopril until instructed to do so by your outpatient doctors.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you Why you were admitted? - You were admitted because there was concern about your safety at home. What we did for you? - Physical therapy evaluated you and recommended that you go to a rehab facility, but unfortunately due to financial constraints, this could not be rearranged. It was determined that it was safest for you to be discharged to your sister's house. What you should do when you go home? - Continue taking all your medications as prescribed and go to the appointments that we have arranged. We wish you the best, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>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: - No baths or swimming. - Keep the pin sites on your external fixator clean and dry. - Keep wound sites wrapped with dry gauze if draining - No dressing is needed if wound is not draining. - Keep your leg elevated on 2 pillows as much as possible to prevent swelling. ACTIVITY AND WEIGHT BEARING: - Activity as tolerated - Left lower extremity: Non weight bearing, elevate on 2 pillows as much as possible until follow up with surgeon to prevent swelling.</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 a day Disp #*60 Tablet Refills:*3 2. Metoprolol Succinate XL 100 mg PO DAILY RX *metoprolol succinate 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 3. Acetaminophen 1000 mg PO Q8H 4. Apixaban 2.5 mg PO BID 5. diclofenac sodium 1 ? topical DAILY PRN pain 6. Fluticasone Propionate NASAL 2 SPRY NU DAILY 7. GlipiZIDE XL 5 mg PO DAILY 8. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 9. Januvia (SITagliptin) 25 mg oral DAILY 10. Ketoconazole Shampoo 1 Appl TP ASDIR 11. Levothyroxine Sodium 25 mcg PO DAILY 12. lutein 20 mg oral BID 13. Magnesium Oxide 400 mg PO QPM 14. nystatin 100,000 unit/gram topical DAILY:PRN 15. Omeprazole 20 mg PO DAILY 16. Pravastatin 40 mg PO QPM 17. Sertraline 50 mg PO DAILY 18. Torsemide 60 mg PO DAILY RX *torsemide 20 mg 3 tablet(s) by mouth daily Disp #*90 Tablet Refills:*3 19. TraMADol 50 mg PO Q6H:PRN Pain - Moderate 20. Vitamin D ___ UNIT PO DAILY 21. Zolpidem Tartrate 5 mg PO QHS:PRN insomnia 22.Home oxygen ICD-10 code: ___.0 Pulmonary Hypertension Home Oxygen: 4L Nasal Cannula with rest and exercise SpO2 with ambulation on 3L: 88% SpO2 seated on 3L NC: 95% Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: =========== Acute Diastolic heart failure exacerbation Acute on chronic hypoxemic respiratory failure Severe pulmonary 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>Ms. ___, Why were you admitted to the hospital? - you were admitted for worsening shortness of breath and low oxygen in your blood, especially with walking around. What was done for you in the hospital? - we gave you medications to take fluid off of your lungs. - We changed your medications as your blood pressure was low. - We decreased your beta blocker to help your heart pump better. - We increased your home oxygen level to 4L What should you do when you go home? - Wear your Oxygen at home all the time. - Take all your medications as prescribed that are listed on your medication sheet. - Weigh yourself every morning, call MD if weight goes up more than 3 lbs. - Please seek medical attention if you develop any chest pain, worsening shortness of breath, swelling in your legs or any other symptoms that concern you It was a pleasure taking care of you! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever 2. Lidocaine 5% Patch 1 PTCH TD QAM pain RX *lidocaine [Lidoderm] 5 % 1 patch qAM Disp #*14 Patch Refills:*0 3. Carbidopa-Levodopa (___) 1.5 TAB PO 5X/DAY 4. Carbidopa-Levodopa CR (___) 1 TAB PO DAILY 5. Pantoprazole 40 mg PO Q24H 6. rOPINIRole 4 mg PO BID 7. Aspirin 81 mg PO DAILY 8. Atorvastatin 80 mg PO QPM 9. FLUoxetine 20 mg PO DAILY 10. HELD- Clopidogrel 75 mg PO DAILY This medication was held. Do not restart Clopidogrel until ___ and then restart this medication 11. HELD- Gabapentin 600 mg PO QHS This medication was held. Do not restart Gabapentin until you see your primary care doctor Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Subarachnoid hemorrhage Type 3 left AC joint separation Nondisplaced left transverse process of the T1 vertebra Severe orthostatic hypotension Syncope Recurrent falls ___ disease Discharge Condition: ***Left upper extremity in sling, weight-bearing as tolerated.*** Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, WHY WAS I IN THE HOSPITAL? ========================== You were admitted to ___ after you fell and hit your head. WHAT HAPPENED TO ME IN THE HOSPITAL? ==================================== You had imaging done here which showed you sustained a bleed in your head, and broke a part of the bone in your spine but this fracture is stable and will heal on its own. You also sustained a left acromioclavicular joint (shoulder) separation. The orthopedic team saw you and recommend conservative management with a sling. You were seen by the neurosurgery team for your head bleed and you do not need any surgical intervention. You were also noted to have low blood pressures especially when standing, which can lead to dizziness and cause falls. Your medications were adjusted to help prevent further falls. It was recommend that you go to rehab to work on your strength, but you refused this. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? ============================================= Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Please take your blood pressure any time you feel lightheaded or if you get headaches. Please wear your abdominal binder and stockings any time you are out of bed. Stand up slowly any time you get up. If you feel lightheaded, sit or lay down immediately. Please do NOT drive until you are cleared by your doctors. 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. Albuterol Inhaler ___ PUFF IH Q4H:PRN sob 2. traZODONE 25 mg PO HS:PRN sleep 3. aluminum chloride *NF* 20 % Topical qhs 4. EpiPen *NF* (EPINEPHrine) 0.3 mg/0.3 mL Injection as directed 5. Minocycline 100 mg PO Q12H 6. Multivitamins 1 TAB PO DAILY Discharge Disposition: Home Discharge Diagnosis: Abdominal pain of unclear cause Antral (stomach) erythema -- biopsies pending Insomnia Mild intermittent asthma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted with severe abdominal pain. Because of this, you had an endoscopy (EGD) performed, which showed some redness (erythema) in the bottom part of your stomach (antrum) and biopsies were taken. The Gastroenterologists that did this procedure also recommended an MRI of your abdomen (MRCP) which showed a dilated common bile duct and some aberrant bile ducts. These findings are non-specific. The Gastroenterologists will review this study more closely and contact you with a follow-up plan.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H:PRN Pain - Mild 2. Bisacodyl 10 mg PO DAILY:PRN Constipation - Second Line 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin (Prophylaxis) 40 mg SC DAILY RX *enoxaparin 40 mg/0.4 mL 40 mg SC dailyl Disp #*28 Syringe Refills:*0 5. Oxybutynin 5 mg PO TID 6. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain - Moderate Reason for PRN duplicate override: pacu v floor RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Third Line 8. Senna 8.6 mg PO BID:PRN Constipation - First Line 9. amLODIPine 5 mg PO DAILY 10. Calcium Carbonate 500 mg PO DAILY 11. Citalopram 40 mg PO DAILY 12. Cyanocobalamin 250 mcg PO DAILY 13. Gabapentin 300 mg PO TID 14. Losartan Potassium 50 mg PO DAILY 15. Magnesium Oxide 140 mg PO DAILY 16. Simvastatin 20 mg PO QPM 17. Tretinoin 0.025% Cream 1 Appl TP QHS 18. Triamcinolone Acetonide 0.1% Cream 1 Appl TP TID 19. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left intertrochanteric hip 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: -Weightbearing as tolerated left 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: 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 ___ regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take Lovenox daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever >101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___. You will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for any new medications/refills. THIS PATIENT IS EXPECTED TO REQUIRE ___ DAYS OF REHAB Physical Therapy: Weightbearing as tolerated left lower extremity Treatments Frequency: Surgical dressing to remain in place. It may be changed as needed.</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:*0 2. Amoxicillin-Clavulanic Acid ___ mg PO/NG Q12H Duration: 3 Weeks RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*40 Tablet Refills:*0 3. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Carvedilol 3.125 mg PO ONCE:PRN as instructed by your doctor Duration: 7 Days RX *carvedilol 3.125 mg 1 tablet(s) by mouth as instructed by your doctor only for high blood pressures Disp #*7 Tablet Refills:*0 5. Docusate Sodium 100 mg PO BID:PRN constipation RX *docusate sodium 100 mg 1 capsule(s) by mouth twice daily as needed Disp #*60 Capsule Refills:*0 6. Fluticasone Propionate NASAL 2 SPRY NU BID RX *fluticasone 50 mcg/actuation 2 spry in twice a day Disp #*60 Spray Refills:*0 7. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. Oxymetazoline 2 SPRY NU TID Duration: 3 Days RX *oxymetazoline 0.05 % 2 spry in three times a day Disp #*6 Spray Refills:*0 9. Sodium Chloride Nasal ___ SPRY NU TID RX *sodium chloride [Saline Nose] 0.65 % ___ spry in daily Disp #*60 Spray Refills:*0 10. Azathioprine 100 mg PO DAILY 11. Multivitamins 1 TAB PO DAILY 12. Omeprazole 40 mg PO DAILY 13. Ondansetron 4 mg PO Q8H:PRN n/v 14. PredniSONE 5 mg PO DAILY 15. Senna 8.6 mg PO BID:PRN constipation 16. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 17. Tacrolimus 3 mg PO Q12H 18. Vitamin B Complex 1 CAP PO DAILY 19.Outpatient Lab Work ICD-10: ___.8 Please draw by ___ Please draw chem-10 panel Fax results to ___, MD, ___ Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Acute CHF exacerbation with preserved EF (45-50%) Hypertension Chronic sinusitis Secondary diagnosis: S/p kidney/pancreas transplant Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, ___ were admitted to the hospital because of shortness of breath and increased swelling in your legs. This was thought to be due to a heart failure exacerbation. Your cardiac ultrasound showed mildly depressed cardiac function with structural changes due to underlying coronary artery disease. However, ___ did not have an acute coronary event or heart attack. ___ were given IV medications to remove extra fluid and improved after a couple of days. Your blood pressure was high. ___ were started on a new medication: amlodipine. Tomorrow morning, afternoon and night, please check your blood pressure. If your blood pressure is above 170, please call your transplant doctor immediately for further instructions. We will write ___ for a few tabs of carvedilol for ___ to take only if your doctor instructs ___ to. ___ have symptoms like lightheadedness, chest pain, trouble breathing, or experience new swelling in your legs, please call your doctor as well. ___ were evaluated by our ear, nose and throat doctors. ___ will need to take Augmentin for a total of 3 weeks. Please continue using the nasal sprays and Netipot. Your kidney function remained stable, as showed by a renal ultrasound. Please follow up with your doctors below as listed. 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 Q8H:PRN pain, fever 2. Amlodipine 5 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Bisacodyl 10 mg PO DAILY:PRN Constipation 5. Docusate Sodium 200 mg PO BID 6. Ferrous Sulfate 325 mg PO DAILY 7. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 8. FoLIC Acid 1 mg PO DAILY 9. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 10. Lisinopril 10 mg PO DAILY 11. Montelukast 10 mg PO DAILY 12. Multivitamins 1 TAB PO DAILY 13. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain or respiratory distress RX *oxycodone 5 mg one to two tablet(s) by mouth every four hours Disp #*60 Tablet Refills:*0 14. Fentanyl Patch 12 mcg/h TD Q72H apply patch every three days. RX *fentanyl [Duragesic] 12 mcg/hour apply one patch every three days Disp #*10 Patch Refills:*0 15. Albuterol Inhaler ___ PUFF IH Q4H:PRN shorntess of breath 16. Calcium Carbonate 650 mg PO DAILY 17. Hydrochlorothiazide 50 mg PO DAILY 18. Ipratropium Bromide MDI 2 PUFF IH QID 19. Magnesium Oxide 280 mg PO DAILY 20. Simvastatin 10 mg PO QPM 21. Senna 17.2 mg PO BID 22. Prochlorperazine 10 mg PO Q6H:PRN nausea RX *prochlorperazine maleate [Compazine] 10 mg 1 tablet(s) by mouth every six hours Disp #*14 Tablet Refills:*0 23. Lorazepam 0.5 mg PO Q6H:PRN pain RX *lorazepam [Ativan] 0.5 mg 1 by mouth every six hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: primary: non small cell lung cancer; COPD exacerbation. secondary: type 2 diabetes; hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at the ___ ___. You were admitted to the hospital because your breathing worsened and you were noted to require more supplemental oxygen. These symptoms are related to your underlying lung cancer and COPD. You had a CAT scan of the lungs, which did not show a clot or an infection. You received your first round of chemotherapy on ___ and part of this treatment included high dose steroids which also treated your COPD. In addition, you received routine nebulizer treatments and an antibiotic azithromycin. Because of the steroids and your underlying diabetes, you required insulin shots to control your blood sugar. In the last few days of your hospital stay, you did not require any insulin. You should hold off on resuming your glyburide until you see Dr. ___ in a week. However, you should check you blood sugars every morning and evening, keep a record of them and take with you to your appointment with Dr. ___. Please call his office earlier if you have blood sugars >200. You will discharged on medications for pain and medicines to take as needed for nausea. Please follow up with all scheduled appointments (see below) and continue taking all medications as prescribed. If you develop any of the danger signs listed below, it is important that you talk with your healthcare providers or go the emergency room immediately. We wish you the best. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice daily Disp #*30 Capsule Refills:*0 2. Phosphorus 500 mg PO DAILY RX *sod phos di, mono-K phos mono [Phospha 250 Neutral] 250 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *polyethylene glycol 3350 17 gram 1 powder(s) by mouth daily Disp #*30 Packet Refills:*0 4. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [Senexon] 8.6 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*0 5. PredniSONE 60 mg PO DAILY Duration: 5 Days RX *prednisone 20 mg 3 tablet(s) by mouth daily Disp #*6 Tablet Refills:*0 6. Fexofenadine 60 mg PO BID 7. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Moderate 8. LORazepam 1 mg PO Q4-6H PRN nausea, insomnia, anxiety 9. Omeprazole 40 mg PO DAILY 10. OxyCODONE SR (OxyconTIN) 60 mg PO Q12H 11. Prochlorperazine 10 mg PO BID:PRN nausea 12.Rolling Walker Diagnosis: Malignant neoplasm of pancreas, unspecified Prognosis: Good Length of need: 13 months Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: 1. Left femoral neck fracture 2. Hypophosphatemia SECONDARY DIAGNOSIS: 1. Metastatic Pancreatic Cancer 2. Hyponatremia 3. Dehydration Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you here at ___ ___. Why you were here: - You had a fall at home and were found to have a fracture of the head of the L femur (a hip fracture). What we did while you were here: - You had surgery on your L femur by the orthopedic surgery team. They fixed the left femur on ___ - We took a look at the imaging that was done of the abdomen after the fall, and saw that your pancreatic cancer has progressed. We spoke with your oncologist, Dr. ___ told him these results. We had a meeting with you and your wife, and ultimately decided it would be best for you to return home with Hospice Services, to manage your symptoms as best we can and to make sure that you have everything at home that you will need to be safe and comfortable. - We gave you the electrolytes to replace the ones that were low. These included phosphate and magnesium. - You worked with the physical therapists and they felt that you would be safe to go home without needing to go to rehab. What to do when you go home? For the care of your broken hip: -Activity: weight-bearing as tolerated on your left leg -Walk several times per day. -Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. -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. OTHER INSTRUCTIONS: -Please follow up with Dr. ___ on ___ at 2pm. -You will need to have your electrolytes checked on ___, ___ ___. You may also need some extra fluid through the IV if you get dehydrated over the weekend or if you are unable to eat much. -Please call Dr. ___ or come to the ER 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. - Continue taking all your medicines as prescribed below. Dr. ___ decide how long you should stay on the boosted dose of Prednisone. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Losartan Potassium 50 mg PO BID 2. Metoprolol Tartrate 100 mg PO BID 3. NIFEdipine CR 60 mg PO BID 4. sevelamer CARBONATE 800 mg PO TID W/MEALS 5. Sodium Bicarbonate 650 mg PO TID 6. Warfarin 5 mg PO DAILY Have INR checked per home regimen 7. Acetaminophen 650 mg PO Q6H:PRN arm pain ___ use up to 8 of the 325 mg tablets daily Discharge Disposition: Home Discharge Diagnosis: ESRD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ and underwent a revision of your AV graft on ___, and had a tunneled dialysis line placed on ___. You are now prepared to complete your recovery at home with the following instructions: - You may not shower with the dialysis line in place. The stitches in your wound will remain in place, to be removed at your follow-up appointment. Do not submerge the right arm, wash the incision gently and pat dry. - You may resume your usual diet, following a low potassium, low sodium, low phosphorous renal diet - You may resume all your usual home medications, including your Coumadin at the regular dose. You have also been prescribed a medication to help with pain control, which you may take once every 6 hours as needed. - You should receive dialysis per your usual schedule of ___ and ___, through the tunneled line until your surgeon tells you that the graft may be used. Please DO NOT allow dialysis to access your graft until your surgeon has approved it. - Try to keep arm elevated as much as possible. Sutures will be removed in follow up with Dr. ___. - Please call Dr. ___ office at ___ if you have any of the following: temperature of 101, shaking chills, Right upper arm appears larger, incision appears red/warm or has bleeding/drainage, numbness of arm or altered circulation</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Linezolid ___ mg PO Q12H RX *linezolid ___ mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 2. Acetaminophen 325 mg PO Q8H:PRN Pain - Mild 3. Albuterol Inhaler ___ PUFF IH Q6H:PRN wheezing 4. Aspirin 81 mg PO DAILY 5. Bisacodyl 10 mg PO QHS:PRN constipation 6. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN wheezing 7. Lactulose 30 mL PO Q8H:PRN constipation 8. Metoprolol Succinate XL 12.5 mg PO DAILY 9. Multivitamins W/minerals 1 TAB PO DAILY 10. Senna 8.6 mg PO BID:PRN constipation 11. Tamsulosin 0.4 mg PO QHS 12. TraZODone 25 mg PO Q12H:PRN agitation 13.Outpatient Lab Work Weekly labs starting ___- CBC w/ diff, BUN, Cr, ESR, CRP. Please send to ___, MD, Phone: ___ ___: ___. ICD: M86.2 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Osteomyelitis Secondary: Anemia of chronic disease, atrial fibrillation, malnutrition Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted because your blood pressure was low and you were confused. Your symptoms improved with intravenous fluids. You continue to have an infection in your foot. You were not deemed a surgical candidate given the high risk of the procedure. You were not able to get antibiotics through the "PICC" line because you kept pulling out your line. Instead we are giving you oral antibiotics with the goals of care discussed with your guardian to not pursue more aggressive care. We also initiated the process of transferring you to hospice care. Your infection in your foot is unlikely to improve. This will serve to focus treatment on measures that will make you more comfortable. Please follow up with the Infectious disease clinic for your antibiotics and the Podiatrists for your foot infection. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 4. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 5. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 6. Creon 12 2 CAP PO TID W/MEALS 7. Fluticasone Propionate NASAL 2 SPRY NU DAILY 8. Lidocaine 5% Patch 1 PTCH TD QAM 9. Metoprolol Succinate XL 50 mg PO DAILY 10. Nicotine Patch 21 mg TD DAILY 11. Omeprazole 40 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY Non-ST Elevated MI L shoulder pain Coronary Artery Disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your hospitalization. You came to ___ ___ because you are having left shoulder pain. We also did some blood tests that showed that your heart was under stress. You underwent a stress test that demonstrated you may have a narrowing in one of the blood vessels of your heart. You were started on aspirin and atorvastatin to prevent a blockage from forming in one of these blood vessels. We will arrange for you to follow up with a cardiologist as an outpatient to monitor this. We think that your left shoulder pain is likely due to your chronic left shoulder pain. Your discharge medications and follow-up appointments are detailed below. We wish you the best!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H last dose on ___. ClonazePAM 0.5 mg PO QAM 3. ClonazePAM 0.5 mg PO QPM 4. Heparin 5000 UNIT SC TID 5. Miconazole Powder 2% 1 Appl TP TID:PRN rash 6. Omeprazole 20 mg PO DAILY 7. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every six (6) hours Disp #*20 Tablet Refills:*0 8. Citalopram 10 mg PO DAILY 9. MetFORMIN (Glucophage) 500 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. Hepatic subcapsular biloma 2. Biliary sepsis 3. Failure to thrive 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>Please resume all regular home medications , unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised. . Right and left hepatic drains: *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 or ___ strength hydrogen peroxide followed by saline rinse, pat dry, and place a drain sponge. Change daily and as needed. *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. . What to watch out for when you have a Dobhoff Feeding Tube: 1. Blocked tube: If the tube won't flush, try using 15 mL carbonated cola or warm water. If it still will not flush, call your nurse or doctor. Always be sure to flush the tube with at least 60 mL water after giving medicine or feedings. 2.Vomiting: *Call doctor if vomiting persists. Vomiting causes the loss of body fluids, salts and nutrients. *Give the feeding ___ an upright position. *Try smaller, more frequent feedings. Be sure the total amount for the day is the same though. *Infection may cause vomiting. Clean and rinse equipment well between feedings. *Do not let formula ___ the feeding bag hang longer than 6 hours unrefrigerated. After the formula can is opened, it should be stored ___ refrigerator until used. 3. Diarrhea: *This is frequent loose, watery stools. *Can be caused by: giving too much feeding at once or running it too quickly, decreased fiber ___ diet, impacted stool or infection. Some medicines also cause diarrhea. *Avoid hanging formula for longer than 6 hours. *Give more water after each feeding to replace water lost ___ diarrhea. *Call doctor if diarrhea does not stop after ___ days. 4. Dehydration: *Due to diarrhea, vomiting, fever, sweating. (Loss of water and fluids) *Signs include: decreased or concentrated (dark) urine, crying with no tears, dry skin, fatigue, irritability, dizziness, dry mouth, weight loss, or headache. *Give more water after each feeding to replace the water lost. *Call your doctor. 5. Constipation: ___ be caused by too little fiber ___ diet, not enough water or side effects of some medicines. *Take extra fruit juice or water between feedings. *If constipation becomes chronic, call the doctor. 6. Gas, bloating or cramping: Be sure there is no air ___ the tubing before attaching the feeding tube. 7.Tube is out of place: If the tube is no longer ___ your stomach, tape it down and call your doctor or home health nurse. Do not use the tube. You will need to have a new tube placed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID 2. Amiodarone 200 mg PO DAILY 3. Artificial Tears ___ DROP BOTH EYES PRN Dry eyes 4. Aspirin 81 mg PO DAILY 5. Cyanocobalamin 1000 mcg PO DAILY 6. Docusate Sodium 100 mg PO DAILY 7. Donepezil 5 mg PO Q24H 8. Ferrous Sulfate 325 mg PO DAILY 9. Furosemide 20 mg PO DAILY 10. Memantine 10 mg PO BID 11. Metoprolol Tartrate 12.5 mg PO BID 12. Multivitamins 1 TAB PO DAILY 13. Ranitidine 150 mg PO BID 14. Sertraline 100 mg PO QHS 15. Sucralfate 1 gm PO QID 16. Vitamin D 1000 UNIT PO DAILY 17. Enoxaparin Sodium 30 mg SC QHS Start: Today - ___, First Dose: Next Routine Administration Time 18. Fexofenadine 60 mg PO Q24H:PRN Allergies 19. magnesium hydroxide 400 mg (170 mg) ORAL DAILY:PRN constipation 20. QUEtiapine Fumarate 12.5 mg PO QHS:PRN agitation 21. TraZODone 50 mg PO QHS:PRN insomnia Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnoses ================== Right intertrochanteric hip fracture Leukocytosis Urinary Tract Infection Hypoxia Delirium Acute Kidney Injury Secondary Diagnoses ================== Atrial fibrillation Dementia Congestive heart failure Gastroesophageal reflux disease Depression Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during your stay at ___. You were admitted to the hospital after a fall, and you were found to have a fracture of your right hip. The orthopedic surgery team took you to the OR on ___ and fixed this fracture. You were also found to have a urinary tract infection treated with antibiotics. You should weigh yourself every day, and call your doctor if your weight goes up by more than 3 pounds. After you leave the hospital you will need rehabilitation to regain your strength after the surgery. Your appointments and medications are listed in your discharge paperwork. We wish you the best! -Your ___ Care Team ORTHOPEDIC POST OPERATVE INSRUCTIONS ====================================== INSTRUCTIONS AFTER ORTHOPEDIC SURGERY: - You underwent surgical fixation of your right hip fracture during your hospitalization. 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: - You are encouraged to bear weight as tolerated on your right lower extremity. MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take Lovenox 40 MG daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ferrous Sulfate 325 mg PO BID 2. Hydrochlorothiazide 25 mg PO DAILY hold for sbp<100 3. Omeprazole 20 mg PO BID 4. Prochlorperazine ___ mg PO Q8H:PRN nausea Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Abdominal Pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure caring for you during your hospital stay. You were admitted for abdominal pain with concern for cholecystitis (infection or inflammation of the gallbladder). You had a scan of your gallbladder which showed that you do not have cholecystitis. Your abdominal pain improved overnight, and all of the lab and imaging studies were reassuring. You should follow up with your Gastroenterologist to discuss having an outpatient endoscopy to look for problems in the stomach and first part of the intestines which may be causing your pain.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID RX *acetaminophen 650 mg 1 tablet(s) by mouth three times a day Disp #*60 Tablet Refills:*0 2. Amoxicillin-Clavulanic Acid ___ mg PO Q8H RX *amoxicillin-pot clavulanate 500 mg-125 mg 1 tablet(s) by mouth three times a day Disp #*42 Tablet Refills:*0 3. ClonazePAM 0.5 mg PO BID Anxiety 4. Docusate Sodium 100 mg PO BID take this while taking narcotics to prevent constipation RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 5. Fluoxetine 20 mg PO DAILY 6. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every 4 hours Disp #*30 Tablet Refills:*0 7. Senna 8.6 mg PO BID:PRN constipation take this while taking narcotics to prevent constipation RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 8. Simvastatin 20 mg PO QPM 9. Aspirin 81 mg PO DAILY 10. Multivitamins 1 TAB PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: ruptured appendicitis complicated by 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. ___, You were seen at ___ for evaluation of your ruptured appendicitis and abscess. You had this abscess drained by interventional radiology and they left a drain in place. Drains were placed in both the right lower part of your abdomen and the presacral area (pelvis). You were started on IV antibiotics as well and improved after that. You will go home with an oral antibiotic. Please take these as instructed and take them to completion. 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. JP 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. Atorvastatin 80 mg PO QPM 2. Metoprolol Succinate XL 25 mg PO DAILY 3. Allopurinol ___ mg PO DAILY 4. ALPRAZolam 0.5 mg PO DAILY:PRN anxiety 5. Aspirin 81 mg PO DAILY 6. Citalopram 20 mg PO DAILY 7. Pantoprazole 20 mg PO Q24H 8. Spironolactone 25 mg PO BID 9. Torsemide 40 mg PO DAILY 10. Zolpidem Tartrate 10 mg PO QHS 11. HELD- Ibuprofen 800 mg PO Q8H:PRN Pain - Moderate This medication was held. Do not restart Ibuprofen until your primary care physician says it is alright to restart Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: PRIMARY DIAGNOSIS ================ Acute on chronic heart failure exacerbation Heart failure with recovered ejection fraction NSTEMI/multivessel CAD SECONDARY DIAGNOSES =================== Anemia HTN Inclusion body myositis Depression Insomnia Gout Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, WHY YOU WERE ADMITTED - You were having shortness of breath and leg swelling WHAT WE DID FOR YOU HERE _ You were found to be volume overloaded, and fluid was removed from your body with a medication called a diuretic - Your heart numbers were elevated in the blood suggesting disease. Coronary angiography showed blockages in many arteries of the heart - You were started on new medications for your heart including metoprolol XL 25mg daily. WHAT YOU SHOULD DO WHEN YOU LEAVE - Please take your medication as directed - Please follow with your primary care doctor and cardiologist - ___ weight yourself daily and if your weight is up by 3 pounds in one day, please call your primary physician! It was a pleasure caring for you! Sincerely, 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 Q4H:PRN pain/fever 2. Metoprolol Tartrate 25 mg PO BID hold if SBP <100 or HR <60 3. Simvastatin 20 mg PO DAILY 4. Tamsulosin 0.4 mg PO HS 5. LeVETiracetam 500 mg PO BID 6. rivastigmine *NF* 1.5 mg Oral BID 7. Aspirin (Buffered) 325 mg PO DAILY 8. Meropenem 500 mg IV Q8H day 1 = ___ Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: right frontal and parietal ischemic stroke, dementia, hypertension, urinary tract infection, hypoactive delirium Secondary Diagnosis: benign hypertrophic prostate Discharge Condition: Mental Status: Confused - most of the time. Not oriented to month/year, oriented to the fact he's in the hospital but not to reason. Level of Consciousness: fluctuates between being alert and interactive and being lethargic but arousable to noxious stimuli Activity Status: Ambulatory - requires assistance or aid (walker or cane). Needs supervision. Neurologic Status: fluctuating level of alertness, does not move left side as much as right side, but withdraws all extremities to noxious stimuli. Appears to have left sided neglect, though difficult to determine. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at ___ ___. You were transferred to here because you had difficulty speaking and moving your left side, and you were found to have right frontal and parietal stroke. In the hospital, you had episodes of very deep sleeping, so EEG was done to monitor your brain waves. Because it showed sharp waves, you were started on a medication called Keppra to help with that. You DID NOT have a clear seizure. You were also found to have a urinary tract infection, so you were started on antibiotics.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Diazepam 5 mg PO TID 2. BuPROPion 300 mg PO DAILY 3. OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN pain refractory to tylenol RX *oxycodone 10 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: SYNCOPE MOTOR VEHICLE ACCIDENT 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 ___, ___ were admitted to ___ neurology after ___ presented with episodes of loss of consciousness concerning for a seizure resulting in a motor vehicle accident. ___ had CT scans of your spine that were normal. ___ had a MRI of your brain that was normal. ___ had a prolonged EEG that was normal. To check for any cardiac causes for your symptoms ___ had a ECG and echocardiogram that were both normal. They recommended an outpatient holter monitor. After ___ are discharged from here ___ should go to the cardiology clinic on Deaconess ___ room 316 to get the holter monitor placed. ___ were seen by the obgyn doctors who recommended a fetal ultrasound that showed an intrauterine pregnancy. ___ should follow up with them in their Family Planning clinic as an outpatient as scheduled below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO BID:PRN pain 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 40 mg PO BID 4. Escitalopram Oxalate 5 mg PO TID 5. Fluticasone Propionate NASAL 1 SPRY NU BID 6. Hydrocortisone Acetate Suppository ___AILY:PRN rectal pain 7. Lidocaine 5% Patch 3 PTCH TD DAILY:PRN pain 8. Lidocaine Jelly 2% 1 Appl TP Q6H:PRN hemorrhoids 9. LORazepam 0.5 mg PO TID 10. Mylanta 2 teaspoons oral TID 11. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 12. Phenazopyridine 100 mg PO DAILY:PRN urinary pain 13. Vitamin D ___ UNIT PO DAILY 14. Zolpidem Tartrate 5 mg PO QHS 15. Cyclobenzaprine 5 mg PO TID:PRN back pain 16. Dexilant (dexlansoprazole) 60 mg oral DAILY 17. salt irrigation solution ___ % nasal unknown 18. Senna with Docusate Sodium (sennosides-docusate sodium) 8.6-50 mg oral DAILY 19. TheraTears (carboxymethylcellulose sodium) 1 drop OPHTHALMIC Frequency is Unknown 20. Diltiazem 30 mg PO Q8H RX *diltiazem HCl 30 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: - Shortness of breath - Chest wall pain unlikely to be ischemic in origin - Costochondritis - Coronary artery disease - Prior coronary artery bypass surgery - Sick sinus syndrome - Paroxysmal atrial fibrillation - Prior implantation of a dual-chamber permanent pacemaker - Hyponatremia - Chronic back pain - Gastroesophageal reflux disease - Chronic abdominal pain - Depression and anxiety - Insomnia - Raynaud's disease 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. ___, Thank you for choosing to receive your care at ___. You were admitted for shortness of breath and chest pressure. Given your history of coronary artery disease and your recent hospital admission for similar symptoms, we assessed the degree of heart vessel blockage by coronary angiogram. The cornoary angiogram did not reveal any blockages in the blood flow. You also underwent a CT scan of your chest, which did not demonstrate any clots or damage to the large vessels in your chest. We did an ultrasound of your heart and the heart valves and pump function was normal. The ultrasound did show that the left side of your heart was enlarged but this was unchanged from your previous ultrasound in ___. We think your pain is likely related to pain in the muscles and bones in your chest wall affecting your jaw, versus small vessel disease in your heart which would not cause significant effects to your heart function. Moving forward, you should make sure to take the medications as listed below, and attend the follow up appointments listed below. If you develop worsening shortness of breath, chest pain, or other concerning symptom, please talk to your doctor right away. Again, it was our pleasure participating in your care here at ___. 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. gabapentin 600 mg PO TID. Disp:*180 Capsule(s)* Refills:*2* 2. tamoxifen 10 mg PO BID. Disp:*60 Tablet(s)* Refills:*1* 3. temazepam 15 mg PO HS. 4. acetaminophen 325-650mg PO q6HR PRN pain. 5. omeprazole 20 mg PO DAILY. 6. oxycodone 20 mg Extended Release 12 hr PO Q12H. Disp:*60 Tablet Extended Release 12 hr(s)* Refills:*0* 7. hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q3H PRN pain. Disp:*100 Tablet(s)* Refills:*0* 8. docusate sodium 100 mg PO BID. 9. senna 8.6 mg PO BID. 10. polyethylene glycol 3350 17 gram Powder in Packet PO DAILY. Disp:*20 Powder in Packet(s)* Refills:*1* 11. prochlorperazine maleate ___ PO q6HR PRN nausea. Disp:*20 Tablet(s)* Refills:*1* 12. alum-mag hydroxide-simeth 200-200-20mg/5mL Sig: ___ PO QID PRN heartburn. 13. ciprofloxacin 500 mg PO Q12H x2 days. Disp:*4 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1. Abdominal pain. 2. New liver metastases. 3. Breast cancer. 4. Chronic right arm and chest pain/neuropathy. 5. Urinary tract infection (UTI). 6. Kidney stone. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital for worsening abdominal pain that is likely due to cancer in the liver. To confirm this, you had a liver biopsy, the results are still pending. In case this is breast cancer and considering your high risk of a breast cancer recurrence, tamoxifen was restarted. Your pain has been controlled with a combination of OxyContin and hydromorphone (Dilaudid). The OxyContin is long-acting and should be taking twice a day regardless of the level of your pain. It will not help taking it for acute/sudden pain. The hydromorphone (Dilaudid) can be taken in addition to the OxyContin for acute/sudden pain. For the chronic pain at the right arm and chest, your gabapentin (Neurontin) dose was increased. You also have a urinary tract infection and will need to complete a course of antibiotics at home. CT of your abdomen shows that you have chronic kidney stones that may be contributing to the urinary tract infection. . MEDICATION CHANGES: 1. OxyContin 20mg 2x a day. 2. Hydromorphone as needed for breakthrough pain. 3. Gabapentin (Neurontin) 600mg 3x a day. 4. Tamoxifen 2x a day. 5. Ciprofloxacin 2x a day.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever max 4000mg/day 2. Amiodarone 400 mg PO BID postop AFib 400mg BID x 3 days, then 200mg BID x 7 days, then 200mg daily RX *amiodarone 400 mg 1 tablet(s) by mouth as directed Disp #*30 Tablet Refills:*2 3. Aspirin EC 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 4. Atorvastatin 10 mg PO DAILY RX *atorvastatin 10 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*1 5. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 6. Furosemide 40 mg PO BID 40mg po BID x 3 days, then decrease to 40mg daily x 7 days RX *furosemide [Lasix] 40 mg 1 tablet(s) by mouth twice a day Disp #*13 Tablet Refills:*0 7. Metoprolol Tartrate 6.25 mg PO TID RX *metoprolol tartrate 25 mg 0.25 tablet(s) by mouth three times a day Disp #*30 Tablet Refills:*1 8. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 9. Potassium Chloride 20 mEq PO BID 20meq po BID x 3 days, then 20meq po daily x 7 days RX *potassium chloride [K-Tab] 20 mEq 1 tablet(s) by mouth as directed Disp #*13 Tablet Refills:*0 10. Ranitidine 150 mg PO BID RX *ranitidine HCl 150 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*1 11. Warfarin 1 mg PO ASDIR tiss MVR & postop Afib Duration: 3 Months 0.5-2 tablets daily as directed for goal INR ___ RX *warfarin 1 mg ___ tablet(s) by mouth as directed Disp #*60 Tablet Refills:*1 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Acute mitral regurgitation atrial fibrillation Secondary: Hypertension Discharge Condition: Alert and oriented x3, non-focal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema. Small amount serous drainage from middle incision. Stable bone. Edema- 1+ BLE Followup Instructions: ___ [/INST] </s><s>Please shower daily -wash incisions gently with mild soap, no baths or swimming, look at your incisions daily Please - NO lotion, cream, powder or ointment to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics Clearance to drive will be discussed at follow up appointment with surgeon No lifting more than 10 pounds for 10 weeks Encourage full shoulder range of motion, unless otherwise specified **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 Q6H:PRN Pain - Mild Reason for PRN duplicate override: Alternating agents for similar severity 2. Ezetimibe 10 mg PO DAILY RX *ezetimibe 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Glargine 35 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 4. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain: moderate/severe 6. QUEtiapine Fumarate 25 mg PO QHS 7. HydrALAZINE 100 mg PO TID RX *hydralazine 100 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 8. LORazepam 0.5 mg PO QHS:PRN anxiety/airhunger without hypoxia RX *lorazepam 0.5 mg 1 tablet by mouth at bedtime Disp #*15 Tablet Refills:*0 9. Warfarin 5 mg PO DAILY16 RX *warfarin [Coumadin] 1 mg 5 tablet(s) by mouth daily Disp #*150 Tablet Refills:*0 10. Allopurinol 50 mg PO EVERY OTHER DAY 11. amLODIPine 10 mg PO DAILY 12. Asmanex HFA (mometasone) 200 mcg/actuation inhalation Q4H:PRN 13. Aspirin EC 81 mg PO DAILY 14. Baclofen ___ mg PO QHS:PRN Muscle Spasms 15. Calcium Acetate 1334 mg PO TID W/MEALS 16. DULoxetine 60 mg PO DAILY 17. Fluticasone Propionate 110mcg 2 PUFF IH BID SOB 18. Hydrocortisone Cream 2.5% 1 Appl TP BID:PRN rash 19. Hydrocortisone Oint 2.5% 1 Appl TP PRN rash 20. Lactulose 30 mL PO Q6H:PRN constipation 21. Levothyroxine Sodium 50 mcg PO DAILY 22. LORazepam 1 mg PO TID 23. Nephrocaps 1 CAP PO DAILY 24. Pantoprazole 40 mg PO Q24H 25. TraMADol ___ mg PO Q4H:PRN Pain - Severe 26. Triamcinolone Acetonide 0.1% Cream 1 Appl TP TID:PRN rash 27.Outpatient Lab Work ___ INR, Na, K, Cl, HCO3, BUN, creatinine. 786.09, ___ Fax: Dr. ___ ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY ======== Heart failure with preserved ejection fraction Pleural effusion Right lung collapse Atrial flutter Coronary artery disease Thrombocytopenia End stage renal disease Hypertension SECONDARY ========== Diabetes Mellitus Anemia Hyperlipidemia Gastroesophageal reflux disease Hypothyroidism Depression Anxiety Gout Back spasm Constipation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, WHAT BROUGHT YOU INTO THE HOSPITAL? - You were admitted for shortness of breath WHAT WAS DONE FOR YOU IN THE HOSPITAL? - You had a CT scan that showed a partial collapse of your right lung and fluid in your lungs. - You had an echocardiogram of your heart showing that your heart was volume overloaded. - You had dialysis to remove excess fluid from your body and your NEW DRY WEIGHT IS = 88.8kg. - You underwent an ablation procedure to treat your abnormal heart rhythm called "atrial flutter," which corrected to sinus rhythm. WHAT SHOULD YOU DO AFTER LEAVING THE HOSPITAL? - It is important that you continue to take your medications as prescribed. - Weigh yourself every morning, call MD if weight goes up more than 3 lbs. - You need to follow up with your PCP, cardiologist and interventional pulmonology according to the appointments below. We wish you the best in your recovery! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol 0.083% Neb Soln 1 NEB IH PRN dyspnea 2. Azithromycin 250 mg PO Q24H Stop taking this medication after two more doses on ___ and ___. RX *azithromycin [Zithromax] 250 mg 1 tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 3. BuPROPion (Sustained Release) 200 mg PO QAM 4. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 5. QUEtiapine Fumarate 200 mg PO BID 6. Simvastatin 40 mg PO QHS 7. Topiramate (Topamax) 350 mg PO DAILY 8. Venlafaxine XR 75 mg PO DAILY 9. Erythromycin 0.5% Ophth Oint 0.5 in BOTH EYES QID Duration: 7 Days Stop taking this medication on ___ (or as early as ___ if symptoms have resolved). RX *erythromycin 5 mg/gram (0.5 %) 0.5 (One half) inch each eye four times a day Disp #*2 Bottle Refills:*0 10. Nicotine Patch 7 mg TD DAILY RX *nicotine 7 mg/24 hour 1 patch daily Disp #*14 Unit Refills:*0 11. Nystatin Oral Suspension 5 mL PO TID Take this medication until 48 hours after symptoms resolve. RX *nystatin 100,000 unit/mL 5 mL by mouth three times a day Disp #*1 Bottle Refills:*0 12. Estradiol 1 mg PO DAILY 13. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation q ___ hrs PRN dyspnea 14. proGESTerone micronized 100 mg oral q HS 15. Tiotropium Bromide 1 CAP IH DAILY 16. PredniSONE 40 mg PO DAILY Duration: 5 Days Tapered dose - DOWN RX *prednisone 10 mg 4 tablet(s) by mouth daily Disp #*20 Tablet Refills:*0 17. PredniSONE 20 mg PO DAILY Duration: 3 Days Tapered dose - DOWN RX *prednisone 10 mg 2 tablet(s) by mouth daily Disp #*6 Tablet Refills:*0 18. PredniSONE 10 mg PO DAILY Duration: 2 Days Tapered dose - DOWN RX *prednisone 10 mg 1 tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: COPD exacerbation, bronchitis, small airway infection Secondary diagnosis: Conjunctivitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking part in your care at ___ ___. As you know, you came to the hospital due to worsening shortness of breath. In the ED, you had a CT scan that was negative for a blood clot in the lungs, and labs were reassuring against a problem with the heart muscle (which were checked due to your chest heaviness). The CT scan did show bronchitis, a possible infection of the small lung airways, and severe emphysema. You were admitted for further treatment of an exacerbation of your emphysema/COPD with prednisone and nebulizer treatments, and you received antibiotics for bronchitis. You were also found to have conjunctivitis, and you were given eye drops. Your breathing improved. Please see the attached medication list for changes to your home medication regimen. You will have short courses of azithromycin and prednisone to finish at home. Other medications include eye drops and nystatin mouth solution. Also, you have a prescription for a nicotine patch. We strongly encourage you to continue avoiding cigarettes, as you have done while hospitalized. Smoking cessation is an important step toward improving your health. Please follow up with Pulmonary Medicine according to the appointment list below. You should have a repeat chest CT scan in ___ weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Glargine 55 Units Dinner Humalog 8 Units Breakfast Humalog 8 Units Lunch Humalog 8 Units Dinner 2. amLODIPine 5 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. CARVedilol 12.5 mg PO BID 6. Gabapentin 100 mg PO TID 7. Losartan Potassium 25 mg PO DAILY 8. Pantoprazole 40 mg PO Q24H 9. sevelamer CARBONATE 800 mg PO TID W/MEALS 10. TraMADol 50 mg PO BID:PRN Pain - Moderate 11. Zolpidem Tartrate 10 mg PO QHS:PRN insomnia Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES ================= Acute Gastrointestinal Bleed SECONDARY DIAGNOSES =================== Gastroparesis Atrial Fibrillation with RVR ESRD on HD Hypoxemic respiratory failure, Resolved Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You were nauseous and vomiting. WHAT HAPPENED TO ME IN THE HOSPITAL? - You received dialysis - You were in the Intensive Care Unit for special monitoring and care of your breathing - You developed bloody vomit and a scope was placed down through your mouth which showed bleeding coming from your feeding tube - You were given medications to help your nausea and to prevent further bleeding 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. 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. Sucralfate 1 gm PO QID Duration: 2 Weeks RX *sucralfate 1 gram 1 tablet(s) by mouth four times a day Disp #*56 Tablet Refills:*0 2. Thiamine 200 mg PO DAILY 3. DULoxetine ___ 90 mg PO DAILY 4. FoLIC Acid 1 mg PO DAILY 5. Furosemide 40 mg PO DAILY 6. HydrOXYzine 25 mg PO Q8H:PRN itching 7. Levothyroxine Sodium 175 mcg PO DAILY 8. MetFORMIN (Glucophage) 500 mg PO BID 9. Nadolol 40 mg PO DAILY 10. Omeprazole 40 mg PO DAILY 11. Spironolactone 100 mg PO DAILY 12. TraZODone 150 mg PO QHS:PRN sleep Discharge Disposition: Home Discharge Diagnosis: #Acute decompensated alcohol cirrhosis #Upper gastrointestinal bleeding #Acute blood loss anemia #Hyponatremia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to the hospital because you were vomiting blood. WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - You received blood transfusions for your bleeding - You also underwent an endoscopy to identify the source of your bleeding. You were noted to have dilated blood vessels in your esophagus (called "varices") which were bleeding. - These blood vessels can cause very serious bleeding that can be life-threatening - You underwent a procedure to stop this bleeding by putting a band around these bleeding blood vessels - After the procedure, we monitored your blood counts and you did not have any repeat bleeding - Overall you were improved and ready to leave the hospital.. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - You must never drink alcohol again or your liver will fail and you will die from this - Please enroll in AA and work with your primary care doctor to determine the best strategy to help you stay sober - Take all of your medications as prescribed (listed below) - Keep your follow up appointments with your doctors - Weigh yourself every morning, before you eat or take your medications. Call your doctor if your weight changes by more than 3 pounds - Please stick to a low salt diet and monitor your fluid intake - If you experience any of the danger signs listed below please call your primary care doctor or come to the emergency department immediately. It was a pleasure participating in your care. We wish you the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___. You were admitted for elevated blood sugars >700 and very high blood pressure at your HD appointment on ___ last week. You were treated with insulin, fluids and IV blood pressure medicines in the ICU until your blood sugar and blood pressure stabilized. You were then transferred to the general medicine floor for continued monitoring. Your sugars ranged from 400 to 100 on insulin. Your blood pressure remained stable on your home dosing of blood pressure medications. You received dialysis on ___ and ___. You should go to your regular dialysis appointment next ___. Please be sure to take your insulin and blood pressure medications as prescribed at home. If you develope headache, shakes, feelings of weakness, feeling like you are having difficulty staying awake, palpitations, nausea, vomiting, lightheadedness or fainting please check your blood sugar quickly. Call your doctor or go to the emergency room if your blood sugar goes above 300 for more than 24 hours or below 70 more than twice in a row. You have a follow up appointment scheduled with your regular nurse practitioner at the ___ on ___ at 2:00 ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sulfameth/Trimethoprim DS 1 TAB PO DAILY For PCP prophylaxis RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 2. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheeze 3. Atorvastatin 20 mg PO QAM 4. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 5. Tiotropium Bromide 1 CAP IH DAILY 6. Azithromycin 250 mg PO Q24H Duration: 4 Days Last day ___. RX *azithromycin 250 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 7. Aspirin 81 mg PO DAILY 8. Creon 12 1 CAP PO TID W/MEALS 9. Dronabinol 5 mg PO BID 10. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 11. Mirtazapine 45 mg PO QHS 12. Omeprazole 40 mg PO DAILY 13. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q4H 14. Sertraline 25 mg PO DAILY 15. Zolpidem Tartrate 5 mg PO QHS:PRN insomnia 16. PredniSONE 40 mg PO DAILY Duration: 2 Doses Take 40 mg on ___ and ___ then 20 mg on ___, and ___ then resume 10 mg daily. Tapered dose - DOWN RX *prednisone 20 mg 2 tablet(s) by mouth daily Disp #*7 Tablet Refills:*0 17. PredniSONE 20 mg PO DAILY Duration: 3 Doses Take 40 mg on ___ and ___ then 20 mg on ___, and ___ then resume 10 mg daily. Tapered dose - DOWN 18. PredniSONE 10 mg PO DAILY Take 40 mg on ___ and ___ then 20 mg on ___, and ___ then resume 10 mg daily. Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: =================== COPD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you during your hospitalization at ___. You were admitted for severe shortness of breath/low oxygen level due to a COPD exacerbation. You were treated with steroids, an antibiotic (azithromycin), and nebulizers. Please continue the steroid taper and antibiotic as prescribed. You were also started on Bactrim, which is an antibiotic to prevent infections while on steroids. You should continue this until directed otherwise by your doctor. Please continue to use your inhalers as prescribed and keep yourself well-hydrated. 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: [/INST] </s><s>1. continue weaning the ventilator as tolerated 2. ambulate daily with assistance 3. staples from back removed, staples from LUQ removed 4. suction as needed/routine tracheostomy care 5. turn/reposition q2 hours when in bed 6. pain control</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q8H:PRN pain RX *oxycodone-acetaminophen 5 mg-500 mg 1 capsule(s) by mouth q8 Disp #*21 Capsule Refills:*0 3. Adderall XR *NF* (amphetamine-dextroamphetamine) 20 mg Oral daily 4. BuPROPion 200 mg PO DAILY 5. Clonazepam 1 mg PO BID 6. Florastor *NF* (saccharomyces boulardii) 250 mg Oral BID 7. Levothyroxine Sodium 75 mcg PO DAILY 8. Pantoprazole 40 mg PO Q12H 9. Venlafaxine XR 150 mg PO DAILY 10. Bisacodyl 10 mg PO DAILY:PRN constipation RX *bisacodyl 5 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 11. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron 4 mg 1 tablet(s) by mouth q8 Disp #*90 Tablet Refills:*0 12. Senna 1 TAB PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a ___ Disp #*60 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Post procedural abdominal pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, Thank you for choosing us for your care. You were admitted for abdominal pain. We performed blood tests look for dangerous causes of pain and there were no concerning findings. A CT scan was done and showed changes consistent with your previous surgeries, but nothing dangerous. Given your recent ERCP, it is likely that this is residual pain from that procedure. Your lipase, a marker for pancreatitis, is normal. We have made no changes to your medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO DAILY 2. Glycerin Supps ___AILY constipation 3. Ramipril 10 mg PO BID 4. Polyethylene Glycol 34 g PO DAILY 5. Ezetimibe 10 mg PO DAILY 6. LACOSamide 100 mg PO BID 7. Simethicone 80 mg PO TID 8. Omeprazole 20 mg PO DAILY 9. Senna 1 TAB PO DAILY 10. Warfarin 3 mg PO DAILY atrial fibrillation 11. Metoprolol Tartrate 50 mg PO TID 12. Acetaminophen 650 mg PO Q6H:PRN pain/fever 13. Docusate Sodium (Liquid) 200 mg PO BID 14. Enoxaparin Sodium 60 mg SC BID Start: ___, First Dose: Next Routine Administration Time Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Abdominal distention to to atony, pulled G-tube, UTI, atrial fibrillation with aberrancy, respiratory failure Secondary: CVA, myleoproliferative disorder Discharge Condition: Activity Status: Bedbound. Level of Consciousness: Lethargic but arousable. Mental Status: Confused, non-verbal. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during your stay. You were admitted for abdominal distention and a pulled G-tube. During your admission your abdominal distention improved with a flexiseal, laxatives, and positioning. In addition, your G-tube was replaced. During your admission you had an episode of respiratory compromise, possibly due to aspiration, for which you were briefly intubated and in the ICU. You recovered quickly and were extubated. In addition, you had an exacerbation of your atrial fibrillation with rapid heart rates. Your heart rate was controlled with medications and at discharge is within normal limits. You were started on lovenox for coagulation because your INR was low. You will go to the nursing home on ___ until your INR is between ___. Your INR should be monitored at the nursing home. You were also treated for a urinary tract infection. You received a full course of antibiotics for the infection. In addition, it was noted that you had an increased number of blasts, or immature white blood cells, in your labs. This should be monitored as it may represent a disease process or malignancy.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Glargine 10 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 2. Acetaminophen 650 mg PO TID 3. amLODIPine 10 mg PO DAILY 4. Ascorbic Acid ___ mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Cyanocobalamin 1000 mcg PO DAILY 7. Escitalopram Oxalate 10 mg PO DAILY 8. Gabapentin 300 mg PO BID 9. Heparin 5000 UNIT SC BID 10. HydrALAZINE 25 mg PO TID 11. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H:PRN shortness of breath 12. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 13. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 14. Levothyroxine Sodium 75 mcg PO DAILY 15. Lidocaine 5% Patch 1 PTCH TD QPM 16. Lisinopril 30 mg PO DAILY 17. Metoprolol Tartrate 25 mg PO BID 18. Polyethylene Glycol 17 g PO DAILY 19. Senna 17.2 mg PO BID 20. Tamsulosin 0.8 mg PO QHS 21. Torsemide 20 mg PO DAILY 22. TraMADol 50 mg PO Q6H:PRN Pain - Moderate 23. TraZODone 50 mg PO QHS:PRN insomnia 24. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Status post spinal surgery Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You came to the hospital after the JP drain in your spinal surgical wound became dislodged. You were evaluated by our Plastic Surgeons who removed the drain. The Plastic Surgery team believes that your surgical wound is healing well and not showing any signs of infection.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO 5X/DAY 2. Docusate Sodium 100 mg PO BID 3. Enoxaparin Sodium 30 mg SC DAILY RX *enoxaparin 30 mg/0.3 mL 30 mg SC daily Disp #*26 Syringe Refills:*0 4. Ramelteon 8 mg PO QHS:PRN insomnia Should be given 30 minutes before bedtime 5. Senna 8.6 mg PO BID 6. TraMADol 25 mg PO TID:PRN pain RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth every eight (8) hours Disp #*25 Tablet Refills:*0 7. TraZODone 25 mg PO QHS:PRN insomnia backup 8. Vitamin D ___ UNIT PO DAILY 9. Losartan Potassium 50 mg PO DAILY Can increase to the home dose after blood pressure monitoring 10. Atenolol 25 mg PO DAILY 11. Atorvastatin 20 mg PO QPM 12. FLUoxetine 10 mg PO DAILY 13. NIFEdipine (Extended Release) 30 mg PO DAILY 14. Pantoprazole 40 mg PO Q24H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Right femoral neck fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: -Weightbearing as tolerated right lower extremity MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 3 hours as needed x 1 day, then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take Lovenox daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - Splint must be left on until follow up appointment unless otherwise instructed. 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 FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___. You will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for any new medications/refills. Physical Therapy: Weightbearing as tolerated bilateral lower extremity, range of motion as tolerated 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 ___ mg PO Q6H:PRN Pain - Mild/Fever Reason for PRN duplicate override: Alternating agents for similar severity Do not take more than 4000 mg in 24 hours RX *acetaminophen 500 mg ___ tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*1 2. Ibuprofen 600 mg PO Q6H:PRN Pain - Mild take with food. Alternate every three hours with Tylenol for pain RX *ibuprofen 600 mg 1 tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*1 3. Lisinopril 10 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Hematosalpinx Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___ ___ were admitted to the gynecology service at ___ for pain management and observation of a possible ovarian torsion and hematosalpinx (blood and fluid in the fallopian tube). We repeated imaging on the second day of your stay, which demonstrated that the fluid collection in your fallopian tube and your abdomen was unchanged since ___ were admitted. Your blood counts remained stable as well, indicating that ___ were likely not continuing to bleed into your abdomen or fallopian tube. Your pain was well controlled on Tylenol and your vital signs remained stable. The team has determined that ___ are stable for discharge with close outpatient follow up with your primary OBGYN for further evaluation and definitive treatment. Call your doctor for: * fever > 100.4F * severe abdominal pain * difficulty urinating * vaginal bleeding requiring >1 pad/hr * abnormal vaginal discharge * nausea/vomiting where ___ are unable to keep down fluids/food or your medication</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Megestrol Acetate 400 mg PO BID RX *megestrol 400 mg/10 mL (10 mL) 400 mg by mouth twice a day Disp #*1 Package Refills:*1 2. Midodrine 15 mg PO TID RX *midodrine 5 mg 3 tablet(s) by mouth three times per day Disp #*270 Tablet Refills:*0 3. Gabapentin 300 mg PO BID RX *gabapentin 300 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 5. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 6. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Lactulose 30 mL PO TID constipation RX *lactulose 10 gram/15 mL (15 mL) 30 mL by mouth three times per day Disp #*4 Package Refills:*0 8. Multivitamins 1 TAB PO DAILY 9. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 10. HELD- Spironolactone 50 mg PO TID This medication was held. Do not restart Spironolactone until discussing with Dr. ___ ___ Disposition: Home With Service Facility: ___ Discharge Diagnosis: Alcoholic cirrhosis Hepatocellular carcinoma Post-TACE decompensation of cirrhosis Acute kidney injury Hepatorenal syndrome C difficile infection Chronic neuropathy QT Prolongation Hyponatremia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to participate in your care. WHY WAS I ADMITTED TO THE HOSPITAL? You were brought to the hospital from your rehab facility because you were experiencing worsening abdominal pain and swelling. WHAT HAPPENED WHILE I WAS HERE? - You were found to have fluid in your abdomen called ascites, which was drained multiple times. - You were found to have a kidney injury for which you received medicine called midodrine and octreotide. - You finished your course of treatment for your C. difficile infection. WHAT SHOULD I DO WHEN I GET HOME? - Please take all of your medicines as prescribed. - Weigh yourself every day and call your liver doctor if your weight increases by 3 pounds. - Go to all of your followup appointments. - Go to ___ next ___ and get a paracentesis. It was a pleasure caring for you and we wish you the best. Sincerely, Your ___ Liver Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Cyanocobalamin 1000 mcg PO DAILY 3. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES: - Syncope SECONDARY DIAGNOSIS: - Elevated blood pressure without diagnosis of hypertension - Pulmonary nodules and micronodules - Thyroid nodule Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at the ___ ___. WHY WAS I SEEN IN THE HOSPITAL? - You had two episodes of falling and losing (or near-losing) consciousness. WHAT WAS DONE WHILE I WAS IN THE HOSPITAL? - We looked at your brain and the blood vessels of your head and neck using a CT scan. We did not find any problems with your brain or blood vessels. - We watched the electrical activity of your heart overnight. You did not have any bad heart rhythms. - We looked at the strength and structure of your heart using an echocardiogram. This is roughly unchanged from the last time you had an echocardiogram with Atrius. WHAT SHOULD I DO WHEN I AM OUT OF THE HOSPITAL? - Please follow up with your primary care doctor and cardiologist as scheduled. - Please ask about your referral for a longer "event monitor" to look at the electrical activity of your heart over a month. We have placed an order through ___, but you may need other information from your ___ team. 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. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing 2. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO TID:PRN heartburn 3. Amlodipine 10 mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. Clonazepam 0.5 mg PO TID 6. CloniDINE 0.2 mg PO BID 7. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 8. Sertraline 100 mg PO BID 9. Zolpidem Tartrate 10 mg PO HS 10. Metoprolol Tartrate 50 mg PO BID 11. Milk of Magnesia 30 mL PO DAILY 12. Nicotine Polacrilex 2 mg PO Q1H:PRN smoking 13. Omeprazole 20 mg PO DAILY 14. Hydrochlorothiazide 25 mg PO DAILY 15. MetFORMIN (Glucophage) 1000 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute Kidney Injury Urinary Tract Infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You were admitted because you had damage to your kidneys. We gave you IV fluids and encouraged you to eat and drink and your kidney function improved. It is very important that you continue to drink plenty of water to prevent dehydration. We also treated you with antibiotics for a urinary tract infection. You will need to see your doctor within one week to recheck your electrolytes (including kidney function). We made the following changes to your medications: Restart: 1. Metformin 1000mg twice per day Stop: 1. glyburide since your blood sugar level was very low 2. duloxetine, please discuss restarting this medication with your mental health provider if it is still needed. 3. oxycodone</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Narcan (naloxone) 4 mg/actuation nasal ONCE TO REVERSE OPIOID OVERDOSE IF USED CALL ___ RX *naloxone [Narcan] 4 mg/actuation 1 spray intranasal ONCE Disp #*1 Spray Refills:*0 2. Allopurinol ___ mg PO BID 3. Baclofen 10 mg PO TID:PRN Pain - Moderate 4. CloNIDine 0.1 mg PO BID 5. Docusate Sodium 100 mg PO DAILY:PRN constipation 6. Fentanyl Patch 75 mcg/h TD Q72H 7. Lidocaine 5% Patch 1 PTCH TD BID:PRN Pain 8. MetFORMIN XR (Glucophage XR) 750 mg PO BID 9. Mirtazapine 45 mg PO QHS 10. OxyCODONE (Immediate Release) 5 mg PO Q8H:PRN Pain - Moderate 11. Pregabalin 300 mg PO TID 12. QUEtiapine Fumarate 50 mg PO QAM 13. QUEtiapine Fumarate 100 mg PO QHS 14. Sertraline 50 mg PO DAILY 15. Spironolactone 25 mg PO DAILY 16. Trandolapril 2 mg PO BID 17. TraZODone 100 mg PO QHS 18. Verapamil SR 180 mg PO Q24H Discharge Disposition: Home Discharge Diagnosis: Primary: Community Acquired Pneumonia Transaminitis Secondary: Hypertension Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to ___ because you had confusion and a headache. WHILE YOU WERE HERE: - We did some labs on your spinal fluid and found that you do not have meningitis - We found that you have pneumonia and we treated this with antibiotics WHEN YOU GO HOME: - Please continue all medications as directed - Please follow-up with the doctors listed below - ___ any shortness of breath, confusion, or worsening headache, please call your doctor or return to the emergency department immediately 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. Enoxaparin Sodium 100 mg SC Q12H Duration: 3 Months Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 100 mg/mL 100 mg SC twice daily Disp #*60 Syringe Refills:*2 2. Benzonatate 100 mg PO TID 3. Gabapentin 600 mg PO TID 4. Levothyroxine Sodium 75 mcg PO DAILY 5. HELD- PAZOPanib 600 mg oral DAILY This medication was held. Do not restart PAZOPanib until you discuss with your oncologist. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right posterior Tibial Vein clot Community acquired pneumonia Discharge Condition: Stable Alert and communicative Independent Followup Instructions: ___ [/INST] </s><s>Dear ___, It was a pleasure taking care of you. You were admitted here because you had a blood clot in right leg. You were treated with subcutaneous lovenox injections for the blood clot. You need to continue this treatment for three months at least. Please follow up with your other appointments as outpatient. Sincerely, ___ MD</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*6 Tablet Refills:*0 2. Albuterol Inhaler 2 PUFF IH Q6H:PRN cough 3. Benzonatate 200 mg PO TID:PRN cough 4. Dexamethasone 8 mg PO ASDIR 5. Enoxaparin Study Med 80 mg Subcutaneous DAILY 6. GuaiFENesin ___ mL PO Q6H:PRN cough 7. LOPERamide 2 mg PO Q4H:PRN diarrhea 8. LORazepam 0.5-1 mg PO Q6H:PRN nausea, vomiting, anxiety 9. Metoclopramide 5 mg PO QID 10. Mirtazapine 30 mg PO QHS 11. Ondansetron 8 mg PO Q8H:PRN as needed for severe nausea 12. Prochlorperazine ___ mg PO Q6H:PRN nausea r/t chemotherapy 13. Zenpep (lipase-protease-amylase) 3 tabs oral qmeals 14.Tube Feeds Jevity 1.5 at 110 ml/hr over 16 hours. Dispense 1 month supply. Refills: 11. Free water 150 mL Q4H. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: - Nausea/Vomiting - Malignant Ascites - Bacterial Peritonitis - Diarrhea - Cough - Oropharyngeal Dysphagia with Aspiration - Severe Protein-Calorie Malnutrition - Metastatic Pancreatic Cancer - Anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___. You were admitted to the hospital with nausea and vomiting. This was likely due to chemotherapy and improved. There was concern that your feeding tube was misplaced so this was replaced. You also had a drainage of your ascites (abdominal fluid). There was concern for infection of the fluid for which you received antibiotics and will finish at home. Your tube feeds were modified to help you tolerated them better at home so as to improve your nutrition. You will start by running the tube feeds over 16 hours. You should follow-up with your outpatient Nutrition team. While on this schedule of tube feeds, you can take your Zenpep (pancreatic enzyme replacement) at bedtime and in the morning. Please continue your prior home medications. Please follow-up with your Oncologist. All the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. cyanocobalamin (vitamin B-12) 250 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 5. tizanidine 2 mg Tablet Sig: Two (2) Tablet PO TID (3 times a day) as needed for pain/muscle spasm. 6. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Adhesive Patch, Medicated Topical DAILY (Daily). 7. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 8. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain. Discharge Disposition: Home Discharge Diagnosis: Anemia, Back pain, s/p eye trauma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Mr. ___, . You were admitted to the hospital for back pain, eye pain, and a decrease in your blood counts after being hit by the blunt end of a pistol. We performed an MRI of your back that shows no damage to your spinal cord. You were also seen by ophthalmology who found no damage to your eye. Your eyelid will remain swollen for the next several days. We suspect that you lost blood in your stool. However, you would not allow us to follow your blood counts, or test your stool for blood. . You were discharged to home. . Medications changed this admission: STOP seroquel STOP celexa START ibuprofen every 6 hours as needed for pain</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 20 mg PO DAILY 2. lactase *NF* 4,500 unit Oral with dairy 3. Simethicone 40-80 mg PO QID:PRN bloating Discharge Disposition: Home Discharge Diagnosis: Abdominal Pain, etiology unclear Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking part in your care during your hospitalization at ___. You were admitted with abdominal pain, and underwent testing to investigate the cause. CT scan did NOT show appendicitis, bowel obstruction, or kidney stones, and ultrasound of the abdomen did NOT show gallstones. With ibuprofen and your usual home medications your symptoms improved and you were able to be discharged home. It is important that you follow up with your PCP as directed below to discuss your symptoms.</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. Multivitamins W/minerals 1 TAB PO DAILY 3. Neutra-Phos 2 PKT PO BID 4. Nicotine Lozenge 2 mg PO Q2H:PRN crave 5. Thiamine 100 mg PO DAILY 6. OLANZapine 2.5 mg PO TID W/MEALS 7. ClonazePAM 0.5 mg PO TID:PRN anxiety 8. DiphenhydrAMINE 50 mg PO QHS:PRN sleep 9. FoLIC Acid 1 mg PO DAILY 10. Gabapentin 200 mg PO TID 11. LamoTRIgine 150 mg PO BID 12. Levothyroxine Sodium 25 mcg PO DAILY 13. Melatin (melatonin) 5 mg oral QPM 14. Simethicone 40-80 mg PO QID:PRN gas/distention Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis - Anorexia nervosa - Malnutrition - Bradycardia 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 ___ because you were still losing weight while at ___ Eating Disorder Unit and the physicians there found your low heart rate to be concerning. You were put on an eating disorder protocol responded well gaining weight appropriately. Your electrolytes and lab values remained stable throughout your stay. You are now healthy enough to restart treatment at ___ and have been accepted there. It was a pleasure taking care of you! Sincerely, Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H:PRN Pain - Mild RX *acetaminophen 325 mg ___ tablet(s) by mouth every 4 hours Disp #*60 Tablet Refills:*0 2. Doxycycline Hyclate 100 mg PO Q12H Duration: 5 Days RX *doxycycline hyclate 100 mg 1 capsule(s) by mouth twice a day Disp #*10 Capsule Refills:*0 3. PredniSONE 10 mg PO DAILY 4. HELD- Humira (adalimumab) 40 mg/0.8 mL subcutaneous EVERY 2 WEEKS This medication was held. Do not restart Humira until instructed by Dr. ___ 5.Outpatient Lab Work Draw CBC with diff on ___. D70.9. Results forwarded to Dr. ___: ___ Discharge Disposition: Home Discharge Diagnosis: arm abscess and soft tissue skin infection, cellulitis pancytopenia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Instructions: Dear Ms. ___, It was a pleasure to be a part of your care team at ___ ___. ==================================== Why did you come to the hospital? ==================================== -You had fever, new rash, and found to also have low blood counts. ==================================== What happened at the hospital? ==================================== -You were found to have an abscess in the right arm that was infected and likely causing your fevers. It was incised and drained which allowed your new antibiotics to work. -Your low blood counts were likely due to bone marrow suppression from the Bactrim antibiotic you were taking prior to this hospital stay. Your bone marrow should continue to recover on its own. You did require a unit of blood transfusion due to a very low blood count. ================================================== What needs to happen when you leave the hospital? ================================================== -WHEN TAKING DOXYCYCLINE: Administer with meals to decrease GI upset. Administer capsules and tablets with at least 8 ounces (240 mL) of water and have patient sit up for at least 30 minutes after taking to reduce the risk of esophageal irritation and ulceration. Use skin protection and avoid prolonged exposure to sunlight and ultraviolet light. Last day to take doxycycline is on ___. Avoid Bactrim antibiotic in the future. -For the right arm wound, cover with gauze and wrap in Kerlix. Change dressing once daily until your appointment with Dr. ___. Do not remove the iodoform packing. -Take your medications every day and have your CBC (blood count) laboratory levels checked as directed by your doctors. ___ should be drawn on ___, with results being forwarded to Dr. ___. -Please attend all of your doctor appointments and arrange for them as below. It was a pleasure taking care of you during your stay! Sincerely, 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 Take ___ hrs after dialysis on dialysis days. 2. Sulfameth/Trimethoprim DS 1 TAB PO Q24H Duration: 5 Days To end ___. Give after dialysis on dialysis days. 3. Warfarin 2.5 mg PO Q24H 4. Amiodarone 200 mg PO DAILY 5. Atorvastatin 10 mg PO DAILY 6. Calcitriol 0.5 mcg PO DAILY 7. Calcium Acetate 1334 mg PO TID W/MEALS 8. FoLIC Acid 1 mg PO DAILY 9. sevelamer CARBONATE 800 mg PO TID W/MEALS 10. Tamsulosin 0.4 mg PO DAILY 11. Viagra (sildenafil) 100 mg oral PRN Sexual activity Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left putamen hemorrhagic stroke Urinary tract infection ESRD Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the ___ after you had right-sided weakness which was due to a bleed, or hemorrhage, in a small part of your brain. This was probably caused by your blood pressure being uncontrolled while you were on a blood thinning medication. Your symptoms had dramatically improved by the time you were discharged. We worked closely with our nephrology team to come up with a good plan to manage your blood pressure without it going too high or too low. After you leave the hospital, it is very important to continue to monitor your blood pressure closely and to work with your primary care doctor to manage your medications. Because you have hypertension, high cholesterol, and a-fib, you are risk to have more strokes in the future. We adjusted your medications as below to minimize the risk of this happening. You are being discharged on a new blood pressure medication, Amlodipine, which you should take every day. You should wait until after dialysis ___ hours) to take it on the days you have dialysis. We are also restarting your Coumadin, a blood thinning medication to help prevent future strokes. You should continue to take your anti-cholesterol medication, atorvastatin, every day. Finally, you were diagnosed with a urinary tract infection prior to discharge and were prescribed an antibiotic, Bactrim, which you should take for a total of 7 days (starting ___. You should take it after dialysis on the days when you have dialysis. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Colchicine 0.6 mg PO DAILY 3. Metoprolol Tartrate 12.5 mg PO BID 4. PredniSONE 5 mg PO DAILY 5. Tamsulosin 0.4 mg PO QHS 6. Atovaquone Suspension 1500 mg PO DAILY RX *atovaquone 750 mg/5 mL 1500 mg by mouth daily Refills:*0 7. CeftriaXONE 2 gm IV Q24H RX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 2 gm IV q24h Disp #*23 Intravenous Bag Refills:*0 8. Zolpidem Tartrate 10 mg PO QHS 9. ezetimibe-simvastatin ___ mg oral DAILY 10. Januvia (sitaGLIPtin) 25 mg oral DAILY 11. Losartan Potassium 50 mg PO QHS 12. NexIUM (esomeprazole magnesium) 40 mg oral BID 13. Mycophenolate Mofetil 500 mg PO BID RX *mycophenolate mofetil 500 mg one tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 14. Tacrolimus 1.5 mg PO Q12H RX *tacrolimus 1 mg one capsule(s) by mouth daily Disp #*60 Capsule Refills:*0 RX *tacrolimus 0.5 mg one capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: Sepsis Gram-negative rod bacteremia Acute kidney injury Neutropenia SECONDARY DIAGNOSES: Autosomal dominant polycystic kidney disease Status-post kidney transplant (___) Hypertension Hyperlipidemia Prostate cancer 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 an infection in your bloodstream; you received intravenous antibiotics. Your blood was checked daily until it was clear of the infection. You underwent a number of laboratory and imaging studies to determine the source of infection, which were unrevealing. Due to the severity of the infection, a PICC line was placed; you will continue on intravenous ceftriaxone 2gm daily through ___ (a 4-week course); the Infectious Disease doctors at ___ then determine whether you need a longer course of antibiotics or if you can stop at that time. In addition, during your stay, your immunosuppression was monitored closely. You should continue taking tacrolimus 1.5mg twice daily, Cellcept 500mg twice daily, and prednisone 5mg daily. Because you had a decrease in your white blood cell count during your stay, your Bactrim was stopped; you should take Dapsone 1500mg daily for prevention of infection while on chronic steroids. Please follow up with your Transplant doctor to monitor these medications. Thank you for letting us be a part of your care! Your ___ Kidney Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: The Preadmission Medication list is accurate and complete. 1. irbesartan 150 mg oral BID 2. Montelukast 10 mg PO DAILY 3. Morphine Sulfate ___ 30 mg PO Q8H:PRN pain 4. NPH 33 Units Breakfast NPH 36 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 5. Potassium Chloride 20 mEq PO BID 6. TraMADOL (Ultram) 50 mg PO TID:PRN pain 7. Baclofen 20 mg PO TID 8. HydrOXYzine 10 mg PO DAILY:PRN very itchy 9. Fluticasone Propionate 110mcg 4 PUFF IH BID 10. Albuterol Inhaler 2 PUFF IH Q4H:PRN dyspnea 11. Fluticasone Propionate NASAL 1 SPRY NU BID 12. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN dyspnea 13. Aspirin 81 mg PO DAILY 14. Ascorbic Acid ___ mg PO DAILY 15. Clindamycin 450 mg PO Q6H Until ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Cellulitis Venous stasis dermatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___. You were admitted for treatment of cellulitis. You were treated with antibiotics and with elevation of your right leg to help drain the infected fluids. We also had our wound care nurses place ___ dressing over the blisters. The cellulitis improved so we felt you were ready to continue treatment from home. However, the cellulitis infection is not yet cured, please continue to take the antibiotic called Clindamycin until ___. We also will have a visiting nurse assist with changing your leg dressing. We'd also like you to follow-up with your PCP. Sincerely, -- 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 a day Disp #*60 Tablet Refills:*0 2. Ferrous Gluconate 325 mg PO TID RX *ferrous gluconate 325 mg (36 mg iron) 1 tablet(s) by mouth three times per day Disp #*90 Tablet Refills:*3 3. Senna 1 TAB PO BID RX *sennosides [senna] 8.6 mg 1 tab by mouth twice per day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Chronic kidney disease iron deficiency anemia symptomatic anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted with symptomatic anemia and chronic kidney disease. You were given 2 units of red blood cells with improvement in your kidneys. You were found to be severely iron deficient. You were started on ferrous gluconate (you did not tolerate ferrous sulfate in the past). Do not discontinue this medication unless you discuss with PCP. You were found to have decreased kidney function. You will need to see the kidney doctor as an outpatient for further assessment and management.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Mr. ___, You were admitted to the hospital for pneumona. You were started on antibiotics for the infection which improved your symptoms. You were given IV fluids and oxygen to help you breathe. We were able to ween you off of oxygen. We are sending you home on antibiotics for an additional 5 days. -Levofloxacin 750 mg Daily for 5 more days.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet(s) by mouth every 6 hours Disp #*30 Tablet Refills:*0 2. Ibuprofen 400 mg PO Q8H:PRN Pain - Moderate RX *ibuprofen 800 mg 1 tablet(s) by mouth every 6 hours Disp #*30 Tablet Refills:*0 3. OxyCODONE (Immediate Release) 10 mg PO Q6H:PRN Pain - Severe RX *oxycodone 5 mg ___ tablet(s) by mouth every 6 hours Disp #*30 Tablet Refills:*0 4. ARIPiprazole 20 mg PO DAILY RX *aripiprazole [Abilify] 20 mg 1 tablet(s) by mouth daily Disp #*14 Tablet Refills:*0 5. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath/wheezing 6. ClonazePAM 1 mg PO TID:PRN worsening anxiety 7. Ipratropium-Albuterol Inhalation Spray 1 INH IH QID:PRN worsening shortness of breath/wheezing 8. TraZODone 50-100 mg PO QHS:PRN insomnia 9. HELD- Amphetamine-Dextroamphetamine 30 mg PO DAILY This medication was held. Do not restart Amphetamine-Dextroamphetamine until advised by your psychiatrist 10. HELD- ClonazePAM 0.5 mg PO TID:PRN worsening anxiety This medication was held. Do not restart ClonazePAM until advised by your psychiatrist 11. HELD- ClonazePAM 0.5 mg PO TID:PRN worsening anxiety This medication was held. Do not restart ClonazePAM until advised by your psychiatrist Discharge Disposition: Home Discharge Diagnosis: Schizoaffective disorder COPD without acute exacerbation R humerus fracture Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the medical service with concerns for a COPD exacerbation. Your oxygen levels were checked and remained normal. You had no evidence of pneumonia or COPD exacerbation. You should continue to use your inhalers and quit smoking. You had an X-ray of your right arm which is known to be broken. You should remain non-weight bearing and start OT and pendulum swings. You will need to follow up with ortho-trauma as an outpatient. You were also seen by psychiatry for psychosis. You were started on abilify and got an injection. However, you should continue taking the abilify pills for 2 weeks until the injection kicks in.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BuPROPion (Sustained Release) 150 mg PO QAM 2. ClonazePAM 1 mg PO BID 3. Docusate Sodium 100 mg PO BID 4. Methadone 20 mg PO QAM 5. Methadone 10 mg PO QPM 6. QUEtiapine Fumarate 50 mg PO QHS 7. Milk of Magnesia 30 mL PO Q6H:PRN constipation 8. Calcium Carbonate 500 mg PO QID:PRN indigestion RX *calcium carbonate 500 mg calcium (1,250 mg) 1 tablet(s) by mouth four times a day Disp #*30 Tablet Refills:*0 9. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*10 Tablet Refills:*0 10. CloniDINE 0.3 mg PO TID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: viral gastroenteritis SECONDARY DIAGNOSIS: radiation enteritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted with abdominal pain and vomiting due to viral gastroenteritis. Your imaging tests were reassuring and you were able to take in oral intake. Please call your PCP tomorrow to schedule a follow up visit in the next ___ days, as this appointment could not be made prior to your discharge. Please discuss a referral to gastroenterology for your chronic radiation enteritis. It was a pleasure caring for you. Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain. 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 3. duloxetine 30 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO QHS (once a day (at bedtime)). 4. digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. methylphenidate 10 mg Tablet Sig: One (1) Tablet PO AM AND NOON, PRN () as needed for patient request. 7. Seroquel XR 50 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO at bedtime. 8. amoxicillin-pot clavulanate 875-125 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 13 days. Disp:*26 Tablet(s)* Refills:*0* 9. Coumadin 5 mg Tablet Sig: One (1) Tablet PO ___. 10. Coumadin 2.5 mg Tablet Sig: One (1) Tablet PO TUE/WED/FRI/SAT/SUN: please continue to check your INR as scheduled. Discharge Disposition: Home Discharge Diagnosis: Cystic duct stump leak and biloma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please call your doctor or nurse practitioner if you experience the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain is not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. *Continue to follow with ___ clinic as scheduled to monitor your INR level. Call Dr. ___ with any question regarding Coumadin.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 400 mg PO BID Take 200mg twice daily for 30 days then starting ___ take 200mg daily thereafter. RX *amiodarone 200 mg 1 tablet(s) by mouth Twice daily for 30 days then switch to once daily on ___ Disp #*60 Tablet Refills:*2 2. Aspirin EC 81 mg PO DAILY RX *aspirin 81 mg 1 tablet,delayed release (___) by mouth Daily Disp #*90 Tablet Refills:*4 3. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth Twice daily Disp #*60 Capsule Refills:*0 4. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q4H:PRN pain RX *oxycodone-acetaminophen 5 mg-325 mg 1 tablet(s) by mouth Every ___ hours Disp #*50 Tablet Refills:*0 5. Warfarin 2 mg PO DAILY16 RX *warfarin [Coumadin] 2 mg As instructed tablet(s) by mouth Daily Disp #*40 Tablet Refills:*2 6. Metoprolol Tartrate 25 mg PO BID RX *metoprolol tartrate 25 mg 1 tablet(s) by mouth Twice daily Disp #*60 Tablet Refills:*2 7. Losartan Potassium 50 mg PO DAILY RX *losartan 50 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*2 8. Ranitidine 150 mg PO BID Duration: 30 Days RX *ranitidine HCl 150 mg 1 tablet(s) by mouth Twice daily Disp #*60 Tablet Refills:*0 9. Tucks Hemorrhoidal Oint 1% ___ID RX *pramoxine-mineral oil-zinc [Tucks] 1 %-12.5 % 1 Ointment(s) rectally four times a day Disp #*1 Tube Refills:*2 10. Atorvastatin 10 mg PO HS RX *atorvastatin 10 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*2 11. Furosemide 40 mg PO DAILY Duration: 7 Days RX *furosemide 40 mg 1 tablet(s) by mouth Daily in AM Disp #*7 Tablet Refills:*0 12. Potassium Chloride 20 mEq PO DAILY Duration: 7 Days RX *potassium chloride 20 mEq 1 Tablet by mouth Daily in AM Disp #*7 Tablet Refills:*0 Discharge Disposition: Extended Care Discharge Diagnosis: Ventricular fibrillation arrest in the setting of 3 vessel coronary disease Hyperlipidemia since age ___ (has a history of being on Lipitor and Crestor but stopped for the past year b/c he was concerned about myalgias) Benign Prostatic Hyperplasia Restless leg syndrome Gastroesophageal Reflux Disease Asthma (in his ___ Tinnitus Cardiomyopathy Postoperative, paroxysmal Atrial Fibrillation Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Incisions: Sternal - healing well, no erythema or drainage Leg Left - healing well, no erythema or drainage. Edema 2+ Followup Instructions: ___ [/INST] </s><s>1) Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage. 2) Please NO lotions, cream, powder, or ointments to incisions. 3) Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart provided. 4) No driving for 6 months per Dr. ___ and while taking narcotics. Driving will be discussed at follow up appointment with Dr. ___. 5) No lifting more than 10 pounds for 10 weeks 6) Please call with any questions or concerns ___ 7) Per Dr. ___ can not return to working in the warehouse for 3 months. **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. Ibuprofen 800 mg PO Q8H RX *ibuprofen 800 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 2. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *polyethylene glycol 3350 [___] 17 gram 1 packet by mouth daily Disp #*30 Packet Refills:*0 3. Senna 1 TAB PO BID RX *sennosides [senna] 8.6 mg 1 capsule by mouth daily Disp #*30 Capsule Refills:*0 4. OxycoDONE (Immediate Release) 15 mg PO Q4H:PRN pain RX *oxycodone 15 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 5. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 6. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H RX *oxycodone 20 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*28 Tablet Refills:*0 RX *oxycodone [OxyContin] 20 mg 1 tablet extended release 12 hr(s) by mouth twice a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: 1. Painful subcutaneous nodules, arthralgias 2. Anemia Discharge Condition: Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you here at ___. You came to the hospital because of arm and leg pains and nodules on your skin. We had the rheumatologists, infectious disease doctors as ___ as the dermatologists see you while you were here. For your pain we gave you ibuprofen, oxycontin and oxycodone. To avoid stomach irritation, please take zantac (ranitidine) or pepcid (famotidine) while you are on ibuprofen. Also while here you were found to be anemic. You had no blood in your stool, and it seems that the inflammation may be causing your blood counts to be low. With improvement of the inflammation, we expect the anemia to improve. Please follow up with your primary care doctor and rheumatologist. Your primary care doctor ___ coordinate the appointment with your rheumatologist. There are still several tests pending and your PCP ___ be informed of the results. The rheumatologists who saw you here will communicate with your rheumatologist to update her on your hospital course. After we confirm you do not have TB you will likely be started on prednisone. Expect a call from the rheumatologists tomorrow.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Abacavir Sulfate 600 mg PO DAILY RX *abacavir 300 mg 2 tablet(s) by mouth once a day Disp #*60 Tablet Refills:*0 2. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild RX *acetaminophen 500 mg 2 tablet(s) by mouth three times a day Disp #*100 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 4. Doxycycline Hyclate 100 mg PO Q12H END ___ RX *doxycycline hyclate 100 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 5. LaMIVudine 150 mg PO DAILY RX *lamivudine [Epivir] 150 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 6. Ondansetron 4 mg PO Q8H:PRN nausea Duration: 10 Days RX *ondansetron HCl 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*12 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY Please stop taking when regular bowel movements. RX *polyethylene glycol 3350 [Miralax] 17 gram 1 powder(s) by mouth once a day Disp #*14 Packet Refills:*0 8. Senna 8.6 mg PO BID constipation RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 9. Ranitidine 150 mg PO QHS RX *ranitidine HCl 150 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 10. Cetirizine 10 mg PO DAILY 11. Cyanocobalamin 500 mcg PO DAILY 12. Etravirine 400 mg PO DAILY 13. Multivitamins 1 TAB PO DAILY 14. Vitamin D ___ UNIT PO DAILY 15. HELD- Epzicom (abacavir-lamivudine) 600-300 mg oral DAILY This medication was held. Do not restart Epzicom until YOUR DOCTOR TELLS YOU TO 16.CRUTCHES ICD-10 CODE: ___.80 EXPECTED LENGTH: 13 MONTHS PROGNOSIS: GOOD Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Septic Arthritis due to gonorrhea Acute Kidney Injury Vaginal Bleeding Secondary: HIV Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted to ___ because you were having severe joint pain. WHILE YOU WERE HERE: - We found out that you had an infection in your joints called gonorrhea - We washed out your joints with surgery and gave you antibiotics - You had some kidney injury while you were here that is recovering now WHEN YOU GO HOME: - Please continue all medications as directed - Please follow-up with the doctors listed below - ___ monitor for the "alarm symptoms" listed below; if you experience any of these symptoms please call your doctor or return to the emergency room immediately We wish you the best, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN pain 2. Docusate Sodium 200 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. Guaifenesin ___ mL PO Q6H:PRN cough RX *guaifenesin 100 mg/5 mL 5 mL by mouth every 6 hours Disp #*1 Bottle Refills:*0 4. Levofloxacin 750 mg PO DAILY RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*4 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Pneumonia Secondary: Ileus 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 after you were diagnosed with pneumonia. We started you on antibiotics and you improved. You also had issues with moving your bowels which resolved with conervative measures. Please continue a full liquid diet at home (soups, jello, shakes) and advance to regular diet slowly as tolerated. ___ MDs</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. MetFORMIN (Glucophage) 500 mg PO BID RX *metformin 500 mg 1 tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 2. Acetaminophen 500 mg PO Q6H:PRN pain 3. Amlodipine 10 mg PO DAILY 4. Atenolol 25 mg PO DAILY 5. Gabapentin 600 mg PO TID 6. Meclizine 25 mg PO Q8H:PRN vertigo 7. Omeprazole 20 mg PO DAILY 8. OxycoDONE (Immediate Release) 15 mg PO Q6H:PRN pain 9. OxyCODONE SR (OxyconTIN) 10 mg PO Q12H 10. Vitamin D 1000 UNIT PO DAILY 11. Simvastatin 10 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: primary diagnosis: hyperglycemia secondary diagnosis: chronic pain, opiate use vaginal yeast infection Discharge Condition: PATIENT LEFT AMA. She did not wait for her paperwork, but was given a prescription for Metformin and instructed to follow up with her PCP. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital because your sugars were very elevated. We think that you likely have diabetes. We wanted to treat you with insulin while we were awaiting some more lab work, but you decided to leave the hospital against medical advice. You understand the risks of leaving the hospital without further treating your elevated blood sugars. It will be VERY important for you to follow up with your primary care doctor this week. We are giving you a prescription for metformin, a medication that can help lower your sugars. Please start taking this medication to help control your sugars and follow up with your primary care doctor. PATIENT LEFT AMA. She did not wait for her paperwork, but was given a prescription for Metformin and instructed to follow up with her PCP.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Azithromycin 250 mg PO DAILY Duration: 4 Doses RX *azithromycin 250 mg 1 tablet(s) by mouth once a day Disp #*1 Tablet Refills:*0 2. Nicotine Patch 14 mg/day TD DAILY RX *nicotine [Nicoderm CQ] 14 mg/24 hour apply one 14mg/24hr daily transdermal patch once a day Disp #*30 Patch Refills:*0 3. PredniSONE 40 mg PO DAILY Duration: 3 Doses RX *prednisone 20 mg 2 tablet(s) by mouth once a day Disp #*2 Tablet Refills:*0 4. TraZODone 50-100 mg PO QHS:PRN unknown 5. Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN GERD 6. Aspirin 81 mg PO DAILY 7. Cetirizine 10 mg PO DAILY 8. ClonazePAM 0.5 mg PO DAILY:PRN panic attack 9. diclofenac sodium 1 % topical QID:PRN pain 10. Fluticasone Propionate NASAL 2 SPRY NU DAILY 11. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 12. HydrOXYzine 50 mg PO Q6H:PRN anxiety 13. Omeprazole 20 mg PO DAILY 14. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q4H:PRN 15.Outpatient Physical Therapy ICD10 H81.10 benign paroxysmal vertigo, unspecified ear Please perform vestibular physical therapy Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: Acute hypoxemic respiratory failure COPD exacerbation Pulmonary edema Secondary diagnosis: Benign paroxysmal positional vertigo Panic attacks GERD Tobacco abuse Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___. Why did you come to the hospital? - You were having worse shortness of breath than usual, as well as leg swelling. What did you receive in the hospital? - You were treated for a COPD exacerbation with steroids and antibiotics. - You received a water pill to help remove fluid from your lungs. - We performed an ultrasound of your heart which did not show obvious signs of heart failure. - We performed a CAT scan of your chest which did not show blood clots. - You were evaluated by our physical therapy team, who diagnosed you with BPPV, which can be easily treated as an outpatient. - Your oxygen level improved and you were ready to leave the hospital. What should you do once you leave the hospital? - Try as hard as you can to stop smoking, as this will help improve your shortness of breath. - Take your medications as prescribed. - Attend your follow up appointments as scheduled. We wish you all the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atenolol 100 mg PO DAILY 3. Ipratropium Bromide MDI 2 PUFF IH QID 4. Nicotine Patch 21 mg TD DAILY 5. Viagra (sildenafil) 100 mg oral 1 tablet(s) 6. Hydrochlorothiazide 25 mg PO DAILY 7. Amlodipine 10 mg PO DAILY 8. Azithromycin 250 mg PO Q24H Duration: 4 Days RX *clarithromycin 250 mg 1 tablet(s) by mouth once a day Disp #*3 Tablet Refills:*0 9. Albuterol Inhaler 2 PUFF IH Q4H:PRN cough 10. Pravastatin 10 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: 1. Right facial droop and difficulty with language concerning for stroke. 2. Stroke work up 3. Alcohol dependency 4. Tobacco dependency 5. Hypertension 6. Hyperlipidemia 7. Headache 8. Diabetes 9. Obesity 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 the sudden onset of a right facial droop, headache, and chest pain. You had a CT and MRI of your brain which showed that you did not have a stroke. The symptoms you experienced were most likely due to a complex migraine, which is a type of headache. You have an appointment with Neurology to follow up. We are not making any changes to your regular medications. Please continue to take your regular medications as prescribed. Please followup with Neurology and your primary care physician as listed below. It was a pleasure providing you with care during this hospitalization. -The ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, . It was a pleasure taking care of you at ___. You were admitted due to having sleep disturbances and a concern for a change in your behavior. After initial evaluation in the ED there was concern that you might have had a stroke, and therfore you were admitted to the Neurology Service. An initial scan of your head was performed (CT Scan) and was reassuring. Afterwards you had another more detailed scan (MRI) to evaluate for stroke and it demonstrated no evidence of stroke, bleeding, masses or other clearly contributory changes. There were no obvious vessel abnormalities. In addition, several investigatory studies were done to evaluate for other causes of cognitive change; there were no signs of significant infectious or toxic-metabolic disturbances. It is thought that your thinking and behavior changed in the setting of increased use of pain medication and sleep aids. We stopped these agents (oxycodone, ambien, benadryl) at the time of admission, with excellent improvement in your thinking. (The abnormalities noted at the admission exam completely resolved as well.) We recommend you refrain from taking these medications in the future; please use tylenol (eg 650 mg every four hours as needed for pain). . We made the following changes to your medications: - discontinue ambien - discontinue benadryl - discontinue oxycodone . Please start thiamine, folate, and a multivitamin. . As you were discharged on the weekend, we were unable to schedule follow up appointments for you. Please coordinate an appointment with Dr. ___ (___).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Docusate Sodium 100 mg PO BID 3. Enoxaparin Sodium 40 mg SC DAILY Duration: 28 Days 4. Escitalopram Oxalate 20 mg PO DAILY 5. Methocarbamol 750 mg PO QID:PRN muscls spasm Please take 1 tablet up to 4 times daily only as needed for muscle spasm. 6. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain 7. Senna 1 TAB PO BID Discharge Disposition: Home Discharge Diagnosis: Left tibial shaft fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 4 weeks WOUND CARE: - You can get the wound wet/take a shower starting 3 days after your surgery. You may wash gently with soap and water, and pat the incision dry after showering. - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. ACTIVITY AND WEIGHT BEARING: - Partial weight bearing in the LLE. - Remain in air cast boot until post op visit.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ertapenem 1 gram injection DAILY Duration: 3 Days Continue through ___ RX *ertapenem [Invanz] 1 gram 1 g IV daily Disp #*3 Vial Refills:*0 2. Fosfomycin Tromethamine 4 g PO EVERY 10 DAYS 3. Bisacodyl ___AILY constipation 4. Docusate Sodium 100 mg PO BID 5. Finasteride 5 mg PO DAILY 6. Polyethylene Glycol 17 g PO DAILY 7. Senna 17.2 mg PO BID 8. Simethicone 40-80 mg PO TID:PRN gas pain 9. Simvastatin 20 mg PO QPM 10. Tamsulosin 0.8 mg PO QHS 11. TraZODone 25 mg PO QHS 12. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP DAILY:PRN itch Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Urosepsis Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Mr. ___ it was a pleasure taking care of you during your stay at ___. You were admitted for an infection of your urinary tract. You were by the infectious disease specialist and treated with antibiotics. You will need to complete your antibiotic course at home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, You came to our hospital because of diarrhea and concern that you might have Crohn's disease. At our hospital we determined that this was an inflammatory bowel disease, possibly Crohn's disease. You had an MRI of your small intestine, an EGD and a colonoscopy, and were treated with steroids. Your pain and diarrhea improved with steroids. Please continue taking oral steroids and follow up with GI. 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. Fluticasone Propionate NASAL 2 SPRY NU BID 2. Gabapentin 300 mg PO QHS 3. Losartan Potassium 100 mg PO DAILY 4. Levofloxacin 750 mg PO DAILY 5. Acetaminophen 1000 mg PO Q8H:PRN pain 6. Docusate Sodium 100 mg PO DAILY:PRN constipation 7. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H 8. Citracal + D Maximum *NF* (calcium citrate-vitamin D3) 315-250 mg-unit ORAL BID 9. Multivitamins 1 TAB PO DAILY 10. Polyethylene Glycol 17 g PO DAILY 11. Psyllium 1 PKT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: Pneumonia, C. difficile infection Secondary diagnoses: Hypertension, spinal stenosis, vertigo, anxiety, sarcoid 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 take care of you during this hospitalization. You were admitted to ___ ___ for abdominal discomfort and a dry cough. A chest X-ray was done that revealed a possible pneumonia, and you were given one dose of intravenous antibiotics followed by antibiotics by mouth. A stool sample was sent and revealed growth of a bacteria called C. difficile for which you were started on an antibiotic by mouth. You did not have any fevers, abdominal pain, or shortness of breath while you were in the hospital. You are now safe to go home to complete your oral antibiotics. The following medications were ADDED: - Please take Levofloxacin 750mg by mouth daily for 6 days - Metronidazole 500mg by mouth three times daily for 14 days Please hold your stool softeners until your diarrhea and infection resolve. Please take your medications as directed and attending your follow-up appointments as scheduled below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q8H 2. Atovaquone Suspension 750 mg PO DAILY 3. Dronabinol 5 mg PO BID 4. esomeprazole magnesium 40 mg oral DAILY:PRN heartburn 5. Lactulose 15 mL PO Q8H:PRN constipation 6. LORazepam 0.5 mg PO BID:PRN nausea 7. mometasone 50 mcg/actuation nasal DAILY 8. Ondansetron 8 mg PO Q8H:PRN nausea 9. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Discharge Disposition: Home Discharge Diagnosis: Drug reaction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted with fevers, nausea, vomiting. You came to the ICU for a fast heart rate. You quickly improved with treatment for nausea and IV fluids. We found no evidence of an infection. We believe your symptoms are related to your chemotherapy regimen. After speaking to your oncologists we are holding this for now. You should follow up with your oncology team next week to discuss the next steps.</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. Calcium Carbonate 500 mg PO QID:PRN heartburn 3. DULoxetine 90 mg PO DAILY RX *duloxetine 30 mg 3 capsule(s) by mouth once a day Disp #*42 Capsule Refills:*0 4. Gabapentin 1200 mg PO TID 5. Methocarbamol 500 mg PO Q6H:PRN pain, muscle spasm 6. Ranitidine 300 mg PO BID 7. lidocaine HCl 3 % topical BID:PRN pain RX *lidocaine HCl 3 % apply to affected area twice a day Refills:*0 8. Melatin (melatonin) 3 mg oral QHS:PRN insomnia this is an over the counter medication to try to help you sleep Discharge Disposition: Home Discharge Diagnosis: # Orthostatic Hypotension / Neuropathy / Lower Extremity Pain # Delirium # Depression # GERD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr ___: It was a pleasure caring for you at ___. You were admitted with dizziness. You were seen by neurologists and given IV fluids. Your symptoms improved and your blood pressure improved. The neurologists recommended following up with them in clinic for additional testing--they will be in touch regarding scheduling a time. During your hospital stay you were were confused. You were seen by psychiatry who felt that this was a reaction to too much stress and not enough sleep. They recommended increasing the dose of your Cymbalta and considering using melatonin to help with your sleep. It is really important that you find health ways to manage your stress--please consider seeing a therapist to discuss this. You are now ready to leave the hospital.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H RX *acetaminophen 325 mg 2 tablet(s) by mouth every six (6) hours Disp #*100 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:*2 3. Milk of Magnesia 30 mL PO Q12H:PRN constipation 4. Nicotine Patch 14 mg TD DAILY RX *nicotine 14 mg/24 hour 1 once a day Disp #*14 Patch Refills:*2 5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*50 Tablet Refills:*0 6. Polyethylene Glycol 17 g PO DAILY:PRN no bm for 48h 7. Senna 8.6 mg PO DAILY RX *sennosides [senna] 8.6 mg 1 tab by mouth once a day Disp #*30 Tablet Refills:*2 8. amLODIPine 10 mg PO DAILY 9. Carvedilol 25 mg PO BID 10. ClonazePAM 0.5 mg PO BID 11. Ferrous Sulfate 325 mg PO DAILY 12. HydrALAZINE 100 mg PO TID 13. TraZODone 50 mg PO QHS:PRN insomnia Discharge Disposition: Home Discharge Diagnosis: Right pleural effusion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>* You were admitted to the hospital for evaluation of your right pleural effusion and eventually required lung surgery to drain the fluid and help to reexpand your lung. You are recovering well and are now ready for discharge. * Continue to use your incentive spirometer 10 times an hour while awake. * Check your incisions daily and report any increased redness or drainage. Cover the area with a gauze pad if it is draining. * Your chest tube dressing may be removed in 48 hours. If it starts to drain, cover it with a clean dry dressing and change it as needed to keep site clean and dry. The chest tube sutures will be removed at your appointment with Dr. ___ week. * You may need pain medication once you are home but you can wean it over the next week as the discomfort resolves. Make sure that you have regular bowel movements while on narcotic pain medications as they are constipating which can cause more problems. Use a stool softener or gentle laxative to stay regular. * No driving while taking narcotic pain medication. * Take Tylenol ___ mg every 6 hours in between your narcotic. * Continue to stay well hydrated and eat well to heal your incisions * Shower daily. Wash incision with mild soap & water, rinse, pat dry * No tub bathing, swimming or hot tubs until incision healed * No lotions or creams to incision site * Walk ___ times a day and gradually increase your activity as you can tolerate. Call Dr. ___ ___ 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. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Dronabinol 2.5 mg PO BID 3. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 4. Heparin 5000 UNIT SC BID may discontinue when ambulatory 5. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 6. LORazepam 0.25 mg PO QHS:PRN insomnia 7. Metoprolol Tartrate 12.5 mg PO Q6H hold for systolic blood pressure <110, hr,60 8. Pantoprazole 40 mg PO Q24H 9. Polyethylene Glycol 17 g PO BID 10. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 11. amLODIPine 10 mg PO DAILY 12. Calcitriol 0.25 mcg PO EVERY OTHER DAY 13. Clopidogrel 75 mg PO DAILY 14. Cyanocobalamin 1000 mcg PO MONTHLY 15. Fentanyl Patch 50 mcg/h TD Q72H 16. Gabapentin 300 mg PO QHS 17. Gabapentin 100 mg PO BID 18. Levothyroxine Sodium 175 mcg PO DAILY 19. OxyCODONE (Immediate Release) ___ mg PO Q8H:PRN Pain - Moderate 20. Senna 8.6 mg PO BID:PRN constipation 21. Vancomycin Oral Liquid ___ mg PO Q6H last dose ___. Vitamin D ___ UNIT PO 1X/WEEK (___) Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Small bowel obstruction clostridium difficile infection Urinary tract infection Pleural effusion acute cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the Acute Care Surgery service on ___ with a small bowel obstruction. You were taken to the operating room for an exploratory laparotomy with extensive lysis of adhesions and a connection made between your intestines to bypass the obstructed area. After surgery you continued to show signs of infection and a CT scan showed an acute infection in your gallbladder. You were too sick to undergo a second operation at this time and therefore you were given IV antibiotics and had a drain places to remove the infected fluid. You were also found to have infection in your urine and stool for which you were treated with appropriate antibitoics based on the cultures. While in the hospital you developed fluid in your lung for which you had a pigtail drain placed to help improve your breathing. Once the fluid was removed, the drain was taken out and your lungs remained inflated. Your existing percutaneous nephrostomy tube accidently became dislodged and was replaced by the interventional radiologists on ___. The lower portion of your surgical wound was opened to allow extra fluid to drain and prevent infection. You should continue to pack this wound with dry kerlex to allow it to heal from the inside. Due to your extended stay in the hospital, you became deconditioned. The physical therapy team worked with you and recommended discharge to an acute rehab to continue your recovery. You are now doing better, tolerating a regular diet, breathing comfortably on room air, and your infections are improving with antibiotic treatment. You are now ready to be discharged to rehab with the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cefpodoxime Proxetil 200 mg PO Q12H Duration: 1 Day Take on ___ RX *cefpodoxime 200 mg 1 tablet(s) by mouth twice a day Disp #*2 Tablet Refills:*0 2. Allopurinol ___ mg PO DAILY RX *allopurinol ___ mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*3 3. Atorvastatin 40 mg PO QPM 4. Calcitriol 0.25 mcg PO 3X/WEEK (___) 5. Digoxin 0.125 mg PO EVERY OTHER DAY 6. Fluticasone Propionate NASAL 1 SPRY NU BID 7. Metoprolol Succinate XL 50 mg PO QHS 8. Multivitamins W/minerals 1 TAB PO DAILY 9. Quinapril 10 mg PO DAILY 10. Tasigna (nilotinib) 300 mg oral BID 11. Torsemide 60 mg PO DAILY 12. Vitamin D 1000 UNIT PO DAILY 13. Warfarin 1 mg PO 4X/WEEK (___) 14. Warfarin 2 mg PO 3X/WEEK (___) ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Urinary tract infection Gross hematuria Sepsis with septic shock Chronic systolic heart failure Atrial fibrillation Coronary artery disease CML 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 with blood in your urine after an outpatient cystoscopy. Due to retained blood clots, you developed a urinary tract infection and sepsis, for which you required treatment in the ICU. You improved with antibiotics and had no further evidence of bleeding after removal of your foley catheter. You will need to complete a course of antibiotics through ___ and follow up with your outpatient urologist. Please continue to take your medications as prescribed. With very best wishes for a speedy recovery, ___ medicine</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. Levothyroxine Sodium 100 mcg PO DAILY 3. Multivitamins 1 TAB PO DAILY 4. Venlafaxine XR 150 mg PO DAILY 5. Ciprofloxacin HCl 500 mg PO Q12H s/p splenic embolization to be taken through ___ RX *ciprofloxacin 500 mg 1 tablet(s) by mouth twice daily Disp #*40 Tablet Refills:*0 6. MetRONIDAZOLE (FLagyl) 500 mg PO TID s/p splenic embolization to be taken through ___ RX *metronidazole 500 mg 1 tablet(s) by mouth every 8 hours Disp #*60 Tablet Refills:*0 7. Acetaminophen 650 mg PO Q8H pain do not take more than 2 grams total per day RX *acetaminophen 650 mg 1 tablet(s) by mouth every eight (8) hours Disp #*30 Tablet Refills:*0 8. Calcium 500 + D *NF* (calcium carbonate-vitamin D3) 1 tab ORAL DAILY 9. Senna 1 TAB PO BID:PRN constipation RX *senna 8.6 mg 1 tab(s) by mouth twice daily Disp #*60 Tablet Refills:*0 10. Polyethylene Glycol 17 g PO DAILY RX *Miralax 17 gram/dose 17 g(s) by mouth daily Disp #*1 Bottle Refills:*0 11. OxycoDONE (Immediate Release) ___ mg PO Q6H:PRN pain Duration: 14 Days RX *oxycodone 5 mg ___ tablet(s) by mouth every 6 hours Disp #*30 Tablet Refills:*0 12. Spironolactone 0 mg PO PRN leg swelling Discharge Disposition: Home Discharge Diagnosis: splenic laceration status post splenic artery embolization Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, . It was a pleasure taking care of you at ___ ___ in ___. You were admitted with abdominal pain after having had a splenic artery embolization at a hospital in ___. While you were admitted, we obtained another cat scan of your abdomen which showed a collection of blood around the spleen which is stable, and no active bleeding. The surgeons evaluated you but do not feel that there is any surgical intervention needed. . Please make the following changes to your medications: 1. start tylenol ___ every 8 hours as needed for pain (do not exceed a total of 2 grams per day) 2. start oxycodone ___ every 6 hours as needed for pain 3. start senna and polyethylene glycol to prevent constipation while you are taking the oxycodone 4. continue the ciprofloxacin and flagyl through ___ in order to complete a total of 28 days of the antibiotics</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lisinopril 20 mg PO DAILY 2. Aspirin EC 81 mg PO DAILY 3. Metoprolol Tartrate 50 mg PO BID 4. Potassium Chloride 20 mEq PO DAILY Hold for K > 4 5. Spironolactone 25 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. Right basal ganglia intraparenchymal hemorrhage 2. Dysphagia s/p PEG placement 3. Hypertension 4. E. faecalis UTI Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for evaluation of a fall and left-sided weakness. Imaging of your brain with CT and MRI showed that your weakness was due to a bleed on the right side of your brain. It is likely that your bleeding was due to high blood pressure, for which your blood pressure medications were adjusted during your stay. As a result of your brain bleed, you also had difficulty swallowing safely. A tube was temporarily placed in your stomach to assist with feeding and administration of medications. During your stay, you also had a urinary tract infection treated with antibiotics. Please follow up with your primary care provider within one week of discharge from your acute rehabilitation facility. Please also follow up with Neurology at the appointment listed below. It was pleasure taking care of you at ___. Sincerely, ___ Neurology</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN shortness of breath 2. Aspirin 81 mg PO DAILY 3. Carvedilol 25 mg PO BID 4. Colchicine 0.6 mg PO DAILY 5. Digoxin 0.125 mg PO EVERY OTHER DAY 6. Pravastatin 80 mg PO DAILY 7. Torsemide 60 mg PO DAILY 8. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID RX *fluticasone-salmeterol [Advair Diskus] 250 mcg-50 mcg/Dose one puff inh twice a day Disp #*1 Disk Refills:*0 9. Fluticasone Propionate 110mcg 2 PUFF IH BID 10. PredniSONE 40 mg PO DAILY Duration: 1 Day RX *prednisone 20 mg two tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 11. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg one tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 12. Tiotropium Bromide 1 CAP IH DAILY RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg one cap inh daily Disp #*30 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: ACUTE DIAGNOSES: 1. COPD exacerbation 2. CHF exacerbation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. You presented to us with worsening shortness of breath. You were found to be volume overloaded as well as COPD exacerbation. You were treated with nebulizer treatment and steroids in addition to more aggressive diuresis. Your symptoms improved and you were able to be discharged. Please take all your medications as instructed. Please attend all your follow up appointments. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. All the best, your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain or fever 2. Benzonatate 100 mg PO TID:PRN cough 3. Diphenoxylate-Atropine 1 TAB PO Q6H:PRN diarrhea for chemotherapy related diarrhea 4. Docusate Sodium 100 mg PO BID 5. Fluticasone Propionate NASAL 1 SPRY NU DAILY 6. Guaifenesin-CODEINE Phosphate 5 mL PO Q8H:PRN cough 7. Metoprolol Succinate XL 50 mg PO DAILY 8. Montelukast Sodium 10 mg PO DAILY 9. Omeprazole 20 mg PO DAILY 10. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH Q12H 11. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain greater than 4 12. Valsartan 160 mg PO DAILY 13. Zolpidem Tartrate 5 mg PO HS insomnia 14. Aspirin 81 mg PO DAILY Resume when the ureteral stent is removed or your are advised by your PCP/Urologist 15. Prochlorperazine 10 mg PO Q6H:PRN nausea 16. Naproxen 375 mg PO Q12H:PRN pain 17. Loratadine *NF* 10 mg Oral DAILY ALLERGIC RHINITIS 18. CAMPTOSAR Resume this medication as directed. 19. RETURN TO WORK NOTE You may return to work without restrictions effective ___. Please excuse her absence from work since ___. 20. F/U APPT WORK NOTICE Ms. ___ will return to clinic during the week of ___ for her post-hospitalization follow-up appointment. Date is to be determined. Please excuse her absence from work. 21. Loperamide 2 mg PO QID:PRN diarrhea 22. magnesium oxide-Mg AA chelate *NF* 399 mg Oral TID Three 133mg tablets (399mg total)taken three times per day. 23. Cephalexin 500 mg PO Q6H Duration: 5 Days Discharge Disposition: Home Discharge Diagnosis: Left 2 mm ureterovesical junction 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--which is attached to a string and may be visible at your urethra. -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. -You will be given a course of antibiotics as prophylaxis to reduce your risk of infection while ureteral stent is in place -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 all of your pre-admission medications, except HOLD aspirin until you see your urologist in follow-up or you have been otherwise explicitly advised. -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 all of your pre-admission medications, except HOLD aspirin until you see your urologist in follow-up -NAPROXEN 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. -NAPROXEN should always be taken with food. Please discontinue taking and notify your doctor should you develop blood in your stool (dark, tarry stools) -Colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. Discontinue if loose stool or diarrhea develops. Colace is a stool softener, NOT a laxative, and available over the counter. The generic name is DOCUSATE SODIUM. It is recommended that you use this medication. -Do not eat constipating foods for ___ weeks, drink plenty of fluids to keep hydrated -No vigorous physical activity or sports until the stent has been removed. Light household activity and work may be performed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Calcium Carbonate 500 mg PO DAILY 4. Furosemide 40 mg PO DAILY 5. LeVETiracetam 750 mg PO BID 6. Metoprolol Succinate XL 12.5 mg PO DAILY 7. Rosuvastatin Calcium 40 mg PO QPM 8. Acetaminophen ___ mg PO Q6H:PRN pain/fever 9. Amiodarone 200 mg PO BID RX *amiodarone 200 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*3 10. Warfarin 7.5 mg PO DAILY16 Discharge Disposition: Home Discharge Diagnosis: Primary: Unstable angina Anticardiolipin antibody syndrome Secondary: Paroxysmal 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 recently admitted because you were experiencing chest pressure and were unable to complete a stress test in the emergency department because of an abnormal heart rhythm and symptoms. You had a different type of stress test in the hospital which was normal. You stayed for a few days afterward in order to have your Coumadin restarted safely. You were started on a new medicine called amiodarone. You are now ready to continue your recovery at home. Your medications were changed to help control your heart rhythm a bit better. ==================== MEDICATION CHANGES ==================== -STOPPED flecainide -STARTED amiodarone 200mg BID to control your atrial fibrillation -DECREASED aspirin to 81mg daily to decrease the chance of stomach bleeding You will need to wear a heart monitor for 30 days to better diagnose your heart rhythms. We wish you a speedy recovery, Your ___ Cardiology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H pain 2. BusPIRone 20 mg PO BID RX *buspirone 10 mg 2 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 3. Citalopram 20 mg PO DAILY RX *citalopram 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Morphine Sulfate ___ 7.5 to 15 mg PO Q2H:PRN Pain, Dyspnea RX *morphine 15 mg ___ tablet(s) by mouth q2h:PRN Disp #*84 Tablet Refills:*0 5. Ondansetron 8 mg PO Q8H:PRN nausea RX *ondansetron 8 mg 1 tablet(s) by mouth q8h:PRN Disp #*21 Tablet Refills:*0 6. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*14 Tablet Refills:*0 7. traZODONE 25 mg PO HS:PRN insomnia RX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth qHS:PRN Disp #*14 Tablet Refills:*0 8. Guaifenesin ___ mL PO Q6H:PRN cough RX *guaifenesin 100 mg/5 mL ___ mL by mouth q6h:PRN Disp #*1 Unit Refills:*0 9. Multivitamins 1 TAB PO DAILY 10. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 11. Prochlorperazine ___ mg PO Q6H:PRN nausea RX *prochlorperazine maleate 5 mg ___ tablet(s) by mouth q6h: PRN Disp #*28 Tablet Refills:*0 12. Nicotine Patch 21 mg TD DAILY 13. Morphine SR (MS ___ 15 mg PO Q12H RX *morphine 15 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*14 Tablet Refills:*0 14. Filgrastim 300 mcg SC Q24H Duration: 5 Days 15. Lorazepam 0.5 mg PO Q4H:PRN anxiety RX *lorazepam 0.5 mg 1 tablet(s) by mouth q4h:PRN Disp #*42 Tablet Refills:*0 16. Guaifenesin-CODEINE Phosphate ___ mL PO HS:PRN cough RX *codeine-guaifenesin 100 mg-10 mg/5 mL ___ mL by mouth qHS:PRN Disp #*1 Unit Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: metastatic large cell neuroendocrine carcinoma of the lung Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your hospitalization at ___. You were admitted to the hospital with chest pain and shortness of breath. Imaging studies showed growth of the cancer in your lungs and the area around your heart. The cancer is causing your pain and trouble breathing, and is compressing your airways and some of the blood vessels around your heart. You recently got chemotherapy, which may help with your symptoms, but your disease is not curable. You told us that your goal is to go home and spend time with your family, and we are sending you home with hospice services.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You were admitted to the hospital with shortness of breath. You were found to have the flu (influenza). This infection likely also triggered a COPD / emphysema flare. Because of the difficulty in breathing, you were briefly admitted to the ICU for special breathing equipment. You will need to complete a course of antibiotics for flu. You are also on a short prednisone burst for mild COPD / emphysema flare. . Please take your medications as listed. . Please follow-up with your physicians as listed. .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 2.5 mg PO DAILY RX *amlodipine 2.5 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Alendronate Sodium 70 mg PO QSUN 3. Atorvastatin 40 mg PO QPM 4. Citalopram 30 mg PO DAILY 5. ClonazePAM 0.5 mg PO Q8H:PRN anxiety 6. Divalproex (EXTended Release) 500 mg PO DAILY 7. Fluticasone Propionate NASAL 2 SPRY NU DAILY:PRN allergies 8. Levothyroxine Sodium 50 mcg PO DAILY 9. Metoprolol Succinate XL 25 mg PO DAILY 10. Naproxen 500 mg PO Q12H 11. QUEtiapine Fumarate 200 mg PO QHS 12. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Chest tightness, ruled out cardiac etiology Secondary Diagnoses: Hypothyroidism Bipolar disease Depression Osteopenia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you were having chest pain and dizziness. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? - You had a cardiac catheterization to look for any disease in your heart vessels. You had no disease in the arteries that feed your heart. - You were given some fluids through the IV. WHAT SHOULD I DO WHEN I GO HOME? - You should continue to take your medications as prescribed. - You should attend the appointments listed below. - Your primary care doctor ___ adjust your blood pressure medications in the outpatient setting. - Seek medical attention if you have new or concerning symptoms or you develop any new chest pain, swelling in your legs, abdominal distention, or shortness of breath at night. We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms. ___, It was a pleasure to meet and care for you during your hospitalization at ___. You were admitted with chest pain and shortness of breath. Lab tests showed evidence of a heart attack. Because of your risk of previous coronary artery disease, you had a catheterization which showed a large obstruction in one of the major heart vessels. A stent was placed. You should continue ticagrelor (a blood thinner) for the next 1 week (end date ___. Once you finish your ticagrelor, please start plavix immediately on ___. You must continue this for at least 4 additional weeks. Please discuss with your cardiologist exactly how long you should be on plavix. You much continue to take aspirin forever. We wish you a speedy recovery. 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 to take care of you. You were admitted to ___ because of belly and back pain likely to be due to a flare of pancreatitis. We treated you with intravenous fluids and pain medications. As you are tolerating oral intake, we are able to discharge you today. Please follow up with your doctors as below. Please review your medication list closely.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ALPRAZolam 1.5 mg PO TID RX *alprazolam 0.5 mg 3 tablet(s) by mouth three times daily Disp #*42 Tablet Refills:*0 2. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet,delayed release (___) by mouth daily Disp #*14 Tablet Refills:*0 3. BusPIRone 15 mg PO BID 4. Divalproex (EXTended Release) 500 mg PO DAILY 5. Gabapentin 400 mg PO TID RX *gabapentin 400 mg 1 capsule(s) by mouth three times per day Disp #*42 Capsule Refills:*0 6. NIFEdipine CR 30 mg PO DAILY 7. Docusate Sodium 100 mg PO BID Do not take if stools are loose. RX *docusate sodium 100 mg 1 tablet(s) by mouth twice daily Disp #*60 Capsule Refills:*0 8. ATRIPLA (efavirenz-emtricitabin-tenofov) ___ mg oral daily 9. benazepril 10 mg ORAL DAILY 10. Omeprazole 20 mg PO DAILY 11. Ondansetron 4 mg PO DAILY:PRN nausea RX *ondansetron 4 mg 1 tablet,disintegrating(s) by mouth every 8 hours Disp #*42 Tablet Refills:*0 12. OxycoDONE (Immediate Release) ___ mg PO DAILY:PRN headache RX *oxycodone 5 mg 1 tablet(s) by mouth every 6 hours Disp #*28 Tablet Refills:*0 13. Polyethylene Glycol 17 g PO DAILY Do not take if stools are loose. RX *polyethylene glycol 3350 [Miralax] 17 gram 1 packet by mouth daily Disp #*1 Box Refills:*0 14. Senna 8.6 mg PO BID Do not take if stools are loose. RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice daily Disp #*60 Tablet Refills:*0 15. Outpatient Lab Work LFT (AST, ALT, AlkPhos, TBili) ___ FAX TO: ___. ___: ___ Fax: ___ Discharge Disposition: Home Discharge Diagnosis: Diagnosis: Nausea/Vomiting Secondary diagnoses: HIV on ART NAFLD 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 for abdominal pain, nausea and diarrhea. You underwent several diagnostic imaging procedures, none of which pointed to any obvious cause for your symptoms. You may have had a viral illness that led to your symptoms. Chronic marijuana use can also lead to a vomiting syndrome similar to yours; we would recommend decreasing or stopping your use of marijuana. You were treated with anti-nausea medications and pain medications, and your symptoms improved. By discharge you were able to eat comfortably and were having normal bowel movements. You were sent home to follow up with your PCP and gastroenterologist for further evaluation and treatment. We wish you the very best in your recovery! -___ medical team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Acyclovir 400 mg PO Q12H RX *acyclovir 400 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*28 Tablet Refills:*0 3. Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN indigestion RX *alum-mag hydroxide-simeth 200 mg-200 mg-20 mg/5 mL 1 cup by mouth twice a day Refills:*0 4. CycloSPORINE (Neoral) MODIFIED 200 mg PO Q12H For aplastic anemia, ICD10 D61.9. RX *cyclosporine modified [Neoral] 100 mg 2 capsule(s) by mouth every twelve (12) hours Disp #*56 Capsule Refills:*0 5. CycloSPORINE (Neoral) MODIFIED 50 mg PO Q12H For aplastic anemia. ICD10 D61.9. RX *cyclosporine modified [Neoral] 25 mg 2 capsule(s) by mouth every twelve (12) hours Disp #*56 Capsule Refills:*0 6. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 7. PredniSONE 10 mg PO DAILY Duration: 7 Doses Start: After 20 mg DAILY tapered dose This is dose # 3 of 3 tapered doses RX *prednisone 10 mg 1 tablet(s) by mouth once a day Disp #*7 Tablet Refills:*0 8. PredniSONE 40 mg PO DAILY Duration: 5 Doses Start: Tomorrow - ___, First Dose: First Routine Administration Time This is dose # 1 of 3 tapered doses RX *prednisone 10 mg 4 tablet(s) by mouth once a day Disp #*5 Tablet Refills:*0 RX *prednisone 10 mg 4 tablet(s) by mouth once a day Disp #*20 Tablet Refills:*0 9. PredniSONE 20 mg PO DAILY Duration: 7 Doses Start: After 40 mg DAILY tapered dose This is dose # 2 of 3 tapered doses RX *prednisone 10 mg 2 tablet(s) by mouth once a day Disp #*7 Tablet Refills:*0 RX *prednisone 10 mg 2 tablet(s) by mouth once a day Disp #*14 Tablet Refills:*0 10. QUEtiapine Fumarate 12.5 mg PO BID:PRN anxiety, nausea RX *quetiapine 25 mg 0.5 (One half) tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 11. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a day Disp #*28 Tablet Refills:*0 12. Simethicone 40-80 mg PO QID:PRN Flatulence/Bloating RX *simethicone [Gas Relief] 80 mg 1 tab by mouth four times a day Disp #*56 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES ================= Aplastic Anemia Tonsillitis Neutropenic fever IgA Deficiency Transaminitis Steroid-induced hyperglycemia 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. Why you were admitted, - You were admitted because you had persistent sore throats and were found to have a condition called aplastic anemia. What we did for you, - We started you on immunosuppressive therapy with ATG and cyclosporine to treat your aplastic anemia - We gave you antibiotics for the infection of your tonsils, which resolved What you should do when you go home, - Please take all your medications as prescribed and go to the appointments that we have arranged</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fish Oil (Omega 3) 1000 mg PO BID 2. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 3. Multivitamins 1 TAB PO DAILY 4. mycophenolate sodium 360 mg Oral BID 5. Polyethylene Glycol 17 g PO DAILY:PRN constipation 6. Sirolimus 1.5 mg PO DAILY 7. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 8. TraMADOL (Ultram) 50 mg PO Q4H:PRN pain 9. Ursodiol 300 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Fever Discharge Condition: Mental Status: Clear and coherent. Activity Status: Ambulatory - Independent. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted because you were having fevers at home. We performed studies to determine the cause of your fevers. All of the studies you have received in the hospital, including a CT scan of your chest and abdomen, has not revealed a source for your fevers. Fortunately, you only had a mild temperature when you came in, and did not have any fevers during your stay. We are very reassured by this. At this time we feel that you are safe for discharge home. It is very important for you to follow up with the appointments listed below. It was a pleasure to be a part of your care! Your ___ treatment team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H 3. Aspirin 81 mg PO DAILY 4. Atenolol 25 mg PO DAILY 5. Atorvastatin 10 mg PO HS 6. Docusate Sodium (Liquid) 100 mg PO BID 7. Glycopyrrolate 1 mg PO TID 8. Guaifenesin-CODEINE Phosphate 5 mL PO BID:PRN cough 9. Guaifenesin-CODEINE Phosphate 5 mL PO BID 10. LOPERamide 2 mg PO QID:PRN loose stools 11. Magnesium Citrate 300 mL PO DAILY:PRN constipation 12. OLANZapine 6.25 mg PO DAILY 13. Omeprazole 20 mg PO BID 14. Ondansetron 4 mg PO Q8H:PRN nausea 15. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 16. Senna 17.2 mg PO BID:PRN constipation 17. TraZODone 25 mg PO Q12H:PRN anxiety/insomnia Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: bleeding from trach chronic trach and peg status Discharge Condition: does not speak writes down to communicate Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>you were hospitalized from some bleeding at your trach site from too much deep suctioning. you should cough up phlegm instead of having deep suctioning</s>