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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 Q6H 2. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 3. Aspirin 81 mg PO DAILY 4. Digoxin 0.0625 mg PO DAILY 5. Erythromycin 0.5% Ophth Oint 0.5 in BOTH EYES QID 6. Metoprolol Succinate XL 150 mg PO DAILY Please start on ___ 7. Lisinopril 2.5 mg PO DAILY 8. Warfarin 1 mg PO DAILY16 9. Atorvastatin 80 mg PO QPM 10. Iron Polysaccharides Complex ___ mg PO DAILY 11. Pantoprazole 40 mg PO Q24H 12. HELD- Furosemide 20 mg PO DAILY This medication was held. Do not restart Furosemide until you follow up with your PCP ___: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY: Atrial fibrillation with rapid ventricular rate Coronary artery disease Acute on chronic heart failure with reduced ejection fraction Urinary tract infection SECONDARY: Facial Contusions Gastroesophageal Reflux Disease 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 ___, ___ was a pleasure taking care of you at the ___ ___. During your hospitalization: -You were found to have a fast heart rate, called atrial fibrillation -You also developed chest pressure while you were here and we checked you for a heart attack which you did not have. -We treated you with medication through your IV and eventually transitioned to pills -We got a stress test of your heart, which did not show any new damage to your heart. What should I do after leaving the hospital? - Please take your medications as listed in discharge summary and follow up at the listed appointments. - You were started on a new medication called digoxin that helps prevent you from having a fast heart rate. Thank you for allowing us to be involved in your care, we wish you all the best! Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice a day. 3. Miralax 17 gram Powder in Packet Sig: One (1) PO once a day as needed for constipation. 4. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. bromfenac 0.09 % Drops Sig: One (1) Ophthalmic BID (2 times a day). 6. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO once a day. 8. cyanocobalamin (vitamin B-12) 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 9. prednisolone acetate 1 % Drops, Suspension Sig: One (1) Drop Ophthalmic DAILY (Daily). 10. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 11. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 12. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO once a day. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY non-ST elevation myocardial infarction SECONDARY gastrointestinal bleeding hypertension hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>It was a pleasure taking care of you during your recent hospitalization. You came in with weakness. We found that there was evidence on blood tests that you had some injury to your heart. We started a blood thinning medication to protect your heart from further damage. After several days we felt that you were stable and stopped this mediation. However, you developed a condition called anemia, or low blood count. You felt very weak and tired and we thought this was due to the anemia. We gave you a blood transfusion and you felt improved. We think that you may have a slow bleeding source from somewhere in your gastrointestinal tract. We started a new medication called omeprazole to protect your gastrointestinal tract. You should follow up with a gastroenterologist regarding this concern. . We made the following CHANGES to your medications: STOPPED lasix (furosemide) STOPPED pravastatin STARTED atorvastatin (replaces pravastatin) STARTED colase to prevent constipation STARTED senna to prevent constipation STARTED miralax as needed for constipation STARTED omeprazole . Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. FoLIC Acid 1 mg PO DAILY 2. Levothyroxine Sodium 150 mcg PO DAILY 3. Omeprazole 40 mg PO BID 4. Verapamil SR 180 mg PO Q24H 5. GuaiFENesin ___ mL PO Q6H:PRN cough RX *guaifenesin 100 mg/5 mL 5 mL by mouth every six (6) hours Disp ___ Milliliter Milliliter Refills:*0 6. Sulfameth/Trimethoprim DS 1 TAB PO 3X/WEEK (___) RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth Three times per week Disp #*12 Tablet Refills:*0 7. PredniSONE 60 mg PO DAILY Duration: 6 Doses This is dose # 1 of 5 tapered doses RX *prednisone 20 mg 3 tablet(s) by mouth Daily Disp #*18 Tablet Refills:*0 8. PredniSONE 50 mg PO DAILY Duration: 7 Doses This is dose # 2 of 5 tapered doses Tapered dose - DOWN RX *prednisone 10 mg 5 tablet(s) by mouth Daily Disp #*35 Tablet Refills:*0 9. PredniSONE 40 mg PO DAILY Duration: 7 Doses This is dose # 3 of 5 tapered doses Tapered dose - DOWN 10. PredniSONE 30 mg PO DAILY Duration: 7 Doses This is dose # 4 of 5 tapered doses Tapered dose - DOWN 11. PredniSONE 20 mg PO DAILY Duration: 7 Doses This is dose # 5 of 5 tapered doses Tapered dose - DOWN Discharge Disposition: Home Discharge Diagnosis: Acute issues: #Interstitial lung disease c/b hypoxia #Community-acquired pneumonia c/b hypoxia #Rheumatoid arthritis 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 for difficulty breathing and were treated for a lung infection as well as for interstitial lung disease. You completed a course of antibiotics and will be discharged on a steroid taper. We have prescribed you home oxygen so that you may return home sooner. Take care, and we wish you the best. Sincerely, Your ___ medicine team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 80 mg PO DAILY 3. Gabapentin 300 mg PO Q24H 4. Levothyroxine Sodium 100 mcg PO DAILY 5. Metoprolol Succinate XL 12.5 mg PO HS 6. Multivitamins 1 TAB PO DAILY 7. Mycophenolate Mofetil 500 mg PO BID 8. NexIUM (esomeprazole magnesium) 40 mg ORAL DAILY 9. Prasugrel 10 mg PO DAILY 10. PredniSONE 5 mg PO DAILY 11. Prograf (tacrolimus) 2 mg ORAL Q12H 12. Sodium Bicarbonate 1300 mg PO TID RX *sodium bicarbonate 650 mg 2 tablet(s) by mouth three times a day Disp #*180 Tablet Refills:*1 13. Alendronate Sodium 70 mg PO QSUN 14. Calcarb 600 With Vitamin D (calcium ___ D3) 600 mg(1,500mg) -400 unit Oral 2 tabs BID 15. Linezolid ___ mg PO Q12H RX *linezolid [Zyvox] 600 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 16. Cefpodoxime Proxetil 400 mg PO Q24H RX *cefpodoxime 200 mg 2 tablet(s) by mouth DAILY Disp #*28 Tablet Refills:*0 17. Outpatient Lab Work Please collect urine for culture in 3 weeks. Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Urinary tract infection Secondary diagnosis: Chronic kidney disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you while you were a patient at ___. You came to us with headache, fatigue, and weakness. You were found to have a UTI for which you were treated with antibiotics. This resulted in improvement in your symptoms. While you were here you were seen by Urology. They recommended that you continue to catheterize yourself a minimum of twice a day. This will help to prevent UTI. Please be sure to call your primary care physician if you develop symptoms of UTI such as pain or buring on urination, urinary frequency, or urinary urgency. Please take all of your medications as listed below. Do NOT take citalopram (Celexa) or cyclobenzaprine (Flexeril) while you are taking linezolid as there is potential for a dangerous medication interaction. Please be sure to keep all of your ___ appointments. Please discuss ___ these medications when you see your primary care doctor and after you are done with the linezolid.</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 once daily Disp #*30 Tablet Refills:*5 2. Benzonatate 100 mg PO TID:PRN cough RX *benzonatate 100 mg 1 capsule(s) by mouth three times daily Disp #*30 Capsule Refills:*0 3. Montelukast - NEW medication 4. Guaifenesin-CODEINE Phosphate ___ mL PO HS:PRN cough RX *codeine-guaifenesin 10 mg-100 mg/5 mL 5 mL by mouth three times daily Refills:*0 5. Lidocaine 5% Patch 1 PTCH TD QPM RX *lidocaine [Lidocaine Pain Relief] 4 % apply to back once daily Disp #*10 Patch Refills:*5 6. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 7. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheeze 8. Hydrochlorothiazide 25 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Asthma exacerbation Discharge Condition: Stable Followup Instructions: ___ [/INST] </s><s>You were admitted with an asthma exacerbation. We treated you with prednisone and nebulizers. You should start taking montelukast on discharge to control your symptoms and follow up with your primary care doctor, who can do a pulmonary function test to assess the severity of your asthma.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID:PRN constipation 2. Enoxaparin Sodium 80 mg SC Q12H RX *enoxaparin 80 mg/0.8 mL 80 mg sc every 12 hours Disp #*14 Syringe Refills:*0 3. Tiotropium Bromide 1 CAP IH DAILY RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 cap inhaled daily Disp #*30 Capsule Refills:*0 4. Warfarin 7.5 mg PO DAILY16 RX *warfarin 2.5 mg 3 tablet(s) by mouth daily Disp #*90 Tablet Refills:*0 5. Allopurinol ___ mg PO DAILY 6. Calcitriol 0.25 mcg PO DAILY 7. Finasteride 5 mg PO DAILY 8. Furosemide 20 mg PO DAILY 9. Timolol Maleate 0.5% 1 DROP BOTH EYES DAILY 10.Oxygen Diagnosis: Pulmonary Hypertension (ICD I27.0) Home oxygen at 4L/min continuous via nasal cannula; conserving device for portability. Length of Time: Indefinite ___ ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: #Primary: Pulmonary embolism #Secondary: Severe pulmonary hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. Why you were admitted: - You presented with right-sided chest pain What we did while you were here: - Imaging of your lungs showed that the pulmonary embolism in your lungs on the left had grown a small amount, and that you have another one on the right, which is new in the last ___ years but has been there for more than a month - You were switched from warfarin to lovenox injections - You talked with our pulmonologist and decided that you would continue on oxygen at home and not start any new medications for your pulmonary hypertension. You were ok with getting some oxygen to keep in your car. - An echo of your heart showed somewhat worsened pulmonary hypertension What you should do once you go home: - Continue doing lovenox twice daily as instructed while waiting for your INR to get within goal range. Your new goal range for now is INR 2.5-3.5 - Please start taking warfarin 7.5 mg daily for now - You will need to follow-up at your ___ (___ ___ Program) in the next ___ days. You can walk in and do not need an appointment - Please follow-up with your primary care provider. You should then get referrals to a pulmonologist and a hematologist - Please start using the Spiriva inhaler daily as well We wish you the best. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: Patient eloped from hospital; no specific changes made to preadmission medications. Discharge Disposition: Home Discharge Diagnosis: Abdominal pain of unclear etiology Discharge Condition: Not evaluated: pt eloped from hospital Followup Instructions: ___ [/INST] </s><s>Patient eloped from hospital. By telephone, she was advised to return to the hospital if she felt unwell or if symptoms persisted or worsened.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO TID 2. Albuterol 2 mg PO BID 3. Atorvastatin 10 mg PO QPM 4. Donepezil 5 mg PO QAM 5. Levothyroxine Sodium 25 mcg PO DAILY 6. Vitamin D 1000 UNIT PO DAILY 7. Acidophilus (L.acidoph & ___ acidophilus) 10 mg oral DAILY 8. ammonium lactate 12 % topical DAILY dry scaly skin 9. Cyanocobalamin 1000 mcg PO 1X/WEEK (MO) 10. Ferrous GLUCONATE 240 mg PO 3X/WEEK (___) 11. Melatin (melatonin) 3 mg oral QHS 12. Amoxicillin 500 mg PO Q8H Duration: 8 Days Please take until ___ RX *amoxicillin 500 mg 1 capsule(s) by mouth every 8 hours Disp #*24 Capsule Refills:*0 13. Sulfameth/Trimethoprim DS 1 TAB PO Q12H Duration: 8 Days Please take until ___ RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth every 12 hours Disp #*16 Tablet Refills:*0 14. Betamethasone Valerate 0.1% Cream 1 Appl TP BID apply to affected area, do not apply to right lower calf while patient has cellulitis RX *betamethasone valerate 0.1 % Apply to affected area two times per day Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Cellulitis Mechanical Fall, skin abrasion Secondary Diagnosis: Eczema, prurigo nodularis 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 allowing us to participate in your care at ___. You were admitted to the hospital with cellulitis which is an infection of your skin. We believe this happened because of the cut on your leg from your recent fall. Scratching your legs may have also contributed to your infection. You were evaluated with a ultrasound of the leg which showed no clots. You were also evaluated with an xray which did not show any fractures in your lower leg. You were treated with IV antibiotics for 2 days and we switched you to antibiotics by mouth after that. After discharge you should continue to taken amoxicillin and bactrim through ___. You should try to avoid scratching your skin. You should continue to put a dressing or an ace bandage on your right leg to prevent yourself from scratching that area. We wish you the best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: One (1) Tablet PO three times a day as needed for headache. 2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 3. valacyclovir 500 mg Tablet Sig: One (1) Tablet PO twice a day. 4. biotin 1 mg Tablet Sig: One (1) Tablet PO three times a day. 5. bisacodyl 10 mg Suppository Sig: One (1) Rectal twice a day as needed for constipation. 6. docusate calcium 240 mg Capsule Sig: One (1) Capsule PO once a day as needed for constipation. 7. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) PO once a day as needed for constipation. Discharge Disposition: Home Discharge Diagnosis: Small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the ___ surgery service for treatment of a small bowel obstruction. This has resolved and you are tolerating a regular diet. Please resume all regular home medications, unless specifically advised not to take a particular medication. Please take any new medications as prescribed. Please take the prescribed analgesic medications as needed. You may not drive or heavy machinery while taking narcotic analgesic medications. You may also take acetaminophen (Tylenol) as directed, but do not exceed 4000 mg in one day. Please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. Avoid strenuous physical activity and refrain from heavy lifting greater than 20 lbs., until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Please also follow-up with your primary care physician.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Albuterol Inhaler ___ PUFF IH Q4H:PRN sob/wheeze 3. Citalopram 40 mg PO DAILY 4. Montelukast Sodium 10 mg PO DAILY 5. Omeprazole 40 mg PO BID 6. DiCYCLOmine 20 mg PO QID This medication may cause drowsiness or sedation RX *dicyclomine 20 mg 1 tablet(s) by mouth four times a day Disp #*60 Tablet Refills:*0 7. Hyoscyamine 0.25 mg SL QID This medication may cause drowsiness or sedation RX *hyoscyamine sulfate 0.125 mg 2 tablets sublingually four times a day Disp #*120 Tablet Refills:*0 8. Acetaminophen-Caff-Butalbital ___ TAB PO Q8H:PRN migraine pls do not take this medication and oxycodone at the same time. 9. PredniSONE 30 mg PO DAILY RX *prednisone 20 mg 1.5 (One and a half) tablet(s) by mouth once a day Disp #*60 Tablet Refills:*0 10. Calcium Carbonate 1000 mg PO DAILY 11. Vitamin D 1000 UNIT PO DAILY 12. OxycoDONE (Immediate Release) 25 mg PO Q4H:PRN break through pain RX *oxycodone 20 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis 1. Crohn's Colitis 2. Clostridium Difficile Infection 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 caring for you during your stay at ___. As you know, you were admitted due to abdominal pain, and concern for flare of your Crohn's disease. You were treated with IV steroids to reduce inflammation, and received medication for pain management. We consulted the gastroenterologists to assist in your care. You had a colonoscopy which showed evidence of colitis, and irritation of your colon. It was felt that your pain may be due to pain around your rectal stoma. Given that your pain was better controlled after the IV steroids, we felt that you were stable to return home. Please follow up with your primary care doctor as well as your gastroenterologist Dr. ___. Thank you for allowing us the opportunity to care for you. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. montelukast 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Tablet(s) 2. fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1) Spray Nasal DAILY (Daily) as needed for rhinitis. 3. ranitidine HCl 150 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. promethazine 12.5 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for nausea. Disp:*56 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: abdominal hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with abdominal pain and nausea. You were evaluated by the Medical, Surgical, and ERCP teams. You had imaging studies done, including a CT scan, a HIDA scan and an MRCP (MRI) which did not show any evidence of bile leak. You still have a fluid collection in your abdomen which is most likely a resolving blood clot (hematoma). On the CT scan, it was noted that your previously placed pancreatic stent had migrated and was now in the small intestine. This stent should pass on its own through your GI tract. . New Medications: 1. Phenergan . Please follow-up with your doctors as listed below. You will see a Gastroenterologist affiliated with your PCP's office. You will need to have a follow-up x-ray of your abdomen to evaluate for passage of the stent. .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth Twice daily Disp #*8 Tablet Refills:*0 2. Amphetamine-Dextroamphetamine 15 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 40 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: Sepsis due to pyelonephritis 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 pyelonephritis -- a urinary infection that spread to your kidneys. You required IV medications for several days, and you were initially septic. Fortunately, you grew a sensitive organism called enterococcus. You will finish a 10 day course of antibiotics (ciprofloxacin). If you ever have urinary symptoms again, you should immediately go to urgent care to have your urine tested. Fortunately, you should be able to do almost any antibiotic (including Bactrim).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation - Second Line 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 40 mg SC DAILY RX *enoxaparin 40 mg/0.4 mL 1 syringe subcutaneous Once nightly Disp #*30 Syringe Refills:*0 5. Milk of Magnesia 30 mL PO Q6H:PRN Constipation - Third Line 6. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet by mouth Every 4 hours as needed Disp #*25 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY constipation 8. Senna 17.2 mg PO HS 9. Citalopram 10 mg PO DAILY 10. Guaifenesin-CODEINE Phosphate 5 mL PO Q4H:PRN cough 11. LORazepam 0.5 mg PO Q6H:PRN anxiety 12. TraZODone 50 mg PO QHS:PRN Insomnia 13. Valsartan 80 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left femoral neck fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: -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 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. - Do NOT get splint wet. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever ___ 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___. You will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for any new medications/refills. THIS PATIENT IS EXPECTED TO REQUIRE <30 DAYS OF REHAB Treatments Frequency: Skin staples in place, to be removed at 2-week follow-up</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 500 mg PO TID W/MEALS RX *calcium carbonate [Calcium 500] 500 mg calcium (1,250 mg) 1 tablet(s) by mouth TID W/MEALS Disp #*90 Tablet Refills:*0 2. PredniSONE 40 mg PO ONCE Duration: 1 Dose RX *prednisone 20 mg 2 tablet(s) by mouth once a day Disp #*10 Tablet Refills:*0 3. Vitamin D 1000 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 2,000 unit 0.5 (One half) tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Ulcerative colitis Secondary diagnosis: History of exercise-induced asthma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you during your hospitalization at the ___. You were admitted for abdominal pain, diarrhea, and blood in your stool. We did a CT scan of your abdomen, a sigmoidoscopy, and tests for infection. Based on these tests, and the recommendations of our gastroenterology doctors, we found that you have moderate to severe ulcerative colitis. We also did tests that showed that you do not have a gastrointestinal infection. We gave you steroids IV then switched you to take steroids as a pill. We also monitored your symptoms, and had a nutritionist talk with you about nutritional tips for people with ulcerative colitis. Please take your medications as instructed, including prednisone 40 mg orally once daily- this will be the dose until you see your GI doctors on ___. Please also take a calcium and vitamin D supplement while you are taking prednisone, because prednisone can lower your calcium levels. Please follow up with your scheduled primary care and gastroenterology appointments (see below). Please seek medical attention urgently if you develop any concerning symptoms, including bloody stool, severe abdominal pain, or fever. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clonazepam 1 mg PO QHS 2. Vitamin D 400 UNIT PO DAILY 3. Lorazepam 1 mg PO DAILY:PRN increased seizure frequency 4. Levothyroxine Sodium 75 mcg PO DAILY 5. LaMICtal XR *NF* (lamoTRIgine) 225 mg Oral BID 6. Concerta *NF* (methylphenidate) 36 mg Oral QAM prn inattention 7. Fish Oil (Omega 3) 1000 mg PO BID 8. Docusate Sodium 100 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Transient neurologic event: Migraine varient vs Seizure varient vs other? Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were placed on the neurology service for events concerning for possible seizure and right leg wekaness. Your evaluation thus far was normal including the physical exam, the MRI, and lumbar puncture study. We are not to sure what the etiology of your presentation was. We will have you follow up as needed. No further tests are needed now.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild Reason for PRN duplicate override: Alternating agents for similar severity 2. Docusate Sodium 100 mg PO BID:PRN constipation 3. 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 4. Atenolol 50 mg PO DAILY 5. Hydrochlorothiazide 25 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Diverrticular abscess Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the Acute Care Surgery service on ___ with an abscess/infection in your large bowel caused by diverticulitis. You were initially managed with antibiotics and aspiration of the fluid collection. Your symptoms did not improved and therefore surgical removal of the affected piece of your colon was recommended. You tolerated the procedure well. Post operatively you were given IV fluids until your ostomy started functioning. Your diet was then progressed to regular with good tolerability. You were seen by the wound and ostomy nurse to help learn how to care for your colostomy and for your VAC dressing on your midline wound. You are now doing better, pain is controlled, and you are tolerating a regular diet. You are now ready to be discharged home with visiting nursing services and 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: *You had a special dressing applied to your surgical incision called a wound vac. This dressing will be changed approximately every 3 days.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325 mg PO BID 2. Aspirin 81 mg PO DAILY 3. Citalopram 20 mg PO DAILY 4. Docusate Sodium 100 mg PO BID 5. Simvastatin 80 mg PO DAILY 6. Acetaminophen 325 mg PO Q4H:PRN pain 7. BusPIRone 5 mg PO BID 8. Hydrocortisone Cream 1% 1 Appl TP QID apply to skin on chest BID until healed 9. Milk of Magnesia 15 mL PO DAILY:PRN constipation 10. Multivitamins W/minerals 1 TAB PO DAILY 11. Naproxen 500 mg PO Q12H 12. nystatin *NF* 100,000 unit/g Topical apply to groin twice daily as needed 13. Nystatin Cream 1 Appl TP BID apply to groin and abdominal folds until healed 14. Oxybutynin 2.5 mg PO BID 15. Metoprolol Tartrate 12.5 mg PO BID RX *metoprolol tartrate 25 mg 0.5 (One half) tablet(s) by mouth twice daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Mechanical fall 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. ___, It was a pleasure caring for you at ___ ___. You were admitted after you fell. You had a cat scan of your head and x-rays of your shoulders, hips, and knees, which did not show any fracture or other concerning findings. . You were evaluated by physical therapy while here, and they felt that you were better off by going to rehab first. We have found you a place at rehab.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day. 2. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 4. cinacalcet 60 mg Tablet Sig: One (1) Tablet PO once a day. 5. sevelamer carbonate 800 mg Tablet Sig: One (1) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS): As previously prescribed, discuss dosing with your nephrologist. 6. lamotrigine 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a day): 100mg extra after HD. 7. levetiracetam 250 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Esophagitis Pyloric ulcer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted for low blood pressure and bleeding from your bottom. This was most likely caused by an ulcer in your stomach, which was seen on EGD (a procedure to look down your throat into your stomach). It will be important for you to STOP TAKING PLAVIX AND INDOMETHACIN!! You should also avoid ALL NSAIDs, like ibuprofen as these medications put you at a risk of more bleeding. Please make an appointment with your primary doctor as soon as possible after discharge, and discuss referral to a gastroenterologist. You should also make sure to follow-up the results of the H. pylori test (the bacteria that can lead to ulcers in the stomach). Please note the following medication changes: -Please DO NOT TAKE PLAVIX -Please DO NOT TAKE INDOMETHACIN or other NSAIDs -Please START omeprazole to reduce the amount of acid in your stomach -Please discuss with the doctor at dialysis whether your blood pressure is at a safe level after dialysis to start your blood pressure medications. These are: --Atenolol --Amlodipine --Dyazide. If safe, you should consider first re-starting atenolol, then amlodipine. You should also discuss this with your primary doctor. - Increase renvela to 800 mg three times a day with meals, as your phosphate was high during this admission. Please discuss this dosing with your kidney doctor.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 40 mg PO QPM 4. Carvedilol 6.25 mg PO BID 5. Cetirizine 10 mg PO DAILY:PRN pruritis 6. Ciprofloxacin HCl 500 mg PO Q12H Duration: 5 Days Please take for total of 14 days with last dose on ___ 7. Gabapentin 600 mg PO QHS 8. HydrALAzine 25 mg PO BID 9. Glargine 66 Units Bedtime Humalog 12 Units Breakfast Humalog 12 Units Lunch Humalog 12 Units Dinner Insulin SC Sliding Scale using HUM Insulin 10. Omeprazole 20 mg PO DAILY 11. Polyethylene Glycol 17 g PO DAILY:PRN constipation 12. Sertraline 50 mg PO DAILY 13. Clindamycin 300 mg PO Q6H Duration: 5 Days Take for 5 days (Last Dose evening of ___ RX *clindamycin HCl 300 mg 1 capsule(s) by mouth every six (6) hours Disp #*20 Capsule Refills:*0 14. Outpatient Lab Work Hyperkalemia Repeat Chem-7 To be drawn at follow-up on ___ Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: - Acute Kidney Injury - Hyperkalemia Secondary Diagnosis: -T1DM -Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted for high levels of potassium and kidney injury, which were attributed to a combination of taking lisinopril and bactrim, as well as low fluid intake. You were given IV fluids, insulin and sugar, kayexalate, and lactulose to control the potassium levels. Your kidney function improved with IV fluids. You were given a new antibiotic regimen for you to continue to take (Clindamycin and Ciprofloxacin). Please do not take lisinopril or chlorthalidone until you follow-up with your primary care physician, who will order a blood test to determine your current potassium level. You can continue to take the ciprofloxacin that was prescribed to you, and you have been given a prescription for the clindamycin. Please take your antibiotics through ___. It is important that you take all of your medications as prescribed, and that you attend all of your follow-up appointments as scheduled. Please Weigh yourself every morning, call MD if weight goes up more than 3 lbs. We wish you the best of health, Your Care Team at ___</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:*3 2. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*3 3. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q8H 4. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID 5. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS Discharge Disposition: Home Discharge Diagnosis: Stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to problems with your speech (aphasia) 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. The blood clot causing your stroke was removed during a thrombectomy procedure. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: - high cholesterol - tobacco use - use of stimulants We are changing your medications as follows: - continue aspirin 81mg daily - continue atorvastatin 40mg daily Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Percocet ___ mg Tablet Sig: ___ Tablets PO every ___ hours as needed for pain. Disp:*30 Tablet(s)* Refills:*0* 2. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO every ___ hours as needed for pain. Disp:*30 Tablet(s)* Refills:*2* 3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as needed for constipation. Disp:*60 Capsule(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: ovarian torsion, adnexal mass (pathology pending) Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>General instructions: * Take your medications as prescribed. * Do not drive while taking narcotics. * Do not combine narcotic and sedative medications or alcohol * Do not take more than 4000mg acetaminophen (APAP) in 24 hrs * No strenuous activity until your post-op appointment * Nothing in the vagina (no tampons, no douching, no sex), no heavy lifting of objects >10lbs for 6 weeks. * You may eat a regular diet Incision care: * You may shower and allow soapy water to run over incision; no scrubbing of incision. No bath tubs for 6 weeks. * If you have steri-strips, leave them on. They will fall off on their own or be removed during your followup visit. To reach medical records to get the records from this hospitalization sent to your doctor at home, call ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H Pain 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*2 3. Enoxaparin Sodium 40 mg SC QPM Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 1 syringe sq qpm Disp #*14 Syringe Refills:*0 4. Senna 8.6 mg PO BID 5. Oxybutynin 5 mg PO QHS 6. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth every four (4) hours Disp #*80 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ for Rehabilitation and Sub-Acute Care) Discharge Diagnosis: Right tibia fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - with assistance Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. ACTIVITY AND WEIGHT BEARING: - touch down weight bearing in right lower extremity Physical Therapy: ACTIVITY AND WEIGHT BEARING: - touch down weight bearing in right lower extremity - ROMAT Treatments Frequency: 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. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 hours) as needed for pain. 2. acetaminophen 325 mg Tablet Sig: ___ Tablets PO every six (6) hours as needed for pain. 3. bupropion HCl 75 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day). 4. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for anxiety. 5. fluticasone 50 mcg/actuation Spray, Suspension Sig: Two (2) Spray Nasal DAILY (Daily). 6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 7. ropinirole 1 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day). Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: s/p laparoscopic hiatal hernia repair with ___ gastroplasty Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the ___ General Surgery Service for concerns that you had a bleed in your abdomen. At this time we do not believe this is the case and we are comfortable with you going home with some in-home services. Please follow up at your appointments with your primary Physician and your surgeon. Please resume all regular home medications as no changes were made to your medications during this admission. Please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. Please follow up with your primary care Physician. Incision Care: *Please call your surgeon or go to the emergency department if you have increased pain, swelling, redness, or drainage from the incision site. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery. Thank you for letting us participate in your care. We wish you a speedy recovery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild RX *acetaminophen 325 mg 2 tablet(s) by mouth every six (6) hours Disp #*40 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*20 Capsule Refills:*0 3. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Moderate RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every four (4) hours Disp #*75 Tablet Refills:*0 4. Polyethylene Glycol 17 g PO DAILY:PRN constipation 5. Senna 8.6 mg PO BID:PRN constipationj RX *sennosides [senna] 8.6 mg 1 by mouth twice a day Disp #*20 Tablet Refills:*0 6. TraMADol 50 mg PO BID RX *tramadol 50 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 7. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL DAILY 8. Citalopram 40 mg PO DAILY 9. ClonazePAM 1 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Left posterior rib fractures ___ Left hemothorax with trapped lung 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 transferred to ___ with a left lung injury after a motorcycle crash. There was blood trapped in the lining of your lung, causing part of the lung to collapse. This required a chest tube be placed to drain the blood and fluid. A repeat CT scan showed a large retained blood clot. You were taken to the operating room and underwent a VATS procedure to remove the retained blood clot. You tolerated this well. Both the chest tubes have now been removed and your chest X-Rays are stable. Your oxygen and vital signs are also stable. You are medically clear to be discharged home to continue your recovery. Please note the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. 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. Humalog 7 Units Breakfast Humalog 9 Units Lunch Humalog 10 Units Dinner NPH 30 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 2. Levofloxacin 750 mg PO Q48H RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 3. Sodium Bicarbonate 650 mg PO TID RX *sodium bicarbonate 650 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 4. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. PredniSONE 15 mg PO DAILY RX *prednisone 10 mg 1.5 tablet(s) by mouth daily Disp #*45 Tablet Refills:*0 6. ValGANCIclovir 450 mg PO EVERY OTHER DAY 7. Calcium Carbonate 1500 mg PO BID 8. CycloSPORINE (Neoral) MODIFIED 50 mg PO Q12H 9. Multivitamins 1 TAB PO DAILY 10. pen needle, diabetic 33 gauge x ___ miscellaneous QID 11. Ranitidine 150 mg PO DAILY 12. HELD- AzaTHIOprine 50 mg PO DAILY This medication was held. Do not restart AzaTHIOprine until cleared by your kidney doctors. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hypotension Insulin dependent Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, ___ were admitted to ___ with low blood pressures. ___ improved with antibiotics and high doses of steroids. We better controlled your blood sugars with insulin with the help of our diabetes doctors. ___ left against medical advice while we were still trying to figure out the cause of your blood pressures. It was a pleasure caring for ___. Wishing ___ the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO TID (3 times a day). 2. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 3. zinc sulfate 220 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4 hours) as needed for fever/pain. 5. levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO DAILY (Daily). 9. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) Injection TID (3 times a day). 10. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) Inhalation Q6H (every 6 hours) as needed for wheezing. 11. ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation Q6H (every 6 hours) as needed for wheezing. 12. diphenoxylate-atropine 2.5-0.025 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for loose stools. 13. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). 14. glargine ___very morning at breakfast 15. novolin -R dose based on sliding scale fingerstick before meals and at bedtime Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: mental status changes s/p sternal dehiscence, debridement, sternal plating Coronary artery disease s/p coronary artery bypass grafts hypertension insulin dependent Diabetes peripheral vascular disease hyperlipidemia Breast CA in ___ s/p lumpectomy (radiation therapy with recurrence in ___ s/p right breast mastectomy and reconstruction Left great toe to left shin cellulitis problem Depression Hypothyroidism s/p appendectomy Obesity Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait and assist of onw Incisional pain managed with Tylenol Incisions: Sternal - healing well, no erythema or drainage Edema 1+ bilateral lower extremities Followup Instructions: ___ [/INST] </s><s>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 Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns ___ Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Calcium Carbonate 500 mg PO BID 3. Docusate Sodium 100 mg PO BID 4. Memantine 10 mg PO BID 5. Polyethylene Glycol 17 g PO DAILY 6. Senna 1 TAB PO BID 7. timolol maleate *NF* 0.25 % ___ BID 8. travoprost *NF* 0.004 % ___ BID 9. Metoprolol Succinate XL 25 mg PO DAILY Hold for systolic BP less than 100 or heart rate less than 55 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: - Syncope with fall - Advanced dementia - Paroxysmal atrial fibrillation Secondary diagnoses: - Prior TIAs - Hyperlipidemia - Pulmonary fibrosis ___ syndrome) - Ataxia - Glaucoma - Chronic constipation - Depression Discharge Condition: Mental Status: Confused - always. Alert and oriented to self only. 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 because you fell at your assisted living facility. Nobody saw you fall, so we don't know exactly why this happened, but you were dehydrated when you arrived and your heart rate was fast, so these may be contributing. It is also likely that your underlying dementia and your balance problems put you at a higher risk for a fall. We recommend that your facility takes measures to help prevent you from falling such as lowering the height of your bed, putting soft mats on the floor near your bed, and helping you when you need to walk somewhere. Because you were in a heart rate called atrial fibrillation, we discussed starting blood thinners with your health care proxy. Because of your frequent falls and recent bleeding in your brain, there is substantial risk with blood thinners, so they were not started. We did start you on a medication to slow your heart called metoprolol. Please discuss this with your primary care doctor.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Protonix 40 mg Susp,Delayed Release for Recon Sig: One (1) 40 mg PO once a day. Disp:*45 dose* Refills:*2* 2. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO once a day as needed. Disp:*20 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: -Esophageal adenocarcinoma s/p MIE ___ -Dysphagia -Asthma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please call Dr. ___ office ___ if you experience: -Fevers > 101 or chills -Difficult or painful swallowing. -Chest or back discomfort. -Abdominal pain</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. Vitamin D 800 UNIT PO DAILY 3. Aspirin 81 mg PO DAILY 4. letrozole *NF* 2.5 mg Oral daily 5. Acetaminophen 1000 mg PO Q6H:PRN pain RX *acetaminophen 500 mg 2 tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: costochondritis Secondary: -aortic atherosclerosis -insomnia -depression -breast cancer -radiographic pancreatic lesion Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to take care of you at ___. You were admitted for chest pain and underwent several studies that did not indicate any serious disease was occuring with your heart or blood vessels. You were treated with tylenol and are feeling better. There were no changes made to your medications. Please continue to take them as prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H Duration: 10 Days Last day to take is on ___ 2. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 3. amLODIPine 10 mg PO DAILY 4. Carbidopa-Levodopa (___) 1 TAB PO BID 5. Glargine 18 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 6. Citalopram 20 mg PO DAILY 7. Levothyroxine Sodium 112 mcg PO DAILY 8. Losartan Potassium 100 mg PO DAILY 9. MetFORMIN (Glucophage) 500 mg PO BID 10. Multivitamins 1 TAB PO DAILY 11. Omeprazole 20 mg PO DAILY 12. Propranolol 10 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: E coli UTI E coli bacteremia Sepsis 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: Dear Ms. ___, It was a pleasure to be a part of your care team at ___ ___. ==================================== Why did you come to the hospital? ==================================== -You had a fall at home. ==================================== What happened at the hospital? ==================================== -The fall was due to general weakness caused by an infection. You were diagnosed with a bloodstream infection caused by a urinary tract infection. You were treated with appropriate antibiotics. ================================================== What needs to happen when you leave the hospital? ================================================== -Take your medications every day and as directed by your doctors -___ attend all of your doctor appointments, this is especially important to help with your essential tremor managed by your PCP. 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. Furosemide 40 mg PO DAILY Duration: 2 Days in ___, no later than 3;30pm, then resume 20mg ___ dose 2. Furosemide 20 mg PO QPM start on ___. Acetaminophen 650 mg PO Q6H:PRN pain 4. Amiodarone 200 mg PO DAILY 5. Amlodipine 10 mg PO DAILY 6. Ascorbic Acid ___ mg PO DAILY 7. Atorvastatin 10 mg PO EVERY OTHER DAY 8. calcium carbonate-vit D3-min 600 mg calcium- 400 unit oral BID 9. Furosemide 40 mg PO QAM 10. Losartan Potassium 100 mg PO DAILY 11. Multivitamins 1 tab Other DAILY 12. Ocuvite (vit C-vit E-lutein-min-om-3) 150-30-5-150 mg-unit-mg-mg oral DAILY 13. Propranolol 10 mg PO TID 14. Rivaroxaban 15 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute on Chronic Diastolic Heart Failure Urinary Tract Infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You presented to the hospital with arm pain and shortness of breath. You were treated with IV antibiotics for possible ongoing urinary tract infection and well as IV diuretics for fluid overload. Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ampicillin-Sulbactam 3 g IV Q6H End date ___. Docusate Sodium 100 mg PO BID 3. Metoprolol Tartrate 25 mg PO TID 4. OLANZapine 5 mg PO DAILY 5. Senna 8.6 mg PO BID 6. ___ MD to order daily dose PO DAILY16 7. Fluticasone Propionate NASAL 2 SPRY NU DAILY 8. Levothyroxine Sodium 75 mcg PO DAILY 9. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Septic shock secondary to urinary tract infection Hypoxic respiratory failure Severe metabolic acidosis ___ secondary to acute tubular necrosis Acute HFrEF Hyperkalemia Atrial fibrillation 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>Dr. ___- You were hospitalized for septic shock, and found to have a urinary tract infection. You also needed a breathing tube placed as you were having trouble breathing. You were given antibiotics which helped your infection, and you were able to be taken off the breathing tube. You had a feeding tube placed to help with your nutrition, and you should continue to get tube feeds while you are working on your swallowing.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO QPM 2. CefePIME 2 g IV Q12H 3. Enoxaparin Sodium 40 mg SC QHS Duration: 30 Days Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 40 mg subcutaneous at bedtime Disp #*30 Syringe Refills:*0 4. Gabapentin 100 mg PO TID 5. Losartan Potassium 25 mg PO DAILY 6. Metoprolol Tartrate 12.5 mg PO TID 7. Omeprazole 20 mg PO DAILY 8. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 9. QUEtiapine Fumarate 25 mg PO QHS:PRN agitation/insomnia Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Septic right knee (native) Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Weight bearing as tolerated on your right leg 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 ___ 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. INFECTIOUS DISEASE INSTRUCTIONS: OPAT Antimicrobial Regimen and Projected Duration: Agent & Dose: CefePIME 2 g IV Q12H Start Date: ___ (date of knee washout) Projected End Date: ___ (6 weeks) LAB MONITORING RECOMMENDATIONS: NOTE: For lab work to be drawn after discharge, a specific standing order for Outpatient Lab Work is required to be placed in the Discharge Worksheet - Post-Discharge Orders. Please place an order for Outpatient Labs based on the MEDICATION SPECIFIC GUIDELINE listed below: ALL LAB RESULTS SHOULD BE SENT TO: ATTN: ___ CLINIC - FAX: ___ ALL OTHER B-LACTAMS (Penicillins, Cephalosporins, Aztreonam): WEEKLY: CBC with differential, BUN, Cr, ESR/CRP. FOLLOW UP APPOINTMENTS: Pending All questions regarding outpatient parenteral antibiotics after discharge should be directed to the ___ R.N.s at ___ or to the on-call ID fellow when the clinic is closed. PLEASE NOTIFY THE ID SERVICE OF ANY QUESTIONS REGARDING THESE RECOMMENDATIONS OR WITH ANY MEDICATION CHANGES THAT OCCUR AFTER THE DATE/TIME OF THIS OPAT INTAKE NOTE. Physical Therapy: Right lower extremity: Weight bearing as tolerated Range of motion as tolerated. Treatments Frequency: WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Please change dressing every 2 days OR if the dressing is saturated. - 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. Atorvastatin 20 mg PO QPM 2. Omeprazole 40 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Vestibular neuronitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the neurology service given concern for possible stroke. Your MRI did not reveal a stroke, and your symptoms of falling to the L rapidly improved during admission. It is most likely that you had an inflammation of the balance system in your inner ear after a viral illness that is self-resolving. You should follow-up with neurology and neurosurgery regarding your aneurysm.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 2. Gabapentin 300 mg PO QHS 3. Omeprazole 20 mg PO BID 4. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 capsule(s) by mouth every four (4) hours Disp #*25 Capsule Refills:*0 5. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 cap by mouth twice a day Disp #*30 Capsule Refills:*0 6. Simvastatin 40 mg PO QPM 7. Tenofovir Disoproxil (Viread) 300 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___ you had undergone an open small bowel resection for a small bowel obstruction. 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. Acetaminophen 650 mg PO Q8H 2. Allopurinol ___ mg PO DAILY 3. Aspirin 325 mg PO DAILY 4. Calcitriol 0.5 mcg PO DAILY 5. Diazepam 2 mg PO HS 6. Finasteride 5 mg PO DAILY 7. LaMOTrigine 225 mg PO DAILY 8. Metoprolol Succinate XL 25 mg PO DAILY Please hold for SBP < 100 or HR < 60 9. Omeprazole 20 mg PO BID 10. Simvastatin 10 mg PO DAILY 11. Tamsulosin 0.8 mg PO DAILY 12. Colchicine 0.6 mg PO DAILY 13. 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 14. Ferrous Sulfate 325 mg PO DAILY 15. HYDROmorphone (Dilaudid) 2 mg PO BID Please hold for RR < 12 16. pramipexole *NF* 0.125 mg Oral hs 17. Torsemide 50 mg PO DAILY 18. traZODONE 50 mg PO HS 19. Losartan Potassium 50 mg PO DAILY 20. Glargine 19 Units Bedtime Insulin SC Sliding Scale using REG Insulin 21. Oxycodone SR (OxyconTIN) 10 mg PO Q12H 22. Senna 1 TAB PO BID 23. Metolazone 2.5 mg PO DAILY 24. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone [Oxecta] 5 mg 1 tablet(s) by mouth Q ___ HOURS Disp #*30 Tablet Refills:*0 25. Minocycline 100 mg PO BID RX *minocycline [Dynacin] 100 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right second digit osteomyelitis 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 ___ for an infection of your right second toe. We gave you antibiotics through an IV to help control the infection. Please keep the surgical site clean and dry. You may shower 48 hours after your surgery. No tub baths. Please do not rub the area.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Creon (lipase-protease-amylase) 24,000-76,000 -120,000 unit oral TID W/MEALS 2. Creon (lipase-protease-amylase) 24,000-76,000 -120,000 unit oral TID W/MEALS RX *lipase-protease-amylase [Creon] 24,000 unit-76,000 unit-120,000 unit 3 capsule(s) by mouth TID W/MEALS Disp #*300 Capsule Refills:*3 3. Sulfameth/Trimethoprim DS 2 TAB PO/NG BID RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 2 tablet(s) by mouth twice a day Disp #*20 Tablet Refills:*0 4. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild/Fever 5. Ondansetron ODT 4 mg PO Q8H:PRN Nausea/Vomiting - First Line 6. Pantoprazole 40 mg PO Q24H 7. Enoxaparin Sodium 60 mg SC Q12H RX *enoxaparin 60 mg/0.6 mL 60 mg SC every twelve (12) hours Disp #*60 Syringe Refills:*1 8. Finasteride 5 mg PO DAILY 9. Metoprolol Succinate XL 25 mg PO DAILY 10. Montelukast 10 mg PO DAILY 11. Multivitamins 1 TAB PO DAILY 12. Rosuvastatin Calcium 5 mg PO QPM 13. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1. Adenocarcinoma, intestinal type 2. Delayed gastric emptying 3. Bacteremia 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 readmitted from clinic with symptoms of dehydration and with non working PICC line. In ED your PICC was accessed and you were started on IV hydration. Gastroenterology team was consulted for EGD, and ___ team was consulted for PEG tube exchange to G/J-tube. You were continued on TPN during admission. On ___ you underwent EGD and PEG tube exchange to gastrojejunostomy tube. ___ procedure you were started on tube feeding. When you tolerate TF at goal, TPN was discontinued and PICC was removed. Unfortunately your J-tube migrated to your stomach, which required holding tube feeding. Your diet was advanced to regular and you were able to tolerate small meals. TF was restarted via J-tube and was well tolerated. During admission you was found to have blood infection and was treated with antibiotics. You are now safe to be discharged home with following instruction. . G/J Tube care: Please keep G-tube capped. J-tube with tube feeding overnight. Flush J-tube with 30 cc of tap water Q6H. Change dressing daily and prn. Keep tube securely attached to prevent dislocation. Monitor for signs and symptoms of infection.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Aspirin 325 mg PO DAILY 3. Atenolol 100 mg PO DAILY RX *atenolol 50 mg 2 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Gabapentin 800 mg PO TID RX *gabapentin 800 mg 1 tablet(s) by mouth three times a day Disp #*90 Capsule Refills:*0 5. Gemfibrozil 600 mg PO BID 6. GlipiZIDE 2.5 mg PO DAILY 7. Mirtazapine 45 mg PO HS 8. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 9. Omeprazole 20 mg PO DAILY 10. Perphenazine 4 mg PO 1 (ONE) TABLET(S) BY MOUTH QAM, 2 PO QHS 11. Cyclobenzaprine 10 mg PO TID:PRN muscle spasm RX *cyclobenzaprine 10 mg 1 tablet(s) by mouth TID: prn Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary headache 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 for severe worsening headache. You underwent a Head CT which was normal as well as an MRI of your brain which was also normal. We trialed different medications for your headache including Depakote and Steroids which did not improve your headache. You were restarted on your home Gabapentin and on three days of Indomethacin as well as continued on home Oxycodone for pain. You were also started on Flexeril for muscle spasms. Given persistent headache, we increased your oxycodone after discussion with the Pain team here and your Primary Care Provider, Dr. ___. You also underwent occipital nerve blocks twice during your hospitalization and preaurical nerve block once with some relief of symptoms. You also received Toradol and Magnesium to aid in headache relief. Your headache improved during your hospital stay. Please keep your Neurology clinic, Pain center, and Primary Care provider appointments as listed below. Please also follow-up with your Psychiatrist following discharge. If you develop worsening of headache and would like for Dr. ___ to perform another nerve block, please call his office ___ to schedule. It was a pleasure taking care of you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. digoxin 250 mcg Tablet Sig: One (1) Tablet PO ___, ___ (). 2. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. folic acid 1 mg Tablet Sig: Five (5) Tablet PO DAILY (Daily). 4. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Caltrate 600 600 mg (1,500 mg) Tablet Sig: One (1) Tablet PO twice a day. 6. alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week: On ___. 7. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. Lidoderm 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One (1) Topical once a day as needed for pain: As needed for pain 12 hours on, 12 hours off. 9. acetaminophen 500 mg Tablet Sig: ___ Tablets PO once a day as needed for fever or pain. 10. tramadol 50 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for pain: hold for sedation, RR<10. 11. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: C5 cervical fracture, paget's disease of the bone, atrial fibrillation, advanced dementia Secondary: Hypertension, hyperlipidemia, benign prostatic hypertrophy, chronic lymphocytic leukemia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was our pleasure to care for you at ___. You were admitted from an outside hospital for a fall and new fracture in your C5 vertebrea. We found that you had fallen as a result of not drinking enough fluid to keep your blood pressure high enough to bring blood to your brain (orthostasis). We trated you with IV fluids and holding some medications which will make your blood pressure lower. We also found that you have atrial fibrillation with rapid ventricular response. We controlled this with a new medication, metoprolol. You should talk with your doctor about starting anticoagulation. We made the following changes to your medications: Please STOP flomax Please STOP KCL Please STOP bumetanide Please DECREASE simvastatin to 40mg daily Please START metoprolol succinate 25mg daily Please START tylenol Please START a lidocaine patch Please START tramadol as needed.</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 Duration: 24 Hours 2. Benzonatate 200 mg PO TID:PRN Cough 3. Glycopyrrolate 0.1-0.2 mg IV Q4H:PRN excess secretions 4. Haloperidol 0.5-2 mg PO Q4H:PRN delirium 5. Morphine Sulfate (Concentrated Oral Solution) 20 mg/mL ___ mg PO Q1H:PRN moderate-severe pain or respiratory distress RX *morphine concentrate 100 mg/5 mL (20 mg/mL) ___ mg by mouth q1 Disp ___ Milliliter Refills:*0 6. QUEtiapine Fumarate 12.5 mg PO BID:PRN Restlessness and agitation 7. Docusate Sodium 100 mg PO BID:PRN Constipation - First Line Reason for PRN duplicate override: Alternating agents for similar severity 8. LORazepam 0.5-2 mg PO Q2H:PRN anxiety RX *lorazepam [Ativan] 0.5 mg 0.5 (One half) tablet(s) by mouth 2 hours Disp #*20 Tablet Refills:*0 9. LevETIRAcetam 500 mg PO DAILY 10. LevETIRAcetam 250 mg PO QHS Discharge Disposition: Extended Care Discharge Diagnosis: Metastatic small cell carcinoma lung cancer Right lower lung mass Pancytopenia B12 deficiency Acute toxic-metabolic encephalopathy Acute on chronic intermittent agitation and confusion Cirrhosis Hepatitis C Severe protein-calorie malnutrition Chronic back and pelvic pain Depression/anxiety Hypertension: Paroxysmal Atrial fibrillation Diabetes mellitus type II Acute hypoxic respiratory failure Acute kidney injury Asymtomatic bacteriuria Seizure disorder/prior traumatic brain injury with seizure. GERD Osteoporosis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Continue to follow with hospice for further guidance and medication adjustment.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID 2. ascorbic acid (vitamin C) 1,000 mg oral BID 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. Fosfomycin Tromethamine 3 g PO PRN UTI 6. Gabapentin 100 mg PO QHS 7. GlipiZIDE XL 2.5 mg PO DAILY 8. Lisinopril 20 mg PO DAILY 9. Multivitamins 1 TAB PO DAILY 10. OLANZapine 20 mg PO QHS 11. Omeprazole 20 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary ======= Mechanical Fall Secondary ========= Hypertension Hyperlipidemia Recurrent Urinary Tract Infections History of Deep Vein Thrombosis with Inferior Vena Cava Filter Placement Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>====================== DISCHARGE INSTRUCTIONS ====================== Dear Ms. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You had a fall and there was concern that you had an abnormal heart rhythm. WHAT HAPPENED TO ME IN THE HOSPITAL? - You had a CAT scan of your head, neck, and chest/abdomen which showed no fractures or injuries. - You had EKGs which showed that while your heart rate was slow while you were here. This was thought to be due to the metoprolol that you were taking, so we discontinued it. You should continue to follow up with your PCP about this. - You urine showed signs of infection, you should continue to take your home antibiotics for this as discussed with your infectious disease doctor. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Clopidogrel 75 mg PO DAILY 3. Finasteride 5 mg PO DAILY 4. Fluticasone Propionate NASAL 1 SPRY NU DAILY:PRN allergy 5. Acetaminophen 650 mg PO Q6H:PRN pain 6. Tube Feed Jevity 1.5 continuous at 60cc/hour via post pyloric feeding tube Supply: 1 month Refill: 3 7. Nystatin Oral Suspension 5 mL PO QID swish and swallow RX *nystatin 100,000 unit/mL 5 mL by mouth four times a day Disp ___ Milliliter Refills:*1 8. Nitroglycerin SL 0.3 mg SL PRN chest pain 9. Tamsulosin 0.4 mg PO HS 10. Atorvastatin 80 mg PO DAILY 11. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 12. Metoprolol Tartrate 12.5 mg PO BID RX *metoprolol tartrate 25 mg 0.5 (One half) tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Dehydration Failure to thrive Esophagitis/gastritis Urinary retention Incision wound s/p ccy/esophagogastroduodenostomy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>AllCare ___ and Home Solutions have been arranged to provide tube feeding supplies and assist you with managing the feedings. Please call Dr. ___ ___ if you have any of the following: temperature of 101, shaking chills, nausea, vomiting, abdominal pain, diarrhea, clogging of feeding tube, continued weight loss Continue tube feeds as instructed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cyanocobalamin ___ mcg PO DAILY 2. Docusate Sodium 100 mg PO BID 3. FoLIC Acid 5 mg PO DAILY 4. Hydroxyurea 1000 mg PO DAILY 5. Magnesium Oxide 400 mg PO DAILY 6. Morphine SR (MS ___ 30 mg PO Q12H 7. Senna 8.6 mg PO BID:PRN constipation 8. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Sickle cell disease, acute pain episode 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 ___ ___. As you know, you came in with back pain. This is due to an acute pain episode from your sickle cell disease. We believe your peroid may have been the trigger of this episode. We treated you with IV fluids and IV pain medications. As you were feeling better, we will discharge you on a higher dose of oxycodone (short-acting pain medication) for a few days until your pain further improves. We encourage you to talk to your primary care physician and hematologist about starting birth control as a way to decrease your acute pain episodes. We glad you are feeling better and we wish you a happy birthday!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever Do not exceed 4G per day. 2. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN wheezing/SOB 3. Atropine Sulfate 1% 1 DROP SL DAILY:PRN excessive secretions 4. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation - Second Line 5. Docusate Sodium 100 mg PO BID 6. Heparin 5000 UNIT SC BID 7. Lidocaine 5% Patch 1 PTCH TD QPM 8. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate RX *oxycodone [Oxaydo] 5 mg 1 tablet(s) by mouth Q6hrs Disp #*20 Tablet Refills:*0 9. Ramelteon 8 mg PO QPM:PRN insomnia 10. Senna 17.2 mg PO QHS 11. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 10 Days Start date ___ end date ___ 12. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY 13. Mirtazapine 15 mg PO DAILY 14. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line Reason for PRN duplicate override: Alternating agents for similar severity 15. sevelamer CARBONATE 800 mg PO TID W/MEALS 16. Tamsulosin 0.4 mg PO QHS 17. TraZODone 25 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: C3-t9 fusion with interval cervical spine hardware failure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Surgery · Your dressing came off on the second day after surgery. · Your incision is closed with sutures. You will need suture removal. Please keep your incision dry until suture removal. · Do not apply any lotions or creams to the site. · Please avoid swimming for two weeks after suture removal. · Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity · We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. · You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. · No driving while taking any narcotic or sedating medication. · No contact sports until cleared by your neurosurgeon. Medications · Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. · *** You may take Ibuprofen/ Motrin for pain. · You may use Acetaminophen(Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. · It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: · Severe pain, swelling, redness or drainage from the incision site. · Fever greater than 101.5 degrees Fahrenheit · New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. anakinra 100 mg SC DAILY RX *anakinra [Kineret] 100 mg/0.67 mL 1 syringe daily Disp #*30 Syringe Refills:*2 2. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*2 3. Sulfameth/Trimethoprim SS 1 TAB PO DAILY RX *sulfamethoxazole-trimethoprim [Bactrim] 400 mg-80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Vitamin D 400 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 400 unit 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Acetaminophen 325-650 mg PO Q4-6H:PRN fever, discomfort 6. Calcium Carbonate 500 mg PO DAILY RX *calcium carbonate [Calcium 500] 500 mg calcium (1,250 mg) 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. PredniSONE 50 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Hemophagocytic Lymphohistiocytosis, Adult Onset Still's Disease Secondary Diagnosis: Shock, Acute Kidney Injury, Disseminated Intravascular Coagulation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___. You were admitted with fever, rash and joint pain and found to have a disease called Adult Onset Still's Disease and HLH. You were treated for this problem with steroids and anakinra. You will ___ with your doctors in ___ and ___ Care Associate's here at ___ for management of this problem going forward. Plaese continue your prednisone at 50mg a day until directed to decrease the dose by your Rheumatology doctor. Best wishes, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Polyethylene Glycol 17 g PO DAILY 3. Aspirin 81 mg PO DAILY 4. Bumetanide 2 mg PO BID 5. CARVedilol 25 mg PO BID 6. Pantoprazole 40 mg PO Q12H 7. HELD- Lisinopril 40 mg PO DAILY This medication was held. Do not restart Lisinopril until follow up with PCP. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Incarcerated umbilical hernia, with bowel ischemia. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid ___ or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the Acute Care Surgery Service on ___ with abdominal pain and found to have a hernia that was obstructing your intestines. You underwent surgery and had your hernia repaired. After surgery your diet was gradually advanced and you were monitored closely. You are now doing better, tolerating a regular diet, and ready to be discharged to rehab to continue your recovery. Please note the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. 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. Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 5 Days RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Biliary leak s/p lap chole Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___! You were here for abdominal pain, and MRI and CT scans show that you had bile leakage. You underwent a procedure called ERCP and you received a stent in your bile duct. You will need a Repeat ERCP in 4 weeks for stent pull and re-evaluation. 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. amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 2. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Capsule PO once a day. 3. calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO 6x/week. 4. Aranesp (polysorbate) 60 mcg/0.3 mL Syringe Sig: One (1) injection Injection q2weeks. 5. gentamicin 0.1 % Cream Sig: One (1) Topical once a day: apply to exit site as directed. 6. hydroxychloroquine 200 mg Tablet Sig: AS DIRECTED Tablet PO once a day: 200 MG (1 TAB) AND 400 MG (2 TABS) ON ALTERNATING DAYS. 7. ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO twice a day. 8. sevelamer carbonate 800 mg Tablet Sig: Three (3) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 9. valacyclovir 500 mg Tablet Sig: One (1) Tablet PO x1: take 1 tablet immediately as needed for cold sore outbreak as soon as ___ have symptoms. 10. phenol 1.4 % Aerosol, Spray Sig: One (1) Spray Mucous membrane Q6H (every 6 hours) as needed for throat pain. Disp:*QS * Refills:*0* 11. prednisone 10 mg Tablet Sig: as directed Tablet PO once a day: take 4 tabs (40 mg) ___ morning, then 3 tabs (30 mg) every morning until further instructions from your rheumatologist. Disp:*50 Tablet(s)* Refills:*1* 12. Ativan 0.5 mg Tablet Sig: One (1) Tablet PO every eight (8) hours as needed for anxiety or nausea for 30 doses. Disp:*30 Tablet(s)* Refills:*0* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: LEFT BRONCHIAL ARTERY BLEED VENTILATOR-ASSOCIATED PNEUMONIA END-STAGE RENAL DISEASE, PERITONEAL DIALYSIS-DEPENDENT HISTORY OF PULMONARY EMBOLISM Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were admitted to the hospital with a life-threatening bleed into your left lung. Your INR was >4 so we stopped coumadin. ___ underwent a procedure to localize and cauterize the source of the bleed: a left bronchial artery. ___ required intubation to help ___ breathe as the blood in your left lung resolved. ___ had multiple bronchoscopies to remove blood clots and mucous plugs. ___ were followed closely by rheumatologists who recommended steroids to dampen any possible lupus vasculitis, which could have caused the bleed. ___ also developed ventilator-associated pneumonia and were treated with antibiotics. Your PCP ___ continue to manage your coumadin. For now, do not take coumadin. We will recommend restarting coumadin in approximately 1 week, after IVC filter removal, but the final decision will be made by Dr. ___ in cooperation with your hematologist and rheumatologist. Please see below for a list of ___ signs. Please pay special attention to any difficulty breathing, chest pain including discomfort with breathing, leg or calf pain or swelling. Also be aware of ___ signs for stroke including sudden weakness or numbness, difficulty speaking, and change in vision. We recommended ___ rehabilitation because ___ were very weak after 10 days in bed in the hospital. Physical therapy did not think ___ were safe to go home. However, ___ refused to go to rehab. We made the following changes to your medications: STOP COUMADIN STOP LISINOPRIL (RECENTLY DISCONTINUED BY YOUR PCP) STOP GUAIFENESIN STOP LOSARTAN, please discuss resuming this medication with your PCP and ___ START CHLOROSEPTIC SPRAY FOR THROAT DISCOMFORT, EVERY 6 HOURS AS-NEEDED START PREDNISONE TAPER, 40 MG ___ THEN 30 MG DAILY UNTIL ___ SEE YOUR RHEUMATOLOGIST, WHO WILL GIVE FURTHER TAPERING INSTRUCTIONS. START ATIVAN 0.5 mg UP TO EVERY 8 HOURS FOR ANXIETY OR NAUSEA FOR 10 DAYS. PLEASE DO NOT DRINK ___ WHILE TAKING THIS MEDICATION.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*60 Tablet Refills:*0 2. Gabapentin 600 mg PO TID 3. Lidocaine 5% Patch 1 PTCH TD QAM 4. losartan-hydrochlorothiazide 100-12.5 mg oral DAILY 5. Morphine SR (MS ___ 45 mg PO Q12H 6. OxyCODONE--Acetaminophen (5mg-325mg) ___ TAB PO Q8H:PRN Pain - Moderate 7. Senna 17.2 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY ======== Hematemesis SECONDARY ========== Hypertension Phantom limb pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___! WHY WAS I IN THE HOSPITAL? ========================== - You were admitted because you had many episodes of bloody vomiting WHAT HAPPENED IN THE HOSPITAL? ============================== - We gave you fluid through your IV to replenish the fluid you lost from vomiting and bleeding. This made you feel much better. - We monitored your lab values to check for ongoing bleed. Your labs were stable, so we felt your bleed had improved and was minimal at discharge. - We recommended performing a study called an EGD, where a scope is used to look at your stomach. You did not want an EGD while inpatient. We explained the benefits of this procedure, including: - Identifying a source of bleeding - Identifying ongoing bleed which would require more IV fluids, possible blood transfusions, and/or ablation with the scope to stop the bleeding WHAT SHOULD I DO WHEN I GO HOME? ================================ - Be sure to take all your medications as listed below - Please schedule follow up with your primary care doctor and with the gastroenterologists to have your bloody vomiting evaluated. This is important to make sure you don't have any more episodes of bleeding. - If you have any difficulty breathing, lightheadedness, continued vomiting of blood, please go to the emergency room urgently. 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. FoLIC Acid 1 mg PO DAILY 2. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath/wheeze 3. Ciprofloxacin HCl 500 mg PO DAILY 4. ergocalciferol (vitamin D2) 50,000 unit oral 1X/WEEK 5. Ferrous Sulfate 325 mg PO DAILY 6. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 7. Furosemide 40 mg PO DAILY 8. Lactulose 15 mL PO BID 9. LevETIRAcetam 1000 mg PO BID 10. Magnesium Oxide 400 mg PO BID 11. Melatin (melatonin) 5 mg oral QHS:PRN sleep aid 12. Multivitamins 1 TAB PO DAILY 13. Pantoprazole 40 mg PO Q24H 14. Prazosin 1 mg PO DAILY 15. QUEtiapine Fumarate 100 mg PO QHS 16. rifAXIMin 550 mg PO BID 17. Spironolactone 100 mg PO DAILY 18. tadalafil 40 mg oral DAILY 19. Thiamine 100 mg PO DAILY 20. Tiotropium Bromide 1 CAP IH DAILY 21. Venlafaxine XR 75 mg PO TID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Final diagnoses: - Acute Toxic/Metabolic/Postictal/Hepatic encephalopathy - Seizure - Acute pulmonary edema c/b acute hypoxic respiratory failure - Polysubstance use disorder - ETOH intoxication/use disorder/withdrawal - ETOH cirrhosis c/b portal hypertension and coagulopathy - Pancytopenia d/t ETOH and splenomegaly - PTSD/Depression/Anxiety Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you here at ___ ___. WHY WAS I ADMITTED TO THE HOSPITAL? - You were admitted because you had a seizure at home, and you were found to be confused and requiring oxygen to maintain normal oxygen levels. WHAT WAS DONE WHILE I WAS HERE? - You were seen by our neurology team, who recommended that you stay on Keppra 1000 mg twice a day. - Your labs were monitored closely. - You had some confusion, which we thought was due to your liver disease. This improved with you taking lactulose. - You required some supplemental oxygen briefly, but you no longer required oxygen on day of discharge. WHAT DO I NEED TO DO ONCE I LEAVE? - Please take your medications and keep your appointments. - It is very important for you to take your lactulose and rifaximin, as this will prevent you from becoming confused due to your liver disease. - We would strongly recommend that you stop drinking. - If you develop fevers (T > 100.4 F), confusion, belly swelling, or shortness of breath, please call your doctor or go to the nearest Emergency Room. Be well, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. PredniSONE 40 mg PO DAILY RX *prednisone 20 mg 2 tablet(s) by mouth DAILY Disp #*6 Tablet Refills:*0 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN Wheezing 3. Cialis (tadalafil) 10 mg oral PRN 4. Fluticasone Propionate 110mcg 2 PUFF IH BID 5. Fluticasone Propionate NASAL 1 SPRY NU DAILY Discharge Disposition: Home Discharge Diagnosis: Asthma exacerbation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital with an asthma exacerbation. You were given steroids and nebulizers and your symptoms improved. Your exacerbation was most likely triggered by a viral upper respiratory infection. You will continue to take oral steroids for 3 more days after you are discharged in order to treat your asthma exacerbation. You should continue to take your albuterol inhaler as needed. Please attend your follow up appointment as listed below. Thank you for choosing ___. It was a pleasure caring for you! Sincerely, 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 875 mg-125 mg 1 tab-cap by mouth twice a day Disp #*9 Tablet Refills:*0 2. Azithromycin 250 mg PO DAILY Duration: 4 Doses RX *azithromycin 250 mg 1 tablet(s) by mouth once a day Disp #*2 Tablet Refills:*0 3. Acetaminophen 1000 mg PO Q8H:PRN Pain - Moderate 4. Amantadine 100 mg PO BID 5. Apixaban 5 mg PO BID 6. Atorvastatin 80 mg PO QPM 7. Benzonatate 100 mg PO TID 8. Bisacodyl ___AILY:PRN constipation 9. Carbidopa-Levodopa (___) 0.5 TAB PO TID 10. Diltiazem Extended-Release 90 mg PO DAILY 11. Ferrous GLUCONATE 324 mg PO DAILY 12. FLUoxetine 20 mg PO DAILY 13. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 14. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H:PRN wheezing 15. MetFORMIN (Glucophage) 1000 mg PO BID 16. Methimazole 5 mg PO DAILY 17. Multivitamins W/minerals 1 TAB PO DAILY 18. Pantoprazole 40 mg PO Q24H 19. Senna 17.2 mg PO QHS 20. Vesicare (solifenacin) 10 mg oral daily Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Viral Bronchitis Aspiration pneumonia Urinary Tract Infection Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear ___, It was a pleasure taking part in your care here at ___! Why was I admitted to the hospital? - You were admitted out of concern for a pneumonia What was done for me while I was in the hospital? - We looked at your lungs with a cat scan, which showed you have bronchitis - We looked at your urine under a microscope, and we were concerned you had a bladder infection - We started you on antibiotics to treat your infections What should I do when I leave the hospital? - Please take your medications as prescribed - Please keep all of your appointments - continue your pureed diet with nectar thickened liquids Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. atazanavir 150 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). 2. raltegravir 400 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 3. ritonavir 100 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 4. emtricitabine 200 mg Capsule Sig: One (1) Capsule PO Q96H (every 96 hours). 5. sulfamethoxazole-trimethoprim 800-160 mg Tablet Sig: One (1) Tablet PO EVERY OTHER DAY (Every Other Day). 6. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap PO DAILY (Daily). 7. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 8. sevelamer carbonate 800 mg Tablet Sig: One (1) Tablet PO TID W/MEALS (3 TIMES A DAY WITH MEALS). 9. lactulose 10 gram/15 mL Syrup Sig: Fifteen (15) ML PO DAILY (Daily) as needed for constipation. 10. acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for pain/fever. 11. metoprolol tartrate 100 mg Tablet Sig: One (1) Tablet PO twice a day. 12. lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day. 13. oxycodone 5 mg Capsule Sig: 0.5 Capsule PO once a day as needed for pain. 14. vancomycin in D5W 1 gram/200 mL Piggyback Sig: 0.5 to 1 gram Intravenous HD PROTOCOL (HD Protochol) for 2 weeks: If Vanc level < 15, give 1 gram If Vanc level ___, give 500 mg If Vanc level > 25, hold dose. Last dose to be given on ___. Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Gram positive, coagulase negative staph bacteremia. Secondary Diagnosis: End Stage Renal Disease on Hemodialysis HIV HCV Hypertension ITP Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure to take care of you at the ___! You came to the hospital yesterday because you had a positive blood culture. You also had abdominal pain, nausea, and vomiting. You were treated in the emergency department with vancomycin, morphine, zofran, and acetaminophen. Your abdominal pain, nausea, and vomiting were relieved by the time you were transferred to the internal medicine floor. You received hemodialysis the following morning. During hemodialysis, you were given another dose of vancomycin. The blood culture from ___ grew a strain of organism that can be treated in the outpatient setting (coagulase negative staph). Hopefully, your line will not need to be changed in order for this strain to be treated. We ADDED Vancomycin (dosed at Hemodialysis) to your medication list -> you will continue vancomycin for 2 weeks - if there are questions about the dosing scheme, these can be directed to Dr. ___ office at ___ Otherwise your medication list is the same as that you had when you visited your primary care physician ___ ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Calcitriol 0.25 mcg PO DAILY 3. Clopidogrel 75 mg PO DAILY 4. Furosemide 40 mg PO BID 5. Metoprolol Tartrate 12.5 mg PO BID 6. Warfarin 3 mg PO 2X/WEEK (___) 7. Atorvastatin 40 mg PO DAILY RX *atorvastatin 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 9. Ferrous Sulfate 325 mg PO TID RX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 10. Senna 1 TAB PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a day Disp #*60 Capsule Refills:*0 11. Colchicine 0.6 mg PO DAILY 12. potassium chloride *NF* 10 mEq Oral daily 13. Ranitidine 150 mg PO BID 14. Warfarin 4 mg PO 5X/WEEK (MO,WE,TH,SA) 15. Lisinopril 5 mg PO DAILY 16. Folic ___ B12 (Ca) *NF* ___ ___ 0 tab ORAL DAILY 17. Outpatient Lab Work Mechanical aortic valve Please measure INR week of ___ and fax results to Dr. ___ of ___ Fax: ___ Discharge Disposition: Home Discharge Diagnosis: Primary: Iron deficiency anemia Secondary: Chronic kidney disease, hypertension, coronary artery disease s/p stent placement, pacemaker, aortic valve repair x2 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 in the hospital. You were admitted for evaluation of anemia. You had imaging done that did not show any signs of bleeding. You had no signs of blood in your upper or lower gastrointestinal tract. You were found to be iron deficient and you should start taking iron supplements. You should also follow up with Dr. ___ Dr. ___ this. As we discussed while you were here, you may need IV iron to get your levels back to normal. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Please make sure to follow up with your outpatient providers as listed below. Please see the attached sheet for your updated medication list. As you know, iron supplements may cause constipation. Please do not stop taking them. Instead, add senna to your ___ medications. If you are still constipated, call Dr. ___ recommend other ___ medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Minocycline 50 mg PO Q24H 2. Acetaminophen 325-650 mg PO Q6H:PRN pain 3. Bisacodyl 10 mg PO DAILY constipation 4. Dexamethasone 4 mg PO Q6H Duration: 48 Hours RX *dexamethasone 4 mg 1 tablet(s) by mouth every six (6) hours Disp #*2 Tablet Refills:*0 5. Dexamethasone 3 mg PO Q6H Duration: 72 Hours RX *dexamethasone 1.5 mg 2 tablet(s) by mouth every six (6) hours Disp #*24 Tablet Refills:*0 6. Dexamethasone 2 mg PO Q6H Duration: 72 Hours RX *dexamethasone 2 mg 1 tablet(s) by mouth every six (6) hours Disp #*12 Tablet Refills:*0 7. Dexamethasone 2 mg PO Q8H Duration: 48 Hours RX *dexamethasone 2 mg 1 tablet(s) by mouth every eight (8) hours Disp #*6 Tablet Refills:*0 8. Dexamethasone 2 mg PO Q12H Duration: 48 Hours RX *dexamethasone 2 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*4 Tablet Refills:*0 9. Dexamethasone 2 mg PO DAILY Duration: 48 Hours Tapered dose - DOWN RX *dexamethasone 2 mg 1 tablet(s) by mouth once a day Disp #*2 Tablet Refills:*0 10. Docusate Sodium 100 mg PO BID 11. Methocarbamol 500 mg PO TID RX *methocarbamol 500 mg 1 tablet(s) by mouth tid prn Disp #*40 Tablet Refills:*0 12. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth q4h prn Disp #*40 Tablet Refills:*0 13. Senna 8.6 mg PO BID constipation 14. Outpatient Physical Therapy Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right cerebellar mass Discharge Condition: Improved AO3. WBAT BLE. Outpatient ___. ___, home OT, assistance w/IADLs. Followup Instructions: ___ [/INST] </s><s>•You underwent surgery to remove a brain lesion from your brain. •You underwent a biopsy. A sample of tissue from the lesion in your brain was sent to pathology for testing. . •Please keep your incision dry until your sutures/staples are removed. •You may shower at this time but keep your incision dry. •It is best to keep your incision open to air but it is ok to cover it when outside. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •If you experienced a seizure while admitted, you are NOT allowed to drive by law. •No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications •***Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •You may experience headaches and incisional pain. •You may also experience some post-operative swelling around your face and eyes. This is normal after surgery and most noticeable on the second and third day of surgery. You apply ice or a cool or warm washcloth to your eyes to help with the swelling. The swelling will be its worse in the morning after laying flat from sleeping but decrease when up. •You may experience soreness with chewing. This is normal from the surgery and will improve with time. Softer foods may be easier during this time. •Feeling more tired or restlessness is also common. •Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY RX *allopurinol ___ mg 0.5 (One half) tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 3. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild 4. Albuterol Inhaler 2 PUFF IH Q6H:PRN dyspnea 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. Benzonatate 100 mg PO TID 8. Carvedilol 6.25 mg PO BID 9. Ipratropium Bromide MDI 1 PUFF IH TID 10. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 11. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP BOTH EYES QHS 12. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH BID 13. HELD- Lisinopril 10 mg PO DAILY This medication was held. Do not restart Lisinopril until speaking with your primary care doctor and having your kidney function tested Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Pneumonia COPD exacerbation Claudication Aortic Stenosis Secondary: CKD Chronic diastolic HF CAD Angina Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You came to the hospital because you were not feeling well. You had a chest x-ray that may have showed pneumonia, though this was hard to tell because of your plaques. You finished a course of treatment for pneumonia with antibiotics and started to feel a lot better. You also got treatment for COPD exacerbation with steroids, which really helped you. When you go home, please work with a physical therapist. Please talk to your cardiologist and primary care doctor about the pain and fatigue in your legs because this may require further testing and treatment. Your lasix (water pill) amount was decreased. Please weigh yourself every morning, call MD if weight goes up more than 3 lbs in one day or 5 lbs in one week. It was a pleasure caring for you and 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. Ibuprofen 800 mg PO Q8H RX *ibuprofen 800 mg 1 tablet(s) by mouth every 8 hours Disp #*90 Tablet Refills:*0 2. Lisinopril 20 mg PO DAILY Hold for SBP <110 RX *lisinopril 10 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 3. OxycoDONE (Immediate Release) 10 mg PO Q4H:PRN pain Hold for RR <12 or sedation RX *oxycodone 5 mg 2 tablet(s) by mouth every 6 hours Disp #*30 Tablet Refills:*0 4. Acetaminophen 650 mg PO Q6H RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6 hours Disp #*120 Tablet Refills:*0 5. Outpatient Physical Therapy 722.1 Displacement of thoracic or lumbar intervertebral disc without myelopathy Evaluate and treat for lumbar radiculopathy from degenerative disc disease with disc herniation Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: L5 lumbar radiculopathy 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 being involved in your care at ___ ___. ___ were admitted to the hospital due to acute worsening of your chronic low back pain. An MRI showed that ___ have a herniated disc in your back that is starting to press on some nerves and causing your symptoms. There was no sign of infection or masses in the back. We started ___ on some pain medications to help control your symptoms. ___ should continue to take ibuprofen and tylenol scheduled around the clock, with oxycodone available as a stronger medicine when the pain is bad. Do not drink alcohol, drive or operate heavy machinery while taking oxycodone. Avoid doing any lifting or twisting motions that may worsen your symptoms. Physical therapy will be an important part of your recovery, so please bring this ___ prescription to your local physical therapy office to begin sessions. ___ also should make an appointment with a back surgeon for evaluation for possible surgery in case your symptoms continue unabated. Your lisinopril was also increased to 20mg to help better control your blood pressure.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO EVERY OTHER DAY 2. Calcitriol 0.25 mcg PO 3X/WEEK (___) 3. Lanthanum 1000 mg PO TID W/MEALS 4. Levothyroxine Sodium 25 mcg PO DAILY 5. Amlodipine 5 mg PO DAILY RX *amlodipine 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Aspirin 81 mg PO DAILY RX *aspirin [Adult Low Dose Aspirin] 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Atorvastatin 10 mg PO QPM RX *atorvastatin 10 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 8. Fluconazole 200 mg PO 2X/WEEK (MO,TH) 9. Nystatin 100,000 UNIT PO Q8H Discharge Disposition: Home Discharge Diagnosis: ACUTE ISCHEMIC STROKE Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of right hand numbness, difficulty speaking, and headache 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. We incidentally found aneurysms in your MCAs which should be evaluated by Neurosurgery in outpatient clinic. Please call tomorrow to make an appointment in their clinic. 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: History of Radiation and Cancer High Cholesterol High Blood pressure We are changing your medications as follows: 1. START Aspirin 81mg daily 2. START Atorvastatin 10mg at bedtime 3. START Amlodipine 5 mg daily Please take your other medications as prescribed. Please followup with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - sudden partial or complete loss of vision - sudden loss of the ability to speak words from your mouth - sudden loss of the ability to understand others speaking to you - sudden weakness of one side of the body - sudden drooping of one side of the face - sudden loss of sensation of one side of the body 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. Gabapentin 100 mg PO BID RX *gabapentin 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. HydrALAzine 25 mg PO BID 4. Lorazepam 0.5 mg PO TID RX *lorazepam 0.5 mg 1 by mouth three times a day Disp #*90 Tablet Refills:*0 5. Losartan Potassium 100 mg PO DAILY 6. Multivitamins W/minerals 1 TAB PO DAILY 7. Omeprazole 20 mg PO BID 8. OxycoDONE (Immediate Release) 5 mg PO Q6H RX *oxycodone 5 mg 1 tablet(s) by mouth q6 Disp #*30 Tablet Refills:*0 9. Simvastatin 40 mg PO QPM 10. Venlafaxine XR 37.5 mg PO BID RX *venlafaxine 37.5 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 11. Vitamin D 1000 UNIT PO DAILY 12. Citalopram 10 mg PO DAILY RX *citalopram 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: - Toxic-metabolic encephalopathy - Acute renal failure - Recurrent falls - Elevated LFTs NOS Secondary: - Dementia NOS - Bifrontal subcortical calcifications secondary to traumatic frontal ICH (___) - Hypertension - Anxiety and Depression - Osteoarthritis w/ chronic pain - GERD - Vertigo - S/P hysterectomy - S/P L cataract repair Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___: You were admitted to ___ after a fall. The cause of your fall was likely related to not eating and drinking enough. You were found to have an acute kidney injury and we gave you fluids to treat this. We also decreased some of your home medications which are known to cause altered mental status. You were seen by geriatricians who think your altered mental status was related to worsening dementia. You were seen by a geriatrician who recommended starting a new medicine called citalopram and going down on your home venlafaxine. Changes to your medications: (1) start citalopram 10mg daily (2) decreased gabapentin to 100mg twice daily (3) decreased ativan to 0.5mg three times daily (4) decrease oxycodone to 5mg every 6 hours as needed (5) decrease venlafaxine to 37.5 mg daily (6) STOP ambien You should take all of the rest of your home medications as you were before. All the best for a speedy recovery! Sincerely, ___ Treatment Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325 mg PO Q6H:PRN pain 2. Cinacalcet 30 mg PO BID 3. Docusate Sodium 100 mg PO BID 4. Finasteride 5 mg PO DAILY 5. Furosemide 80 mg PO 4X/WEEK (___) 6. Levothyroxine Sodium 100 mcg PO DAILY 7. Metoprolol Succinate XL 150 mg PO DAILY 8. Nephrocaps 1 CAP PO DAILY 9. Pantoprazole 40 mg PO Q12H 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation 11. sevelamer CARBONATE 1600 mg PO TID W/MEALS 12. Sucralfate 1 gm PO TID 13. Warfarin 2 mg PO EVERY OTHER DAY 14. Warfarin 3 mg PO EVERY OTHER DAY 15. Zolpidem Tartrate 5 mg PO HS:PRN insomnia 16. Paricalcitol 6 mcg IV QHD 17. Allopurinol ___ mg PO DAILY 18. Neomycin-Polymyxin B GU 1 mL / 1000 ml SW ___ Q48H please leave 10 cc of neosporin in bladder dwell between flushes 19. Collagenase Ointment 1 Appl TP DAILY RX *collagenase clostridium hist. [Santyl] 250 unit/gram As directed once a day Disp #*1 Each Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Generalized weakness Volume depletion Hypothyroidism ESRD 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. ___, It was a pleasure taking care of you at the ___ ___ ___. You were admitted to the hospital because of generalized weakness. It is possible that this was caused in part by dehydration. You were given some fluids IV and you improved. You missed a dialysis session on ___ so had dialysis on ___ in the hospital. Following the dialysis you were feeling back to baseline. You had another dialysis session on ___ and were discharged home. Please weigh yourself every morning, call MD if weight goes up more than 3 lbs. You were also found to have mildly low thyroid levels. We are going to check some additional test and your PCP, ___ let you know whether any changes to your thyroid medications are necessary.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen-Caff-Butalbital ___ TAB PO Q6H:PRN headache 2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 3. Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN indegestion 4. Docusate Sodium 100 mg PO BID 5. Fish Oil (Omega 3) 1000 mg PO DAILY 6. HydrOXYzine 25 mg PO Q6H:PRN anxiety 7. Lorazepam 0.5-1 mg PO TID hold for sedation 8. Maalox/Diphenhydramine/Lidocaine ___ mL PO QID:PRN GI discomfort 9. Multivitamins 1 TAB PO DAILY 10. Pantoprazole 40 mg PO Q12H before breakfast and dinner 11. Polyethylene Glycol 17 g PO DAILY:PRN constipation 12. Psyllium 1 PKT PO TID 13. Ranitidine 300 mg PO HS 14. Sumatriptan Succinate 50 mg PO QID:PRN headache do not exceed 200mg/24hours 15. Vitamin D 400 UNIT PO DAILY 16. Venlafaxine XR 225 mg PO DAILY 17. Senna 1 TAB PO BID:PRN constipation 18. Ondansetron 4 mg PO Q6H:PRN nausea 19. Lubiprostone 24 mcg PO BID RX *lubiprostone [___] 24 mcg 1 capsule(s) by mouth twice a day Disp #*40 Capsule Refills:*2 20. OLANZapine 2.5 mg PO HS RX *olanzapine 2.5 mg 1 tablet(s) by mouth bedtime Disp #*30 Tablet Refills:*1 21. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain RX *tramadol 50 mg 1 tablet(s) by mouth every 6 hours Disp #*30 Tablet Refills:*2 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: - anorexia Secondary: - Anxiety - Chronic abdominal pain - Orthostatic hypotension 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 came to the hospital out of concern for misplacement of your Dobhoff feeding tube. This was found to be in the correct location. We made the following changes to your medications: 1. Lubiprostone 24 mcg twice a day 2. Olanzapine 2.5 mg at nighttime 3. Tramadol (Ultram) 50 mg every 6 hours as needed for pain Please stop the following medications: 1. Bentyl 20mg QID 2. Trazadone 100mg at nighttime Please continue to take your other medications. Please follow-up with your providers as listed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. HYDROmorphone (Dilaudid) 4 mg PO Q4H:PRN Pain - Moderate 2. Minocycline 100 mg PO Q12H 3. Aspirin 81 mg PO DAILY 4. Ferrous Sulfate 325 mg PO DAILY 5. Furosemide 20 mg PO DAILY 6. Levothyroxine Sodium 75 mcg PO DAILY 7. Methadone 5 mg PO TID 8. Omeprazole 20 mg PO DAILY 9. Pregabalin 50 mg PO TID 10. Rosuvastatin Calcium 5 mg PO QPM 11. Sertraline 125 mg PO DAILY 12. Tresiba FlexTouch U-100 (insulin degludec) 46 units subcutaneous QAM 13. Vitamin D 1000 UNIT PO DAILY 14. HELD- irbesartan 75 mg oral Q24H This medication was held. Do not restart irbesartan until instructed by your doctor Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis ================= Suspected spinal abscess Acute kidney injury Secondary diagnosis =================== Osteoarthritis Diabetes Hypertension Peripheral vascular disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. WHY WERE YOU IN THE HOSPITAL? - You were admitted to the hospital for a spinal abscess WHAT HAPPENED WHEN YOU WERE IN THE HOSPITAL? - You were seen by infectious disease and radiology and it was determined that your abscess was too small for drainage - You received IV antibiotics for your infection WHAT SHOULD YOU DO AFTER YOU LEAVE THE HOSPITAL? - Continue to take all your medicines as prescribed below. - You decided to leave against medical advice as we have not placed a PICC or set up home antibiotic infusions with vancomycin. We will try to schedule this once you leave the hospital, but this will be difficult and you will likely miss several doses of your vancomycin. Since you understand the risks of death, septic shock, recurrent bacteremia, we are discharging you against medical advice. - Please come to the emergency room if you develop fevers, worsening back pain, numbness or weakness, lightheadedness, or any other symptoms that concern you as it may be a sign that your infection is back. *** It is very important that you attend your appointments as listed below, especially your appointment with infectious disease. *** 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. HYDROcodone-Acetaminophen (5mg-325mg) 1 TAB PO Q8H:PRN Pain - Severe DOSE FREQUENCY UNKNOWN, NOT VERIFIED BY HOME PHARMACY 2. Fentanyl Patch 25 mcg/h TD Q72H NOT VERIFIED BY HOME PHARMACY 3. Metoprolol Tartrate 25 mg PO BID 4. Pravastatin 20 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: left lower extremity weakness urinary retention Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at the ___ ___. You came to the hospital because you developed weakness and changes in sensation in your legs. You chose to leave the hospital against medical advice prior to the completion of your workup. We recommend that you return to an emergency room if your symptoms worsen. Please continue to take your medications as prescribed and follow-up with your doctors as ___. We wish you all the best, Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. oxycodone 10 mg Tablet Extended Release 12 hr Sig: One (1) Tablet Extended Release 12 hr PO Q12H (every 12 hours). Disp:*60 Tablet Extended Release 12 hr(s)* Refills:*0* 2. prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). Disp:*60 Tablet(s)* Refills:*0* 3. gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3 times a day). Disp:*90 Capsule(s)* Refills:*2* 4. erlotinib 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. Inlyta 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2* 7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for Constipation. 8. oxycodone 5 mg Tablet Sig: ___ Tablets PO every four (4) hours as needed for pain. Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Metastatic renal cell carcinoma Fevers Hypotension Abdominal Pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dr. ___, ___ was a pleasure taking care of you at ___. You were admitted to the hospital due to fevers and hypotension. You initially went to the ICU and were given IV fluids and IV antibiotics. Your blood pressure rapidly improved and you remained afebrile. As the clinical suspicion for recurrent pneumonia was low, your antibiotics were stopped. You were also started on steroids for your cancer as well. You also had abdominal pain during this admission and were started on long-acting pain medications. You also underwent an EGD which showed no abnormalities. CHANGES to your medications: START prednisone 40mg by mouth daily START OxyconTIN 10mg by mouth twice daily START gabapentin 300mg by mouth three times daily START omeprazole 20mg by mouth daily</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 2.5 mg PO DAILY 2. Dipyridamole-Aspirin 1 CAP PO BID 3. Docusate Sodium 100 mg PO DAILY:PRN constipation 4. Doxazosin 8 mg PO HS 5. Isosorbide Dinitrate 30 mg PO DAILY 6. Lisinopril 40 mg PO DAILY 7. Senna 8.6 mg PO BID:PRN constipation 8. Acetaminophen 650 mg PO TID 9. Atorvastatin 80 mg PO DAILY 10. Bisacodyl ___AILY:PRN constipation 11. Lidocaine 5% Patch 1 PTCH TD QPM 12. Metoprolol Tartrate 6.25 mg PO BID 13. OxycoDONE (Immediate Release) 2.5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 0.5 (One half) tablet(s) by mouth every four (4) hours Disp #*10 Tablet Refills:*0 14. Nitroglycerin SL 0.4 mg SL PRN chest pain 15. Omeprazole 20 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Primary diagnoses: - NSTEMI - T11 compression fracture - Mediastinal mass Secondary diagnoses: - Lung nodules, kidney nodule - CLL - Hypertension - Coronary artery disease - Prostate cancer 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 our pleasure participating in your care here at ___. You were admitted on ___ with back pain and found to have damage to your heart based on your lab work, despite not having any chest pain. You underwent testing called a stress test that showed you would not likely benefit from another cardiac catheterization. You also had imaging of your chest and abdomen. This imaging showed you had nodules in your lungs and kidney as well as a mass in your chest that may be a cancer. You will have follow-up with thoracic surgery and may need to have a biopsy. You will also likely need to have further imaging as an outpatient. Your main concern was back pain. You had a special study called a bone scan that showed you had a fracture in one of your vertebrae. If you have worsening back pain, you may benefit from wearing a special brace when you walk. If you have chest pain, worsening back pain, shortness of breath, or any other concerning symptoms, please let your doctor know right away. Again, it was our pleasure participating in your care. We wish you the very best, -- Your ___ Medicine Team --</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*14 Tablet Refills:*0 2. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals 1 tablet(s) by mouth daily Disp #*14 Tablet Refills:*0 3. Cetirizine 10 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: # Acute alcohol pancreatitis # Pancreatic pseudocyst # Transaminitis # Alcohol abuse complicated by withdrawal # Peripheral neuropathy 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 at ___. You were admitted with abdominal pain and found to have pancreatitis and a fluid collection in your pancreas ("pancreatic pseudocyst"). You were seen by GI specialists and surgeons and underwent additional testing. You improved and are now able to be discharged home. It will be important to avoid all alcohol, as this can cause your pancreatitis to occur again.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CeFAZolin 2 g IV Q8H 2. Heparin Flush (10 units/ml) 5 mL IV DAILY and PRN, line flush RX *heparin lock flush (porcine) 10 unit/mL 5 mL IV daily and PRN Disp #*10 Vial Refills:*0 3. Heparin Flush (100 units/ml) 5 mL IV PRN DE-ACCESSING port RX *heparin lock flush (porcine) 100 unit/mL 5 mL IV PRN Disp #*2 Vial Refills:*0 4. Lidocaine 5% Patch 1 PTCH TD QPM 5. Miconazole Powder 2% 1 Appl TP QID:PRN fungal rash 6. Ondansetron 4 mg PO Q8H:PRN nausea 7. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line flush 8. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line flush 9. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Mild Hold for sedation or RR<12 RX *oxycodone 5 mg ___ tablet(s) by mouth q4h prn Disp #*12 Tablet Refills:*0 10. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H Hold for sedation or RR<12 RX *oxycodone [OxyContin] 20 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*8 Tablet Refills:*0 11. Torsemide 20 mg PO DAILY 12. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild 13. Asmanex Twisthaler (mometasone) 110 mcg (30 doses) inhalation QHS 14. Calcium 600 + D(3) (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit oral NOON 15. Docusate Sodium 200 mg PO DAILY 16. Fluticasone Propionate NASAL 2 SPRY NU DAILY 17. Gabapentin 600 mg PO BID 18. Levothyroxine Sodium 75 mcg PO DAILY 19. LORazepam 1 mg PO QHS:PRN insomnia RX *lorazepam 1 mg 1 mg by mouth QHS PRN Disp #*6 Tablet Refills:*0 20. Metoprolol Succinate XL 125 mg PO BID 21. Omeprazole 20 mg PO NOON 22. Polyethylene Glycol 17 g PO DAILY 23. Pravastatin 40 mg PO QPM 24. Senna 8.6 mg PO BID:PRN Constipation - First Line 25. Tamsulosin 0.4 mg PO QHS 26. HELD- Rivaroxaban 20 mg PO DAILY This medication was held. Do not restart Rivaroxaban until your doctor says it is ok and your platelet count has recovered Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnosis: ================== Infectious Arthritis Secondary Diagnosis: =================== Prostate Cancer Hypothyroidism Atrial Fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>====================== DISCHARGE INSTRUCTIONS ====================== Dear Mr. ___, It was a pleasure caring for you at ___. WHY WAS I ___ THE HOSPITAL? - You were ___ the hospital for lightheadedness and right shoulder pain. WHAT HAPPENED TO ME ___ THE HOSPITAL? - You had an infection ___ your right shoulder joint. You were started on antibiotics for the infection and had a procedure done to wash the infected joint out. - We gave you pain medications to help control your right shoulder pain. - We gave you blood and platelet transfusions, because your blood and platelet counts were low. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. - Weigh yourself every morning, call your doctor if weight goes up more than 3 lbs. We wish you the ___! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Azithromycin 250 mg PO DAILY Duration: 4 Doses RX *azithromycin 250 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 2. Cefpodoxime Proxetil 200 mg PO Q12H RX *cefpodoxime 200 mg 1 tablet(s) by mouth twice a day Disp #*7 Tablet Refills:*0 3. Multivitamins 1 TAB PO DAILY 4. Venlafaxine XR 75 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS ----------------- Acute bacterial bronchitis SECONDARY DIAGNOSES ------------------- #HISTORY OF BREAST CANCER #DEPRESSION Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you at ___! Why was I admitted to the hospital? - you had worsening cough and shortness of breath - imaging of you lungs showed signs of an infection of your lower airways, likely with bacteria - you were given medications (antibiotics) to treat the infection - your breathing improved during your hospital stay and you were safe to complete the treatment at home What should I do after discharge? - please continue taking the antibiotics as prescribed - please follow up with you primary care physician as detailed below All the best, Your ___ care team!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: None Discharge Disposition: Home Discharge Diagnosis: Pancreatitis 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 ___ for pancreatitis and dehydration. your lab work returned to normal and your symptoms resolved with hydration with IV fluids. At this point, it is not clear why you had pancreatitis. I have made an appointment for you with a new primary care physician to further investigate this concern. Please keep the appointments as listed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q4H:PRN dyspnea/wheeze/cough 2. Aspirin EC 81 mg PO DAILY 3. Cimetidine 300 mg PO BID 4. ClonazePAM 2 mg PO BID 5. Fluticasone Propionate 110mcg 1 PUFF IH BID 6. Methadone 160 mg PO DAILY 7. QUEtiapine Fumarate 150 mg PO QHS 8. Sertraline 200 mg PO DAILY 9. Simvastatin 40 mg PO DAILY 10. Temazepam 15 mg PO QHS:PRN sleep 11. Tiotropium Bromide 1 CAP IH DAILY 12. Nicotine Polacrilex 2 mg PO Q1H:PRN nicotine craving 13. Gabapentin 300 mg PO TID 14. Rolling Walker Diagnosis: unsteady gait Prognosis: good Length of need: 13 months Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: C2 lateral mass 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>Discharge Instructions Cervical Fracture Activity • You must wear your hard cervical collar at all times. • We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. • You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. • No driving while taking any narcotic or sedating medication. • No contact sports until cleared by your neurosurgeon. • Do NOT smoke. Smoking can affect your healing and fusion. Medications • You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. • It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: • Fever greater than 101.5 degrees Fahrenheit • New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Furosemide 40 mg PO DAILY 2. Lisinopril 5 mg PO DAILY 3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 4. Docusate Sodium 100 mg PO BID 5. OLANZapine (Disintegrating Tablet) 2.5 mg PO QHS 6. Polyethylene Glycol 17 g PO TID 7. Senna 8.6 mg PO BID 8. Klor-Con M20 (potassium chloride) 20 mEq oral daily Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Altered mental status of unclear etiology Constipation Acute kidney injury Secondary diagnoses: Atrial fibrillation Diastolic congestive heart failure Dementia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ on ___ for concerns about confusion, weakness, decreased food intake, and abdominal pain. We ruled out infection, including pneumonia or urinary tract infection, electrolyte imbalances, medication-related changes, or possible bleeding in your head after your fall a few days prior. Your abdominal discomfort was likely due to constipation, which resolved. Your kidney function was decreased when you arrived but has since returned to normal. You have remained confused since your admission, but we have ruled out important reversible or life-threatening causes of your mental status changes. It is possible that given the reported onset of these changes since your admission for pneumonia at ___, it will take significant time to return to baseline. We had to hold your warfarin during the admission, and we will restart it at rehab. Thank you for allowing us to take part in your care. ___ MDs</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Furosemide 20 mg PO DAILY:PRN lower extremity swelling 2. Acetaminophen ___ mg PO Q8H:PRN Pain - Mild 3. amLODIPine 5 mg PO DAILY 4. Aspirin 81 mg PO DAILY 5. Carbidopa-Levodopa (___) 1 TAB PO QID 6. Citalopram 40 mg PO DAILY 7. Lisinopril 40 mg PO DAILY 8. Multivitamins 1 TAB PO DAILY 9. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES ----------------- # Falls # Weakness SECONDARY DIAGNOSES ------------------- # Possible UTI # ___ disease # Deconditioning # Hypertension # Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you at ___! Why was I admitted to the hospital? - you were weak and had difficulty walking - physical therapy saw you and recommended discharge to rehab - you were found to have a possible infection in your urine and were given antibiotics to treat the infection What should I do after discharge? - please take all of your medications as prescribed - please go to all follow up appointments as detailed below All the best! 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 2. Lorazepam 0.5 mg PO Q4H:PRN Anxiety RX *lorazepam 0.5 mg 1 tablet by mouth every our hours as needed for anxiety Disp #*60 Tablet Refills:*0 3. Amoxicillin-Clavulanic Acid ___ mg PO Q12H Duration: 7 Days RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every 12 hours Disp #*7 Tablet Refills:*0 4. Fluconazole 400 mg PO Q24H RX *fluconazole 200 mg 2 tablet(s) by mouth every day (same time each day) Disp #*3 Tablet Refills:*0 5. Lisinopril 20 mg PO DAILY ___ were taking this medication at home but should stop taking it and discuss with your primary care physician when to ___ 6. LOPERamide 2 mg PO TID RX *loperamide 2 mg 1 capsule by mouth three times a day Disp #*100 Capsule Refills:*0 7. Hydrochlorothiazide 25 mg PO DAILY ___ were taking this medication at home but should stop taking it and discuss with your primary care physician when to ___ 8. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ capsule(s) by mouth every four hours as needed for pain Disp #*50 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Perforated colon with peritonitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>___ were admitted to the hospital after a perforated colon, for which ___ underwent numerous operations, including the creation of a diverting loop ileostomy and abdomen with a VAC. ___ have recovered from these operations and hospital course well and ___ are now ready to return home. ___ have tolerated a regular diet, passing gas/stool in your ostomy and your pain is controlled with pain medications by mouth. ___ may return home to finish your recovery. ___ will get ___ and physical therapy at home (set up by the hospital). ___ have a new ileostomy. The most common complication from a new ileostomy placement is dehydration. The output from the stoma is stool from the small intestine and the water content is very high. The stool is no longer passing through the large intestine which is where the water from the stool is reabsorbed into the body and the stool becomes formed. ___ must measure your ileostomy output for the next few weeks. The output from the stoma should not be more than 1200cc or less than 500cc. If ___ find that your output has become too much or too little, please call the office for advice. The office nurse or nurse practitioner can recommend medications to increase or slow the ileostomy output. Keep yourself well hydrated, if ___ notice your ileostomy output increasing, take in more electrolyte drink such as Gatorade. Please monitor yourself for signs and symptoms of dehydration including: dizziness (especially upon standing), weakness, dry mouth, headache, or fatigue. If ___ notice these symptoms please call the office or return to the emergency room for evaluation if these symptoms are severe. ___ may eat a regular diet with your new ileostomy. However it is a good idea to avoid fatty or spicy foods and follow diet suggestions made to ___ by the ostomy nurses. Please monitor the appearance of the ostomy and stoma and care for it as instructed by the wound/ostomy nurses. ___ stoma (intestine that protrudes outside of your abdomen) should be beefy red or pink, it may ooze small amounts of blood at times when touched and this should subside with time. The skin around the ostomy site should be kept clean and intact. Monitor the skin around the stoma for bulging or signs of infection listed above. Please care for the ostomy as ___ have been instructed by the wound/ostomy nurses. ___ will be able to make an appointment with the ostomy nurse in the clinic 7 days after surgery. ___ will have a visiting nurse at home for the next few weeks helping to monitor your ostomy until ___ are comfortable caring for it on your own. If ___ have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or extended constipation. In addition, continue eating small, frequent meals throughout the day to maintain your nutritional status. Your goal caloric intake is approximately 2800 calories/day, but do not eat so much that ___ feel nauseated or vomit. ___ have a long vertical incision on your abdomen. The skin is left open. ___ had a VAC on it while in the hospital. When ___ go home, ___ will go home with wet to dry dressings and the visiting nurses ___ replace the VAC. Please monitor the incision for signs and symptoms of infection including: increasing redness at the incision, increased pain at the incision line, draining of white/green/yellow/foul smelling drainage, or if ___ develop a fever. Please call the office if ___ develop these symptoms or go to the emergency room if the symptoms are severe. ___ may shower, let the warm water run over the incision line and pat the area dry with a towel, do not rub. No heavy lifting for at least 6 weeks after surgery unless instructed otherwise by Dr. ___ may gradually increase your activity as tolerated but clear heavy exercise with Dr. ___. ___ will be prescribed a small amount of the pain medication oxycodone. Please take this medication exactly as prescribed. ___ may take Tylenol as recommended for pain. Please do not take more than 4000mg of Tylenol daily. Do not drink alcohol while taking narcotic pain medication or Tylenol. Please do not drive a car while taking narcotic pain medication. ___ will also be prescribed Ativan for your anxiety. Please continue to take it as needed, but be sure to follow up with your primary care doctor for further long-term management. In addition, as discussed, your baseline heart rate since ___ left the ICU was 110-120 beats per minute. We are not concerned about this and feel that it is your current baseline, but ___ should also follow up with your primary care physician about this. ___ were taking lisinopril and hydrochlorothiazide (HCTZ) before ___ came to the hospital. Please do not ___ these, but ask your primary care physician when it would be appropriate to ___ them. Thank ___ for allowing us to participate in your care! Our hope is that ___ will have a quick return to your life and usual activities. Good luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. PredniSONE 50 mg PO DAILY decrease by 10mg every 3 days (i.e. 50 mg for 3 days, then 40mg for 3 days, etc.) Tapered dose - DOWN 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB RX *albuterol sulfate 2.5 mg/3 mL (0.083 %) 1 NEB INH Q6H:PRN Disp #*30 Ampule Refills:*0 3. Atorvastatin 40 mg PO QPM 4. Clopidogrel 75 mg PO DAILY 5. Fluticasone Propionate NASAL 2 SPRY NU DAILY 6. Levothyroxine Sodium 200 mcg PO DAILY 7. Losartan Potassium 25 mg PO DAILY 8. MetFORMIN (Glucophage) 500 mg PO BID 9. Metoprolol Succinate XL 25 mg PO DAILY 10. mometasone-formoterol 200-5 mcg/actuation inhalation 2 puffs BID 11. Montelukast 10 mg PO DAILY 12. Tiotropium Bromide 1 CAP IH DAILY Discharge Disposition: Home Discharge Diagnosis: Tracheobronchomalacia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospital stay at ___. You were hospitalized for shortness of breath. You were treated for shortness of breath related to tracheobronchomalacia with breathing treatments. On discharge, it is important for you to complete the recommended diagnostic testing and attend your scheduled outpatient appointments for further treatment and follow up. Please continue to follow up with your primary care physician, and specialists upon discharge from the hospital. Please continue to take your home medications as prescribed. Please decrease your prednisone (decrease by 10mg every 3 days, meaning you should take 50mg for three days, then 40mg for three days, then 30mg for three days, etc.). Take Care, Your ___ Team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Doxazosin 8 mg PO HS 3. Fluticasone Propionate NASAL ___ SPRY NU DAILY 4. Hydrochlorothiazide 25 mg PO DAILY 5. Metoprolol Tartrate 25 mg PO BID 6. Omeprazole 20 mg PO BID 7. Simvastatin 40 mg PO DAILY 8. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*10 Tablet Refills:*0 9. Ibuprofen 600 mg PO Q8H:PRN pain 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *polyethylene glycol 3350 [Miralax] 17 gram 17 gm powder(s) by mouth Daily Disp #*20 Packet Refills:*0 11. Sildenafil 50 mg PO PRN prior to sex activity Discharge Disposition: Home Discharge Diagnosis: Urinary tract infection Benign prostate hypertrophy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>As you know, you were admitted with urinary tract infection and fever. You were treated with oral antibiotics and intravenous fluids with good response. You did well on this and had no subsequent fever. Please continue to take the antibiotics for the next 5 days. Please see Dr. ___ in the next ___ weeks.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Docusate Sodium 100 mg PO BID 3. Enoxaparin Sodium 30 mg SC QHS RX *enoxaparin 30 mg/0.3 mL ___t bedtime Disp #*28 Syringe Refills:*0 4. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain don't drink/drive while taking RX *oxycodone 5 mg ___ tablet(s) by mouth q4h prn Disp #*30 Tablet Refills:*0 5. Senna 8.6 mg PO BID 6. PredniSONE 2 mg PO ONCE Duration: 1 Dose 7. PredniSONE 0.5 mg PO QAM 8. PredniSONE 1.5 mg PO QPM 9. Chlorthalidone 25 mg PO DAILY 10. PredniSONE 2 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Left intertrochanteric hip 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>Started discharge Instructions: INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: -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: 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. - If you have a splint in place, splint must be left on until follow up appointment unless otherwise instructed. Do NOT get splint wet. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever ___ 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns THIS PATIENT IS EXPECTED TO REQUIRE ___ DAYS OF REHAB Physical Therapy: wbat lle</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/headache Do not drink alcohol on this medication. RX *acetaminophen 325 mg 2 tablet(s) by mouth every 6 hours as needed Disp #*30 Tablet Refills:*1 2. Amoxicillin-Clavulanic Acid ___ mg PO Q24H RX *amoxicillin-pot clavulanate 500 mg-125 mg 1 tablet(s) by mouth every 24 hours Disp #*14 Tablet Refills:*0 3. Aspirin 325 mg PO DAILY RX *aspirin 325 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*12 4. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 5. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth two times a day as needed Disp #*60 Capsule Refills:*0 6. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain Please do not drink alcohol or drive while on this medication. RX *oxycodone 5 mg 1 tablet(s) by mouth every ___ hours as needed Disp #*30 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram/dose 17 g by mouth daily as needed Refills:*0 8. Senna 8.6 mg PO BID:PRN Constipation - First Line RX *sennosides [senna] 8.6 mg 1 tablet by mouth two times a day as needed Disp #*60 Tablet Refills:*0 9. sevelamer CARBONATE 1600 mg PO TID W/MEALS RX *sevelamer carbonate 800 mg 2 tablet(s) by mouth three times a day with meals Disp #*180 Tablet Refills:*3 10. Albuterol Inhaler ___ PUFF IH Q6H:PRN short of breath 11. amLODIPine 10 mg PO DAILY 12. Atorvastatin 40 mg PO QPM 13. BusPIRone 10 mg PO BID 14. Carvedilol 25 mg PO DAILY 15. Gabapentin 200 mg PO QHS 16. Januvia (SITagliptin) 100 mg oral DAILY 17. Lisinopril 5 mg PO DAILY 18. Metoclopramide 5 mg PO QID 19. Nortriptyline 25 mg PO TID 20. Pantoprazole 20 mg PO Q24H Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: critical right lower limb ischemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - partially weight bearing Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ with worsening lower extremity pain and critical limb ischemia due to a clot in your prior graft site. You underwent thrombectomy or removal of clot in your prior graft and peroneal angioplasty or ballooning of one of your arteries. You have now recovered from surgery and are ready to be discharged. Please follow the instructions below to continue your recovery: MEDICATION: • Take Aspirin 325mg (enteric coated) once daily • If instructed, take Plavix (Clopidogrel) 75mg once daily • Continue all other medications you were taking before surgery, unless otherwise directed • You make take Tylenol or prescribed pain medications for any post procedure pain or discomfort WHAT TO EXPECT: It is normal to have slight swelling of the legs: • Elevate your leg above the level of your heart with pillows every ___ hours throughout the day and night • Avoid prolonged periods of standing or sitting without your legs elevated • It is normal to feel tired and have a decreased appetite, your appetite will return with time • Drink plenty of fluids and eat small frequent meals • It is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing • To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication ACTIVITIES: • When you go home, you may walk and use stairs • You may shower (let the soapy water run over groin incision, rinse and pat dry) • Your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area • No heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) • After 1 week, you may resume sexual activity • After 1 week, gradually increase your activities and distance walked as you can tolerate • No driving until you are no longer taking pain medications CALL THE OFFICE FOR: ___ • Numbness, coldness or pain in lower extremities • Temperature greater than 101.5F for 24 hours • New or increased drainage from incision or white, yellow or green drainage from incisions • Bleeding from groin puncture site SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site) • Lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. If bleeding stops, call vascular office ___. If bleeding does not stop, call ___ for transfer to closest Emergency Room. You are being discharged home with visiting nursing and home physical therapy. If at any point this is too difficult, you have been accepted at the following facility ___ Please call ___ admission to see if there is still a bed: ___. If one is available they have accepted your admission.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*80 Tablet Refills:*0 3. Enoxaparin Sodium 40 mg SC QPM Duration: 14 Days Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 1 syringe SC QPM Disp #*14 Syringe Refills:*0 Discharge Disposition: Home Discharge Diagnosis: left distal third tibia fracture & ___ fibula fracture Discharge Condition: Pt was A&Ox3 and able to ambulate with crutches. His vital signs were stable, pain controlled without nausea and tolerating PO's 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 2 weeks ACTIVITY AND WEIGHT BEARING: - WBAT LLE Physical Therapy: - WBAT LLE Treatments Frequency: - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get Air Cast Boot wet</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! Why you were admitted: -You were admitted because blood work showed that you were not receiving sufficient anticoagulation with the dose of warfarin you were taking. What we did for you: - We changed the dose of your warfarin so that you are being anticoagulated sufficiently. - You also became short of breath during your hospitalization, and we determined that this was likely because you had fluid in your lungs, a pneumonia, and exacerbation of your asthma. We removed the fluid with hemodialysis, treated your pneumonia with antibiotics, and treated you with steroids for your asthma. You improved after receiving these treatments. What to do when you leave: - You will need to complete a course of antibiotics (levofloxacin) for your pneumonia, which is scheduled to end on ___. - Please take all of your other medications as directed. - Please also make sure to set up a follow-up appointment with your primary care physican after your discharge from your rehabilitation facility.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Polyethylene Glycol 17 g PO BID constipation RX *polyethylene glycol 3350 17 gram/dose 1 powder(s) by mouth twice a day Refills:*0 2. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*10 Tablet Refills:*0 3. Acetaminophen 1000 mg PO Q8H 4. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Severe Do not take with Ativan. RX *oxycodone 5 mg 1 tablet(s) by mouth q4h PRN pain Disp #*20 Tablet Refills:*0 5. FLUoxetine 20 mg PO DAILY 6. FoLIC Acid 5 mg PO DAILY 7. Hydroxyurea 500 mg PO BID 8. Ibuprofen 800 mg PO Q8H:PRN Pain - Mild 9. LORazepam 1 mg PO QHS:PRN insomnia Do not take with oxycodone. 10. maca (bulk) miscellaneous DAILY 11. turmeric root extract ___ mg oral DAILY 12. Vitamin D 1000 UNIT PO DAILY 13.Outpatient Lab Work ICD 9 282.62 Labs to be drawn: CBC, LFTs/Tbili, LDH, Chem-7. Fax results to: ___ ___ Discharge Disposition: Home Discharge Diagnosis: Sickle cell crisis Splenic infarct Pneumonia vs. Acute chest syndrome Bilateral avascular necrosis of the femoral head Transaminitis Acute kidney injury Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to take care of you at ___ ___. WHY YOU WERE HERE: - You came into the hospital because you had left-sided abdominal pain and some shortness of breath, likely representing a sickle cell event. WHAT WE DID FOR YOU: - We did imaging of your abdomen and found that you had an enlarged spleen with impaired blood flow likely from sickling of blood cells. This was most likely causing your abdominal pain. There was no need for surgery for this. - You were also seen by the hematology (blood) team. - We gave you blood transfusions, IV fluid, oxygen and worked on controlled your pain. - You were also found on imaging to have imparied blood flow to your hip joints (called "avascular necrosis of the femoral head"): we contacted orthopedic surgery, and they decided that there was no intervention at this point because you had no symptoms. You have an appointment with them scheduled below. - Of note, we also found you have gallstones. This can happen in sickle cell disease. Please talk to your primary care doctor about this. There is nothing to do for it right now. WHAT TO DO WHEN YOU LEAVE THE HOSPITAL: - Please follow up with your doctors as ___ below. - Please be sure to take the hydroxyurea, as this can help prevent sickle cell events. - Please have your labs re-checked next ___ before you see your primary care doctor, we have given you a lab slip. - Please make sure you take senna and miralax while you are taking pain medication, this will prevent constipation! - We noticed your blood pressures are high. Please have your primary care doctor check this and discuss if you need further evaluation or treatment. - Please do not take oxycodone and drive, and do not take oxycodone and drink alcohol. Please do not take it with lorazepam (also called Ativan) as this can cause dangerous sedation and respiratory depression. PLEASE CALL OR VISIT YOUR DOCTOR IF YOU DEVELOP: - Worsening abdominal pain. - Worsening shortness of breath. - Fevers, chills, lightheadedness. - Any symptoms that concern you. We wish you all the best! Sincerely, Your Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. FoLIC Acid 1 mg PO DAILY 2. Multivitamins W/minerals 1 TAB PO DAILY 3. Polyethylene Glycol 17 g PO BID titrate intake as needed for regular bowel movements 4. Thiamine 100 mg PO DAILY 5. Warfarin 2 mg PO DAILY16 FOLLOW UP WITH PCP ___ ___ ON ___ for dosage adjustments. RX *warfarin 2 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 6. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 7. Albuterol Inhaler 1 PUFF IH Q4H:PRN shortness of breath 8. Docusate Sodium 200 mg PO DAILY 9. Hydrocortisone (Rectal) 2.5% Cream ___ID:PRN Rectal pain 10. Lactulose 30 mL PO DAILY 11. LORazepam 0.5 mg PO Q4H:PRN anxiety 12. Magnesium Citrate 300 mL PO DAILY:PRN third line constipation 13. nystatin 100,000 unit/gram topical Q12H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Constipation Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, ___ was a pleasure taking care of you at ___ ___! Why was I in the hospital? - You were admitted to the hospital for severe constipation and rectal pain. What was done for me in the hospital? - We gave you pain medications to help with your rectal pain. - We gave you medications for your constipation to help you have bowel movements. - The palliative care physicians worked with you and your daughter. What should I do when I leave the hospital? - Please take all of your medications as prescribed. - Please keep all of your doctors ___. We wish you the best in your recovery! Sincerely, 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 2. Bumetanide 0.5 mg PO DAILY 3. Clotrimazole Cream 1 Appl TP BID 4. Cyanocobalamin 1000 mcg PO DAILY 5. Enalapril Maleate 10 mg PO BID 6. Entecavir 0.5 mg PO DAILY 7. Lorazepam 1 mg PO QHS:PRN insomnia 8. Nadolol 40 mg PO DAILY 9. Prochlorperazine 10 mg PO Q8H:PRN nausea 10. Sucralfate 1 gm PO QID 11. Thiamine 100 mg PO DAILY 12. Ciprofloxacin HCl 500 mg PO Q24H RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 13. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*60 Tablet Refills:*0 14. Aspirin 81 mg PO DAILY 15. Ferrous Sulfate 325 mg PO DAILY 16. ketotifen fumarate 0.025 % ophthalmic QD 17. Multivitamins 1 TAB PO DAILY 18. Voltaren (diclofenac sodium) 1 % topical bid pain Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis ================= Cirrhosis Secondary to Hepatitis B c/b portal hypertension, esophageal varices, ascites. Peptic Ulcer Disease Chronic Iron Deficiency Anemia Secondary Diagnosis =================== -Hypertension -Sleep Apnea on CPAP -Paroxysmal Atrial Fibrillation -Mild Aortic Dilatation -Reflux Esophagitis -Depression/Anxiety Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ after developing fatigue and weakness. You were found to have low blood counts requiring blood transfusions. In order to determine the cause of the bleding, you underwent a procedure to look at the stomach and small intestine. This did not reveal any acute source of bleeding. This procedure did reveal ulcers in the esophagus, stomach, and small intestine. Your blood counts stabilized after receiving the blood transfusions. Due to these ulcers, you were started on a medication called pantoprazole. Please continue to take pantoprazole 40 mg by mouth EVERY 12 HOURS. As you were noted to have fluid within your abdomen (ascites), please continue to take ciprofloxacin 500 milligrams by mouth EVERY DAY with end date ___. Please assess your stools and look for any dark or tarry stools. Please avoid alcohol and non-steroidal anti-inflammatories such as ibuprofen or naproxen. Since you had an MRI of your liver obtained during this hospitalization, you do not need the repeat MRI that was previously scheduled for ___. It was a pleasure taking care of you during your hospitalization. We wish you all the best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H Use for baseline pain control. Discontinue when no longer needed. RX *acetaminophen 325 mg 2 capsule(s) by mouth 5 times daily while awake Disp #*120 Capsule Refills:*1 2. Docusate Sodium 100 mg PO BID Use to prevent post-operative constipation. Hold for diarrhea/loose stools. RX *docusate sodium 100 mg 2 capsule(s) by mouth daily Disp #*20 Capsule Refills:*0 3. Enoxaparin Sodium 40 mg SC QPM Use for 4 weeks post-operatively to prevent blood clots. RX *enoxaparin 40 mg/0.4 mL 1 syringe subcutaneously every evening Disp #*24 Syringe Refills:*0 4. Gabapentin 300 mg PO BID Don't take before driving, operating machinery, or with alcohol/sedatives/hypnotics. RX *gabapentin 300 mg 1 capsule(s) by mouth twice daily Disp #*28 Capsule Refills:*0 5. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN pain Discontinue when not needed. Do not take before driving/operating machinery/with sedatives. RX *oxycodone 5 mg 1 tablet(s) by mouth every 6 hours as needed Disp #*15 Tablet Refills:*0 6. Senna 8.6 mg PO DAILY Use to prevent post-operative constipation. Hold for diarrhea/loose stools. RX *sennosides 8.6 mg 2 tablets by mouth nightly Disp #*20 Tablet Refills:*0 7. Furosemide 20 mg PO DAILY 8. Lisinopril 2.5 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right distal tibia fracture (above existing ankle ORIF hardware) Discharge Condition: Activity Status: Ambulatory - requires assistance or aid (walker or cane). Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Nonweightbearing of 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 daily for 4 weeks post-operatively to prevent blood clots. WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Please remain in your dressing and do not change unless it is visibly soaked or falling off. - Cast must be left on until follow up appointment unless otherwise instructed - Do NOT get cast wet DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns Per discussion with Dr. ___ may ___ with the following surgeon in ___: Dr. ___ Address: ___ Phone: ___ You should ___ in 1 week after discharge. Physical Therapy: Patient to remain non-weightbearing to the RLE in short leg cast. He should use walker provided for BUE assist. Patient instructed to ___ with Dr. ___) in 1 week following discharge from ___. Should remain ___ until otherwise directed by Dr. ___. Treatments Frequency: Patient in short leg cast. No need for dressing changes.</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 2. Docusate Sodium 100 mg PO BID 3. Hydrochlorothiazide 25 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: anterior communicating artery aneurysm left ICA aneurysm Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Dr. ___ ___ Angiogram Activity · You may gradually return to your normal activities, but we recommend you take it easy for the next ___ hours to avoid bleeding from your groin. · Heavy lifting, running, climbing, or other strenuous exercise should be avoided for ten (10) days. This is to prevent bleeding from your groin. · You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. · Do not go swimming or submerge yourself in water for five (5) days after your procedure. · You make take a shower. Medications · Resume your normal medications and begin new medications as directed. · It is very important to take the medication your doctor ___ prescribe for you to keep your blood thin and slippery. This will prevent clots from developing and sticking to the stent. · You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. Care of the Puncture Site · You will have a small bandage over the site. · Remove the bandage in 24 hours by soaking it with water and gently peeling it off. · Keep the site clean with soap and water and dry it carefully. · You may use a band-aid if you wish. What You ___ Experience: · Mild tenderness and bruising at the puncture site (groin). · Soreness in your arms from the intravenous lines. · The medication may make you bleed or bruise easily. · Fatigue is very normal. When to Call Your Doctor at ___ for: · Severe pain, swelling, redness or drainage from the puncture site. · Fever greater than 101.5 degrees Fahrenheit · Constipation · Blood in your stool or urine · Nausea and/or vomiting Call ___ and go to the nearest Emergency Room if you experience any of the following: · Sudden numbness or weakness in the face, arm, or leg · Sudden confusion or trouble speaking or understanding · Sudden trouble walking, dizziness, or loss of balance or coordination · Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Humalog 10 Units Breakfast Humalog 10 Units Lunch Humalog 10 Units Dinner Insuline Glargine (___ Solostar) 60 Units Breakfast Insulin SC Sliding Scale using HUM Insulin 2. Warfarin 4 mg PO DAILY16 3. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 4. Albuterol Inhaler ___ PUFF IH Q6H:PRN wheezing 5. Allopurinol ___ mg PO DAILY 6. Atenolol 25 mg PO DAILY 7. Benzonatate 100 mg PO TID:PRN cough 8. Calcipotriene 0.005% Cream 1 Appl TP BID 9. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID 10. Desonide 0.05% Cream 1 Appl TP BID 11. Docusate Sodium 100 mg PO BID 12. fenofibrate micronized 200 mg oral DAILY 13. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 14. Halobetasol Propionate 0.05 % topical BID 15. Metolazone 2.5 mg PO 1X/WEEK (MO) 16. Pantoprazole 40 mg PO Q12H:PRN hearburn 17. Pravastatin 40 mg PO QPM 18. Tamsulosin 0.4 mg PO QHS 19. Torsemide 100 mg PO DAILY 20. Vitamin D ___ UNIT PO DAILY 21. Voltaren (diclofenac sodium) 1 % topical TID W/MEALS Discharge Disposition: Home Discharge Diagnosis: TIA Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Neuro: nonfocal Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted for sudden onset lightheadedness, blurry vision, and triplicate vision that was concerning for a stroke in the setting of having a subtherapeutic INR. You had an MRI of your brain done, and thankfully, it did not show a stroke. Nevertheless, you likely had a TIA (transient ischemic attack) given your symptoms and your risk factors. A TIA is a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot transiently. 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: Lupus anticoagulant positive High cholesterol Sleep apnea Diabetes Hypertension We are changing your medications as follows: Coumadin 4mg Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 2. Cephalexin 500 mg PO Q6H Last day: ___ RX *cephalexin 500 mg 1 capsule(s) by mouth Every 6 hours Disp #*14 Capsule Refills:*0 3. TraMADol 50 mg PO Q6H:PRN Pain - Moderate RX *tramadol 50 mg 1 tablet(s) by mouth Every 6 hours Disp #*20 Tablet Refills:*0 4. Allopurinol ___ mg PO DAILY 5. Amiodarone 200 mg PO DAILY 6. Levothyroxine Sodium 200 mcg PO DAILY 7. Lidocaine 5% Ointment 1 Appl TP TID 8. Lidocaine 5% Patch 1 PTCH TD QAM 9. Lisinopril 20 mg PO DAILY 10. Loratadine 10 mg PO DAILY 11. Omeprazole 20 mg PO DAILY 12. Polyethylene Glycol 17 g PO DAILY:PRN constipation 13. Rivaroxaban 20 mg PO DAILY 14. Rosuvastatin Calcium 5 mg PO QPM 15. Torsemide 10 mg PO EVERY OTHER DAY 16. Vitamin D ___ UNIT PO 1X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: PRIMARY: - Cellulitis - Urinary tract infection SECONDARY: - Lymphedema Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___. Please see below for information on your time in the hospital. WHY WAS I IN THE HOSPITAL? - You came to the hospital because you were having chills and back pain WHAT HAPPENED IN THE HOSPITAL? - We found that you had an skin infection called cellulitis - We also found that you had a infection in your urine - We gave you antibiotics by IV to treat this, and once you got better we gave you antibiotic by mouth WHAT SHOULD I DO WHEN I GO HOME? - Your should continue to take your antibiotics as prescribed - You should follow up in ___ clinic to help with the swelling in your leg We wish you the best! -Your Care Team at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Duloxetine 30 mg PO DAILY 3. LOPERamide 1 mg PO DAILY 4. Lorazepam 0.5 mg PO Q4H:PRN anxiety 5. Pyridoxine 25 mg PO Q6H 6. Ranitidine 150 mg PO DAILY 7. Prenatal Vitamins 1 TAB PO DAILY 8. Ondansetron 4 mg PO Q8H:PRN nausea 9. Unisom (doxylamine) (doxylamine succinate) 25 mg oral QHS 10. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain take this for the shortest amount of time only, do not drink alcohol or drive a car while taking RX *hydromorphone 2 mg 1 tablet(s) by mouth every four (4) hours Disp #*25 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Umbilical Incision Pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with pain at the umblicial site from your prior Total Abdominal Colectomy for Chronic constipation. You had an MRI for imaging as you are pregnant which showed a small umbilical incision hernia which will improve on your own. Your pain is relatively well controlled with oral pain medication. You will be sent home with a small amount of oral pain medication. You will likely have pain as you heal from your surgery and your abdomen expands from the developing baby. You will be sent home with a small amount of the pain medication Dilaudid. Please take this exactly as prescribed. Do not drive a car or drink alcohol while taking this medication. Please only take this medication as needed, try tylenol for pain first and then, if you still have pain take the small dose of dilaudid. The OB team has approved the medication for a short amount of time only in regaurds to safety in pregnancy. Please monitor your bowel function closely. Please continue to titrate the liquid imodium a you have been at home. Please call the office if you have more than 1200cc of stool out in 24 hours. If you have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or extended constipation. You have ___ laparoscopic surgical incisions on your abdomen which are closed with internal sutures and a skin glue called Dermabond. These are healing well however it is important that you monitor these areas for signs and symptoms of infection including: increasing redness of the incision lines, white/green/yellow/malodorous drainage, increased pain at the incision, increased warmth of the skin at the incision, or swelling of the area. Please call the office if you develop any of these symptoms or a fever. You may go to the emergency room if your symptoms are severe. You may shower; pat the incisions dry with a towel, do not rub. The small incisions may be left open to the air. If closed with steri-strips (little white adhesive strips) instead of Dermabond, these will fall off over time, please do not remove them. Please no baths or swimming for 6 weeks after surgery unless told otherwise by your surgical team. No heavy lifting greater than 6 lbs for until your first post-operative visit after surgery. Please no strenuous activity until this time unless instructed otherwise by Dr. ___ Dr. ___. Thank you for allowing us to participate in your care! Our hope is that you will have a quick return to your life and usual activities. Good luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain do not exceed >4g per 24 hours 2. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain do not drive or use machinery while taking this medication RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID constipation Duration: 2 Weeks do not use when having loose stool RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: head laceration left medial rib fractures of ribs 1 and 2 a fracture of bilateral C6 laminae with extension into C6-7 facet and anterolisthesis of C6 on C7 Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were brought to the hospital on ___ after two unwitnessed falls from standing height. You suffered a head laceration, left medial rib fractures of ribs 1 and 2 and a fracture of bilateral C6 laminae with extension into C6-7 facet and anterolisthesis of C6 on C7 for which you need to wear a collar for 8 weeks. Please call Dr. ___ as seen below if having increased neck pain. Keep the collar on at all times. Be sure to follow up with your XRAYS that are scheduled for you to have in 2 weeks. You are now stable and ready to be discharged from the hospital . Please adhere to the following instructions regarding your discharge. Rib Fractures: * Your injury caused 2 rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. * You should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. If the pain medication is too sedating take half the dose and notify your physician. * Pneumonia is a complication of rib fractures. In order to decrease your risk you must use your incentive spirometer 4 times every hour while awake. This will help expand the small airways in your lungs and assist in coughing up secretions that pool in the lungs. * You will be more comfortable if you use a cough pillow to hold against your chest and guard your rib cage while coughing and deep breathing. * Symptomatic relief with ice packs or heating pads for short periods may ease the pain. * Narcotic pain medication can cause constipation therefore you should take a stool softener twice daily and increase your fluid and fiber intake if possible. * Do NOT smoke * If your doctor allows, non-steroidal ___ drugs are very effective in controlling pain ( ie, Ibuprofen, Motrin, Advil, Aleve, Naprosyn) but they have their own set of side effects so make sure your doctor approves. * Return to the Emergency Room right away for any acute shortness of breath, increased pain or crackling sensation around your ribs (crepitus). Please follow up with Spine and ACS. Your appointments have already been scheduled as seen below.</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 [Augmentin] 875 mg-125 mg 1 tablet(s) by mouth every 12 hours Disp #*20 Tablet Refills:*0 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 3. Bisacodyl 10 mg PO DAILY:PRN constipation 4. Docusate Sodium 100 mg PO BID 5. Fexofenadine 180 mg PO DAILY:PRN allergies 6. Gabapentin 100 mg PO TID 7. LORazepam 0.5 mg PO QID PRN anxiety 8. Omeprazole 20 mg PO DAILY 9. Senna 17.2 mg PO BID 10. Triple Antibiotic (neomycin-bacitracnZn-polymyxnB) 3.5mg-400 unit- 5,000 unit/gram topical TID Discharge Disposition: Home With Service Facility: ___ ___: Left buttock phlegmon, possible myonecrosis, not a drainable fluid collection 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. ___, It was a pleasure taking care of you here at ___. You were admitted for a left buttock wound that may be developing into a pressure ulcer. Ultrasound and MRI demonstrated a large phlegmon in that location. Interventional Radiology was consulted but reported that there was no fluid collection that they could drain. After discussion it was determined that you would go home with oral antibiotics for 10 days and close follow-up with Acute Care Surgery clinic this week to re-evaluate the wound. Please follow the below instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acebutolol 200 mg PO DAILY 2. Atorvastatin 80 mg PO DAILY 3. ClonazePAM 0.5 mg PO BID 4. Fexofenadine 180 mg PO DAILY 5. Levothyroxine Sodium 200 mcg PO Q ___ 6. Levothyroxine Sodium 300 mcg PO Q ___ 7. Omeprazole 40 mg PO DAILY 8. Vitamin D 3000 UNIT PO DAILY 9. Acetaminophen 1000 mg PO Q8H:PRN pain do not take more than 3000mg in 24 hours or drink alcohol RX *acetaminophen 500 mg 2 tablet(s) by mouth every eight (8) hours Disp #*50 Tablet Refills:*0 10. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin [Cipro] 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*28 Tablet Refills:*0 11. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain do not drink alcohol while taking this medication RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every four (4) hours Disp #*50 Tablet Refills:*0 12. LOPERamide 2 mg PO BID please monitor your ileostomy output. RX *loperamide [Anti-Diarrhea] 2 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*1 13. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*42 Tablet Refills:*0 14. Psyllium Wafer 1 WAF PO BID RX *psyllium [Metamucil] 1.7 g 1 wafer(s) by mouth twice a day Disp #*60 Wafer Refills:*1 15. travoprost 0.004 % ___ continue home med 16. AndroGel (testosterone) 1.62 % (20.25 mg/1.25 gram) transdermal daily 17. Aspirin 325 mg PO DAILY 18. Pulmosal (sodium chloride) 7 % inhalation prn 19. sodium chloride 0.9 % 20 ml into JP drain daily Please flush JP drain with 20ml of sterile normal saline and draw back as instructed RX *sodium chloride 0.9 % [Normal Saline Flush] 0.9 % 20 ml JP drain once a day Disp #*60 Syringe Refills:*1 20. Outpatient Lab Work Please draw a creatinine on ___, at d/c creat is 2.6, please call ___ if not returning to normal, it has improved prior to discharge. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Diverticulitis with anastomotic leak after sigmoid colectomy. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>___ were admitted to the hospital after a Laparoscopic Colectomy for surgical management of your Diverticulitis. Unfortunately, have this surgery ___ developed a leak at the anastomosis in the Colon and this required a second surgery and drain to control the infection as well as a diverting ileostomy. ___ were given antibiotics through your IV and now your will take antibiotics by mouth until your follow-up appointment with Dr. ___ will take Cipro and Flagyl. The drain will stay in place at least until your follow-up with Dr. ___. The drain is draining a small amount ___ have recovered from this procedure well and ___ are now ready to return home. Drain irrigation instructions: Remove bulb drain and flush tube with 20cc sterile normal saline towards patient, then draw 20cc fluid back into syringe. Replace bulb drain to suction. ___ can shower with the drain in. Clean around the jp drain site with sterile normal saline once daily and apply a new gauze dressing and secure with paper tape. The drain is draining a small amount of stool from the leak, pus, and small amounts of blood/abdominal fluid. Please record the output from the drain on the provided sheet and bring with ___ to your clinic appointment. Please call our office if ___ have any of the following issues: increased pain at the drain site, drainage of bright red blood, more than 150cc from the drain in 24 hours, difficulty flushing the drain, or any concerning symptoms or worries. ___ unfortunately had a kidney injury from dehydration, with ct contrast dye, and vancomycin. This is returning to normal. ___ must have a creatinine level drawn at your primary care providers office on ___. They can call our office if the number has not decreased to under 1.0. At discharge it is 2.6 however, it will still take a number of days to improve. Please be aware of your urine outout. If ___ feel as though your output is decreasing, please call the office. Please call if: urine is dark orangy brown, output is low, burning with urination, or lower abdominal pain. Do not take Motrin for pain. Hold of taking lisinopril until clears by primary care provider. ___ have tolerated a regular diet, are passing gas and your pain is controlled with pain medications by mouth. ___ may return home to finish your recovery. Please monitor your bowel function closely. If ___ have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or extended constipation. ___ have a new ileostomy. The most common complication from a new ileostomy placement is dehydration. The output from the stoma is stool from the small intestine and the water content is very high. The stool is no longer passing through the large intestine which is where the water from the stool is reabsorbed into the body and the stool becomes formed. ___ must measure your ileostomy output for the next few weeks. The output from the stoma should not be more than 1200cc or less than 500cc. Continue to take the medications to control the ostomy output (imodium/metamucil wafers). The office nurse or nurse practitioner can recommend medications to increase or slow the ileostomy output. Keep yourself well hydrated, if ___ notice your ileostomy output increasing, take in more electrolyte drink such as Gatorade. Please monitor yourself for signs and symptoms of dehydration including: dizziness (especially upon standing), weakness, dry mouth, headache, or fatigue. If ___ notice these symptoms please call the office or return to the emergency room for evaluation if these symptoms are severe. ___ may eat a regular diet with your new ileostomy. However it is a good idea to avoid fatty or spicy foods and follow diet suggestions made to ___ by the ostomy nurses. Please monitor the appearance of the ostomy and stoma and care for it as instructed by the wound/ostomy nurses. ___ stoma (intestine that protrudes outside of your abdomen) should be beefy red or pink, it may ooze small amounts of blood at times when touched and this should subside with time. The skin around the ostomy site should be kept clean and intact. Monitor the skin around the stoma for bulging or signs of infection listed above. Please care for the ostomy as ___ have been instructed by the wound/ostomy nurses. ___ will be able to make an appointment with the ostomy nurse in the clinic 7 days after surgery. ___ will have a visiting nurse at home for the next few weeks helping to monitor your ostomy until ___ are comfortable caring for it on your own. Currently your ileostomy is allowing the surgery in your large intestine to heal, which does take some time. ___ will come back to the hospital for reversal of this ileostomy when decided by Dr. ___, Dr. ___ Dr. ___. At your follow-up appointment in the clinic, we will decide when is the best time for your second surgery. Until this time there is healthy intestine that is still functioning as it normally would. This functioning healthy intestine will continue to produce mucus. Some of this mucus may leak or ___ may feel as though ___ need to have a bowel movement - ___ may sit on the toilet and empty this mucus as though ___ were having a bowel movement, it is not abnormal to have some leakage of mucus from the rectum, please place a gauze pad in your underwear if this is happening. If ___ change this pad more than ___ times daily please call the office. ___ have ___ laparoscopic surgical incisions on your abdomen which are closed with internal sutures and a skin glue called Dermabond. And there is a larger incision near your umbilical site, the staples were removed from this. These are healing well however it is important that ___ monitor these areas for signs and symptoms of infection including: increasing redness of the incision lines, white/green/yellow/malodorous drainage, increased pain at the incision, increased warmth of the skin at the incision, or swelling of the area. Please call the office if ___ develop any of these symptoms or a fever. ___ may go to the emergency room if your symptoms are severe. ___ may shower; pat the incisions dry with a towel, do not rub. The small incisions may be left open to the air. Please no baths or swimming for 6 weeks after surgery unless told otherwise by your surgical team. ___ will be prescribed a small amount of the pain medication Oxycodone. Please take this medication exactly as prescribed. ___ may take Tylenol as recommended for pain. Please do not take more than 4000mg of Tylenol daily. Do not drink alcohol while taking narcotic pain medication or Tylenol. Please do not drive a car while taking narcotic pain medication. No heavy lifting greater than 6 lbs for until your first post-operative visit after surgery. Please no strenuous activity until this time unless instructed otherwise by Dr. ___ Dr. ___. Thank ___ for allowing us to participate in your care! Our hope is that ___ will have a quick return to your life and usual activities. Good luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Diazepam 5 mg PO QHS Anxiety 2. Gabapentin 600 mg PO BID 3. Ranitidine 300 mg PO DAILY 4. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth Twice a day Disp #*30 Capsule Refills:*3 5. Metoclopramide 10 mg PO QIDACHS RX *metoclopramide HCl 10 mg 1 tablet by mouth QIDACHS Disp #*60 Tablet Refills:*1 6. Senna 1 TAB PO BID Constipation RX *sennosides [senna] 8.6 mg 1 tablet by mouth Twice a day Disp #*30 Tablet Refills:*1 7. Levothyroxine Sodium 75 mcg PO DAILY RX *levothyroxine 75 mcg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 8. Ondansetron 4 mg PO Q 8H RX *ondansetron 4 mg 1 tablet,disintegrating(s) by mouth every 8 hours Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Gastroparesis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted for abdominal pain and nausea. During your time here you were given several medications to alleviate your pain and control the nausea. Your symptoms on presentation were suggestive of a gastrointestinal disease called GASTROPARESIS (your stomach and gut moves slower). When we treated you with a medication that promotes movement of your gut, you felt better and were able to eat some food and keep it down. We conducted lab tests to evaluate you for other possible autoimmune diseases such as Celiac's and we did not find anything irregular. You had an imaging study (CT Scan of your abdomen and pelvis) that came back with no abnormalities. You also had an endoscopy which did not reveal abnormalities. The GI (stomach and gut) doctors recommended that ___ with them in outpatient clinic. They will determine if a gastric emptying study or other examination such as colonscopy will be needed. Your TSH level was high during admission, so we increased your Levothyroxine dose to 75mcg. Please ___ with your primary care physician for continued maintenance of your hypothyroidism. Please take these NEW medications: - Reglan 10 mg before every meal and bedtime to help your gut and stomach move food better to reduce nausea and vomiting. - Docusate Sodium 100 mg twice a day as needed for constipation. This medication helps soften your stool. - Senna 1 tablet twice a day as needed for constipation. Please CHANGE the dose of the following medications: - Take 75 mcg of Levothyroxine daily Please ___ with your gastroenterologist and primary care physicians with appointments scheduled.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Aspirin 81 mg PO DAILY 3. Atovaquone Suspension 1500 mg PO DAILY 4. Calcium Carbonate 500 mg PO QID 5. Citalopram 20 mg PO DAILY 6. Docusate Sodium 100 mg PO BID 7. Furosemide 20 mg PO DAILY Please hold for SBP <100. 8. Gabapentin 600 mg PO TID 9. HYDROmorphone (Dilaudid) ___ mg IV Q6H:PRN Pain/premedicate before dressing changes 10. HYDROmorphone (Dilaudid) ___ mg PO Q6H:PRN Pain 11. Levofloxacin 500 mg PO Q24H 12. Lisinopril 40 mg PO DAILY Please hold for SBP <100. 13. Lorazepam 1 mg PO HS:PRN Insomnia Please hold for oversedation or RR <10. 14. Miconazole Powder 2% 1 Appl TP BID:PRN fungal rash 15. Morphine SR (MS ___ 30 mg PO Q12H 16. Nystatin Oral Suspension 5 mL PO QID Mouth pain 17. OLANZapine 5 mg PO HS 18. Omeprazole 40 mg PO DAILY 19. Polyethylene Glycol 17 g PO DAILY:PRN constipation 20. PredniSONE 5 mg PO DAILY 21. Senna 1 TAB PO BID:PRN Constipation 22. ValGANCIclovir 900 mg PO Q24H 23. Vitamin D 800 UNIT PO DAILY 24. Warfarin 3 mg PO DAILY16 please titrate dose for INR goal ___, since INR 2.6 on admission, we kept his dose at 3mg daily during this admission Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Weakness - generalized Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You presented to the emergency department for diffuse weakness, and a CT of your head was initially concerning for a possible small stroke. You were admitted to the stroke service and received a CT-angiogram, and this was not revealing for a new stroke. Additionally, the final read from the CT you had in the ED returned as negative for stroke as well. Your blood work was overall reassuring, and you are already receiving medications to help prevent future strokes (aspirin and warfarin). Your weakness is thought to be secondary to your underlying medical conditions (HES) and perhaps deconditioning or mild dehydration. We felt your exam improved while in the hospital and you also reported you felt your weakness was improved. We will discharge you back to your rehab facility with the same medications you were on before.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>ACTIVITY: DO NOT lift anything greater than 10 lbs for 2 weeks. ___ times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. You will be more comfortable if you do not sit or stand more than ~45 minutes without changing positions. BRACE: You have been given a brace. This brace should be worn for comfort when you are walking. You may take it off when sitting in a chair or while lying in bed. WOUND: Remove the external dressing in 2 days. If your incision is draining, cover it with a new dry sterile dressing. If it is dry then you may leave the incision open to air. Once the incision is completely dry, (usually ___ days after the operation) you may shower. Do not soak the incision in a bath or pool until fully healed. If the incision starts draining at any time after surgery, cover it with a sterile dressing. Please call the office. Please call the office if you have a fever>101.5 degrees Fahrenheit and/or drainage from your wound. MEDICATIONS: You should resume taking your normal home medications. Refrain from NSAIDs immediately post operatively. You have also been given Additional Medications to control your post-operative pain. Please allow our office 72 hours for refill of narcotic prescriptions. Please plan ahead. You can either have them mailed to your home or pick them up at ___ ___, ___. We are not able to call or fax narcotic prescriptions to your pharmacy. In addition, per practice policy, we only prescribe pain medications for 90 days from the date of surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Carvedilol 12.5 mg PO BID 2. Lanthanum 500 mg PO TID W/MEALS 3. sevelamer CARBONATE 800 mg PO TID W/MEALS 4. Warfarin 3 mg PO DAILY16 5. Allopurinol ___ mg PO EVERY OTHER DAY 6. Acetaminophen 325 mg PO Q8H:PRN Pain - Mild 7. amLODIPine 10 mg PO DAILY 8. Clopidogrel 75 mg PO DAILY 9. Clotrimazole Cream 1 Appl TP BID:PRN fungal 10. Cyanocobalamin 1000 mcg PO DAILY 11. Donepezil 10 mg PO DAILY 12. Fexofenadine 180 mg PO DAILY 13. Fish Oil (Omega 3) ___ mg PO BID 14. Multi-Vitamins with Iron (pediatric multivit-iron-min) ___ mg oral DAILY 15. Nephrocaps 1 CAP PO DAILY 16. Rosuvastatin Calcium 40 mg PO QPM 17. Tamsulosin 0.4 mg PO DAILY 18. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: ================== PRIMARY DIAGNOSES: ================== Undifferentiated shock Type II non-ST elevation myocardial infarction Severe aortic stenosis, status post transcatheter aortic valve replacement Chronic kidney disease, initiated on hemodialysis Aspiration pneumonia Paroxysmal atrial fibrillation ====================== CHRONIC/STABLE ISSUES: ====================== Coronary artery disease with known three vessel disease, status post drug eluting stent to OM2 Hypertension Normocytic anemia Ethanol cirrhosis Type II diabetes mellitus Benign prostatic hypertrophy 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 ___, WHY YOU CAME TO THE HOSPITAL - You came to ___ as you had chest pain. WHAT HAPPENED WHILE YOU WERE IN THE HOSPITAL? - You were found to have a heart attack. This was thought to be largely due to a bad heart valve, in addition to your coronary artery disease. Your heart valve was replaced. - Your kidney function worsened, and you were started on dialysis. - You were treated for a pneumonia. WHAT SHOULD YOU DO ONCE YOU LEAVE THE HOSPITAL? - It is important the rehab arrange follow-up with your PCP when you are discharged - You need to follow-up with your cardiologist as arranged - You will start dialysis at ___ dialysis ___ and attend every ___ - It is important you continue to take all your medications as prescribed It was our pleasure taking care of you. We wish you all the best! Your ___ Healthcare Team MEDICATION CHANGES: [] changed allopurinol to 100mg every other day [] started carvedilol 12.5mg twice daily [] started lanthanum 500mg three times daily with meals [] started sevelamer 800mg three times daily with meals [] started warfarin 3mg daily; next INR recheck ___ [] stopped aspirin 81mg daily [] stopped hydralazine 50mg every six hours [] stopped metoprolol succinate 100mg daily [] stopped sodium bicarbonate 650mg three times daily</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ARIPiprazole 2 mg PO DAILY 2. Cetirizine 10 mg PO Q12H 3. ClonazePAM 0.5 mg PO QHS:PRN insomnia 4. Creon 12 2 CAP PO TID W/MEALS 5. Venlafaxine XR 300 mg PO DAILY 6. 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 7. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 8. Polyethylene Glycol 17 g PO BID:PRN Constipation RX *polyethylene glycol 3350 17 gram 1 powder(s) by mouth Daily Disp #*30 Packet Refills:*0 9. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp #*60 Tablet Refills:*0 10. Omeprazole 20 mg PO DAILY 11. Ondansetron 4 mg PO Q8H:PRN Nausea RX *ondansetron HCl 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*30 Tablet Refills:*0 12. Pyridoxine 50 mg PO DAILY RX *pyridoxine 50 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 13. Isoniazid ___ mg PO DAILY RX *isoniazid ___ mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Pancreatic Cancer Latent TB Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted with abdominal pain likely due to a recent liver biopsy and your underlying pancreatic cancer. You were also having constipation which has now improved. A port was placed as previously scheduled. You were also tested for TB given a concerning finding on your chest CT and started on treatment for latent TB.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). 3. clindamycin HCl 300 mg Capsule Sig: One (1) Capsule PO every six (6) hours for 6 doses. Disp:*6 Capsule(s)* Refills:*0* 4. isosorbide mononitrate 60 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). 5. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). 6. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). 8. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet, Sublingual Sublingual PRN (as needed) as needed for chest pain, SOB: can repeat every five minutes up to 3 pills total. If taking ___ pill, please call ___. 9. glyburide-metformin ___ mg Tablet Sig: One (1) Tablet PO twice a day. 10. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). 11. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO DAILY (Daily). 12. terazosin 5 mg Capsule Sig: One (1) Capsule PO HS (at bedtime). 13. Actos 30 mg Tablet Sig: One (1) Tablet PO once a day. 14. Calcium+D Oral 15. cholecalciferol (vitamin D3) 1,000 unit Tablet Sig: One (1) Tablet PO once a day. 16. acetaminophen 500 mg Tablet Sig: ___ Tablets PO every ___ hours as needed for pain for 10 days. Disp:*qs Tablet(s)* Refills:*0* 17. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 18. linagliptin 5 mg Tablet Sig: One (1) Tablet PO once a day. Discharge Disposition: Home Discharge Diagnosis: Syncope asystole Secondary: Diabetes Mellitus type 2 Coronary Artery Disease Hypertension ___ Prostatic Hyperplasia Abdominal Aortic Aneurysm Chronic Obstructive Pulmonary Disease Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure to take care of you at ___ ___. You were admitted for a couple of long pauses in your heart rate and syncope, likely vasovagal in nature. This means that a trigger, (usually emotional like fear or physical like straining) causes changes in your vascular system such that your heart rate and blood pressure drops. We have placed a pacemaker to keep your heart rate regular, which should help should future episodes occur. . Please decrease aspirin to 81mg daily. Please take clindamycin 300mg every six hours through ___. You may also take tylenol ___, ___ every ___ hours as needed for pain. . Please continue taking all of your medications as previously prescribed and attend your outpatient follow up clinic visits as detailed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID Duration: 3 Months Last dose to be given on ___ RX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day Disp #*44 Tablet Refills:*0 2. Acetaminophen 1000 mg PO Q8H pain 3. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN shortness of breath 4. Amlodipine 10 mg PO DAILY 5. Aripiprazole 10 mg PO DAILY 6. Aspirin 81 mg PO DAILY 7. Calcium Carbonate 500 mg PO BID 8. Diltiazem Extended-Release 120 mg PO DAILY 9. Docusate Sodium 100 mg PO BID:PRN constipation RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*50 Tablet Refills:*0 10. Ipratropium Bromide Neb 1 NEB IH Q6H:PRN shortness of breath 11. Nicotine Patch 14 mg TD DAILY 12. QUEtiapine Fumarate 25 mg PO BID 13. Senna 8.6 mg PO BID:PRN constipation 14. Glycerin Supps ___AILY constipation 15. Loratadine 10 mg PO DAILY 16. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 17. Polyethylene Glycol 17 g PO DAILY constipation 18. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth Q3H Disp #*80 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left subacute proximal tibia 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 2 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet ACTIVITY AND WEIGHT BEARING: - Touch down weight bearing in the left leg - Range of motion as tolerated in left knee in an unlocked ___ brace Physical Therapy: LLE TDWB, ROMAT at knee in unlocked ___ Treatments Frequency: Dressings may be changed as needed for drainage. No dressings needed if wounds are clean and dry. Staples will be removed in Ortho trauma clinic in ___ weeks during follow up appointment.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Artificial Tears ___ DROP BOTH EYES PRN dry eyes, blurry vision RX *dextran 70-hypromellose [Artificial Tears] 0.1 %-0.3 % ___ drops per eye PRN Refills:*0 2. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Hydrocortisone 5 mg PO QAM RX *hydrocortisone 5 mg 1 tablet(s) by mouth qam Disp #*30 Tablet Refills:*0 4. Hydrocortisone 2.5 mg PO QPM RX *hydrocortisone 5 mg 0.5 (One half) tablet(s) by mouth qpm Disp #*15 Tablet Refills:*0 5. Midodrine 5 mg PO TID RX *midodrine 5 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 6. Multivitamins 1 TAB PO DAILY RX *multivitamin [Daily Multi-Vitamin] 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 7. Nicotine Patch 7 mg TD DAILY RX *nicotine 7 mg/24 hour As directed once a day Disp #*2 Each Refills:*0 8. 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 9. Citalopram 20 mg PO DAILY RX *citalopram 20 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 10. Acetaminophen 650 mg PO Q8H:PRN Pain 11. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth once a day Disp #*30 Capsule Refills:*0 12. Sodium Chloride Nasal ___ SPRY NU QID:PRN Nasal congestion Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS Acute hepatitis Hyponatremia Nutritional Deficiency Alcohol Abuse Suicidal Ideation 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 because you were having back pain and nausea and were found to have inflammation of your liver. We did a lot of blood tests and imaging studies which did not show a definitive cause of your liver inflammation. We also gave you medicine to prevent you from withdrawing from alcohol. We think this may have been a reaction to medication you received during your last hospitalization called phenobarbital.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth q4 Disp #*30 Tablet Refills:*0 3. Amlodipine 0 mg PO Frequency is Unknown 4. GlipiZIDE 10 mg PO DAILY 5. Lisinopril 40 mg PO DAILY 6. MetFORMIN (Glucophage) 1000 mg PO BID 7. Cyanocobalamin 1000 mcg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Carcinoid tumor and small-bowel obstruction related to internal hernia. 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 a small bowel obstruction. You were given bowel rest and intravenous fluids and a nasogastric tube was placed in your stomach to decompress your bowels. You then underwent an operation to relieve your bowel obstruction and it has now resolved. You have tolerated a regular diet, are passing gas and your pain is controlled with pain medications by mouth. You may return home to finish your recovery. Please monitor your bowel function closely. You may or may not have had a bowel movement prior to your discharge which is acceptable, however it is important that you have a bowel movement in the next ___ days. After anesthesia it is not uncommon for patient’s to have some decrease in bowel function but you should not have prolonged constipation. Some loose stool and passing of small amounts of dark, old appearing blood are expected. However, if you notice that you are passing bright red blood with bowel movements or having loose stool without improvement please call the office or go to the emergency room if the symptoms are severe. If you are taking narcotic pain medications there is a risk that you will have some constipation. Please take an over the counter stool softener such as Colace, and if the symptoms do not improve call the office. If you have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or extended constipation. You have a long vertical incision on your abdomen that is closed with staples. This incision can be left open to air or covered with a dry sterile gauze dressing if the staples become irritated from clothing. The staples will stay in place until your first post-operative visit at which time they can be removed in the clinic, most likely by the office nurse. Please monitor the incision for signs and symptoms of infection including: increasing redness at the incision, opening of the incision, increased pain at the incision line, draining of white/green/yellow/foul smelling drainage, or if you develop a fever. Please call the office if you develop these symptoms or go to the emergency room if the symptoms are severe. You may shower, let the warm water run over the incision line and pat the area dry with a towel, do not rub. No heavy lifting for at least 6 weeks after surgery unless instructed otherwise by Dr. ___ Dr. ___. You may gradually increase your activity as tolerated but clear heavy exercise should be avoided. You will be prescribed a small amount of the pain medication oxycodone. Please take this medication exactly as prescribed. You may take Tylenol as recommended for pain. Please do not take more than 4000mg of Tylenol daily. Do not drink alcohol while taking narcotic pain medication or Tylenol. Please do not drive a car while taking narcotic pain medication. Thank you for allowing us to participate in your care! Our hope is that you will have a quick return to your life and usual activities. Good luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 2.5 mg PO QAM 2. Amlodipine 5 mg PO HS 3. Aspirin 81 mg PO DAILY Hx of Stroke 4. Atenolol 25 mg PO BID 5. Atorvastatin 80 mg PO QPM 6. Diclofenac Sodium ___ 50 mg PO BID Pain 7. Estradiol 0.5 mg PO BID 8. Tizanidine 4 mg PO BID 9. Lisinopril 40 mg PO BID 10. Lidocaine 5% Patch 2 PTCH TD QAM 11. Outpatient Physical Therapy Dx: L4-5 herniated nucleus pulposes Discharge Disposition: Home Discharge Diagnosis: L4-5 herniated nucleus pulposes Right hip pain, numbness 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 ___ Neurosurgery service for evaluation of your left hip pain/numbness. You underwent a MRI of your lumbar spine that showed you have a bulging disc at L4-5, but that did not explain your left hip symptoms. Neurology was consulted to further evaluate those symptoms. You are now being discharged with the following instructions: You may continue to take your home medications as you were prior to this hospitalization.</s>