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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 QID 2. TraMADol 25 mg PO Q6H:PRN Pain - Moderate RX *tramadol 50 mg 0.5 (One half) tablet(s) by mouth every six (6) hours Disp #*10 Tablet Refills:*0 3. Donepezil 15 mg PO QHS 4. Famotidine 20 mg PO BID 5. Finasteride 5 mg PO DAILY 6. Sertraline 100 mg PO DAILY 7. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Left ___ rib fractures and pneumothorax 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 ___ and underwent pigtail tube placement for a small pneumothorax and non-operative management of your left rib fractures. You are recovering well and are now ready for discharge. Please follow the instructions below to continue your recovery: Rib Fractures: *Your injury caused left ___ rib fractures which can cause severe pain and subsequently cause you to take shallow breaths because of the pain. *You should take your pain medication as directed to stay ahead of the pain otherwise you won't be able to take deep breaths. If the pain medication is too sedating take half the dose and notify your physician. Please do not drive for the next ___ weeks while taking your pain medication *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). Warm regards, Your ___ Surgery Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*24 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID 3. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*36 Tablet Refills:*0 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 5. Pantoprazole 40 mg PO Q12H 6. Senna 8.6 mg PO BID Discharge Disposition: Home Discharge Diagnosis: 1. Leukocytosis 2. Fever of unknown origin Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the surgery service at ___ for evaluation of leukocytosis and fever. You were started on antibiotics and you leukocytosis started to improve. You are now safe to return home to complete your recovery with the following instructions: . Please call Dr. ___ office at ___ if you have any questions or concerns. . Please call your doctor or nurse practitioner if you experience the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain is not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. . General Discharge Instructions: Please resume all regular home medications , unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon, who will instruct you further regarding activity restrictions. Avoid driving or operating heavy machinery while taking pain medications. Please follow-up with your surgeon and Primary Care Provider (PCP) as advised.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet(s) by mouth every 6 hours Disp #*50 Tablet Refills:*0 2. DiphenhydrAMINE 12.5-50 mg PO/IV Q6H:PRN Insomnia/Pruritis 3. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*40 Capsule Refills:*0 4. Enoxaparin Sodium 40 mg SC QHS RX *enoxaparin 40 mg/0.4 mL at bedtime Disp #*14 Syringe Refills:*0 5. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 3 hours Disp #*100 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: R ulna fracture, R tibia/fibula fracture, L great toe proximal phalanx 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>******SIGNS OF INFECTION******** - Please return to the emergency department or notify MD if you should experience severe pain, increased swelling, decreased sensation, difficulty with movement; fevers >101.5, chills, redness or drainage at the incision site; chest pain, shortness of breath or any other concerns. ********Wound Care******** - You can get the wound wet/take a shower starting from 3 days post-op. No baths or swimming for at least 4 weeks. Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. No dressing is needed if wound continues to be non-draining. ******WEIGHT-BEARING******* non weight bearing right upper extremity; may bear weight through elbow weight bearing as tolerated bilateral lower extremity Left lower extremity in hard soled shoe ******MEDICATIONS*********** - Resume your pre-hospital medications. - You have been given medication for your pain control. Please do not operate heavy machinery or drink alcohol when taking this medication. As your pain improves please decrease the amount of pain medication. This medication can cause constipation, so you should drink ___ glasses of water daily and take a stool softener (colace) to prevent this side effect. - Medication refills cannot be written after 12 noon on ___. *****ANTICOAGULATION****** Take Lovenox for DVT prophylaxis for 2 weeks post-operatively Physical Therapy: Activity: Activity: Activity as tolerated qid Right lower extremity: Full weight bearing Right upper extremity: Non weight bearing Pt can weight bear throuh R elbow Treatments Frequency: daily dressing changes</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 7 Doses 2. amLODIPine 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Docusate Sodium 100 mg PO BID 5. Fish Oil (Omega 3) 1000 mg PO DAILY 6. Furosemide 20 mg PO DAILY 7. Gabapentin 600 mg PO TID 8. GlipiZIDE 5 mg PO DAILY 9. Isosorbide Mononitrate 30 mg PO DAILY 10. Methocarbamol 500 mg PO Q6H:PRN takes occasionally 11. Metoprolol Tartrate 37.5 mg PO BID 12. Potassium Chloride 10 mEq PO DAILY 13. Pravastatin 40 mg PO QPM 14. Sertraline 50 mg PO DAILY 15. Warfarin 4 mg PO DAILY16 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Urinary tract infection SECONDARY DIAGNOSIS: Stroke recrudescence Weakness Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You came to the hospital because you had return of the symptoms you had during your stroke, consisting primarily of left-sided weakness. While you were here, you were seen by our neurologists who did not feel you had had a new stroke. We found evidence of a urinary tract infection. We gave you antibiotics for this, and your weakness improved. This is a phenomenon called stroke "recrudescence," in which an infection can bring back old stroke symptoms. Still, if you do have symptoms return, it is important to be certain that you have not had a new stroke, and you should return to the hospital if you have any similar symptoms. It was a pleasure participating in your care. Sincerely, Your ___ Care</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol 0.083% Neb Soln 1 NEB IH PRN shortness of breath, wheezing, or coughing 2. Finasteride 5 mg PO DAILY 3. Lorazepam 1 mg PO Q12H:PRN nausea or anxiety 4. Omeprazole 20 mg PO DAILY 5. Prochlorperazine 10 mg PO Q8H:PRN nausea 6. Terazosin 10 mg PO HS 7. Vitamin D 1000 UNIT PO DAILY 8. Acerola C *NF* (ascorbic acid) 500 mg Oral daily 9. M-Vit *NF* (PNV w/o calcium-iron fum-FA) ___ mg Oral daily 10. Ondansetron 8 mg PO Q8H:PRN nausea 11. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth twice a day Disp #*8 Tablet Refills:*0 12. Acetaminophen 500 mg PO Q6H:PRN pain 13. Simvastatin 40 mg PO DAILY 14. Metoprolol Succinate XL 150 mg PO DAILY RX *metoprolol succinate 100 mg 1 tablet extended release 24 hr(s) by mouth DAILY Disp #*30 Tablet Refills:*0 RX *metoprolol succinate 50 mg 1 tablet extended release 24 hr(s) by mouth daily Disp #*30 Tablet Refills:*0 15. Simethicone 40-80 mg PO QID:PRN gas 16. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 17. Albuterol Inhaler ___ PUFF IH Q4H:PRN before activity, wheezing, shortness of breath 18. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID Discharge Disposition: Home Discharge Diagnosis: Primary: Acute pancreatitis Urinary tract infection Sepsis Secondary: Tachycardia (accelerated junctional rhythm) Constipation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your stay at ___. You were admitted to the hospital with fevers and abdominal pain. You were found to have pancreatitis (inflammation of the pancreas). We gave you IV fluids and placed you on bowel rest (nothing by mouth), and your pain improved. Avoid fatty foods or heavy meals. Abdominal pain may persist for weeks to months. You were also found to have a urinary tract infection, for which you will complete a 7 day course of antibiotics. It was a pleasure being involved in your care, Your ___ Doctors ___ CHANGES - ___ propranolol to metoprolol XL for fast heart rate - Decreased simvastatin dose to 40mg daily - Stop diclofenac for now, which can cause worsening abdominal pain</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Digoxin 0.125 mg PO DAILY RX *digoxin 125 mcg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Furosemide 20 mg PO DAILY:PRN weight gain RX *furosemide 20 mg 1 tablet(s) by mouth daily prn Disp #*20 Tablet Refills:*0 3. Lisinopril 2.5 mg PO DAILY RX *lisinopril 2.5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Enoxaparin Sodium 80 mg SC Q12H 5. Atorvastatin 40 mg PO QPM 6. efavirenz-emtricitabin-tenofov ___ mg oral DAILY Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis ================= Non-ischemic Cardiomyopathy Heart Failure with Reduced Ejection Fraction Secondary Diagnosis: ==================== HIV T-cell lymphoma Anemia Hx of stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at the ___ ___! Why was I admitted to the hospital? -You were admitted because you were feeling tired and short of breath. What happened while I was in the hospital? - We did an ultrasound of your heart which showed that your heart muscle is weakened. - You had multiple procedures to help us decide which medications would be best for your heart failure. - We started you on medications to help your heart pump stronger and lower your blood pressure. What should I do after leaving the hospital? - We have made changes to your medication list, so please make sure to take your medications as directed. You will also need to have close follow up with your heart doctor and your primary care doctor. Please take your medications as listed in your discharge summary and follow up at the listed appointments. - Please stop taking your home labetalol - Please start taking lisinopril, digoxin - Please continue to take your lovenox and atorvastatin - Please weigh yourself every day in the morning after you go to the bathroom and before you get dressed. If your weight goes up by more than 3 lbs please take one tablet of Lasix and please call your heart doctor to notify them of this change. - Please seek medical attention if you have new or concerning symptoms or you develop swelling in your legs, abdominal distention, or shortness of breath at night. Thank you for allowing us to be involved in your care, we wish you all the best! Sincerely, Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q6H:PRN sob 2. Apri (desogestrel-ethinyl estradiol) 0.15-0.03 mg oral DAILY 3. Acetaminophen 325-650 mg PO Q6H:PRN pain 4. Naproxen 500 mg PO Q8H:PRN pain RX *naproxen 500 mg 1 tablet(s) by mouth EVERY 8 HOURS AS NEEDED Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Fever of Unknown Etiology Secondary Diagnoses: Anxiety 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 plesaure caring for you at ___. You were admitted to the hospital with fevers, fatigue, and chest pain for two weeks. Your D-Dimer was high, but a CT scan showed that you did not have an pulmonary embolism. You had other blood tests that showed that there is inflammation in your body, but did not identify the cause of your symptoms. You can take naproxen for pain, but take this with food. You had a pelvic xray that was normal. You should see your primary care physician within two weeks. Thank you for allowing us to participate in your care. Sincerely, Your ___ Team Dear Ms. ___, It was a plesaure caring for you at ___. You were admitted to the hospital with fevers, fatigue, and chest pain for two weeks. Your D-Dimer was high, but a CT scan showed that you did not have an pulmonary embolism. You had other blood tests that showed that there is inflammation in your body, but did not identify the cause of your symptoms. You can take naproxen for pain, but take this with food. You had a pelvic xray that was normal. You should see your primary care physician within two weeks. Thank you for allowing us to participate in your care. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO once a day. Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: Sick sinus syndrome, tricuspid regurgitation Secondary Diagnosis: Polymyositis; upper respiratory infection, likely viral Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___ was a pleasure to take care of you at ___ ___. You were brought into the hospital because you had pauses on your heart monitor. You had a cardiac MRI done which preliminarily showed that the right side of your heart had worsening leak through the tricuspid valve (called tricuspid regurgitation) and that the chambers of your heart are becoming larger than normal. You were seen by Dr. ___ cardiac surgery and you and your family discussed tricuspid valve repair with cardiac surgery team. Right and left heart catheterizations were done to evaluate pressures in the chambers of your heart and your coronary arteries (arteries that feed your heart) prior to your surgery. On the preliminary report, it showed that the coronary arteries were normal, and the pressures in your heart chambers were little high. You are having some cough and sputum production, but your chest x-ray on admission did not show any pneumonia. If your cough worsens and you have fevers greater than ___ F at home, please see your primary care physician. These NEW medications were started for you. - Metoprolol succinate (Toprol XL) 25 mg by mouth daily</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H RX *acetaminophen 650 mg 1 tablet(s) by mouth every 6h Disp #*90 Tablet Refills:*1 2. amLODIPine 5 mg PO BID 3. Atorvastatin 20 mg PO QPM 4. Ciprofloxacin HCl 500 mg PO Q12H UTI Duration: 3 Days RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*6 Tablet Refills:*0 5. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 6. Levothyroxine Sodium 50 mcg PO DAILY 7. Metoprolol Succinate XL 50 mg PO DAILY 8. QUEtiapine Fumarate 100 mg PO QHS 9. Senna 17.2 mg PO HS RX *sennosides 8.6 mg 2 tabs by mouth at bedtime Disp #*60 Tablet Refills:*0 10. Sertraline 50 mg PO DAILY 11. ZIPRASidone Hydrochloride 160 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Left subdural hematoma, Left orbital wall fracture, diplopia, urinary tract infection (UTI) Discharge Condition: Good Mental Status: Confused - sometimes . Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the Trauma Service at ___, because you had a fall on ice about 1 week before your admission, resulting in pain on the left side of your face. You were evaluated in ___ and a bleed on the left side of your brain (left sided subdural hematoma), a fracture of your eye socket on the left (Left orbital wall fracture) and you were then transferred to ___ which confirmed the 2 injuries. During your admission you were evaluated by Neurosurgery who did not think that you head bleed need surgery. You were also evaluated by Plastics for your Left orbital wall fracture and did not offer surgery at this admission but would consider treating as an outpatient. You had double vision but your nerve was not trapped. During your admission you were diagnosed with a urinary infection and a 3 day course of antibiotic were prescribed. Plastics clinic, appointment ___ with the Chief Resident's clinic for re-evaluation in 2 weeks. Given your discharge on a weekend the clinic was not available to contact. ___: Please call ___ for a Neurosurgery follow-up appointment with Dr. ___ in 4 weeks. Follow-up with ophthalmology ___ weeks after discharge with Dr. ___ in ___ ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 50 mg PO DAILY 2. Creon ___ CAP PO TID W/MEALS 3. Docusate Sodium 100 mg PO BID 4. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain RX *hydromorphone [Dilaudid] 4 mg ___ tablet(s) by mouth q4 Disp #*8 Tablet Refills:*0 5. Lorazepam 0.5-1 mg PO Q6H:PRN nausea/insomnia 6. Polyethylene Glycol 17 g PO DAILY:PRN constipation 7. Senna 8.6 mg PO BID 8. Lovastatin 40 mg oral daily 9. Ondansetron 8 mg PO Q8H:PRN nausea Discharge Disposition: Home Discharge Diagnosis: Pancreatic insufficiency Pancreatic adenocarcinoma s/p Whipple 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 for abdominal pain. We did lab tests and scans and did not see any concerning findings. Your symptoms improved with pain medication and you were able to tolerate food. In the future, please avoid large fatty meals, as the amount of Creon (pancreatic enzymes) you are taking is likely not enough to help you digest that amount of fat. We have made no changes to your medication.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Omeprazole 20 mg PO DAILY Duration: 7 Doses 2. BD ___ Syringe (syringe (disposable);<br>syringe with needle) 3 mL 23 x 1 IM ONCE 3. Bisacodyl 10 mg PO BID 4. Cholestyramine 4 gm PO BID 5. Citalopram 30 mg PO DAILY 6. Docusate Sodium 100 mg PO BID 7. Ferrous Sulfate 325 mg PO BID 8. FoLIC Acid 1 mg PO DAILY 9. Fosfomycin Tromethamine 3 g PO 1X/WEEK (WE) 10. Furosemide 20 mg PO DAILY 11. Hydrocortisone 15 mg PO QAM 12. Hydrocortisone 10 mg PO QPM 13. Glargine 20 Units Bedtime Humalog 3 Units Breakfast Humalog 3 Units Lunch Humalog 3 Units Dinner Insulin SC Sliding Scale using HUM Insulin 14. Lactulose 30 mL PO TID 15. Levothyroxine Sodium 125 mcg PO DAILY 16. Methadone 50 mg PO DAILY Consider prescribing naloxone at discharge 17. Multivitamins 1 TAB PO DAILY 18. Naloxone Nasal Spray 4 mg IH ONCE MR1 19. Nicotine Patch 14 mg/day TD DAILY 20. Nicotine Polacrilex 2 mg PO Q2H:PRN smoking cessation 21. Nystatin Ointment 1 Appl TP BID 22. Polyethylene Glycol 17 g PO BID:PRN Constipation - Third Line 23. Rifaximin 550 mg PO BID 24. Sarna Lotion 1 Appl TP QID:PRN pruritis 25. Simvastatin 10 mg PO QPM 26. Sodium Chloride Nasal ___ SPRY NU QID:PRN nasal congestion 27. Spironolactone 25 mg PO DAILY 28. Thiamine 100 mg PO DAILY 29. TraZODone 25 mg PO QHS:PRN insomnia 30. Ursodiol 300 mg PO BID 31. Vitamin D 1000 UNIT PO DAILY 32.Outpatient Physical Therapy ___ Rolling Walker Dx: needs rolling walker prognosis: good ___: 13 months ___ #: ___ ICD-9: ___ Name and contact info for outpatient provider: Name: ___. Location: ___ Address: ___ Phone: ___ Fax: ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: -Recurrent complicated cystitis -Pancytopenia -Shoulder pain SECONDARY DIAGNOSES: -Chronic HCV cirrhosis -Insulin dependent type II diabetes mellitus -Panhypopituitarism -History of transfusion reaction -Cocaine use disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you at ___. WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted for back pain and abdominal pain WHAT WAS DONE FOR YOU WHILE YOU WERE IN THE HOSPITAL? - You were treated with antibiotics for a urinary tract infection - You had imaging of your shoulder which showed a tear in your rotator cuff WHAT SHOULD YOU DO WHEN YOU LEAVE THE HOSPITAL? - Do physical therapy for your shoulder to improve your pain - You should take all of your medications as prescribed - You should keep all your follow up appointments</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID RX *acetaminophen 650 mg 1 tablet(s) by mouth Every 8 hours Disp #*60 Tablet Refills:*0 2. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID Take while taking narcotic pain medications RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth Twice a day Disp #*30 Capsule Refills:*0 4. Enoxaparin Sodium 40 mg SC DAILY Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 0.4 ml subcutaneous Daily Disp #*14 Syringe Refills:*0 5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate Reason for PRN duplicate override: new order Use caution when taking with lorazepam as they can cause respiratory depression when combined RX *oxycodone 5 mg ___ tablet(s) by mouth Every 4 hours Disp #*60 Tablet Refills:*0 6. Amitriptyline 10 mg PO QHS 7. amLODIPine 2.5 mg PO BREAKFAST 8. Atenolol 50 mg PO DAILY 9. LORazepam 1 mg PO QHS 10. Ranitidine 150 mg PO DAILY 11. Simvastatin 20 mg PO QPM Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Bursitis and fluid collection with compression of femoral vasculature 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: - As tolerated, weight bearing as tolerated - Assistive devices as needed for additional support MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take aspirin 81 mg daily for 4 weeks - Continue to take the lovenox injections until follow up - We will discuss anticoagulation going forward at your follow up visit 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. - You may change the dressing with a dry dressing every ___ days 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. ___. Physical Therapy: Patient may weight bear as tolerated. Assistive devices as needed. Treatments Frequency: Dry dressing to surgical site every ___ days</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. naloxone 4 mg/actuation nasal DAILY:PRN 2. Pregabalin 300 mg PO BID 3. Acetaminophen 1000 mg PO TID 4. Lisinopril 10 mg PO DAILY 5. amLODIPine 5 mg PO DAILY 6. Asmanex HFA (mometasone) 200 mcg/actuation inhalation BID 7. Aspirin 81 mg PO DAILY 8. Atorvastatin 10 mg PO QPM 9. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 10. CeFAZolin 2 g IV Q8H 11. Docusate Sodium 200 mg PO BID 12. DULoxetine 60 mg PO DAILY 13. Ferrous Sulfate 325 mg PO DAILY 14. FLUoxetine 20 mg PO DAILY 15. Fluticasone Propionate NASAL 2 SPRY NU DAILY 16. Levemir FlexTouch (insulin detemir) 100 unit/mL (3 mL) subcutaneous BID 17. Lidocaine 5% Patch 1 PTCH TD QAM 18. MetFORMIN (Glucophage) 1000 mg PO DAILY 19. Milk of Magnesia 15 mL PO Q6H:PRN Constipation 20. Nortriptyline 20 mg PO QHS 21. Omeprazole 20 mg PO DAILY 22. OxyCODONE (Immediate Release) 10 mg PO Q3H:PRN Pain - Moderate RX *oxycodone 10 mg 1 tablet(s) by mouth q3h:prn Disp #*14 Tablet Refills:*0 23. Polyethylene Glycol 17 g PO DAILY 24. ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation Q6H:PRN SOB 25. Senna 8.6 mg PO QHS 26. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 27. TraZODone 150 mg PO QHS:PRN insomnia Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Vertebral osteomyelitis Psoas abscess Acute pain SECONDARY DIAGNOSIS: Diabetes mellitus 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 ___ due to severe flank and abdominal pain. We did a CT scan that did not show any severe worsening of your infection. We treated your pain and you felt improved so you were discharged home. Please make sure to keep all your follow up appointments. It will be very important for your doctors to follow ___ closely. 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. Sulfameth/Trimethoprim DS 1 TAB PO BID RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*10 Tablet Refills:*0 2. Naproxen 250 mg PO Q12H 3. Warfarin 3 mg PO DAILY16 RX *warfarin 3 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Acetaminophen 650 mg PO BID 5. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN shortness of breath 6. Carbidopa-Levodopa (___) 1.5 TAB PO BID 7. Carbidopa-Levodopa (___) 1 TAB PO QPM 8. Docusate Sodium 100 mg PO BID 9. Furosemide 20 mg PO DAILY 10. Humalog ___ 2 Units Breakfast Humalog ___ 2 Units Bedtime 11. Metoprolol Succinate XL 25 mg PO DAILY 12. Omeprazole 20 mg PO BID 13. QUEtiapine Fumarate 12.5 mg PO BID 14. Senna 17.2 mg PO DAILY 15. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home with Service Discharge Diagnosis: # Acute bacterial UTI secondary to Ecoli # Right hilar lung cancer # Chronic Atrial fibrillation # Aortic Stenosis # ___ Disease # Dementia # Chronic Urinary Retention Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital after you experienced a few weeks of worsening confusion and weakness at home. It was noticed that you had purulent drainage from your Foley catheter, so your Foley was changed. Your urine was tested and it appeared you had evidence of another urinary tract infection (bacteria growing in your bladder). Because of this we have treated you with an antibiotic course (this will continue through evening of ___ As you know, your cancer is ongoing, and in the year since your last oncology appointment, it is likely that your cancer has progressed and will eventually cause you more symptoms and continue to contribute to a decline in your health. There was ongoing discussion with your family about the importance of clarifying your wishes regarding what you would want done in the event of a health care emergency. It is likely that as your cancer gets worse, you will move more toward end of life care. As you have stated your wishes, you elected to have "everything done" in the event that your heart should give way or your lungs have difficulty breathing. The last thing we would want to do would be to expose you to a traumatic experience, like a cardiac resuscitation (with the possibility of broken ribs) or intubation, if the experience were not something you would wish and there were little chance of meaningful recovery. There is a decent chance that as your cancer gets worse, there may be a medical emergency from which there can be no definitive or meaningful recovery. Should you wish to focus on your comfort in such a scenario, it would be very helpful to clarify this with your family and your outpatient oncologist before any medical emergencies happen. Your sugars appeared to be fairly well controlled while you were in the hospital. We have resumed your Humalog insulin at a reduced number of units. Please monitor your blood sugar throughout the day and ask the hospice program for assistance should you have concerns about your sugar being too high or too low. We have written you for an antibiotic that we recommend you take through ___ evening. It was a pleasure to be involved with your care at ___! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H:PRN pain 2. Ascorbic Acid ___ mg PO BID 3. Bisacodyl 10 mg PO HS 4. Clotrimazole Cream 1 Appl TP BID 5. Docusate Sodium 100 mg PO BID:PRN constipation 6. Gabapentin 800 mg PO Q6H 7. LaMOTrigine 100 mg PO BID 8. LeVETiracetam ___ mg PO BID 9. Lorazepam 0.5 mg PO BID 10. Lorazepam 0.5 mg PO BID:PRN anxiety 11. Lorazepam 1 mg PO DAILY 12. Methocarbamol 500 mg PO Q8H:PRN muscle spasm 13. Milk of Magnesia 30 mL PO DAILY:PRN constipation 14. Morphine SR (MS ___ 15 mg PO Q8H 15. Heparin 5000 UNIT SC TID 16. Morphine Sulfate ___ 7.5 mg PO Q6H:PRN breakthrough pain 17. Multivitamins 1 TAB PO DAILY 18. Nystatin Cream 1 Appl TP BID 19. OLANZapine 20 mg PO HS 20. OLANZapine 10 mg PO QAM 21. Omeprazole 40 mg PO DAILY 22. Perphenazine 8 mg PO QHS 23. Tizanidine 2 mg PO Q8H 24. TraZODone 50 mg PO HS:PRN insomnia 25. Zinc Sulfate 220 mg PO DAILY 26. Acidophilus (L.acidoph & ___ acidophilus) 1 capsule oral daily 27. Detrol LA (tolterodine) 4 mg oral daily 28. Furosemide 40 mg PO DAILY 29. HYDROmorphone (Dilaudid) 2 mg PO BID:PRN pain 30. Lorazepam 1 mg PO 1X PRN:SEIZURE seizure 31. Vitamin D 50,000 UNIT PO ONCE MONTHLY 32. Perphenazine 20 mg PO Q8H:PRN hallucination Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Gluteal hematoma SECONDARY DIAGNOSES: Bacterial colonization of urinary tract Schizophrenia Chronic pain Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to take care of your during this hospitalization. You were admitted to ___ ___ after you were found at your extended living facility to have a low blood count. At ___, you were found to have a "hematoma," or blood collection, in your buttock region. Your blood counts were trended and remained stable. During this admission, there was a concern that you may have a urinary tract infection. You were initially treated with intravenous antibiotics. However, given that you never had a fever or elevation in white blood cell count to suggest infection, antibiotics were stopped prior to discharge. Instead, it is thought that your urine grew bacteria because of your chronic foley catheter. This was removed and you were found to be able to urinate on your own. You are now safe to leave the hospital. Please follow-up with your doctors and take your medications as prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Insulin Syringe (insulin syringe-needle U-100) 0.5 mL 29 gauge x ___ miscellaneous qd please provide 30 syringes RX *insulin syringe-needle U-100 [Advocate Syringes] 29 gauge x ___ as directed Disp #*30 Syringe Refills:*0 2. levemir 4 Units Breakfast levemir 6 Units Bedtime novolog 5 Units Breakfast novolog 5 Units Lunch novolog 5 Units Dinner Insulin SC Sliding Scale using novolog Insulin RX *insulin detemir [Levemir FlexTouch] 100 unit/mL (3 mL) AS DIR 4 Units before BKFT; 6 Units before BED; Disp #*2 Syringe Refills:*0 RX *insulin aspart [Novolog Flexpen] 100 unit/mL AS DIR as dir Disp #*3 Syringe Refills:*0 3. lancets 32 gauge subcutaneous 10x per day please provide 300 lancets RX *lancets 30 gauge as directed Disp #*300 Each Refills:*0 4. NovoLIN R (insulin regular human) 100 unit/mL intraperitoneal as dir RX *insulin regular human [Novolin R] 100 unit/mL 18 units IV as directed Disp #*3 Vial Refills:*0 5. Pen Needle (pen needle, diabetic) 32 gauge x ___ miscellaneous 5 per day please provide 150 needles RX *pen needle, diabetic ___ Tier Unifine Pentips] 32 gauge X ___ as directed Disp #*150 Needle Free Injection Refills:*0 6. amLODIPine 5 mg PO DAILY 7. Aspirin 81 mg PO DAILY 8. Atorvastatin 80 mg PO QPM 9. BuPROPion XL (Once Daily) 150 mg PO DAILY 10. Calcium Acetate ___ mg PO TID W/MEALS 11. Carvedilol 37.5 mg PO BID 12. Citalopram 20 mg PO DAILY 13. Clopidogrel 75 mg PO DAILY 14. Lisinopril 40 mg PO DAILY 15. Metoclopramide 5 mg PO QIDACHS 16. Pantoprazole 40 mg PO Q12H 17. PredniSONE 5 mg PO DAILY 18. ___ (B complex-vitamin C-folic acid) 0.8 mg oral DAILY 19. sevelamer CARBONATE 1600 mg PO TID W/MEALS 20.Outpatient Lab Work Labs: CBC with diff. Name/contact: ___. Phone: ___. Fax: ___. ICD-10: D63.1, anemia in chronic kidney disease. Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Diabetic ketoacidosis Hypertensive emergency SECONDARY DIAGNOSIS ESRD on peritoneal dialysis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you while you were in the hospital. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? - You were admitted due to electrolyte abnormalities, very high blood pressure and high blood sugars - You were seen by the ___ physicians who helped make insulin adjustments to control your blood sugar. Please follow both their long acting and short acting insulin regimen recommendations as prescribed. - We think your high blood pressures caused some strain on your heart, but there is no sign of permanent damage - We did an extensive evaluation to find a trigger for your symptoms, but unfortunately could not find one, so we believe it may be related to not taking any long-acting insulin at home WHAT SHOULD I DO WHEN I LEAVE THE HOSPITAL? - Please resume your normal PD schedule - Please follow-up with your usual outpatient providers - ___ take your insulin injections and peritoneal insulin as directed. - Weigh yourself every morning, call MD if weight goes up more than 3 lbs. 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. Amlodipine 10 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 10 mg PO QPM 4. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q12H 5. Carvedilol 12.5 mg PO BID 6. Mycophenolate Mofetil 1000 mg PO BID 7. Tacrolimus 1.5 mg PO QAM 8. Tacrolimus 1 mg PO QPM 9. Famotidine 20 mg PO Q12H RX *famotidine 20 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 10. Alendronate Sodium 70 mg PO QMON 11. Amoxicillin ___ mg PO PREOP 12. Calcium 500 + D (D3) (calcium carbonate-vitamin D3) 500 mg(1,250mg) -125 unit oral DAILY 13. Fish Oil (Omega 3) 1000 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Viral illness status post kidney and pancreas transplant Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because of nausea and elevated liver tests. We believe this is likely due to some type of virus. Tests for EBV and CMV are pending and you should follow up with your primary care doctor and kidney doctor to follow up the results of this test. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 2. Citracal + D Petites (calcium citrate-vitamin D3) 200 mg calcium -250 unit oral 2 tabs BID 3. Magnesium Oxide Dose is Unknown PO ASDIR 4. Multivitamins 1 TAB PO DAILY 5. Simvastatin 20 mg PO QPM 6. valsartan-hydrochlorothiazide 160-25 mg oral DAILY 7. Yuvafem (estradiol) 10 mcg vaginal 2X/WEEK Discharge Disposition: Home Discharge Diagnosis: Diverticular bleed Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___! WHY WERE YOU ADMITTED? You were admitted for bloody bowel movements. WHAT HAPPENED IN THE HOSPITAL? You received three blood transfusions. A colonoscopy was performed, which showed diverticulosis, which was likely the cause of your bleeding. WHAT SHOULD YOU DO AT HOME? -Please stop taking aspirin -Please monitor your bowel movements and return to the ED in the event of bloody ones -Please take your stool softeners daily Thank you for allowing us be involved in your care, we wish you all the best! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Warfarin 4.5 mg PO DAILY16 RX *warfarin 1 mg 4.5 tablet(s) by mouth Daily Disp #*40 Tablet Refills:*0 2. Acetaminophen-Caff-Butalbital 1 TAB PO BID:PRN Headache Do not exceed 6 tablets/day 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. FoLIC Acid 1 mg PO DAILY 6. Furosemide 40 mg PO BID 7. GlyBURIDE 10 mg PO DAILY 8. Hydrocortisone (Rectal) 2.5% Cream ___ID:PRN rectal bld 9. HydrOXYzine 25 mg PO Q8H:PRN itching 10. Methotrexate 15 mg PO QFRI 11. Metoprolol Succinate XL 50 mg PO QHS 12. Metoprolol Succinate XL 100 mg PO QAM 13. mometasone 0.1 % topical BID 14. Multivitamins 1 TAB PO DAILY 15. Nitroglycerin SL 0.4 mg SL ONCE:PRN as directed 16. Nystatin Cream 1 Appl TP BID Rash 17. Omeprazole 20 mg PO DAILY 18. OxyCODONE--Acetaminophen (5mg-325mg) 1 TAB PO BID:PRN Pain - Moderate 19. Tamsulosin 0.4 mg PO QHS 20. TraMADol 100 mg PO QID:PRN Pain - Moderate 21. Triamcinolone Acetonide 0.1% Cream 1 Appl TP BID 22. ValACYclovir 500 mg PO Q12H 23. Vitamin D 400 UNIT PO DAILY 24.Outpatient Lab Work Please draw: ___ and BMP weekly starting on ___ Fax results to: ___, fax: ___ ICD10 code: ___ and I___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY - systolic heart failure exacerbation - community acquired pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___. You were admitted because of your shortness of breath, for which you were treated for pneumonia and heart failure exacerbation. It is very important for you to take your medications as prescribed and follow up with your doctors as ___ (see below for your upcoming appointments). Please measure your weight every day and call your primary care physician if your weight increases by 2 pounds. Please have your labs drawn on ___. Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 1 PUFF IH BID 2. ClonazePAM 0.5 mg PO QHS:PRN anxiety 3. Duloxetine 60 mg PO DAILY 4. Fluticasone Propionate 110mcg 2 PUFF IH BID 5. 70/30 50 Units Breakfast 70/30 50 Units Lunch 70/30 50 Units Dinner aspart 25 Units Breakfast aspart 25 Units Lunch aspart 25 Units Dinner Insulin SC Sliding Scale using aspart Insulin 6. LaMOTrigine 200 mg PO QPM 7. Lisinopril 5 mg PO BID 8. LOPERamide 2 mg PO QID:PRN Diarrhea 9. Montelukast 10 mg PO BID 10. Atovaquone Suspension 1500 mg PO DAILY Continue while taking prednisone, may dc once off prednisone 11. Bacitracin Ointment 1 Appl TP TID:PRN Facial abrasions. 12. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 13. Morphine SR (MS ___ 120 mg PO Q12H Pain RX *morphine [MS ___ 60 mg 2 tablet(s) by mouth q12hrs Disp #*60 Tablet Refills:*0 14. Nystatin Oral Suspension 5 mL PO TID:PRN thrush 15. Nystatin Cream 1 Appl TP BID Fungal Intertrigo 16. zaleplon 10 mg oral qhs:prn insomnia 17. Theophylline ER 100 mg PO BID 18. Sumatriptan Succinate 50 mg PO DAILY:PRN migraine 19. Stimate (desmopressin) 150 mcg/spray nasal QD:prn bleeding 20. Ranitidine 300 mg PO QHS:PRN heart burn 21. Loratadine 10 mg PO DAILY 22. Aminocaproic Acid 5 gm PO DAILY:PRN bleeding 23. Vitamin D 1000 UNIT PO DAILY 24. Ipratropium Bromide Neb 1 NEB IH Q6H 25. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain RX *hydromorphone 2 mg ___ tablet(s) by mouth q4hrs Disp #*60 Tablet Refills:*0 26. Calcium Carbonate 1000 mg PO TID 27. Docusate Sodium 100 mg PO BID 28. Gabapentin 200 mg PO BID 29. Prochlorperazine 10 mg PO Q6H:PRN nausea 30. PredniSONE 5 mg PO BID Duration: 5 Days Continue for 5 days after discharge, then discontinue Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left proximal femur fracture Thoracic vertebral body fractures at levels T7 and T8 Acute kidney injury Hyperkalemia Hypoimmunoglobulinemia Left upper extremity thrombus 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>Mrs. ___, ___ was a pleasure caring for you during your most recent hospitalization. You presented to the emergency department with worsening left hip pain, weakness in both legs, and progressive urinary incontinence. You were examined by the emergency department doctors. ___ were collected and showed your kidney was under stress. You were given a foley which helped restore your kidney function to your normal baseline. While in the emergency department, you had an x-ray of your left hip taken to evaluate you left hip pain. It showed a left femoral neck fracture. You were transferred to the medicine floor, where you underwent a MRI of your ___ to evaluate leg weakness and urinary changes. The MRI showed fractures in two of you thoracic vertebrae. Surgical repair of your left hip and veterbral fractures was discussed. Your left femur fracture was surgically repaired. Subsequently, your vertebral fractures were surgically repaired. You were followed by the orthopaedic, thoracic, pulmonary and neuro teams. While on the medicine floor you were cared for and examined by doctors and ___ frequently. Physical therapy worked with you regularly. More ___ were collected which showed a low number of immune proteins in your blood. You were given IVIG to correct this. The ulcers that you presented with were kept clean and dressed appropriately. You were seen by wound care and dermatology. You developed a clot in your left arm near your PICC site. Your PICC was removed. The decision was made not to anticoagulate you because of your underlying history of ___ ___ disease. The clot was stable on subsequent imaging. You had no significant bleeds during your stay, however did receive 1 unit of packed red blood cells after your ___ surgery to help your anemia. You developed an episode of thrush which was treated with antibiotic mouthwash. You managed your diabetes with insulin. The prednisone you were taking for your Elhers Danlos syndrome and asthma was weaned down. On discharge, you did not have a fever. Your physical exam was notable for intact sensation in both your legs. You had full strength of your toes and ankles with unchanged weakness in your knees and hips. You were discharged to a rehabilitation facility. You have follow up scheduled with orthopedics on ___ for your left femur fracture. You will also need follow up with Dr. ___ from ___ surgery for follow up of your back surgeries. Please have your rehab facility assist you in making an appointment with his office in the next 2 weeks (phone: ___. Again, it was a pleasure caring for you. We wish you a speedy recovery. Sincerely, Your BI Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levofloxacin 750 mg PO DAILY Duration: 10 Days RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*10 Tablet Refills:*0 2. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: ================== 1. Atypical pneumonia 2. Vasitis SECONDARY DIAGNOSIS: ==================== None 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 due to cough, fever, and pain in your groin. A chest xray was performed and your cough and fever were determined to be due to a pneumonia. The pain in your groin was felt to be due to an infection of one of the structures in your scrotum, the "spermatic cord." You were evaluated by surgery in the emergency room and they did not feel that you needed any surgical intervention at this time. We treated your pneumonia and groin infection with antibiotics that you will continue after you are discharged. Please avoid lifting heavy objects for at least the next ___ days. We wish you a speedy recovery! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Bisacodyl 10 mg PO DAILY:PRN Constipation 3. Docusate Sodium 100 mg PO BID 4. Polyethylene Glycol 17 g PO DAILY 5. Senna 8.6 mg PO BID 6. Spironolactone 25 mg PO DAILY 7. Torsemide 60 mg PO DAILY 8. Vitamin D 1000 UNIT PO DAILY 9. Warfarin 4 mg PO DAILY16 10. Zolpidem Tartrate 5 mg PO HS 11. Atovaquone Suspension 1500 mg PO DAILY 12. Omeprazole 20 mg PO DAILY 13. Potassium Chloride 20 mEq PO DAILY Hold for K >5.0 14. Lisinopril 2.5 mg PO DAILY hold for SBP<100 15. Metoprolol Succinate XL 100 mg PO DAILY 16. Ipratropium Bromide Neb 1 NEB IH Q6H 17. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 18. PredniSONE 60 mg PO DAILY Duration: 2 Weeks After 2 weeks, change to 50mg PO daily 19. PredniSONE 50 mg PO DAILY Duration: 1 Week START after completing 2 weeks of 60mg daily Tapered dose - DOWN 20. PredniSONE 40 mg PO DAILY Duration: 1 Week START after completing 1 week of 50mg daily Tapered dose - DOWN 21. PredniSONE 30 mg PO DAILY Duration: 1 Week START after completing 1 week of 40mg daily Tapered dose - DOWN 22. PredniSONE 20 mg PO DAILY START after completing 1 week of 30mg daily, and continue until pulmonology followup Tapered dose - DOWN 23. Calcium Carbonate 1500 mg PO BID WITH MEALS Discharge Disposition: Extended Care Facility: ___ ___ Rehabilitation and Sub-Acute Care) Discharge Diagnosis: PRIMARY: Amiodarone-Induced Pulmonary Fibrosis Interstitial Lung Disease SECONDARY: Systolic Congestive Heart Failure, Atrial Fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking part in your care at ___ ___. You were admitted to the hospital because you had respiratory distress. We found that your lungs were reacting badly to the medication amiodarone. You received steroids, and your lungs improved rapidly, suggesting another possible steroid-responsive lung disease. While in hospital, you were also seen by the cardiology team who aided in the management of your heart medications while you were being treated. With therapy, your lung function improved and you were discharged to rehab to complete recovery. You will need to followup with pulmonology to complete the diagnositic workup and decide on duration of therapy. You also will followup with cardiology and orthopedics 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. clonazepam 1 mg Tablet Sig: as directed Tablet PO three times a day: 5.5 mg in the morning, 3mg at noon, 5.5 mg at bedtime. 2. clotrimazole 1 % Cream Sig: One (1) Topical twice a day. 3. ketoconazole 2 % Cream Sig: One (1) Appl Topical BID (2 times a day). 4. levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO 6X/WEEK (___). 5. nystatin 100,000 unit/g Powder Sig: One (1) Topical once a day. 6. phenobarbital 32.4 mg Tablet Sig: Two (2) Tablet PO twice a day. 7. triamcinolone acetonide 0.1 % Cream Sig: One (1) Appl Topical BID (2 times a day). 8. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation. 9. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day) as needed for constipation. 10. Tylenol ___ mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for fever or pain. 11. amoxicillin-pot clavulanate 875-125 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 hours) for 3 days: last day ___. Disp:*6 Tablet(s)* Refills:*0* 12. Outpatient Lab Work ___ CBC w/ diff Please fax to ___ Phone: ___ Fax: ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: Aspiration Pneumonia Neutropenia (transient) SECONDARY: Cerebral Palsy Discharge Condition: Level of Consciousness: Alert and interactive, but non-verbal Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure participating in your care at ___. You were admitted because you were more tired and had more seizures. We found that you had an aspiration pneumonia. We treated you with antibiotics. You also underwent speech and swallow evaluation, which showed you are at risk for aspiration and we changed your diet to pureed with thin liquid. We will also arrange home visiting nurse to evaluate your ability to swallow at home. We made the following changes to your medications: STARTED Augmentin (last day ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. BuPROPion 75 mg PO BID 2. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL TID 3. Docusate Sodium 100 mg PO BID 4. Gabapentin 100 mg PO TID 5. Heparin 5000 UNIT SC BID 6. Lorazepam 0.5 mg PO TID:PRN anxiety, insomnia 7. OxycoDONE Liquid ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg/5 mL ___ mg by mouth every four (4) hours Refills:*0 8. Senna 8.6 mg PO BID 9. Acetaminophen 1000 mg PO Q6H:PRN fever, pain 10. Aspirin 81 mg PO DAILY 11. Bisacodyl ___AILY:PRN constipation 12. Chloraseptic Throat Spray 1 SPRY PO Q4H:PRN pain 13. Levofloxacin 750 mg PO DAILY Duration: 5 Days 5 day course total stop on ___ RX *levofloxacin 750 mg 1 tablet(s) by mouth Daily Disp #*4 Tablet Refills:*0 14. Polyethylene Glycol 17 g PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. Acute respiratory failure and need for enteral nutrition, status post C4-5 dislocation and C3 through C7 fusion, and C4 through C5 laminectomies. 2. Fracture dislocation C4-C5. 3. Spinal cord injury, C4 quadriplegia. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Bedbound-Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Posterior Cervical Fusion You have undergone the following operation: Posterior Cervical Decompression and Fusion Cervical Collar / Neck Brace: You need to wear the brace at all times until your follow-up appointment which should be in 2 weeks. You may remove the collar for hygiene. Limit your motion of your neck while the collar is off. Wound Care: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually ___ days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Call the office at that time. Please call the office if you have a fever>101.5 degrees Fahrenheit, drainage from your wound, or have any questions. Dispo to Spinal Cord Rehab Neuro:Continue to Monitor Weakness, Pain/Anxiety Mgmt, C-collar ___ weeks CV:Vertebral Artery Thrombosis: ASA 81mg Daily Pulm:Trach-Wean as Tolerated, pulmonary toilet, PMV GI:Bowel Regimen Nutrition:TF's Jevity 1.5 60cc/hr goal, monitor for re-feeding syndrome Renal:St Cath Regimen MSK:Cont to monitor RUE strength. Episode of decreased BI strength on ___ but improved Physical Therapy: C-Collar at all times X ___ weeks Frequent Repositioning TEDS when OOB Aggressive Skin Care Trach Care/Collar Hygiene Bowel/Bladder Program ___ Care: Patient Education, Therapeutic Activities, Functional Mobility Training, Balance Training, Continuous Pulse Oximetry, Neuromuscular Re-education OT Care:ADL Re-training, Cognitive Re-training, Delirium prevention/treatment, Balance and mobility Re-training, Patient/Caregiver ___ ___: Wound Care: If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually ___ days after the operation) you may leave it open to air. Do not soak the incision in water. If the incision starts draining at anytime after surgery, do not get the incision wet. Call the office at that time. Trach/PEG Care Aggressive Skin Care and Prevention Measures/Frequent Repositioning</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CycloSPORINE (Neoral) MODIFIED 75 mg PO Q12H RX *cyclosporine modified 25 mg 3 capsule(s) by mouth twice a day Disp #*180 Capsule Refills:*0 2. Torsemide 100 mg PO BID RX *torsemide 100 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Triamcinolone Acetonide 0.1% Cream 1 Appl TP ASDIR 4. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild 5. amLODIPine 10 mg PO DAILY 6. Aranesp (in polysorbate) (darbepoetin alfa in polysorbat) 150 mcg/0.3 mL injection monthly 7. Aspirin 81 mg PO DAILY 8. Atorvastatin 40 mg PO QPM 9. Calcitriol 0.25 mcg PO DAILY 10. Carvedilol 25 mg PO BID 11. Docusate Sodium 100 mg PO BID:PRN constipation 12. HydrALAZINE 25 mg PO BID 13. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 14. Levothyroxine Sodium 150 mcg PO DAILY 15. Mycophenolate Mofetil 500 mg PO BID 16. Omeprazole 20 mg PO DAILY 17. Sodium Bicarbonate 650 mg PO BID 18. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 19. Tamsulosin 0.4 mg PO QHS 20. trospium 20 mg oral DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: ================== 1. Acute on Chronic Systolic CHF SECONDARY DIAGNOSES: ==================== 1. Normocytic Anemia 2. Chronic Kidney Disease 3. Hepatitis C 4. HCC s/p liver transplant Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___! WHY WAS I IN THE HOSPITAL? ========================== -You were admitted because you were feeling short of breath WHAT HAPPENED IN THE HOSPITAL? ============================== - You were found to have fluid on your lungs. This was felt to be due to your heart failure, where your heart does not pump hard enough and fluid backs up into your lungs. - You were given a diuretic medication through the IV to help get the fluid out. - You also had low blood counts so you received a blood transfusion. This was probably caused by your kidney disease. - You improved considerably and were ready to leave the hospital. WHAT SHOULD I DO WHEN I GO HOME? ================================ - Take all of your medications as prescribed (listed below). Your torsemide dose is 100 mg twice a day and your Cyclosporine dose is 75mg twice a day - Follow up with your doctors as listed below - Weigh yourself every morning, seek medical attention if your weight goes up more than 3 lbs. Your discharge weight is 170 lbs. - Seek medical attention if you have new or concerning symptoms or you develop swelling in your legs, abdominal distention, or shortness of breath at night. Thank you for allowing us to be involved in your care, we wish you all the best! Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Miss ___, Thank you for allowing us at ___ to take part in your care. You were admitted due to difficulty breathing and abnormal sugars. You were treated for these. We are also treating you for suspected pneumonia with Levofloxacin from ___ You were also started on lisinopril daily for your blood pressures. We also noticed you were on a lot of sedating medications, like ativan, and oxycodone. We recommend you cut back on these. You are being discharged on lisinopril due to elevated pressures while here. Follow up with your PCP after discharge in ___ days. Thank you, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Donepezil 10 mg PO DAILY 2. Lisinopril 10 mg PO DAILY 3. Lorazepam 1 mg PO BID 4. MEMAntine *NF* 10 mg Oral Daily 5. Omeprazole 20 mg PO DAILY 6. Quetiapine extended-release 200 mg PO HS 7. Simvastatin 10 mg PO DAILY 8. Trihexyphenidyl HCl 5 mg PO BID 9. GlipiZIDE 5 mg PO BID 10. MetFORMIN (Glucophage) 500 mg PO BID 11. Haloperidol *NF* (haloperidol lactate) 2 mg/ml ORAL BID 5 drops qam, 5 drops qpm Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Hypovolemic hyponatremia Secondary: Cognitive disorder Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted for increased confusion. This was likely related to dehydration, and changes in your blood (called hyponatremia). We made sure that your heart was not the cause of your symptoms, and there was no evidence for a stroke. . We treated you with fluids through the veins, and this helped you improve. Please note that we have not changed any of your medications. Make sure that you eat and drink enough to stay hydrated.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Fluconazole 400 mg PO Q24H RX *fluconazole 100 mg 4 tablet(s) by mouth daily Disp #*56 Tablet Refills:*0 2. Piperacillin-Tazobactam 4.5 g IV Q8H RX *piperacillin-tazobactam 4.5 gram 4.5 g IV q8 hours Disp #*42 Vial Refills:*0 3. Acyclovir 400 mg PO Q12H 4. Enoxaparin Sodium 60 mg SC Q12H 5. Escitalopram Oxalate 5 mg PO DAILY 6. LORazepam 0.5-1 mg PO Q4H:PRN nausea/vomiting/anxiety/insomnia 7. Maalox/Diphenhydramine/Lidocaine ___ mL PO QID:PRN mouth pain 8. OxyCODONE (Immediate Release) 2.5-5 mg PO Q6H:PRN Pain - Moderate 9. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: # Hepatosplenic candidiasis # Liver abscess # AML, in remission 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 after a CT found showed increasing size of the abscesses in your liver. We changed your antibiotics course and you underwent a liver biopsy. While not quite all tests are back from the biopsy, the pathology showed a healing abscess, but no micro-organisms were found. We will need to keep you on IV zosyn and fluconazole at least until you follow up with your infectious disease doctors next week. 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 BID 2. Ranitidine 150 mg PO DAILY 3. Soma (carisoprodol) 350 mg oral qid RX *carisoprodol 350 mg 1 tablet(s) by mouth four times a day Disp #*100 Tablet Refills:*0 4. Bisacodyl 10 mg PO/PR DAILY RX *bisacodyl 5 mg 2 tablet,delayed release (___) by mouth once a day Disp #*60 Tablet Refills:*0 5. Fluticasone Propionate NASAL 1 SPRY NU DAILY 6. Morphine SR (MS ___ 45 mg PO Q8H RX *morphine [MS ___ 15 mg 3 tablet extended release(s) by mouth every eight (8) hours Disp #*270 Tablet Refills:*0 7. Morphine Sulfate ___ ___ mg PO Q3H:PRN pain RX *morphine 15 mg ___ tablet(s) by mouth Q3H;PRN Disp #*120 Tablet Refills:*0 8. Docusate Sodium 200 mg PO BID RX *docusate sodium 100 mg ___ capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*2 Discharge Disposition: Home Discharge Diagnosis: Lumbar spondylosis, pseudarthrosis and foraminal stenosis. Discharge Condition: Good Followup Instructions: ___ [/INST] </s><s>You have undergone the following operation: POSTERIOR Lumbar Decompression With Fusion Immediately after the operation: -Activity: You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit or stand more than ~45 minutes without getting up and walking around. -Rehabilitation/ Physical Therapy: o2-3 times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. oLimit any kind of lifting. -Diet: Eat a normal healthy diet. You may have some constipation after surgery. You have been given medication to help with this issue. -Brace: You have been given a brace. This brace is to be worn for comfort when you are walking. You may take it off when sitting in a chair or while lying in bed. -Wound Care: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually ___ days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Cover it with a sterile dressing. Call the office. -You should resume taking your normal home medications. No NSAIDs. -You have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so please plan ahead. You can either have them mailed to your home or pick them up at the clinic located on ___ 2. We are not allowed to call in or fax narcotic prescriptions (oxycontin, oxycodone, percocet) to your pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. Please call the office if you have a fever>101.5 degrees Fahrenheit and/or drainage from your wound.</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 #*30 Tablet Refills:*1 2. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 3. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*1 Discharge Disposition: Home Discharge Diagnosis: Hemoptysis secondary to vascular malformation/bronchiectasis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for coughing up blood. We performed a CT scan which showed fluid in your lungs and widening of your airways. We were concerned you may have tuberculosis and performed several test which indicate that you do not. A bronchoscopy was perfomed which showed no active bleeding with some residual blood. There was a blood clot in a small airway branch, which the team had difficulty removing. Interventional Pulmonology will contact you regarding possible further evaluation of the blood clot.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Vyvanse *NF* (lisdexamfetamine) 70 mg Oral Daily 2. Levofloxacin 750 mg PO Q24H Duration: 4 Days RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 3. Oseltamivir 75 mg PO Q12H Duration: 5 Days RX *oseltamivir [___] 75 mg 1 capsule(s) by mouth twice a day Disp #*7 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Influenza Pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking part in your care. You were admitted to ___ with influenza and pneumonia. You were given IV fluids and were treated with Tamiflu (you will need 5 days of treatment) and levofloxacin (you will also need 5 days of treatment with this medication). At the time of discharge your symptoms were greatly improved. If you develop any worsening symptoms of increased fever, worsening body aches, worsening cough, or lethargy, please call your PCP to be evaluated or return to the ___ ER. Meds: - Start Tamiflu 75mg by mouth, twice a day for 3.5 days (evening dose tonight, then 3 days) - Start levofloxacin 750mg by mouth daily for 3 more days</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H Do not exceed 4gm in a day 2. Tamsulosin 0.4 mg PO DAILY RX *tamsulosin 0.4 mg 1 capsule(s) by mouth each evening Disp #*14 Capsule Refills:*0 3. TraMADol 50 mg PO Q6H:PRN Pain - Moderate RX *tramadol 50 mg 1 tablet(s) by mouth every four-six hours as needed for pain Disp #*10 Tablet Refills:*0 4. Aspirin 81 mg PO DAILY 5. Atorvastatin 80 mg PO QPM 6. Metoprolol Succinate XL 25 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Left renal laceration Left retroperitoneal hematoma Left kidney urine extravasation 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 ___ after you suffered a fall and injured your left kidney. Imaging showed that you had a hematoma as well as urine leaking around the left kidney. You also had a left sided 10th rib fracture. To help your symptoms and address the fluid collection, the urology service took you to the operating room and placed a stent in your left ureter (which drains urine from the kidney to bladder). After this your symptoms improved greatly. You also had a foley catheter placed while you were in the operating room. This should remain in place until you follow up with urology. You will need to call ___ to schedule an appointment in about one week (___). You have also been prescribed a new medication called tamsulosin to avoid urinary retention. Please take 1 tablet each evening. Continuation of this medication will be discussed at your urology follow up. During your hospitalization, your labs were monitored closely and showed improving renal function and stable blood counts. You were started on all your home medications and were tolerating a full diet prior to discharge. 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. It was a pleasure taking care of you, Your ___ Surgery Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Alendronate Sodium 70 mg PO QSUN 2. amLODIPine 5 mg PO DAILY 3. Atorvastatin 20 mg PO QPM 4. Docusate Sodium 100 mg PO DAILY 5. FLUoxetine 30 mg PO DAILY 6. Levothyroxine Sodium 25 mcg PO DAILY 7. OLANZapine 2.5 mg PO QHS 8. Polyethylene Glycol 17 g PO DAILY:PRN constipation 9. Senna 17.2 mg PO QHS 10. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: syncope cerebral amyloid angiopathy memory impairment Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted after an un-witnessed fall at home. Imaging showed that you did not have any head bleeds. It also showed that you did not have any acute fracture of your spine or pelvis. It is still unclear what caused your fall. Your known aortic stenosis could have been a cause. We are aware that you were recently evaluated for a potential trans-catheter aortic valve repair in the future. However, you and your family agreed that you will not elect to perform this procedure at this time. It was a pleasure taking care of you! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q6H:PRN asthma 2. Amlodipine 5 mg PO DAILY 3. Gabapentin 300 mg PO DAILY 4. Hydrochlorothiazide 25 mg PO DAILY 5. Lisinopril 40 mg PO DAILY 6. Omeprazole 40 mg PO BID 7. Simvastatin 60 mg PO DAILY 8. traZODONE 100 mg PO HS 9. Wellbutrin XL *NF* (buPROPion HCl) 300 mg ORAL DAILY 10. ALPRAZolam 0.5 mg PO DAILY:PRN anxiety Discharge Disposition: Home Discharge Diagnosis: visual changes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, It was a pleasure taking care of you at ___ ___. You were admitted for visual changes worsening in the past week with blurry vision, halos around lights, and sensitivity to light. You also had a lump on the left side of your head that was causing you sharp pain and pressure. A CT scan of your head with contrast did not show any concerning findings in your head, and the mass on the side of your head is likely a sebaceous cyst, and is unchanged from your last CT scan on ___. Lumbar puncture, MRI brain scan, and visual evoked potentials were normal, which rules out infectious or inflammatory neurologic causes of your visual changes such as optic neuritis. Your vision improved while you were here, and was ___ at discharge. Additionally, it is likely your visual changes are partially related to your cataracts, and you were given outpatient opthalmology follow up. It is important that you take all medications as perscribed, and keep all of your follow up appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID 2. Docusate Sodium 100 mg PO BID 3. Lidocaine 5% Patch 1 PTCH TD QAM 4. MetroNIDAZOLE 500 mg PO Q8H Duration: 2 Weeks 5. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain - Moderate 6. amLODIPine 5 mg PO DAILY 7. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 8. Lisinopril 10 mg PO DAILY 9. Senna 17.2 mg PO BID:PRN Constipation - First Line 10. HELD- Oxybutynin 5 mg PO QPM This medication was held. Do not restart Oxybutynin until follow up with Urology. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: type III odontoid fracture Urinary Retention Clostridium Difficile Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the Acute Care Surgery Service on ___ after a motor vehicle crash and found to have multiple injuries including fractures in your neck, back, pelvis, and nasal bone. You were seen by the orthopedic and orthopedic spine team who recommend management of your neck, back, and pelvic fractures non-operatively. For your neck fracture, please continue to wear your hard cervical spine at all times. No lifting, twisting, or bending until cleared by the orthopedic teams. You may walk and be full weight bearing on your legs. You had a catheter placed for urine because you were not able to empty your bladder on your own. A urine test showed an infection and therefore you were given antibiotics. You should follow up in the ___ clinic to have a voiding trial. Please keep the foley catheter in place until your appointment. You were seen and evaluated by the physical and occupation therapists who recommend discharge to rehab to continue your recovery. You are now ready to be discharged to rehab with the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Artificial Tears GEL 1% ___ DROP BOTH EYES Q4H:PRN dry eyes 3. Docusate Sodium 100 mg PO BID 4. OxyCODONE (Immediate Release) 5 mg PO Q3H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth Q3H Disp #*20 Tablet Refills:*0 5. Senna 8.6 mg PO BID 6. BuPROPion XL (Once Daily) 300 mg PO DAILY 7. Citalopram 40 mg PO DAILY 8. Gabapentin 300 mg PO TID 9. Levothyroxine Sodium 25 mcg PO DAILY 10. LORazepam 0.5 mg PO ASDIR anxiety 11. metoprolol ta-hydrochlorothiaz 50-25 mg oral DAILY 12. Omeprazole 20 mg PO DAILY 13. Simvastatin 20 mg PO QPM Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. Cervical spondylotic myelopathy. 2. Cervical degenerative disc disease. 3. Cervical spinal stenosis, C3 to C7. 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>Posterior Cervical Fusion You have undergone the following operation: Posterior Cervical Decompression and Fusion Immediately after the operation: • Activity:You should not lift anything greater than 10 lbs for 2 weeks.You will be more comfortable if you do not sit in a car or chair for more than~45 minutes without getting up and walking around. • Rehabilitation/ Physical ___ 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.Limit any kind of lifting. • Cervical Collar / Neck Brace:You need to wear the brace at all times until your follow-up appointment which should be in 2 weeks.You may remove the collar to take a shower.Limit your motion of your neck while the collar is off.Place the collar back on your neck immediately after the shower. • Wound Care: Please keep the incision covered with a dry dressing on until your follow up appointment. Do not soak the incision in a bath or pool.If the incision starts draining at anytime after surgery,do not get the incision wet.Call the office at that time.If you have an incision on your hip please follow the same instructions in terms of wound care. • You should resume taking your normal home medications • You have also been given Additional Medications to control your pain.Please allow 72 hours for refill of narcotic prescriptions, so please plan ahead.You can either have them mailed to your home or pick them up at the clinic located on ___.We are not allowed to call in narcotic prescriptions (oxycontin,oxycodone,percocet) to the pharmacy.In addition,we are only allowed to write for pain medications for 90 days from the date of surgery. • Follow up: Please Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. At the 2-week visit we will check your incision,take baseline x rays and answer any questions. We will then see you at 6 weeks from the day of the operation.At that time we will most likely obtain Flexion/Extension X-rays and often able to place you in a soft collar which you will wean out of over 1 week. Please call the office if you have a fever>101.5 degrees Fahrenheit,drainage from your wound,or have any questions. Opthamology and Plastics teams were consulted for her Orbital wall fracture and bilateral nasal bone fractures respectively. ***She will require sinus precautions per (HOB elevated to 30 degrees, no blowing nose and no drinking from a straw) -She will require plastics surgery outpatient follow up for nasal bone fractures Per Plastic Surgery Note: She may follow up with plastic surgery in a week with Dr. ___ ___ to discuss next steps and possible need for operative repair of nasal bone fracture. Plastic Surgery/Dr. ___: ___ Fax: ___ -She will also follow up with her primary ophthalmologist on discharge for her orbital wall fracture. Per Ophthalmology Consult Note: Large R orbital floor fracture and opacified maxillary sinus No evidence of globe injury or retrobulbar hematoma Assessment: ___ presenting s/p fall with R inferior orbital floor fracture. She has full EOMs and her ophthalmic exam is otherwise unremarkable. There are no signs of intraocular trauma. Recommendations/follow-up: 1. Fracture management per plastic surgery 2. Follow up with primary ophthalmologist on discharge. Physical Therapy: 1)Weight bearing as tolerated.2)Gait,balance training.3)No lifting >10 lbs.4)No significant bending/twisting. c-collar at all times; may remove for hygiene. Treatments Frequency: Please keep a dry dressing over the incision on until your follow up appointmen.Do not soak the incision in a bath or pool.If the incision starts draining at anytime after surgery,do not get the incision wet.Call the office at that time.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amitriptyline 25 mg PO QHS 2. ARIPiprazole 10 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Benztropine Mesylate 0.5 mg PO BID 5. ClonazePAM 1 mg PO TID 6. ClonazePAM 1 mg PO QHS 7. Fluoxetine 40 mg PO DAILY 8. Fluticasone Propionate NASAL 1 SPRY NU BID 9. FoLIC Acid 1 mg PO DAILY 10. Losartan Potassium 50 mg PO DAILY 11. Multivitamins 1 TAB PO DAILY 12. Omeprazole 20 mg PO BID 13. Propranolol LA 80 mg PO DAILY 14. Vitamin E 800 UNIT PO DAILY 15. Loratadine 10 mg PO DAILY:PRN allergies 16. MetFORMIN (Glucophage) 1000 mg PO BID 17. Sildenafil 50-100 mg PO DAILY:PRN prior to intercourse 18. Thiamine 100 mg PO DAILY 19. Glargine 100 Units Breakfast humulin 10 Units DinnerMax Dose Override Reason: on home med Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: Dementia history of alcohol abuse SECONDARY DIAGNOSES: diabetes depression hypertension Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Mental Status: Confused - always. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___: You were admitted to ___ for evaluation of your confusion. There was no infection that we found to cause this. You were seen by our psychiatrists who felt that you would be served best by living in a facility with closer supervision. It was a pleasure to care for you! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Guaifenesin-CODEINE Phosphate ___ mL PO Q6H:PRN cough RX *codeine-guaifenesin [Coditussin AC] 10 mg-200 mg/5 mL 10 mL by mouth every six (6) hours Refills:*0 2. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN 3. Benzonatate 100 mg PO TID:PRN cough 4. BuPROPion XL (Once Daily) 300 mg PO DAILY 5. Escitalopram Oxalate 10 mg PO DAILY 6. Hydrochlorothiazide 25 mg PO DAILY 7. lisdexamfetamine 20 mg oral DAILY 8. LORazepam 0.5 mg PO DAILY:PRN anxiety, insomnia 9. Losartan Potassium 25 mg PO DAILY 10. Pantoprazole 40 mg PO DAILY 11. Symbicort (budesonide-formoterol) 80-4.5 mcg/actuation inhalation BID 12. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Thrombocytopenia Hemolytic anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure looking after you. As you know, you were admitted with very low platelet counts. You received steroids (intravenous dexamethasone) for a total of 4 days during the hospitalization. The platelet count is at the ___ range. The cause of the low platelets is, at present, unclear. This may be due to a recent viral infection, medications (particularly from one of the recent antibiotics) or simply idiopathic. You have a close follow-up with the ___ clinic in 2 days to determine whether there should be additional treatments for the low platelet count. There is no need for additional medications. You may continue with the medications you were previously prescribed (obviously, no antibiotics for now). If there is any signs of bleeding (gastrointestinal, lightheadedness, headache), then please contact your primary care doctor or go to the urgent/emergency room for further evaluation. Again, it was a pleasure. We wish you good health! Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing 2. Aspirin EC 81 mg PO DAILY 3. Fluticasone Propionate 110mcg 2 PUFF IH BID 4. Hydrochlorothiazide 25 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Docusate Sodium 100 mg PO BID 7. Acetaminophen 325-650 mg PO Q6H:PRN pain 8. Albuterol-Ipratropium 2 PUFF IH Q6H 9. Senna 2 TAB PO HS:PRN constipation Discharge Disposition: Home With Service Facility: ___ 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 hospital for a small bowel obstruction. We managed you conservatively with an NG tube, bowel rest, and medications to move your bowels. Over time, your bowels started to move and were able to tolerate a regular diet. Return to the emergency department if you are unable to move your bowels, are not passing gas, your abdominal pain worsens, are unable to tolerate foods/liquids. Continue to take any medications you were taking prior to coming to the hospital. You will need to follow up with your PCP. An appointment has been made for you (see below).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ferrous Sulfate 325 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. Furosemide 80 mg PO BID RX *furosemide 80 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 4. Lactulose 30 mL PO BID 5. Nicotine Patch 14 mg TD DAILY 6. Rifaximin 550 mg PO BID 7. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone [Oxecta] 5 mg 1 tablet, oral only(s) by mouth every six (6) hours Disp #*10 Tablet Refills:*0 8. Spironolactone 200 mg PO DAILY RX *spironolactone 100 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 9. Outpatient Lab Work Please check chem-10 between ___. Please fax results to Dr. ___ (___) & Dr. ___ (___). Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: - Hepatic hydrothorax SECONDARY DIAGNOSES: - Cirrhosis - Hepatitis C Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, it was a pleasure to participate in your care while you were at ___. You came to the hospital because you experienced some shortness of breath. We found that this symptom was due to a collection of fluid around your lung which is a complication of cirrhosis. The fluid around your lung was drained and you were safe to be discharged home. You are being discharged on increased doses of your water pills (lasix & spironolactone). You will need to have your bloodwork checked ___ days after you are discharged to make sure there are no problems on these increased doses.</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. Apixaban 5 mg PO BID 3. Bisacodyl ___AILY:PRN constipation 4. Diltiazem Extended-Release 180 mg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. Polyethylene Glycol 17 g PO DAILY 7. Senna 8.6 mg PO BID:PRN Constipation 8. Lisinopril 40 mg PO DAILY 9. MetFORMIN XR (Glucophage XR) 1500 mg PO QAM 10. MetFORMIN XR (Glucophage XR) 1000 mg PO QPM Do Not Crush 11. Metoprolol Succinate XL 200 mg PO DAILY 12. Simvastatin 20 mg PO QPM Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute spinal infarct C6-T12 Aortic dissection Atrial fibrillation Diabetes Hyperlipidemia Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of leg weakness resulting from an ACUTE ISCHEMIC SPINAL STROKE, a condition where a blood providing oxygen and nutrients to the spine is decreased. 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: Aortic dissection Atrial fibrillation Diabetes Hyperlipidemia Hypertension We are changing your medications as follows: We started you on Apixaban and Diltiazam We stopped your Aspirin Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*12 2. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*6 3. Pregabalin 75 mg PO BID RX *pregabalin [Lyrica] 75 mg 1 capsule(s) by mouth twice a day Disp #*28 Capsule Refills:*0 4. ARIPiprazole 7 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Venlafaxine XR 75 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Left hippocampal stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___ ___ presented to the hospital because of confusion. We performed imaging of your brain and ___ were found to have a very small stroke in a region on the left side of your brain that is important in memory. We think that ___ will recover your memory functions over the next few weeks. We have started ___ on aspirin 81 mg daily and atorvastatin 40 mg daily to help reduce your risk of having another stroke. ___ will need to ask your primary care physician for ___ referral to follow up with a neurologist. We have prescribed ___ a two week course of pregabalin for management of the pain ___ are having because of your recent shingles infection. If ___ need more of this medication beyond this please reach out to your primary care provider. Thank ___ for allowing us to care for ___. ___ Neurology</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 10 mg PO DAILY 2. Hydrochlorothiazide 12.5 mg PO DAILY 3. MetFORMIN (Glucophage) 500 mg PO BID 4. Acetaminophen 650 mg PO Q6H:PRN pain 5. Carvedilol 3.125 mg PO BID 6. Docusate Sodium 100 mg PO BID 7. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*25 Tablet Refills:*0 8. Bystolic (nebivolol) 20 mg oral DAily Discharge Disposition: Home Discharge Diagnosis: Left subarachnoid hemorrhage in sylvian fissure. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>•Take your pain medicine as prescribed. •Exercise should be limited to walking; no lifting, straining, or excessive bending. •Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) while taking narcotic pain medication. •Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild/Fever 2. Bisacodyl ___AILY:PRN constipation 3. Brimonidine Tartrate 0.15% Ophth. 1 DROP RIGHT EYE Q8H 4. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID 5. Heparin 5000 UNIT SC BID 6. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN BREAKTHROUGH PAIN 7. HYDROmorphone (Dilaudid) 2 mg PO Q4H 8. Ipratropium-Albuterol Neb 1 NEB NEB Q6H 9. Lidocaine 5% Patch 1 PTCH TD QAM 10. Nicotine Patch 14 mg TD DAILY 11. Polyethylene Glycol 17 g PO DAILY:PRN Constipation 12. Senna 17.2 mg PO BID constipation 13. Acetylcysteine 20% ___ mL NEB Q8H:PRN sob 14. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN sob 15. Docusate Sodium 100 mg PO BID PRN no BM in 24 hours 16. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP RIGHT EYE BID 17. Latanoprost 0.005% Ophth. Soln. 1 DROP RIGHT EYE QHS 18. Pilocarpine 4% 1 DROP RIGHT EYE Q8H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: actue hypercarbic respiratory failure Secondary: pneumonia, advanced non-small cell lung cancer Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ because you were having trouble breathing. You were connected to a breathing machine (ventilator) to help you breath. You were also give a breathing tube through your neck (tracheostomy) and a feeding tube in your belly (PEG tube). While you were here, you were found to have an infection in your lungs (pneumonia), and you were started on antibiotics.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild 2. Aluminum-Magnesium Hydrox.-Simethicone ___ mL PO QID:PRN indigestion 3. Bisacodyl 10 mg PO/PR DAILY constipation 4. Ciprofloxacin HCl 500 mg PO Q12H Duration: 7 Days End date ___ 5. Desmopressin Nasal 10 mcg NAS DAILY 6. Dexamethasone 2 mg PO Q12H 7. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol 8. Docusate Sodium 100 mg PO BID 9. Glucagon 1 mg IM Q15MIN:PRN hypoglycemia protocol 10. Glucose Gel 15 g PO PRN hypoglycemia protocol 11. Heparin 5000 UNIT SC BID 12. HydrALAZINE ___ mg IV Q6H:PRN SBP>160 13. Insulin SC Sliding Scale Fingerstick q6h Insulin SC Sliding Scale using HUM Insulin 14. LevETIRAcetam 500 mg PO BID 15. Ondansetron 4 mg IV Q8H:PRN nausea 16. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate 17. QUEtiapine Fumarate 12.5 mg PO QHS 18. Senna 17.2 mg PO BID:PRN constipation 19. Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush 20. Carbidopa-Levodopa (___) 1.5 TAB PO TID 21. Omeprazole 40 mg PO BID 22. rOPINIRole 2 mg PO TID 23. Sertraline 100 mg PO DAILY 24. Simvastatin 40 mg PO QHS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Craniopharyngioma Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Tumor Surgery •You underwent surgery to remove a brain lesion from your brain. •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 have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •You may 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. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •Nausea and/or vomiting •Extreme sleepiness and not being able to stay awake •Severe headaches not relieved by pain relievers •Seizures •Any new problems with your vision or ability to speak •Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: •Sudden numbness or weakness in the face, arm, or leg •Sudden confusion or trouble speaking or understanding •Sudden trouble walking, dizziness, or loss of balance or coordination •Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms. ___, It was a pleasure caring for you during your most recent hospitalization. You were admitted with concern for a blood stream infection and possible infection of your port. Upon further examination of the culture and the port, the bacteria was thought to be a contaminent. You were initially given antibiotics but that was stopped after just a few doses. We had the podiatrists come and see your left foot. Your foot did not appear infected at this time. There is concern that your blood flow may be limited which may make the surgical site difficult to heal. You should see a vascular doctor ___ for ___ to have more of a work-up to possibly help improve blood flow. Please continue to keep all of your weight from the front portion of your left foot. You are allowed to place weight on the heel of your left foot only. Continue to do daily dressing changes. Finally, please continue to weigh yourself daily. If your weight increases by 2 or 3 pounds, call your cardiologist immediately. We wish you a speedy recovery and all the best, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H:PRN pain 2. Losartan Potassium 25 mg PO DAILY 3. Omeprazole 20 mg PO DAILY 4. Rosuvastatin Calcium 20 mg PO QPM 5. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 6. Vancomycin Oral Liquid ___ mg PO Q6H RX *vancomycin 125 mg 1 capsule(s) by mouth every six (6) hours Disp #*56 Capsule Refills:*0 7. Cetirizine 10 mg PO DAILY 8. Fish Oil (Omega 3) 1000 mg PO BID 9. Halobetasol Propionate 0.05 % topical DAILY:PRN Skin rash 10. Multivitamins 1 TAB PO DAILY Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: C. difficile colitis, s/p radical cystectomy and ileal conduit ___ Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>-Please also refer to the instructions provided to you by the Ostomy nurse specialist that details the required care and management of your Urostomy -You will be sent home with Visiting Nurse ___ services to facilitate your transition to home care of your urostomy -Resume your pre-admission/home medications except as noted. Always call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor -___ you have been prescribed IBUPROFEN, please note that you may take this in addition to the prescribed NARCOTIC pain medications and/or tylenol. FIRST, alternate Tylenol (acetaminophen) and Ibuprofen for pain control. -REPLACE the Tylenol with the prescribed narcotic if the narcotic is combined with Tylenol (examples include brand names ___, Tylenol #3 w/ codeine and their generic equivalents). ALWAYS discuss your medications (especially when using narcotics or new medications) use with the pharmacist when you first retrieve your prescription if you have any questions. Use the narcotic pain medication for break-through pain that is >4 on the pain scale. -The MAXIMUM dose of Tylenol (ACETAMINOPHEN) is 4 grams (from ALL sources) PER DAY and remember that the prescribed narcotic pain medication may also contain Tylenol (acetaminophen) so this needs to be considered when monitoring your daily dose and maximum. -If you are taking Ibuprofen (Brand names include ___ this should always be taken with food. If you develop stomach pain or note black stool, stop the Ibuprofen. -Please do NOT drive, operate dangerous machinery, or consume alcohol while taking narcotic pain medications. -Do NOT drive and until you are cleared to resume such activities by your PCP or urologist. You may be a passenger -Colace may have been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. Discontinue if loose stool or diarrhea develops. Colace is a stool-softener, NOT a laxative.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY 2. Docusate Sodium 100 mg PO BID constipation RX *docusate sodium 100 mg 1 capsule(s) by mouth twice daily Disp #*40 Capsule Refills:*0 3. Enoxaparin Sodium 60 mg SC BID Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 60 mg/0.6 mL 60 mg subcutaneous every ___ hours Disp #*10 Syringe Refills:*0 4. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 capsule by mouth once daily Disp #*30 Capsule Refills:*0 5. Tamsulosin 0.4 mg PO HS RX *tamsulosin 0.4 mg 1 capsule,extended release 24hr(s) by mouth once daily Disp #*30 Capsule Refills:*0 6. Warfarin 5 mg PO DAILY16 RX *warfarin 5 mg 1 tablet(s) by mouth once a day Disp #*10 Tablet Refills:*0 7. Acetaminophen 500 mg PO Q6H:PRN pain RX *acetaminophen 500 mg 1 tablet(s) by mouth every six (6) hours Disp #*40 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Right lower extremity claudication Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr ___, It was a pleasure taking care of you here at ___ ___. You were admitted to our institution after undergoing a procedure to clear an occlusion in your right lower extremity that was causing you pain. After a brief hospital stay and successful recovery, we now feel comfortable discharging you home, provided you follow these recommendations. Division of Vascular and Endovascular Surgery Lower Extremity Angioplasty Discharge Instructions MEDICATION: •Take new medications as instructed: Coumadin and Lovenox •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.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Epoetin Alfa 40,000 unit/mL SC QWEEK 2. Ferrous Sulfate 325 mg PO TID 3. FoLIC Acid 3 mg PO DAILY 4. Furosemide 20 mg PO DAILY 5. Gabapentin 400 mg PO TID 6. Omeprazole 20 mg PO DAILY 7. OxycoDONE (Immediate Release) 5 mg PO BID:PRN pain 8. PredniSONE 10 mg PO DAILY 9. Ribavirin 200 mg PO DAILY 10. Senna 8.6 mg PO HS 11. Sofosbuvir 400 mg PO DAILY16 12. Spironolactone 50 mg PO DAILY 13. Sulfameth/Trimethoprim DS 1 TAB PO 3X/WEEK (___) 14. Ursodiol 300 mg PO BID 15. Zolpidem Tartrate 10 mg PO HS:PRN insomnia 16. Rifaximin 550 mg PO BID 17. Ganciclovir 470 mg IV Q12H RX *ganciclovir sodium 500 mg 470 mg IV every 12 hours Disp #*30 Vial Refills:*0 18. Lactulose 30 mL PO TID 19. Outpatient Lab Work Please check CBC with diff, chem 10, ___, PTT, INR, LFTs, CMV viral load and fax result to Dr. ___ at ___ ___. Fax ___ 20. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1. Acute CMV infection with high load viremia 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 at ___. You were admitted with fevers, headaches, muscle aches and found to have a viral infection called CMV. You were seen by our infectious disease team who recommended IV Ganciclovir as treatment. You will continue IV ganciclovir for at least two more weeks. You are scheduled to follow up with infectious disease doctors on ___ for further management. As part of your treatment, you should have your labs checked on ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Metoprolol Succinate XL 25 mg PO DAILY 3. NPH 30 Units Breakfast NPH 30 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 4. Simvastatin 20 mg PO DAILY 5. Lisinopril 5 mg PO DAILY 6. Gabapentin 300 mg PO DAILY 7. Vancomycin 1000 mg IV Q48H 8. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush 9. Bisacodyl 10 mg PO/PR BID:PRN constipation 10. HydrOXYzine 25 mg PO Q6H:PRN n 11. Pantoprazole 40 mg PO Q24H 12. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H 13. Ondansetron 4 mg PO Q8H:PRN nausea 14. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 15. Heparin 5000 UNIT SC TID 16. Glucose Gel 15 g PO PRN hypoglycemia protocol 17. Docusate Sodium 100 mg PO BID 18. CefePIME 2 g IV Q24H 19. Acetaminophen 325-650 mg PO Q6H:PRN ha, pain 20. Dextrose 50% 12.5 gm IV PRN hypoglycemia protocol 21. Blood glucose checks before meals and before bed Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Right heel ulcer complicated by deep posterior compartment infection now s/p R below the knee amputation SECONDARY DIAGNOSES: Diabetes Mellitus, uncontrolled Peripheral neuropathy Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you at the ___ ___. You were admitted to ___ for a bone infection involving your right heel and the lower half of your right leg. You received IV antibiotics while you were here and you were taken to the operating room for debridement of your right heel ulcer by podiatry. The podiatrists found that your bone infection was more extensive than previously thought and recommended a below the knee amputation of your right leg. Your amputation was done by the vascular surgeons. You will need to continue IV antibiotics after your surgery. A special IV line was placed ___ your left upper arm so you could continue to receive these antibiotics. These will continue through ___. DIVISION OF VASCULAR AND ENDOVASCULAR SURGERY AMPUTATION DISCHARGE INSTRUCTIONS ACTIVITY: •On the side of your amputation you are non weight bearing for ___ weeks. •You should keep this amputation site elevated when ever possible. •You may use the opposite foot for transfers and pivots. •No driving until cleared by your Surgeon. •No heavy lifting greater than 20 pounds for the next 3 weeks. BATHING/SHOWERING: •You may shower when you get home •No tub baths or pools / do not soak your foot for 4 weeks from your date of surgery WOUND CARE: •Sutures / Staples may have been removed before discharge. If they are not, an appointment will be made for you to return for staple removal. •When the sutures are removed the doctor may or may not place pieces of tape called steri-strips over the incision. These will stay on about a week and you may shower with them on. If these do not fall off after 10 days, you may peel them off with warm water and soap ___ the shower. CAUTIONS: •If you smoke, please make every attempt to quit. Your primary care physician can help with this. Smoking causes narrowing of your blood vessels which ___ turn decreases circulation. DIET: •Low fat, low cholesterol / if you are diabetic – follow your dietary restrictions as before CALL THE OFFICE FOR: ___ •Bleeding, redness of, or drainage from your foot wound •New pain, numbness or discoloration of the skin on the effected foot •Fever greater than 101 degrees, chills, increased redness, or pus draining from the incision site.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clindamycin 450 mg PO Q6H RX *clindamycin HCl 300 mg 1 capsule(s) by mouth every 6 hours Disp #*28 Capsule Refills:*0 RX *clindamycin HCl 150 mg 1 capsule(s) by mouth every 6 hours Disp #*28 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES: 1. Subdural hematoma 2. Amphetamine overodose 3. Acute rhabdomyolysis 4. Intracranial hemorrhage 5. Seizure 6. MSSA pneumonia 7. Hypoxemia 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 the Internal Medicine service at ___ ___ on ___ regarding management of your toxic ingestion, seizure and recent fall with head bleeding and skull fracture. You were also found to have a pneumonia and were treated with oral antibiotics with improvement ___ your breathing. Your confusion and balance issues improved during your hospital stay and we are hopeful that these issues continue to improve. YOU ARE NOT PERMITTED TO OPERATE A ___ FOR 6-MONTHS FOLLOWING YOUR SEIZURE EVENT. Please call your doctor or go to the emergency department if: * You experience new chest pain, pressure, squeezing or tightness. * You develop new or worsening cough, shortness of breath, or wheezing. * You are vomiting and cannot keep down fluids, or your medications. * If you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit, or have a bowel movement. * You experience burning when you urinate, have blood ___ your urine, or experience an unusual discharge. * Your pain is not improving within 12 hours or is not under control within 24 hours. * Your pain worsens or changes location. * You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. * You develop any other concerning symptoms.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY 2. Atorvastatin 20 mg PO DAILY 3. Multivitamins 1 TAB PO DAILY 4. Aspirin 81 mg PO DAILY 5. Sulfameth/Trimethoprim DS 1 TAB PO BID End date: ___ RX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*16 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Cellulitis SECONDARY DIAGNOSIS: Transaminitis Thrombocytopenia Normocytic anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___ ___. You came in because of fever and low blood pressure. The source of your infection is likely the ___ excision site. We treated you with IV antibiotics, and we will continue to treat you with oral antibiotics for a total of 10 days (___). We are glad to see your infection is improving. We hope your muscle strain improves. We will let your PCP know that ___ would be beneficial. Please follow up with your PCP, the appointment is listed below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN 2. Atorvastatin 20 mg PO QPM 3. Calcium Carbonate 500 mg PO BID 4. Culturelle (Lactobacillus rhamnosus GG) 10 billion cell oral BID 5. Fluticasone Propionate NASAL 1 SPRY NU DAILY 6. Lactulose 45 mL PO BID 7. Meclizine 12.5 mg PO Q8H:PRN dizziness 8. Multivitamins 1 TAB PO DAILY 9. Omeprazole 40 mg PO BID 10. Rifaximin 550 mg PO BID 11. Sucralfate 1 gm PO TID 12. Vitamin D ___ UNIT PO 1X/WEEK (___) 13. HELD- Furosemide 20 mg PO DAILY This medication was held. Do not restart Furosemide until outpatient follow up. Discharge Disposition: Home Discharge Diagnosis: Acute hepatic encephalopathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were hospitalized with diarrhea and confusion. You may have had an infection which caused the diarrhea and confusion. We gave you lactulose and rifaximin which helped clear the confusion. We did not find any other evidence of infection: no bacteria in your blood or urine. Please follow up with your PCP and hepatologist Dr. ___. It was a pleasure taking care of you! Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. 70/30 120 Units Breakfast 70/30 60 Units DinnerMax Dose Override Reason: ___ recs on prednisone RX *insulin NPH and regular human [Humulin 70/30 KwikPen] 100 unit/mL (70-30) AS DIR 120 Units before BKFT; 60 Units before DINR; Disp #*5 Syringe Refills:*2 2. PredniSONE 40 mg PO DAILY Duration: 2 Doses Start: Today - ___, First Dose: Next Routine Administration Time This is dose # 1 of 2 tapered doses RX *prednisone 5 mg AS DIR tablet(s) by mouth daily Disp #*149 Tablet Refills:*0 3. PredniSONE 35 mg PO DAILY Duration: 7 Doses Start: After 40 mg DAILY tapered dose This is dose # 2 of 2 tapered doses 4. PredniSONE 30 mg PO DAILY Start: After last tapered dose completes This is the maintenance dose to follow the last tapered dose 5. Aspirin 81 mg PO DAILY 6. Fish Oil (Omega 3) 1000 mg PO BID 7. Fluticasone Propionate NASAL 1 SPRY NU DAILY 8. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 9. Lisinopril 10 mg PO DAILY 10. Pantoprazole 40 mg PO Q24H 11. Simvastatin 40 mg PO QPM 12. Zolpidem Tartrate 10 mg PO QHS 13.Insulin Needle Nano Needle for 70/30 Kwikpen # 50 Refill: 1 Use as directed with Kwikpen Discharge Disposition: Home Discharge Diagnosis: # Inflammatory Bowel Disease with acute flare complicated by diarrhea # Diabetes type 2 with hyperglycemia # Transaminitis # Hypertension # GERD # Hyperlipidemia # 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 taking care of ___ at ___. ___ were admitted with abdominal pain and diarrhea. ___ were seen by GI specialists and underwent testing including a colonoscopy. ___ tests were concerning for a new diagnosis of inflammatory bowel disease. ___ were started on steroids and improved. ___ are now ready for discharge on a slow prednisone taper: - Take prednisone 40mg once a day (8 pills) ___, THEN - Take prednisone 35mg once a day (7 pills) from ___ until ___, THEN - Take prednisone 30mg once a day (6 pills) until your GI appointment with Dr. ___ ___ were also started on insulin for your diabetes. This type is called ___. ___ should inject ___ Units with Breakfast and 60 Units with Dinner As your prednisone dose changes ___ will need to change your insulin dose: - When at prednisone 35mg: change to 70/30 100 units with breakfast, 50 units with dinner - When at prednisone 30mg: change to 70/30 90 units with breakfast, 40 units with dinner At your upcoming appointment, Dr. ___ will help manage your insulin and discuss with ___ regarding seeing a diabetes specialist. If ___ have questions about your insulin between now and then, please call Dr. ___ saw ___ as an inpatient) at ___. As we discussed your ultrasound showed a small gallbladder polyp. The radiologist recommends ___ have a repeat ultrasound in ___ year to make sure it has not changed size. We have communicated this to your primary care doctor as well.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. BuPROPion 200 mg PO BID 3. ClonazePAM 0.5 mg PO TID 4. Docusate Sodium 100 mg PO BID 5. Gabapentin 600 mg PO TID 6. Mirtazapine 15 mg PO QHS 7. Phenytoin (Suspension) 100 mg PO Q8H 8. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth every 8 hours Disp #*51 Tablet Refills:*0 9. Levofloxacin 500 mg PO Q24H RX *levofloxacin [Levaquin] 500 mg 1 tablet(s) by mouth daily Disp #*17 Tablet Refills:*0 10. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY RX *lansoprazole [Prevacid] 30 mg 1 capsule(s) by mouth daily Disp #*10 Capsule Refills:*0 11. HYDROmorphone (Dilaudid) 4 mg PO Q6H:PRN pain RX *hydromorphone [Dilaudid] 4 mg 1 tablet(s) by mouth every 6 hours Disp #*20 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___. Discharge Diagnosis: Perforated intestine Bacteremia 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 ___ after stabbing yourself with a foreign body and were taken to the operating room for an exploratory laparotomy and suturing of enterotomy and placement of drain. Your post operative course was complicated by a blood stream infection. You also have developed a fistula, which is a tract from your intestines out through your skin. You should continue to pouch with an ostomy appliance this while there is stool coming out however it may close up eventually. Incidentally, it was noted that you have an active hepatitis C infection, and the liver doctors recommend ___ treatment for this at an outpatient Liver clinic. 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. Please change your dressings over the right lower abdominal wound daily. Apply moist gauze and place a dry gauze on top and secure the dressing with tape.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Wound Care: You can get the **right** wound wet/take a shower starting from 3 days post-op. No baths or swimming for at least 4 weeks. Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. No dressing is needed if wound continued to be non-draining. Do not remove the splint from the **left** hand. keep the splint dry at all times. ******WEIGHT-BEARING******* non-weight bearing bilateral upper extremities. you may use your right hand for daily acitivities, but do not bear weight on this hand ******MEDICATIONS*********** - Resume your pre-hospital medications. - You have been given medication for your pain control. Please do not operate heavy machinery or drink alcohol when taking this medication. As your pain improves please decrease the amount of pain medication. This medication can cause constipation, so you should drink ___ glasses of water daily and take a stool softener (colace) to prevent this side effect. -Medication refills cannot be written after 12 noon on ___. *****ANTICOAGULATION****** - None</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 a day Disp #*60 Tablet Refills:*0 RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth twice a day Disp #*84 Tablet Refills:*0 2. MetroNIDAZOLE 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*126 Tablet Refills:*0 3. Vancomycin Oral Liquid ___ mg PO Q6H RX *vancomycin 125 mg 1 capsule(s) by mouth four times a day Disp #*120 Capsule Refills:*0 RX *vancomycin 125 mg/2.5 mL 1 syringe(s) by mouth every six (6) hours Disp #*224 Syringe Refills:*0 4. Vitamin D 1000 UNIT PO DAILY 5. Aspirin 81 mg PO DAILY 6. Chlorthalidone 25 mg PO DAILY 7. Lisinopril 20 mg PO DAILY 8. Metoprolol Succinate XL 12.5 mg PO DAILY 9. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 10. Omeprazole 20 mg PO DAILY 11. Rosuvastatin Calcium 40 mg PO QPM 12. Sertraline 200 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: C.diff intestinal infection Inflammatory bowel disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted for evaluation of abdominal pain and nausea and diarrhea. You were found to have an infection and started on antibiotic therapy (Cipro and flagyl) for which your GI team would like you to continue for likely 4 weeks. In addition, you will need to take PO vancomycin for concern of recurrent C.diff. You should follow-up with your PCP and GI teams on discharge.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ertapenem 1 gram intravenous DAILY stop date: ___. Lactulose 30 mL PO TID 3. Polyethylene Glycol 17 g PO BID 4. Vitamin A ___ UNIT PO DAILY Duration: 5 Doses last day of treatment is ___. Acetaminophen 1000 mg PO Q12H:PRN Pain - Mild/Fever Max 2g acetaminophen per day 6. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Severe Reason for PRN duplicate override: Patient is NPO or unable to tolerate PO RX *oxycodone 5 mg ___ capsule(s) by mouth q4hr Disp #*20 Capsule Refills:*0 7. Betamethasone Dipro 0.05% Oint 1 Appl TP BID 8. Gabapentin 600 mg PO QHS 9. LOXO-101 Study Med 100 mg PO BID 10. Multivitamins W/minerals 1 TAB PO DAILY 11. Nadolol 20 mg PO DAILY Hold for HR <50 or SBP <90 12. Rifaximin 550 mg PO BID 13. Sarna Lotion 1 Appl TP QID:PRN itching 14. Vancomycin Oral Liquid ___ mg PO BID Stop date ___. Vitamin D 800 UNIT PO DAILY 16. HELD- Spironolactone 25 mg PO DAILY This medication was held. Do not restart Spironolactone until evaluation by outpatient hepatology or development of ascites 17. HELD- Torsemide 20 mg PO DAILY This medication was held. Do not restart Torsemide until evaluation by outpatient hepatology or development of ascites Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Chronic osteomyelitis and cord compression SECONDARY DIAGNOSOIS: ___ cirrhosis Coagulopathy Urethral trauma Constipation History of C. diff colitis Stage IIIC metastatic melanoma Chronic pancytopenia Macrocytic anemia Toxic-metabolic encephalopathy Pre-renal ___ 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 at the ___ ___! Why was I admitted to the hospital? ================================= - You were admitted because you were not behaving as you typically do and we noted that you were having weakness in your legs concerning for a worsening of the infection in your spine. What happened while I was in the hospital? ==================================== - You had an MRI scan of your spine, which showed that the infection in your back which you received treatment for in the past had not resolved and was likely the cause of your symptoms. You underwent spine surgery to drain this fluid collection and remove infected tissue. - You were started on IV antibiotics to treat a chronic infection in the bones of your spine. - You resumed taking the study medication for your melanoma - You were fitted with a brace to protect your back when sitting up or moving. What should I do after leaving the hospital? ==================================== - Please take your medications as listed in discharge summary and follow up at the listed appointments. - Please continue your IV antibiotics until ___ - You need weekly labs drawn and sent to the infectious disease clinic. - Your urinary catheter should be removed on ___ Thank you for allowing us to be involved in your care, we wish you all the best! Sincerely, Your ___ Healthcare Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear ___, You were admitted to ___ because you were having chest pain and were found to be having a myocardial infarction (heart attack) which required care in the cardiac intensive care unit. You had 3 stents placed to treat your heart attack. In order to prevent clots from forming on these stents you were started on two new medictions: Aspirin and Plavix. You were also started on a medication called Atorvastatin to decrease your risk of future heart attacks. While you were here you developed severe confusion. This may have been due to an acute stress reaction or a parasite infection. You were treated for the parasite infection with antibiotics. Your confusion resolved and you were eager to return ___. Please attend your follow up appointments as listed below. Thank you for choosing ___ for your healthcare. Sincerely, your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms ___, It was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - You were admitted for worsening shortness of breath. WHAT HAPPENED TO ME IN THE HOSPITAL? - You were found to have fluid reaccumulating around your lung. This is related to your cancer. - The interventional pulmonary team placed a catheter into your chest to drain the fluid around the lung. - You were evaluated by physical therapy, who recommended rehab to help you regain your strength. 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. amLODIPine 10 mg PO DAILY 2. Atorvastatin 40 mg PO QPM 3. Cinacalcet 30 mg PO 4X/WEEK (___) 4. Cinacalcet 60 mg PO 3X/WEEK (___) 5. CloNIDine 0.2 mg PO BID 6. Metoclopramide 10 mg PO QIDACHS 7. Pantoprazole 40 mg PO Q12H 8. Promethazine 25 mg PO Q8H:PRN nausea/vomiting 9. TraZODone 50 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS ================= Pulmonary Edema ___ End Stage Renal Disease on Hemodialysis Hypertensive Urgency Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___! You were admitted to the ICU for having difficulty breathing and requiring a large amount of oxygen. Your chest imaging was concerning for increased fluid in your lungs. The kidney doctors did ___ and took out the extra fluid, and your breathing got better. We did an ultrasound of your heart that showed it is a bit stiff, but otherwise beating well. You will continue dialysis as an outpatient. You are scheduled to see your pulmonologist in ___, please make every effort to make that appointment. We wish you the best of health, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sulfameth/Trimethoprim DS 2 TAB PO BID Duration: 7 Days RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 2. Acetaminophen 1000 mg PO BID 3. Aspirin 81 mg PO DAILY 4. Calcium Carbonate 500 mg PO DAILY 5. Cyanocobalamin 500 mcg PO DAILY 6. Levothyroxine Sodium 150 mcg PO DAILY 7. mometasone 0.1 % topical BID 8. Multivitamins W/minerals 1 TAB PO DAILY 9. Pantoprazole 40 mg PO Q12H 10. Rivaroxaban 20 mg PO QPM 11. Senna 8.6 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Cellulitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___. Why did you come to the hospital? You had redness, swelling, and pus on your right lower leg that is consistent with an infection called cellulitis. What did you receive in the hospital? You were seen by the Infectious Disease team and received an antibiotic called Bactrim, after one day your leg already looked better. You will continue taking the Bactrim at home for 5 more days. What should you do once you leave the hospital? - Please take your medications as prescribed and go to your future appointments which are listed below. We wish you all the ___! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Dexamethasone 4 mg PO Q12H 2. Sodium Bicarbonate 1300 mg PO QID Alkalinize urine Please start on morning of ___. 3. Fluconazole 200 mg PO Q24H 4. Nystatin Oral Suspension 5 mL PO TID 5. Acyclovir 400 mg PO Q8H 6. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 7. Atovaquone Suspension 1500 mg PO DAILY 8. Bisacodyl 10 mg PO DAILY:PRN constipation 9. Docusate Sodium 100 mg PO BID 10. Enoxaparin Sodium 80 mg SC Q12H 11. Ipratropium-Albuterol Neb 1 NEB NEB TID:PRN wheezing/dyspnea 12. Lidocaine Viscous 2% 15 mL PO TID:PRN mouth sores 13. Maalox/Diphenhydramine/Lidocaine ___ mL PO QID:PRN mucositis pain 14. Metoprolol Succinate XL 50 mg PO DAILY 15. Milk of Magnesia ___ mL PO DAILY:PRN constipation 16. Pantoprazole 40 mg PO Q12H 17. Prochlorperazine ___ mg PO Q6H:PRN nausea 18. Tamsulosin 0.4 mg PO QHS 19. Tenofovir Disoproxil (Viread) 300 mg PO DAILY 20. Vitamin D 1000 UNIT PO BID 21. HELD- LORazepam 0.5 mg PO Q8H:PRN nausea anxiety insomnia This medication was held. Do not restart LORazepam until your doctor tells you to do soi 22. HELD- TraZODone 50 mg PO QHS:PRN insomnia This medication was held. Do not restart TraZODone until your doctor tells you to do so. Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: #Primary: Secondary CNS lymphoma #Secondary: Stage IV diffuse large B-cell lymphoma History of cavernous sinus thrombosis Chronic hepatitis B infection Dysphagia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___ ___. Why you were admitted to the hospital: - You were having confusion and somnolence What happened while you were here: - Imaging of your head showed that your known lymphoma had spread to the area around the brain. - You were treated with high dose chemotherapy and monitored for several days. - Your confusion improved and you were discharged to a rehabilitation facility. What you should do once your return home: - Please continue taking your medications and follow up at the appointments outlined below - Please call clinic or return to the emergency for a fever (temp >100.4) Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO HS 2. Aspirin 81 mg PO DAILY 3. Bisacodyl ___AILY:PRN constipation 4. Calcium Carbonate 1000 mg PO QHS 5. CloniDINE 0.2 mg PO BID 6. Docusate Sodium 200 mg PO DAILY 7. Metoprolol Tartrate 12.5 mg PO BID 8. Nephrocaps 1 CAP PO DAILY 9. Phenytoin Sodium Extended 400 mg PO QAM 10. Phenytoin Sodium Extended 300 mg PO QPM 11. Sertraline 100 mg PO DAILY 12. sevelamer CARBONATE 1600 mg PO TID W/MEALS 13. Gentamicin 80 mg IV QHD 14. Vancomycin 1000 mg IV HD PROTOCOL 15. Acetaminophen 650 mg PO Q4H:PRN pain 16. FoLIC Acid 1 mg PO DAILY 17. Lactinex (lactobacillus acidoph & bulgar) 1 million cell oral 2 TABS TID 18. Lactulose 30 mL PO DAILY:PRN for no BM in 3 days 19. Senna 17.2 mg PO HS Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: left forearm cellulitis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: wheelchair bound Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You came to the ___ Emergency Department from your dialysis center due to redness and swelling of your left forearm AV graft site, and you were admitted to Transplant Surgery service for further observation and evaluation. While here, you remained afebrile and hemodynamically stable. We continued you on IV antibiotics during hemodialysis, which you received today prior to discharge. You are now being discharged back to your living facility, and will continue to get your antibiotics through dialysis. You will need to follow-up with Dr. ___ week, please follow the instructions below to make an appointment. Thank you for allowing us to participate in your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN headache/pain 2. Dexamethasone 4 mg IV Q8 Duration: 90 Days 3. Docusate Sodium 100 mg PO BID 4. Heparin 5000 UNIT SC TID 5. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 6. Fleet Enema ___AILY:PRN constipation 7. LeVETiracetam 500 mg IV BID 8. Polyethylene Glycol 17 g PO DAILY:PRN constipation 9. Famotidine 20 mg IV Q12H 10. Senna 1 TAB PO BID Discharge Disposition: Extended Care Facility: ___ ___ Rehabilitation and Sub-Acute Care) Discharge Diagnosis: L frontal brain mass Cerebral edema Lung mass Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>•Have a friend/family member check your incision daily for signs of infection. •Take your pain medicine as prescribed. •Exercise should be limited to walking; no lifting, straining, or excessive bending. •Your wound was closed with staples- you must wait until after they are removed to wash your hair. You may shower before this time using a shower cap to cover your head. •Increase your intake of fluids and fiber, as narcotic pain medicine can cause constipation. We generally recommend taking an over the counter stool softener, such as Docusate (Colace) & Senna while taking narcotic pain medication. •Unless directed by your doctor, do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. •You have been discharged on Keppra (Levetiracetam), you will not require blood work monitoring. •If you are being sent home on steroid medication, make sure you are taking a medication to protect your stomach (Prilosec, Protonix, or Pepcid), as these medications can cause stomach irritation. Make sure to take your steroid medication with meals, or a glass of milk. •Clearance to drive and return to work will be addressed at your post-operative office visit. •Make sure to continue to use your incentive spirometer while at home. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING •New onset of tremors or seizures. •Any confusion or change in mental status. •Any numbness, tingling, weakness in your extremities. •Pain or headache that is continually increasing, or not relieved by pain medication. •Any signs of infection at the wound site: increasing redness, increased swelling, increased tenderness, or drainage. •Fever greater than or equal to 101.5° F.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Alendronate Sodium 70 mg PO QWED 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 80 mg PO QPM 5. Calcium 600 with Vitamin D3 (calcium carbonate-vitamin D3) 600 mg(1,500mg) -500 unit oral DAILY 6. Clopidogrel 75 mg PO DAILY 7. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 8. Warfarin 3 mg PO DAILY16 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: =============== Dyspnea New atrial fibrillation Chest pressure Acute on chronic systolic heart failure with EF 30% Secondary: =============== Coronary artery disease Possible mural thrombus 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 has been a pleasure taking part in your care during your hospitalization. Why you were admitted to the hospital: =================================================== - You were admitted to the hospital because you were short of breath and having chest pressure. What happened during your hospitalization: =================================================== - A number of tests were performed which were reassuring for your heart not having further injury - You were found to have extra fluid in your lungs contributing to your shortness of breath. You were given a medication to help you urinate out the extra fluid, and your breathing and chest discomfort improved. - You were found to have an abnormal heart rhythm called atrial fibrillation. For this, you should continue to take Coumadin, which you are already taking, and we increased your dose of metoprolol. What you should do at home: =================================================== - Please take all of your medications as prescribed. The dose of your metoprolol was increased as described below. - Follow up at the appointments as listed below. - Please weigh yourself every morning, and call the doctor if your weight goes up more than 3 lbs. in one day or 5 lbs. in one week. This may indicate extra fluid in your body. - Should you notice any new or concerning symptoms, please seek urgent medical care. We wish you the best! - Your ___ Care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID 2. Colchicine 0.6 mg PO DAILY gout flare 3. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN wheezing 4. Atorvastatin 20 mg PO QPM 5. esomeprazole magnesium 20 mg PO QHS:PRN 6. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 7. Hydrochlorothiazide 25 mg PO QAM 8. Levothyroxine Sodium 75 mcg PO QAM 9. Metoprolol Succinate XL 50 mg PO QAM 10. Ranitidine 150 mg PO QHS:PRN acid reflux Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute ischemic stroke in R MCA territory 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 ___, You were hospitalized due to symptoms of left sided weakness resulting from an ACUTE ISCHEMIC STROKE, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: High blood pressure High cholesterol Atrial Fibrillation Coronary Artery Disease We are changing your medications as follows: Please continue taking Atorvastatin 20mg every evening Please continue taking Eliquis 5mg twice daily Please take your other medications as prescribed. Please followup with Neurology and your primary care physician. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Glargine 36 Units Bedtime 3. Atorvastatin 40 mg PO QPM 4. GlipiZIDE 5 mg PO DAILY 5. Hydrochlorothiazide 25 mg PO DAILY 6. MetFORMIN (Glucophage) 1700 mg PO DAILY 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Trulicity (dulaglutide) 0.75 mg/0.5 mL subcutaneous 1X/WEEK Discharge Disposition: Home Discharge Diagnosis: Complete left ophthalmoplegia Multiple cranial neuropathies 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 came to the hospital because you were having problems opening and moving your left eye. We imaged your brain with an MRI which showed worsening of your previous brain abnormality. We performed a lumbar puncture and sent out basic studies which did not show evidence of acute infection. We sent fluid for more extensive studies which is pending. Depending on these results we will develop a plan of treatment. You will need to follow up in the ___ clinic to discuss the possibility of a biopsy (taking a piece of the abnormal tissue for diagnosis). We did not make any medication changes. It has been a pleasure caring for you, Your ___ Neurology team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY 2. Docusate Sodium 100 mg PO DAILY 3. Famotidine 20 mg PO DAILY 4. Gabapentin 600 mg PO QHS 5. Gabapentin 300 mg PO BID 6. Lactulose 30 mL PO Q8H:PRN constipation 7. Lidocaine 5% Patch 1 PTCH TD QPM 8. Polyethylene Glycol 17 g PO DAILY 9. Ertapenem Sodium 1 g IV Q24H 10. Warfarin 5 mg PO DAILY16 DVT RX *warfarin [Coumadin] 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 11. Enoxaparin Sodium 100 mg SC BID DVT Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 100 mg/mL 1 syringe SC twice a day Disp #*30 Syringe Refills:*0 12. Outpatient Lab Work ICD___.40 Lab draw ___ on ___. Please call ___ pharmacy clinic @ ___ with ___ results and for subsequent coumadin adjustment. 13. Tizanidine 4 mg PO QHS pain RX *tizanidine 4 mg 1 capsule(s) by mouth at bedtime Disp #*14 Capsule Refills:*0 14. OxycoDONE (Immediate Release) 15 mg PO Q4H:PRN pain RX *oxycodone 10 mg 1.5 tablet(s) by mouth q4h PRN Disp #*37 Tablet Refills:*0 15. Acetaminophen 1000 mg PO Q8H pain or fever Discharge Disposition: Home With Service Facility: ___ ___: upper extremity deep venous thrombosis bilaterally chronic right flank pain multidrug resistant E. coli and Klebsiella UTI from prior admission 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 at ___ ___. You were seen in the hospital becuase of your right flank pain and your left flank pain. You were found to have a clot in both your right and left arms. We treated this with a medication called lovenox. We also started an anti-clotting medication called coumadin, also known as warfarin. You will take this for 3 months, and you can ___ with your PCP for management. For your right flank pain, we consulted a pain management team who made recommendations to optimize your pain control in the hospital. We also set you up to follow up in their clinic for chronic control. Thank you for involving us in your medical care. Your ___ team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever 2. Ciprofloxacin HCl 500 mg PO Q12H RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day Disp #*12 Tablet Refills:*0 3.Outpatient Lab Work Date: ___ Please draw CBC, ALT, AST, Alk Phos and Tbili Fax results to ___: K80.0 Discharge Disposition: Home Discharge Diagnosis: Cholethiasis Choledocholithiasis Jaundice 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 jaundice (yellowing of the skin). You were found to have gallstones in your gallbladder and your common bile duct causing your jaundice. You underwent an ERCP for removal of the common bile duct stones. Following your ERCP, you were seen by the surgery team with plan for cholecystectomy (gallbladder removal). This will be done as an outpatient and is scheduled for ___ as below. Your bilirubin is still elevated which raises the possibility of ongoing gallstones in your bile duct. You were started on ciprofloxacin to prevent infection until you have your surgery. You will follow-up with a new primary care doctor here who will check labs on ___ to ensure your bilirubin is continuing to down trend. On your initial CT scan, you were noted to have a pulmonary nodule. Please discuss a dedicated CT scan of your chest with your primary care doctor after discharge. It was a pleasure taking care of you, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atenolol 12.5 mg PO DAILY 3. Cyanocobalamin 1000 mcg PO DAILY 4. Furosemide 20 mg PO DAILY 5. Nitroglycerin SL 0.4 mg SL PRN chest pain 6. Polyethylene Glycol 17 g PO DAILY:PRN constipation 7. Pravastatin 40 mg PO DAILY 8. Tamsulosin 0.4 mg PO HS 9. Vitamin D 1000 UNIT PO DAILY 10. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*2 11. Calcium 600 + D(3) *NF* (calcium carbonate-vitamin D3) 600 200 unit ORAL DAILY 12. MetFORMIN (Glucophage) 500 mg PO BID 13. TraZODone 50 mg PO HS:PRN insomnia Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Costochondritis Secondary Diagnosis: Coronary Artery Disease Dementia Sick sinus syndrome s/p dual chamber pacemaker Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You came in with chest pain and shortness of breath. We attempted to perform 2 stress tests but you declined both times. Your symptoms improved soon after admission. We strongly suggest you avoid the outdoors while it is hot and stay in a coool environment. Please 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 1000 mg PO Q6H:PRN Pain - Mild 2. Lidocaine 5% Patch 1 PTCH TD QAM RX *lidocaine 5 % 1 patch daily as needed Disp #*30 Patch Refills:*0 3. Ondansetron ODT 4 mg PO Q8H:PRN nausea RX *ondansetron 4 mg 1 tablet(s) by mouth Q8 hours PRN Disp #*30 Tablet Refills:*0 4. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth Q8 hours PRN Disp #*60 Tablet Refills:*0 5. OxyCODONE SR (OxyconTIN) 10 mg PO Q12H RX *oxycodone 10 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 6. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram/dose 1 powder(s) by mouth daily Refills:*0 7. Senna 8.6 mg PO BID:PRN Constipation - First Line RX *sennosides [senna] 8.6 mg 1 tablet by mouth BID PRN Disp #*60 Tablet Refills:*0 8. Levothyroxine Sodium 50 mcg PO DAILY 9. Omeprazole 20 mg PO DAILY 10. Rosuvastatin Calcium 40 mg PO QPM 11. ValACYclovir 500 mg PO Q24H 12. HELD- valsartan-hydrochlorothiazide 320-25 mg oral DAILY This medication was held. Do not restart valsartan-hydrochlorothiazide until restarted by your PCP ___: Home With Service Facility: ___ Discharge Diagnosis: Leg pain Bone mass concerning for cancer Lung lesions concerning for cancer Orthostatic hypotension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Instructed to use walker to offload weight on left leg. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted with left leg pain found to have a left bone mass and lesions in your lungs concerning for cancer. You had a bone biopsy ___, which will determine the diagnosis and the plan. Please follow up these results with your PCP who will send you to the appropriate doctors. You were started on pain medications with improvement in your pain. Please talk to your PCP if your pain is not manageable. It was a pleasure taking care of you. -Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H:PRN pain 2. Docusate Sodium (Liquid) 100 mg PO BID 3. Hydrocortisone Cream 0.5% 1 Appl TP BID:PRN rash 4. Hydroxychloroquine Sulfate 200 mg PO BID 5. Miconazole Powder 2% 1 Appl TP QID:PRN rash 6. Pantoprazole 40 mg PO Q12H 7. Senna 1 TAB PO BID:PRN constipation 8. Calcium 600 + D(3) *NF* (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit Oral TID 9. Florastor *NF* (saccharomyces boulardii) 250 mg Oral BID 10. Multivitamins 1 TAB PO DAILY 11. Vitamin D 1000 UNIT PO DAILY 12. Ketoconazole 2% 1 Appl TP BID 13. Enoxaparin Sodium 40 mg SC DAILY Duration: 2 Weeks 14. Vancomycin 1500 mg IV Q 12H 15. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush 16. Furosemide 20 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: sRight septic knee Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted from rehab on ___ for fevers. You were on the antibiotic Vancomycin at rehab, and on admission you were put on broad-spectrum antibiotics. Due to pain in your right knee and your recent joint space infection, orthopedics drew fluid from the joint. Analysis of that fluid showed inflammation that was suspicious for an infection. On ___ the orthopedics team washed out the right knee, removed the hardware from your knee replacement, and placed intra-joint antibiotics for a persistent septic joint. You will need to be on IV antibiotics for 8 weeks for this joint infection. A long-term IV, A PICC, was placed on ___ in order for you to get antibiotics at rehab.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amitriptyline 125 mg PO HS 2. FoLIC Acid 1 mg PO DAILY 3. Multivitamins 1 TAB PO DAILY 4. Omeprazole 40 mg PO DAILY 5. Thiamine 100 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Alcohol intoxification Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because of Alcohol intoxification. You were monitored while you were here for signs of withdrawal and we gave you medication to treat your withdrawal symptoms. While you were here you were also seen by the psychiatry team. You have had some difficulty with alcohol detox in the past, and it is very likely that depression is contributing to this. You completed treatment for active alcohol withdrawal and now you will be going to a treatment facility for your depression.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H 2. Furosemide 80 mg PO DAILY 3. Potassium Chloride 20 mEq PO DAILY 4. Glargine 28 Units Breakfast Humalog 14 Units Breakfast Humalog 12 Units Lunch Humalog 14 Units Dinner 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. CarBAMazepine 200 mg PO BID 8. Cyanocobalamin 500 mcg PO DAILY 9. Ferrous Sulfate 325 mg PO DAILY 10. Finasteride 5 mg PO DAILY BPH 11. Fish Oil (Omega 3) 1000 mg PO BID 12. Magnesium Oxide 500 mg PO DAILY 13. Metoprolol Tartrate 12.5 mg PO BID 14. Omeprazole 40 mg PO DAILY 15. OxyCODONE (Immediate Release) ___ mg PO Q6H:PRN Pain - Severe RX *oxycodone 5 mg 1 tablet(s) by mouth twice a day Disp #*10 Tablet Refills:*0 16. Tamsulosin 0.4 mg PO DAILY 17. Vitamin D 1000 UNIT PO DAILY 18. Warfarin 9 mg PO DAILY16 Discharge Disposition: Home Discharge Diagnosis: PRIMARY: Non-cardiac chest pain Acute Kidney Injury SECONDARY: Acute on chronic diastolic heart failure Aortic stenosis s/p ___ Atrial Fibrillation Diabetes Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you. Why you were admitted? - You were admitted because you were having worsening chest pain. What we did for you? - Your pain is likely due to a musculoskeletal reason. Your EKG and cardiac enzymes were reassuring. You had a scan to look at your lungs and there was no evidence of a clot in your lungs. - You were given IV Lasix to help urinate extra fluid. What should you do when you leave the hospital? - Please continue taking Lasix 80mg daily. Please weigh yourself everyday. If your weight is increasing, please call your cardiologist as you may require an additional dose of Lasix. - Please take all your medications as prescribed. - Please attend your follow up appointments. Your kidney function needs to be re-checked at your next outpatient appointment. - You can continue taking pain medications to help with the pain.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Cyanocobalamin 1000 mcg PO DAILY 3. Finasteride 5 mg PO DAILY 4. FoLIC Acid 1 mg PO DAILY 5. Lidocaine 5% Ointment 1 Appl TP QID PRN: pain 6. Losartan Potassium 50 mg PO DAILY 7. Acetaminophen 650 mg PO Q6H 8. Colchicine 0.6 mg PO DAILY 9. Docusate Sodium 100 mg PO BID 10. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN moderate pain RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 11. Polyethylene Glycol 17 g PO DAILY:PRN constipation 12. Senna 8.6 mg PO BID 13. Vitamin D 800 UNIT PO DAILY 14. PredniSONE 10 mg PO DAILY Duration: 6 Days Take 20 mg daily for 2 days, then 10 mg daily for 2 days, then 5 mg tab daily for 2 days, then stop. Tapered dose - DOWN Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Polyarticular gout flare Claw toe of the right great toe with associated neuropathy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - with assistance Gen: comfortable HEENT: EOMI, PERRLA, OP clear, sclera anicteric Neck: no LAD, JVP nl Chest: CTAB CV: RR, no m/r/g, 2+ peripheral pulses Abd: S/ND/NT/BS+ GU: no foley, no CVA tenderness Ext: overall are warm and well perfused RUE - normal strength and ROM LUE - normal strength and ROM RLE - -right leg: proximal shin with circumscribed erythematous nodule approximately 2 cm in diameter which is smaller in size and less erythematous today, also not significantly tender to light palpation today -right knee: significant swelling of right knee is improving, knee joint is now only mildly TTP at joint line; ROM still moderately reduced due to pain -right ankle: edema is improving, tenderness is now minimal, reduced ROM due to pain persists; overall is improving -right MTP: edema is improving, mildly TTP, erythema has resolved, warmth is improving, reduced ROM is improving LLE - knee normal; ankle normal; left MTP with improving edema, tenderness, and warmth; erythema has resolved; mildly reduced ROM due to pain persists Neuro: AAOx3, clear speech, tongue midline, moving all four extremities spontaneously, follows commands Psych: Calm, cooperative, normal affect Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ with severe joint pain due to a gout flare. You were treated with steroids and other anti-inflammatory medications with improvement. The physical therapy doctors ___ and recommended you go to rehab to continue to get better prior to returning home. You are being discharged on a steroid taper. You will follow-up with the Rheumatology doctors in ___. We wish you a full and expeditious recovery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Glargine 15 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 2. Acetaminophen 650 mg PO Q6H:PRN Headache 3. Atorvastatin 80 mg PO QPM 4. Atropine Sulfate Ophth 1% 1 DROP RIGHT EYE BID 5. Bacitracin/Polymyxin B Sulfate Opht. Oint 1 Appl BOTH EYES BID 6. Carvedilol 37.5 mg PO BID 7. Clonidine Patch 0.3 mg/24 hr 1 PTCH TD QTUES 8. Losartan Potassium 50 mg PO BID 9. Metoclopramide 5 mg PO QIDACHS 10. Nephrocaps 1 CAP PO DAILY 11. NIFEdipine (Extended Release) 120 mg PO QPM 12. Pantoprazole 40 mg PO Q12H 13. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP RIGHT EYE QID 14. sevelamer CARBONATE 800 mg PO TID W/MEALS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hypertensive crisis Hypoglycemia End-stage renal disease on HD Discharge Condition: Discharge condition–stable Mental status–alert and oriented x3 Ambulatory Followup Instructions: ___ [/INST] </s><s>You admitted to hospital with low blood glucose and elevated elevated blood pressure. Your low blood glucose was due to taking too much insulin. Your elevated blood blood pressure was likely secondary to not taking your chronic antihypertensives. Your blood glucose was stable on the current insulin regimen. Your blood pressure also normalized after restarting her home antihypertensives. You underwent dialysis on ___. You were discharged after dialysis with the plan to follow-up with your PCP.</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. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 3. Dexamethasone 2 mg PO DAILY 4. Docusate Sodium 100 mg PO TID 5. Heparin 5000 UNIT SC TID 6. Levothyroxine Sodium 100 mcg PO DAILY 7. Metoprolol Tartrate 25 mg PO BID 8. Milk of Magnesia 30 mL PO Q6H:PRN Constipation 9. Omeprazole 20 mg PO DAILY 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation 11. Vitamin B Complex 1 CAP PO DAILY 12. Vitamin D 1000 UNIT PO DAILY 13. Senna 1 TAB PO BID:PRN constipation 14. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: R humerus pathologic fracture Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>You were admitted after suffering a fracture of your right upper arm while at a rehab facility. You were seen by orthopedic surgery and given a brace to help the arm heal. You had an MRI of the arm which suggested that there may have been a myeloma lesion in the bone which weakened it and caused it to break easily. You were seen by radiation oncology and given treatment to the arm to help it heal. You received morphine for pain control with good effect.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H RX *acetaminophen [Acetaminophen Extra Strength] 500 mg 2 tablet(s) by mouth Four times a day Disp #*100 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID 3. Atorvastatin 10 mg PO DAILY 4. Polyethylene Glycol 17 g PO DAILY 5. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth Every 4 hours Disp #*30 Tablet Refills:*0 6. Ibuprofen 800 mg PO Q8H RX *ibuprofen 800 mg 1 tablet(s) by mouth three times a day Disp #*30 Tablet Refills:*0 7. Sertraline 100 mg PO DAILY 8. Citracal + D (calcium phosphate-vitamin D3) 250 mg calcium- 250 unit oral Daily Discharge Disposition: Home Discharge Diagnosis: Mechanical Fall Iliac wing fracture Proximal Humerus 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>You were admitted to the hospital after a fall and fracture of your left iliac bone and left humerus. You were seen by ortho who recommended pain control and no surgical intervention. You will have follow-up with the orthopedist in ___ weeks. Also, you were found to have a mild anemia. This may be due to the bruising after the fall, however, you should have a repeat blood check with a primary doctor and ___ screening colonoscopy to ensure no polyps/cancer.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID 2. Artificial Tears ___ DROP BOTH EYES PRN Eye discomfort 3. Bisacodyl 10 mg PO DAILY:PRN constipation 4. Calcium Carbonate 500 mg PO TID 5. Docusate Sodium 100 mg PO BID 6. Enoxaparin Sodium 40 mg SC QPM Duration: 28 Days Start: Today - ___, First Dose: Next Routine Administration Time 7. Hydrochlorothiazide 6.25 mg PO DAILY 8. Metoprolol Tartrate 25 mg PO BID 9. Milk of Magnesia 30 mL PO Q6H:PRN constipation 10. Multivitamins 1 TAB PO DAILY 11. Nafcillin 2 g IV Q4H 12. Omeprazole 20 mg PO DAILY 13. OxycoDONE (Immediate Release) 2.5-10 mg PO Q4H:PRN pain please wean as pain improves RX *oxycodone 5 mg 1 tablet(s) by mouth every 4 hours Disp #*40 Tablet Refills:*0 14. Polyethylene Glycol 17 g PO DAILY:PRN constipation 15. Senna 8.6 mg PO BID 16. Vitamin D 800 UNIT PO DAILY 17. Ziac (bisoprolol-hydrochlorothiazide) 2.5-6.25 mg oral DAILY Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: right femur ___ 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: - Flat foot TDWB in RLE 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. - 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</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. LevETIRAcetam 1000 mg PO BID Duration: 11 Doses RX *levetiracetam 1,000 mg 1 tablet(s) by mouth twice a day Disp #*8 Tablet Refills:*0 2. Albuterol Inhaler 2 PUFF IH Q6H 3. Bumetanide 1 mg PO BID 4. Diltiazem Extended-Release 240 mg PO QAM 5. Diltiazem Extended-Release 120 mg PO QPM 6. MetFORMIN (Glucophage) 500 mg PO BID 7. Simvastatin 20 mg PO QPM 8. HELD- Apixaban 5 mg PO BID This medication was held. Do not restart Apixaban until ___ Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS Intraparenchymal hemorrhage SECONDARY DIAGNOSIS Chronic lymphedema Atrial fibrillation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking part in your care here at ___! Why was I admitted to the hospital? - You were admitted after a fall What was done for me while I was in the hospital? - You were found to have some bleeding in your brain - You were seen by the neurosurgeons who recommended close monitoring, no surgery - We gave you a water pill since we felt you had a lot of fluid What should I do when I leave the hospital? 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. • You make take a shower 3 days after surgery. • No driving while taking any narcotic or sedating medication. • If you experienced a seizure while admitted, you are NOT allowed to drive by law. • No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications • Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) for 7 days after discharge. • You may resume your Eliquis in 7 days. • You have been discharged on Keppra (Levetiracetam). This medication helps to prevent seizures. Please continue this medication as indicated on your discharge instruction. It is important that you take this medication consistently and on time. • You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: • You may have difficulty paying attention, concentrating, and remembering new information. • Emotional and/or behavioral difficulties are common. • Feeling more tired, restlessness, irritability, and mood swings are also common. • Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Headaches: • Headache is one of the most common symptoms after traumatic brain injury. Headaches can be long-lasting. • Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. • Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. • There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. More Information about Brain Injuries: • You were given information about headaches after TBI and the impact that TBI can have on your family. • If you would like to read more about other topics such as: sleeping, driving, cognitive problems, emotional problems, fatigue, seizures, return to school, depression, balance, or/and sexuality after TBI, please ask our staff for this information or visit ___ When to Call Your Doctor at ___ for: • Severe pain, swelling, redness or drainage from the incision site. • Fever greater than 101.5 degrees Fahrenheit • Nausea and/or vomiting • Extreme sleepiness and not being able to stay awake • Severe headaches not relieved by pain relievers • Seizures • Any new problems with your vision or ability to speak • Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: • Sudden numbness or weakness in the face, arm, or leg • Sudden confusion or trouble speaking or understanding • Sudden trouble walking, dizziness, or loss of balance or coordination • Sudden severe headaches with no known reason Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Vancomycin Oral Liquid ___ mg PO QID RX *vancomycin 125 mg 1 capsule(s) by mouth every 6 hours Disp #*52 Capsule Refills:*0 2. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild 3. amLODIPine 10 mg PO DAILY 4. Benztropine Mesylate 2 mg PO QHS 5. Divalproex (DELayed Release) 1000 mg PO QHS 6. Fexofenadine 60 mg PO DAILY 7. Fluticasone Propionate NASAL 2 SPRY NU BID 8. GlipiZIDE 20 mg PO QAM 9. GlipiZIDE 10 mg PO QPM 10. Lisinopril 5 mg PO DAILY 11. Nephrocaps 1 CAP PO DAILY 12. Pravastatin 40 mg PO DAILY 13. RisperiDONE 3 mg PO DAILY 14. Triamcinolone Acetonide 0.1% Cream 1 Appl TP BID 15. Vancomycin 1000 mg IV POST HD (___) 16. Viagra (sildenafil) 20 mg oral PRN 17. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: Anemia of chronic inflammation Dizziness SECONDARY DIAGNOSES: Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you at the ___ ___. Why was I seen in the hospital? –You were feeling unwell after your scheduled session of dialysis. –Some of the people caring for you worried about your blood counts. What happened while I was in the hospital? –You received a blood transfusion. –We checked your blood counts. These were stable. -You did not have any more dizziness. -We checked your diarrhea for signs of an infectious diarrhea ("C. diff"); this test showed that you do have C. diff, and you were started on treatment which you should continue for 2 weeks total. –You received your scheduled session of hemodialysis on ___. What should I do when I leave the hospital? -Please follow up with your primary care doctor as previously scheduled. -Please see your diabetes doctor at ___ to discuss whether or not you need to start insulin. 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. HYDROmorphone (Dilaudid) 4 mg PO Q4H:PRN pain RX *hydromorphone [Dilaudid] 4 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 2. Artificial Tears Preserv. Free ___ DROP BOTH EYES PRN dry eyes 3. Aspirin 81 mg PO DAILY 4. Bisacodyl 10 mg PO DAILY:PRN Constipation 5. Duloxetine 60 mg PO DAILY 6. LeVETiracetam 500 mg PO DAILY 7. LeVETiracetam 250 mg PO POST HD 8. Nephrocaps 1 CAP PO DAILY 9. Sodium Chloride Nasal ___ SPRY NU QID:PRN dryness/ congestion 10. Vancomycin 1000 mg IV HD PROTOCOL Duration: 3 Days Last dose at dialysis on ___. 11. traZODONE 50 mg PO HS:PRN insomnia 12. Acetaminophen 650 mg PO Q8H:PRN pain Do not exceed ___ mg in 24 hours. 13. Albuterol-Ipratropium ___ PUFF IH Q4H:PRN SOB 14. Calcium Carbonate ___ mg PO QID 15. Cinacalcet 30 mg PO DAILY 16. Guaifenesin ER 600 mg PO BID:PRN mucous 17. ipratropium-albuterol *NF* 0.5 mg-3 mg(2.5 mg base)/3 mL Inhalation q6h prn wheeze/ sob 18. Ondansetron 4 mg PO Q6H:PRN nausea 19. Vitamin E 100 UNIT PO DAILY 20. Vancomycin Oral Liquid ___ mg PO Q6H Duration: 10 Days 21. Diltiazem Extended-Release 240 mg PO DAILY 22. Omeprazole 20 mg PO DAILY 23. Lisinopril 40 mg PO DAILY 24. TRIAzolam 0.125 mg PO QHS:PRN insomnia RX *triazolam 0.125 mg 1 tablet(s) by mouth at bedtime Disp #*5 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary Diagnoses: MRSA Pneumonia Severe Sepsis Clostridium Difficile Infection Cirrhosis (HCV Infection) Atrial Fibrillation eith Rapid Ventricular Response Secondary Diagnoses: End Stage Renal Disease on Hemodialysis Chronic Back and Knee Pain Chronic Obstructive Pulmonary Disease Opioid Dependence 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 caring for you during your stay at ___ ___. You were sent to the hospital from your nursing home with pneumonia, low oxygen levels, and confusion. Your blood pressure dropped in the Emergency Department, and you were admitted to the Medical Intensive Care Unit (MICU). Your breathing worsened and you became increasingly confused, so you had to be intubated and placed on a ventilator. While on the ventilator, you had bronchoscopy and a large amount of mucous blocking your airways was removed. Cultures from the mucous grew a type of bacteria called MRSA (Methicillin Resistant Staph Aureus). Your antibiotics were narrowed to Vancomycin, which covers this bacteria well, and your breathing slowly improved. You were able to have the breathing tube taken out and be transferred out of the MICU. You also developed worsening diarrhea during your stay and stool testing came back positive for a bacterium called Clostridium difficile (C.diff). You were initially treated with Metronidazole (Flagyl) for this infection, but then switched to oral Vancomycin, which works differently than the IV Vancomycin for your pneumonia. Imaging during your stay showed evidence of cirrhosis, likely from chronic Hepatitis C infection. This can decrease your bodies ability to clear medications, and may have contributed to your confusion and lethargy on admission. Because of your liver disease and confusion on admission, the doses of several of your medications were adjusted. You will need to complete a treatment course of Vancomycin IV for your MRSA pneumonia. This should be given at your dialysis sessions, with your last dose on ___. You will also need to complete a total 14 day antibiotic course for Cdiff. This will be completed in another 10 days on ___. You should follow up with your outpatient providers soon after discharge. You indicated that you have already been in contact with your nephrologist and have arranged for dialysis tomorrow.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM 2. GlipiZIDE 5 mg PO DAILY 3. Glargine 10 Units Breakfast RX *insulin glargine [Lantus Solostar] 100 unit/mL (3 mL) 10 u Subcutaneous 10 Units before BKFT; Disp #*2 Syringe Refills:*3 4. LeVETiracetam 750 mg PO BID RX *levetiracetam [Keppra] 750 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*3 5. MetFORMIN (Glucophage) 1000 mg PO BID 6. NIFEdipine CR 90 mg PO DAILY 7. Ranitidine 300 mg PO QHS 8. Insulin Test Strips Please dispense 1 month supply of One Touch Ultra Test Strips. 2 Refills 9. Insulin Pen Needles Please dispense One month supply of Insulin Pen Needles- 32 gauge x ___ (4mm Nano) 2 Refills 10. Lancets Please dispense 1 month supply of Delica Lancets. 2 Refills. Discharge Disposition: Home Discharge Diagnosis: Epilepsy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were hospitalized at ___ following several episodes very concerning for seizures. While in the hospital, you were managed by the neurology service. You underwent EEG, which did not clearly reveal seizures. Your brain MRI did not show any specific abnormality to explain your seizures. However, seizures are a clinical diagnosis, and based on the description of the events, your doctors ___ it was necessary to start you on an anti-seizure medication Keppra. While in the hospital, you saw ___ Diabetes, who recommended starting Lantus (a type of insulin you can take once daily) to help control your diabetes. You were also seen by the diabetes educator to help address your diabetes.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Multivitamins 1 TAB PO DAILY 2. OxycoDONE (Immediate Release) 5 mg PO Q4-Q6:PRN pain 3. Verapamil 240 mg PO QAM 4. Paroxetine 30 mg PO DAILY 5. Verapamil 120 mg PO QPM 6. Acetaminophen 650 mg PO Q6H:PRN pain RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet(s) by mouth every 6 hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: #Pleural effusion secondary to RFA Secondary diagnoses: #Fatigue #Depression #HTN Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___. You were transferred from ___ for further evaluation of a pleural effusion after your radiofrequency ablation proceedure. After extensive discussion with interventional radiology and with Dr. ___ was determined that the pleural effusion is an expected side effect of your procedure. The effusion was also relatively small, making it more difficult to tap and increasing the risk of complications from the tap. Your oxygenation also improved during your hospital stay and you were able to walk without experiencing a significant decrease in your oxygenation. Please call your primary care provider or go to the emergency department if you experience worsening shortness of breath or fever. 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. Carvedilol 25 mg PO BID 2. Cyanocobalamin 1000 mcg PO DAILY 3. Furosemide 20 mg PO DAILY 4. GlipiZIDE 5 mg PO BID 5. Lisinopril 5 mg PO DAILY 6. MetFORMIN (Glucophage) 1000 mg PO BID 7. Multivitamins 1 TAB PO DAILY 8. Aspirin 81 mg PO DAILY 9. Calcium Carbonate 1000 mg PO DAILY 10. Fenofibrate 160 mg PO DAILY 11. Mercaptopurine 50 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Primary diagnosis: 1. Left parieto occipital stroke with hemorrhagic conversion. 2. Right frontal ischemic stroke. Secondary diagnosis: 1. Hypertension 2. Hyperlipidemia 3. Type 2 Diabetes 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 hospitalized due to symptoms of slurred speech and left facial droop. These were found on CT and MRI to be resulting from both an acute hemorrhagic, as well as an ACUTE ISCHEMIC STROKE. An ischemic stroke is a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The hemorrhagic stroke happened very close to your previous left sided stroke. 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. We assessed your blood cholesterol, sugar, as well as your blood pressure. We found your blood sugar to be stable but elevated so we have continued with your oral medications. We have found your cholesterol well controlled so we have continued you on your home medication. You had an ultrasound of your heart which was improved from the previous ones. We have resumed your home aspirin after holding it briefly during this admission. We are not changing your medications. Instructions: 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</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 2. Erythromycin Ethylsuccinate Suspension 200 mg PO TID W/MEALS RX *erythromycin ethylsuccinate 200 mg/5 mL 5 ml by mouth three times a day Refills:*0 3. HydrALAZINE 25 mg PO Q8H RX *hydralazine 25 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 4. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 5. Glargine 4 Units Dinner Insulin SC Sliding Scale using HUM Insulin 6. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever 7. Atropine Sulfate Ophth 1% 1 DROP RIGHT EYE BID 8. clotrimazole 1 % topical BID 9. Docusate Sodium 200 mg PO DAILY 10. Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP RIGHT EYE BID 11. Metoclopramide 10 mg PO QIDACHS 12. Omeprazole 20 mg PO BID 13. Ondansetron 8 mg PO BID:PRN Nausea/Vomiting - First Line 14. OxyCODONE (Immediate Release) 15 mg PO Q8H:PRN Pain - Moderate RX *oxycodone 15 mg 1 tablet(s) by mouth every eight (8) hours Disp #*21 Tablet Refills:*0 15. OxyCODONE SR (OxyCONTIN) 10 mg PO Q12H RX *oxycodone 10 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*14 Tablet Refills:*0 16. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP RIGHT EYE QID 17. Senna 17.2 mg PO DAILY 18. Sucralfate 1 gm PO QID Discharge Disposition: Home Discharge Diagnosis: Acute Kindey Injury SECONDARY: Gastroparesis Diabetes Mellitus Type 2 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 Mr. ___, It was a pleasure caring for you at ___ ___. WHY WAS I IN THE HOSPITAL? - you had a decrease in your kidney function from prior contrast and decreased oral intake WHAT HAPPENED TO ME IN THE HOSPITAL? - you received IV fluids - erythromycin was started to help with your nausea - your kidney function slowly recovered WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. - Continue to drink water (of if you have to apple juice), try to take crackers or a small snack with this throughout the day - If you have fever, productive cough, shortness of breath please call your primary care provider as your gastroparesis means you are higher risk of pneumonia. 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. Amantadine 100 mg PO BID 2. Aspirin 81 mg PO DAILY 3. Citalopram 40 mg PO DAILY 4. Clopidogrel 75 mg PO DAILY 5. Glargine 15 Units Bedtime 6. Ranitidine 150 mg PO BID 7. Simethicone 80 mg PO BID 8. Clopidogrel 75 mg PO DAILY 9. Simvastatin 20 mg PO DAILY 10. Topiramate (Topamax) 125 mg PO HS 11. Vitamin D 50,000 UNIT PO 1X/WEEK (TH) RX *ergocalciferol (vitamin D2) 50,000 unit 1 capsule(s) by mouth once a week Disp #*4 Capsule Refills:*0 12. OLANZapine 2.5 mg PO HS RX *olanzapine 2.5 mg 2.5 tablet(s) by mouth once a day at night Disp #*30 Tablet Refills:*0 13. Potassium Chloride 40 mEq PO BID 14. Fludrocortisone Acetate 0.1 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: 1. Acute encephalopathy 2. Symptomatic hypoglycemia 3. Polypharmacy SECONDARY DIAGNOSES: 1. Paranoid schizophrenia 2. Diabetes mellitus Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the Internal Medicine service at ___ ___ on ___ regarding management of your recent confusion and fall. Your medical evaluation was reassuring and we attribute your recent fainting and confusional state to medication changes and low blood sugar, which improved with titration of your medications in discussion with your outpatient providers. Please call your doctor or go to the emergency department if: * You experience new chest pain, pressure, squeezing or tightness. * You develop new or worsening cough, shortness of breath, or wheezing. * You are vomiting and cannot keep down fluids, or your medications. * If you are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include: dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit, or have a bowel movement. * You experience burning when you urinate, have blood in your urine, or experience an unusual discharge. * Your pain is not improving within 12 hours or is not under control within 24 hours. * Your pain worsens or changes location. * You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. * You develop any other concerning symptoms.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>ACTIVITY * AVOID contact sports and/or any activity that may cause injury to your abdominal area for the next ___ weeks. * If you suddenly become dizzy, lightheaded, feeling as if you are going to pass out go to the nearest Emergency Room as this could be a sign that you are having internal bleeding from your liver or spleen injury. * AVOID any blood thinners such as Motrin, Naprosyn, Indocin, Aspirin, Coumadin or Plavix for at least ___ days unless otherwise instructed by the MD/NP/PA. WOUND CARE You have an open wound The dressing needs to be changed and packed every day with wet to dry dressing You also have staples at your midline incision - this will be addressed at your follow up appointment</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Carvedilol 6.25 mg PO BID RX *carvedilol 6.25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Lisinopril 20 mg PO DAILY RX *lisinopril 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. AcetaZOLamide 500 mg PO Q24H 4. Aspirin 81 mg PO DAILY 5. Divalproex (EXTended Release) 500 mg PO DAILY 6. Ketorolac 0.5% Ophth Soln 1 DROP RIGHT EYE QID 7. moxifloxacin 0.5 % ophthalmic (eye) QID 8. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP RIGHT EYE Q4H 9. Pregabalin 25 mg PO DAILY 10. Sertraline 150 mg PO DAILY 11. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: #New-onset atrial fibrillation with rapid ventricular response SECONDARY DIAGNOSIS: #Hypertensive Urgency #Thrombocytopenia #Macrocytic Anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege to take care of you at ___. WHY WAS I IN THE HOSPITAL? - You nearly passed out and had chest pain. Your eye doctor found that you had an irregular heart rhythm ("atrial fibrillation" or "a-fib") and your heart was beating very fast. Thus, you were sent to the hospital. WHAT WAS DONE FOR ME IN THE HOSPITAL? - You were started on medications to control the fast heart rate - You were also given medications to manage your blood pressure, as it was very high - You were evaluated for causes of the irregular rhythm -- Infections can sometimes cause stress to the heart, causing afib. You were given antibiotics for a possible urinary tract infection. -- You got an ultrasound of your heart ("transthoracic echocardiogram" or "TTE" or "echo") which showed some changes you should discuss with your primary care doctor and your heart doctor - Your heart went back into normal rhythm - The risks and benefits of starting a blood thinner to reduce your risk of stroke was discussed, but you opted to discuss this further with a cardiologist before making a decision WHAT SHOULD I DO AFTER THE HOSPITAL? - You should follow up with your primary care doctor at the ___ within a week. - You should follow up with your eye doctor as soon as possible. We called your eye doctor to let them know you'd be discharged so they can arrange an appointment for you. - You should follow up with a heart doctor ("cardiologist") at the ___. - Please discuss starting a blood thinner to reduce the risk of stroke with your cardiologist. - You should have a repeat echocardiogram in 6 months to check your dilated aorta. Your cardiologist or primary care physician can arrange this. - You should call the lung doctor at the ___ for an appointment to evaluate your breathing. 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. senna 8.6 mg tablet Sig: One (1) Tablet PO BID (2 times a day): while taking opiates. Disp:*60 Tablet(s)* Refills:*1* 2. docusate sodium 100 mg capsule Sig: One (1) capsule PO BID (2 times a day): while taking opiates. Disp:*60 capsule(s)* Refills:*1* 3. ondansetron HCl 4 mg tablet Sig: ___ tablets PO Q8H (every 8 hours) as needed for nausea. Disp:*30 tablet(s)* Refills:*1* 4. nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr Transdermal DAILY (Daily) as needed for Tobacco withdrawal: nicotine patch 21 mg daily (21 mg/day) for 6 weeks, followed by step 2 (14 mg/day) for 2 weeks; finish with step 3 (7 mg/day) for 2 weeks . Disp:*QS for taper Patch 24 hr(s)* Refills:*0* 5. polyethylene glycol 3350 17 gram Powder in Packet Sig: One (1) Powder in Packet PO DAILY (Daily) as needed for constipation. Disp:*QS for 1 month Powder in Packet(s)* Refills:*0* 6. bisacodyl 5 mg tablet,delayed release (___) Sig: Two (2) tablet,delayed release (___) PO DAILY (Daily) as needed for constipation. Disp:*QS for 1 month tablet,delayed release ___ Refills:*0* 7. morphine 30 mg tablet extended release Sig: One (1) tablet extended release PO Q12H (every 12 hours). Disp:*60 tablet extended release(s)* Refills:*0* 8. acetaminophen 650 mg tablet Sig: One (1) tablet PO three times a day. Disp:*90 tablet(s)* Refills:*0* 9. Outpatient Lab Work Please draw a CBC and LFT's in 1 week and send to the patients Oncologist (Dr. ___ ___ ) and Surgeon (Dr. ___ (___) and PCP ___ ___ (576.2 bile duct obstruction) 10. oxycodone 5 mg tablet Sig: One (1) tablet PO every four (4) hours as needed for pain. Disp:*150 tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Pancreatic Cancer Cholangitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You presented to the hospital with jaundice, fever and chills consistent with cholangitis. You were treated with antibiotics and the signs of infection resolved. You underwent endoscopy to attempt to open the obstruction to the drainage of bile, but the narrowing was too severe. You then underwent radiology guided placement of biliary drains, which were exchanged as an inpatient and then removed. For your underlying pancreatic cancer, which is the cause of the cholangitis, you were evaluated by the Oncologists and the Surgical Oncologists, and you will need to start chemotherapy as an outpt. The surgeons also did a diagnostic laparoscopy to look for spread of cancer. You also had a port device placed at the same time in anticipation for use by chemotherapy. You will be discharged home on by mouth pain medications and a medication regimen to prevent constipation. . You will need to take your medications as listed below. Please note that opiate medications can cause excessive sedation. Please do not use before driving, using machinery, or with alcohol. . Please f/u with your doctors as listed below. . Medication changes: 1) tylenol ___ mg three times a day to be used for pain 2) bisacodyl 10 daily as needed for constipation 3) docusate 100 twice a day 4) nicotine patch 21 mg daily (21 mg/day) for 6 weeks, followed by step 2 (14 mg/day) for 2 weeks; finish with step 3 (7 mg/day) for 2 weeks 5) MS ___ 30 mg Q12H for pain 6) oxycodone 5 mg Q4H prn pain 7) polyethylene glycol 17 g daily prn for constipation 8) senna 8.6 twice a day for constipation 9) zofran 4 mg Q8H prn nausea</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aquaphor Ointment 1 Appl TP TID:PRN scleroderma 2. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 3. Docusate Sodium 100 mg PO BID:PRN constipation 4. HYDROmorphone (Dilaudid) 4 mg PO Q6H:PRN prior to dressing change RX *hydromorphone [Dilaudid] 4 mg 1 tablet(s) by mouth every six (6) hours Disp #*20 Tablet Refills:*0 5. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 6. Senna 8.6 mg PO BID:PRN constipation 7. Gabapentin 900 mg PO TID RX *gabapentin 300 mg 3 capsule(s) by mouth three times a day Disp #*30 Capsule Refills:*0 8. Levothyroxine Sodium 100 mcg PO DAILY RX *levothyroxine 100 mcg 1 tablet(s) by mouth once a day Disp #*14 Tablet Refills:*0 9. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 10 mg 1 tablet(s) by mouth every four (4) hours Disp #*20 Tablet Refills:*0 10. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H RX *oxycodone [OxyContin] 20 mg 1 tablet(s) by mouth twice a day Disp #*20 Tablet Refills:*0 11. Sirolimus 0.5 mg PO DAILY Daily dose to be administered at 6am 12. Venlafaxine 37.5 mg PO QPM RX *venlafaxine 75 mg 0.5 (One half) tablet(s) by mouth QPM Disp #*30 Tablet Refills:*0 13. Venlafaxine 75 mg PO QAM RX *venlafaxine 75 mg 1 tablet(s) by mouth QAM Disp #*30 Tablet Refills:*0 14. Acyclovir 400 mg PO Q12H 15. Amoxicillin 500 mg PO Q12H 16. Atovaquone Suspension 1500 mg PO DAILY 17. Azithromycin 250 mg PO EVERY OTHER DAY 18. Budesonide 180 mcg/actuation inhalation BID RX *budesonide [Pulmicort Flexhaler] 180 mcg/actuation (160 mcg delivered) 1 puff inhaled twice a day Disp #*30 Inhaler Refills:*0 19. Ciprofloxacin HCl 750 mg PO Q12H 20. Clobetasol Propionate 0.05% Cream 1 Appl TP DAILY 21. Dakins ___ Strength 1 Appl TP ASDIR 22. DentaGel (sodium fluoride) 1.1 % dental QHS 23. FoLIC Acid 2 mg PO DAILY 24. Metoprolol Succinate XL 12.5 mg PO DAILY 25. MetronidAZOLE Topical 1 % Gel 1 Appl TP DAILY 26. Montelukast 10 mg PO DAILY 27. Multivitamins 1 TAB PO DAILY 28. petrolatum (mineral oil-hydrophil petrolat) topical DAILY 29. Phos-NaK (potassium, sodium phosphates) ___ mg oral EVERY OTHER DAY PRN low phos 30. pilocarpine HCl 5 mg oral TID 31. Posaconazole Delayed Release Tablet 200 mg PO DAILY 32. PredniSONE 20 mg PO DAILY RX *prednisone 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 33. Vitamin D ___ UNIT PO 1X/WEEK (MO) 34. Vitamin E 800 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY: Skin and soft tissue infection SECONDARY: Chronic graft vs host disease Compression fracture Acute myeloid leukemia Chronic systolic heart failure Hypothyroidism Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, It was a pleasure taking care of you at ___ ___. Why was I in the hospital? You were in the hospital because you had a fever at home. What happened to me while I was in the hospital? We gave you antibiotics to treat an infection. What should I do when I leave the hospital? You should continue to take your medications and go to your doctor's appointments as scheduled. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Best wishes, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amitriptyline 10 mg PO HS 2. Lisinopril 20 mg PO DAILY 3. Metoprolol Tartrate 50 mg PO BID 4. Omeprazole 20 mg PO BID 5. Sertraline 100 mg PO DAILY 6. ALPRAZolam 2 mg PO QHS 7. ALPRAZolam 1 mg PO DAILY:PRN anxiety 8. Docusate Sodium 100 mg PO BID please take while on your pain medication 9. Fluticasone Propionate NASAL 1 SPRY NU DAILY 10. Gabapentin 600 mg PO Q8H 11. HYDROmorphone (Dilaudid) 8 mg PO Q3H:PRN pain 12. Multivitamins 1 TAB PO DAILY 13. OxycoDONE (Immediate Release) 30 mg PO Q3H:PRN home dose 14. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: 1. Cervical spinal cord injury C4-5. 2. Severe cervical stenosis, secondary to herniated disk C4- 5. 3. Recent history trauma. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>ACDF: You have undergone the following operation: Anterior Cervical Decompression and Fusion Immediately after the operation: • Activity: You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit in a car or chair for more than ~45 minutes without getting up and walking around. • Rehabilitation/ Physical Therapy: ___ times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. • Swallowing: Difficulty swallowing is not uncommon after this type of surgery. This should resolve over time. Please take small bites and eat slowly. Removing the collar while eating can be helpful – however, please limit your movement of your neck if you remove your collar while eating. • Cervical Collar / Neck Brace: You have been given a collar. You may remove the collar to take a shower or eat. Limit your motion of your neck while the collar is off. You should wear the collar when walking, especially in public • Wound Care: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually ___ days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Call the office at that time. If you have an incision on your hip please follow the same instructions in terms of wound care. • You should resume taking your normal home medications. • You have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so plan ahead. You can either have them mailed to your home or pick them up at the clinic located on ___. We are not allowed to call in narcotic (oxycontin, oxycodone, percocet) prescriptions to the pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. • Follow up: Please Call the office and make an appointment for 2 weeks after the day of your operation if this has not been done already. At the 2-week visit we will check your incision, take baseline x rays and answer any questions. We will then see you at 6 weeks from the day of the operation. At that time we will most likely obtain Flexion/Extension X-rays and often able to place you in a soft collar which you will wean out of over 1 week. Please call the office if you have a fever>101.5 degrees Fahrenheit, drainage from your wound, or have any questions. Physical Therapy: -You should not lift anything greater than 10 lbs for 2 weeks. You will be more comfortable if you do not sit in a car or chair for more than ~45 minutes without getting up and walking around. -___ 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. Treatments Frequency: Remove the dressing in 2 days. If the incision is draining cover it with a new sterile dressing. If it is dry then you can leave the incision open to the air. Once the incision is completely dry (usually ___ days after the operation) you may take a shower. Do not soak the incision in a bath or pool. If the incision starts draining at anytime after surgery, do not get the incision wet. Call the office at that time. If you have an incision on your hip please follow the same instructions in terms of wound care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Citalopram 20 mg PO DAILY 2. Enoxaparin Sodium 90 mg SC Q12H Start: ___, First Dose: Next Routine Administration Time take until directed to stop by your PCP ___ *enoxaparin 100 mg/mL 90 mg SubQ every 12 hours Disp #*14 Syringe Refills:*1 3. Warfarin 5 mg PO DAILY16 take as directed by your PCP ___ *warfarin 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Left lower extremity deep venous thrombosis, pulmonary embolism with pulmonary infarction, hematuria Secondary: 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 our pleasure caring for you at ___ ___. You were admitted to the hospital with a large blood clot in your left leg. We looked for evidence of a blood clot in your right leg and did not find any. It appears as though a small piece of the blood clot has broken off and lodged in your lungs, a condition called pulmonary embolism. Fortunately, you are not having severe symptoms from this. We started you on a blood thinner medication called Warfarin, also called Coumadin. While the levels of this drug build up to therapeutic levels in your body, you will need to take another blood thinner called Lovenox that you inject twice daily. You will need to ___ with your primary care physician for further testing to find out why you had this blood clot. Be sure to keep your left leg tightly wrapped from the foot all the way up to the groin with an ace bandage. This is important to prevent ___ syndrome, a painful consequence of having a blood clot in the leg. Also, keep your leg elevated on 2 pillows while sleeping, and keep it elevated this way for at least 2 - 3 hours every day. Thank you for allowing us to participate in your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth once a day Disp #*90 Tablet Refills:*0 2. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild 4. Albuterol Inhaler ___ PUFF IH Q6H:PRN dyspnea 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 80 mg PO QPM 7. Docusate Sodium 100 mg PO BID 8. Gabapentin 100 mg PO BID 9. GlipiZIDE 10 mg PO DAILY 10. Ibuprofen 400 mg PO Q6H:PRN Pain - Moderate 11. Januvia (SITagliptin) 100 mg oral DAILY 12. MetFORMIN (Glucophage) 1500 mg PO BID 13. Omeprazole 20 mg PO DAILY 14. TraMADol 50 mg PO Q6H:PRN Pain - Moderate 15. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Non-ST Elevation Myocardial Infarction Secondary Coronary artery disease s/p Coronary Artery Bypass Graft Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital because you had pain in your left shoulder and neck. This occurred because you had a blockage of one of the blood vessels that was placed during your surgery. A stent was placed in your original blood vessel to restore blood flow. You felt well after the procedure. You will need to take a medication called clopidogrel/Plavix to keep your new stent open. It is very important that you take this medication, as well as aspirin, every day. You will follow up with your usual doctors. ___ was a pleasure taking care of you during your stay. - 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. Levothyroxine Sodium 125 mcg PO 5X/WEEK (___) 3. Levothyroxine Sodium 250 mcg PO 2X/WEEK (MO,TH) 4. Amiodarone 200 mg PO BID 5. Artificial Tear Ointment 1 Appl BOTH EYES PRN dry eye 6. Digoxin 0.125 mg PO EVERY OTHER DAY 7. Ipratropium Bromide MDI 2 PUFF IH QID 8. LeVETiracetam 750 mg PO BID 9. Nystatin Oral Suspension 5 mL PO QID:PRN thrush 10. QUEtiapine Fumarate 25 mg PO BID 11. QUEtiapine Fumarate 50 mg PO QHS insomnia, agitation 12. Vancomycin Oral Liquid ___ mg PO Q6H Last dose is ___. 13. Metoprolol Tartrate 37.5 mg PO Q8H Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left temporoparietal IPH Subdural Hemorrhage C difficile Colitis Ventilator Associated Pneumonia Delirium Atrial Fibrillation with Rapid Ventricular Response Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your admission to ___. You came into the hospital because you were found down. We found that you had a bleed in your brain. You had brain surgery to help to stop the bleeding. During your hospitalization you had a second bleed in your brain and required a breathing tube for a long period of time so you had a tracheostomy and a feeding tube placed. You were treated for 2 pneumonias, an infection in your GI tract (c difficile), fast heart rate (atrial fibrillation with rapid ventricular response), and delirium (altered mental status). You worked with physical therapy and we determined you were ready to continue further treatment at ___. Please continue to take your medications as prescribed and follow up with your physicians as recommended below. Be well and take care. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing 2. Ranitidine 300 mg PO DAILY 3. OxycoDONE (Immediate Release) 5 mg PO Q3H:PRN pain Duration: 2 Weeks RX *oxycodone [Oxaydo] 5 mg ___ tablet(s) by mouth every three (3) hours Disp #*40 Tablet Refills:*0 4. Ondansetron 4 mg PO Q8H:PRN nausea Duration: 1 Week RX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Acute cholecystitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with acute cholecystitis. You were taken to the operating room and had your gallbladder removed laparoscopically. You tolerated the procedure well but were found to have a stone remaining. You then had an ERCP to remove that stone and are now being discharged home to continue your recovery with the following instructions. Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q24H Duration: 3 Doses RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth once a day Disp #*4 Tablet Refills:*0 2. Linezolid ___ mg PO BID RX *linezolid ___ mg 1 tablet(s) by mouth twice a day Disp #*8 Tablet Refills:*0 3. Warfarin 2.5 mg PO DAILY16 4. Albuterol Inhaler 1 PUFF IH Q6H:PRN sob 5. Allopurinol ___ mg PO DAILY 6. amLODIPine 10 mg PO DAILY 7. Calcitriol 0.25 mcg PO QHS 8. Docusate Sodium 100 mg PO BID 9. Epoetin ___ ___ units SC Q ___ 10. Gabapentin 100 mg PO DAILY 11. Glargine 55 Units Breakfast Glargine 25 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 12. LORazepam 0.5 mg PO QHS:PRN anxiety 13. Potassium Chloride 50 mEq PO BID 14. Torsemide 100 mg PO DAILY 15. Vitamin D ___ UNIT PO 1X/WEEK (___) 16. HELD- Atorvastatin 10 mg PO QPM This medication was held. Do not restart Atorvastatin until after you finish the ciprofloxacin 17. HELD- Ferrous Sulfate 325 mg PO DAILY This medication was held. Do not restart Ferrous Sulfate until after you finish the ciprofloxacin 18. HELD- MetOLazone 5 mg PO DAILY:PRN 4lb weight gain This medication was held. Do not restart MetOLazone until your doctor tells you to restart Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Osteomyelitits CKD ANemia of chronic disease CHF Hypokalemia 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>Mr. ___, You were admitted to ___ after having infected bone removed from your toe. After the surgery we are treating you with a few more days of antibiotics to ensure the infection is resolved. You should follow up with podiatry in clinic.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. PredniSONE 60 mg PO DAILY Duration: 2 Doses Start: Tomorrow - ___, First Dose: First Routine Administration Time This is dose # 1 of 3 tapered doses RX *prednisone 20 mg 3 tablet(s) by mouth Once a day Disp #*6 Tablet Refills:*0 2. PredniSONE 40 mg PO DAILY Duration: 3 Doses Start: After 60 mg DAILY tapered dose This is dose # 2 of 3 tapered doses RX *prednisone 20 mg 2 tablet(s) by mouth Once a day Disp #*6 Tablet Refills:*0 3. PredniSONE 20 mg PO DAILY Duration: 3 Doses Start: After 40 mg DAILY tapered dose This is dose # 3 of 3 tapered doses RX *prednisone 20 mg 1 tablet(s) by mouth Daily Disp #*3 Tablet Refills:*0 4. PredniSONE 5 mg PO DAILY Start: After last tapered dose completes This is the maintenance dose to follow the last tapered dose RX *prednisone 5 mg 1 tablet(s) by mouth Daily Disp #*60 Tablet Refills:*5 5. sevelamer CARBONATE 2400 mg PO TID W/MEALS RX *sevelamer carbonate [Renvela] 800 mg 3 tablet(s) by mouth Three times a day with meals Disp #*270 Tablet Refills:*0 6. Acetaminophen 1000 mg PO Q8H:PRN pain 7. amLODIPine 10 mg PO DAILY 8. Aspirin 81 mg PO DAILY 9. Calcitriol 0.25 mcg PO DAILY 10. Cinacalcet 60 mg PO DAILY 11. Etravirine 200 mg PO BID 12. Glargine 10 Units Breakfast 13. Labetalol 900 mg PO BID 14. LaMIVudine 25 mg PO DAILY 15. Losartan Potassium 100 mg PO DAILY 16. Omeprazole 20 mg PO DAILY 17. Pravastatin 80 mg PO QPM 18. Sulfameth/Trimethoprim SS 1 TAB PO 3X/WEEK (___) 19. Tenofovir Disoproxil (Viread) 300 mg PO 1X/WEEK (MO) 20. Torsemide 20 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Acute allograft rejection End stage renal disease on hemodialysis 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 part of your care at ___. You were admitted to the hospital due to abdominal pain. You were found to have acute rejection of your transplanted kidney, which was caused by missing medications. Your medications were adjusted and your symptoms improved. You were seen by the transplant surgeons for consideration of removing your kidney, which may need to be done if your rejection continues. After discharge, it is very important for you to keep taking your medications. Please also follow up with your outpatient doctors. ___ was a pleasure being part of your care. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q8H:PRN pain 2. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID 3. Cyanocobalamin 1000 mcg PO DAILY 4. Docusate Sodium 100 mg PO DAILY 5. Doxepin HCl 100 mg PO HS 6. Enoxaparin Sodium 70 mg SC Q12H 7. Multivitamins 1 TAB PO DAILY 8. Omeprazole 40 mg PO BID 9. Polyethylene Glycol 17 g PO DAILY:PRN constipation 10. Sucralfate 1 gm PO QID 11. Cholestyramine 4 gm PO BID RX *cholestyramine (with sugar) 4 gram 4 grams by mouth twice a day Refills:*0 12. Ondansetron 4 mg PO Q8H:PRN nausea 13. Fluconazole 400 mg PO Q24H RX *fluconazole 200 mg 2 tablet(s) by mouth daily Disp #*8 Tablet Refills:*0 14. BuPROPion (Sustained Release) 200 mg PO QAM 15. ClonazePAM 1.5 mg PO QHS 16. ClonazePAM 0.5 mg PO QAM 17. QUEtiapine Fumarate 50 mg PO QAM 18. QUEtiapine Fumarate 150 mg PO HS 19. TraMADOL (Ultram) 50 mg PO BID:PRN pain only take if needed 20. Bisacodyl 10 mg PO DAILY 21. Senna 8.6 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Esophagitis, esophageal candidiasis, Gastritis Secondary: abd pain, history of narcotics abuse on ___, hx DVT/PE Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital with abdominal pain and weight loss. You underwent an EGD notable for esophagitis and gastritis. Biopsies were taken and showed yeast infection. You were continued on your home medications with the addition of cholestyramine and ultram for pain control. You will need to follow-up with ___ as an outpatient for ongoing evaluation and treatment. Per your PCP's request, a colonoscopy was performed while you were in the hospital given difficulty with completing the prep as an outpatient. This went well, there were a few small polyps, and you will likely be due for another colonoscopy in ___ years. You were noted to have a small infection in the labial that was treated with ___ baths. Please see below for your follow up appointments and medications.</s>