Datasets:

Jarmac

/

llama2_di_dataset_train_prompt

like 0

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Docusate Sodium 100 mg PO BID 3. Hydrocodone-Acetaminophen (5mg-500mg) ___ TAB PO Q6H:PRN pain 4. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 5. Metoprolol Succinate XL 50 mg PO DAILY RX *metoprolol succinate 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Montelukast Sodium 10 mg PO DAILY 7. Nabumetone 750 mg PO BID:PRN pain 8. PredniSONE 40 mg PO daily Duration: 2 Days RX *prednisone 20 mg ___ tablet(s) by mouth daily Disp #*7 Tablet Refills:*0 9. PredniSONE 20 mg PO daily Duration: 2 Days Start: After 40 mg tapered dose. 10. PredniSONE 10 mg PO daily Duration: 2 Days Start: After 20 mg tapered dose. 11. Pulmicort Flexhaler *NF* (budesonide) 180 mcg/actuation Inhalation BID 12. Rosuvastatin Calcium 20 mg PO QHS 13. Senna 1 TAB PO BID:PRN constipation 14. Triamterene-Hydrochlorothiazide 1 CAP PO DAILY 15. Levofloxacin 750 mg PO DAILY RX *levofloxacin [Levaquin] 750 mg 1 tablet(s) by mouth daily Disp #*2 Tablet Refills:*0 16. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth q 8 hr Disp #*4 Tablet Refills:*0 17. Xopenex Neb *NF* 0.63 mg/3 mL Inhalation q4hrs prn wheezing Reason for Ordering: albuterol inducing vtach RX *levalbuterol tartrate [Xopenex HFA] 45 mcg/actuation ___ puffs q4-6hr prn Disp #*1 Inhaler Refills:*0 18. Tiotropium Bromide 1 CAP IH DAILY 19. Valsartan 80 mg PO DAILY RX *valsartan [Diovan] 80 mg 1 tablet(s) by mouth daily Disp #*20 Tablet Refills:*0 20. Furosemide 20 mg PO DAILY RX *furosemide 20 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: pneumonia systolic heart failure exacerbation asthma exacerbation Secondary: ventricular tachycardia diverticulitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted with worsening cough and shortness of breath, which we think is due to a combination of pneumonia, asthma exacerbation and fluid overload. We started an antibiotic called levaquin and gave you a diuretic to decrease the fluid. Your breathing improved and you did not have any episodes of ventricular tachycardia while you were here. While you were on water pills, your electrolyte levels changed rapidly. While your body re-adjusts, we would like you to take half of your Valsartan (Diovan) for the next few days and then have your blood tests rechecked ___. You will also start a new water pill called Furosemide (Lasix). 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: [/INST] </s><s>ACTIVITY: DO NOT lift anything greater than 10 lbs for 2 weeks. ___ times a day you should go for a walk for ___ minutes as part of your recovery. You can walk as much as you can tolerate. You will be more comfortable if you do not sit or stand more than ~45 minutes without changing positions. BRACE: You have been given a brace. This brace should be worn for comfort when you are walking. You may take it off when sitting in a chair or while lying in bed. WOUND: Remove the external dressing in 2 days. If your incision is draining, cover it with a new dry sterile dressing. If it is dry then you may leave the incision open to air. Once the incision is completely dry, (usually ___ days after the operation) you may shower. Do not soak the incision in a bath or pool until fully healed. If the incision starts draining at any time after surgery, cover it with a sterile dressing. Please call the office. Please call the office if you have a fever>101.5 degrees Fahrenheit and/or drainage from your wound. MEDICATIONS: You should resume taking your normal home medications. Refrain from NSAIDs immediately post operatively. You have also been given Additional Medications to control your post-operative pain. Please allow our office 72 hours for refill of narcotic prescriptions. Please plan ahead. You can either have them mailed to your home or pick them up at ___ ___, ___. We are not able to call or fax narcotic prescriptions to your pharmacy. In addition, per practice policy, we only prescribe pain medications for 90 days from the date of surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN fever/pain RX *acetaminophen 325 mg ___ tablet(s) by mouth Q6-8h Disp #*60 Tablet Refills:*2 2. Aspirin 121.5 mg PO DAILY RX *aspirin 81 mg 1.5 tablet(s) by mouth once a day Disp #*45 Tablet Refills:*0 3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 4. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*2 5. Enoxaparin Sodium 40 mg SC QD Duration: 14 Days RX *enoxaparin 40 mg/0.4 mL 1 injection once a day Disp #*14 Syringe Refills:*0 6. Senna 1 TAB PO BID:PRN constipation 7. Morphine SR (MS ___ 15 mg PO Q12H RX *morphine [MS ___ 15 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*28 Tablet Refills:*0 8. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth Q4-6h Disp #*100 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: Left lower extremity tissue defect overlying tib-fib fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires crutches Followup Instructions: ___ [/INST] </s><s>-You should keep your left lower extremity elevated when you are not dangling or walking (you may use pillows at home) to help with swelling and drainage. -You should walk around utilizing your crutches and not bearing any weight on your left leg. -Report any change in color of your flap area including increased redness and/or any dusky or darkened appearance to Dr. ___. -use gauze, as needed, to help absorb any drainage from flap. -Your left lower extremity should be wrapped with clean ace wrap daily from your foot to just under your knee and you should wear your posterior boot/splint. -Your left forearm dressing should be changed daily; apply xeroform to graft area, then gauze fluffs and then wrap with ace wrap. -You may shower but cover your thigh donor site and your left forearm skin graft site with plastic wrap/bag to shield from moisture. You may leave your left lower extremity flap/repair site open to let warm water run over it. Pat dry with soft towel and re-apply ace wrap. No tub baths until directed by Dr. ___. -Leave your graft donor site open to air to dry out. -You may continue to dangle and walk around according to the protocol which you started in the hospital. On ___, you may advance to 1 hour dangles, three times per day. Continue this for a few days then advance to 90 minutes, three times per day. You should dangle a maximum of 90 minutes three times/day. Continue with the 90 minutes three times/day until further instructed by Dr. ___ at your first follow up appointment. . Diet/Activity: 1. You may resume your regular diet. 2. Avoid heavy lifting and do not engage in strenuous activity until instructed by Dr. ___. . Medications: 1. Resume your regular medications unless instructed otherwise and take any new meds as ordered. 2. You may take your prescribed pain medication for moderate to severe pain. You may switch to Tylenol or Extra Strength Tylenol for mild pain as directed on the packaging. 3. Take prescription pain medications for pain not relieved by tylenol. 4. Take Colace, 100 mg by mouth 2 times per day, while taking the prescription pain medication. You may use a different over-the-counter stool softener if you wish. 5. Do not drive or operate heavy machinery while taking any narcotic pain medication. You may have constipation when taking narcotic pain medications (oxycodone, percocet, vicodin, hydrocodone, dilaudid, etc.); you should continue drinking fluids, you may take stool softeners, and should eat foods that are high in fiber. . Call the office IMMEDIATELY if you have any of the following: 1. Signs of infection: fever with chills, increased redness, swelling, warmth or tenderness at the surgical site, or unusual drainage from the incision(s). 2. A large amount of bleeding from the incision(s). 3. Fever greater than 101.5 oF 4. Severe pain NOT relieved by your medication. . Return to the ER if: * If you are vomiting and cannot keep in fluids or your medications. * If you have shaking chills, fever greater than 101.5 (F) degrees or 38 (C) degrees, increased redness, swelling or discharge from incision, chest pain, shortness of breath, or anything else that is troubling you. * Any serious change in your symptoms, or any new symptoms that concern you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen ___ mg PO Q6H RX *acetaminophen 500 mg ___ tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*1 2. Ibuprofen 600 mg PO Q6H:PRN Pain - Mild RX *ibuprofen 600 mg 1 tablet(s) by mouth every six (6) hours Disp #*30 Tablet Refills:*1 3. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate Reason for PRN duplicate override: Alternating agents for similar severity RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*15 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: ruptured ectopic Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the gynecology service after your procedure. You have recovered well and the team believes you are ready to be discharged home. Please call ___ with any questions or concerns. Please follow the instructions below. General instructions: * Take your medications as prescribed. * Do not drive while taking narcotics. * Take a stool softener such as colace while taking narcotics to prevent constipation. * Do not combine narcotic and sedative medications or alcohol. * Do not take more than 4000mg acetaminophen (APAP) in 24 hrs. * No strenuous activity until your post-op appointment. * You may eat a regular diet. * You may walk up and down stairs. Incision care: * You may shower and allow soapy water to run over incision; no scrubbing of incision. No tub baths for 6 weeks. * Since you have steri-strips, leave them on. They will fall off on their own or be removed during your followup visit. * If you have staples, they will be removed at your follow-up visit. Call your doctor for: * fever > 100.4F * severe abdominal pain * difficulty urinating * vaginal bleeding requiring >1 pad/hr * abnormal vaginal discharge * redness or drainage from incision * nausea/vomiting where you are unable to keep down fluids/food or your medication Constipation: * Drink ___ liters of water every day. * Incorporate 20 to 35 grams of fiber into your daily diet to maintain normal bowel function. Examples of high fiber foods include: Whole grain breads, Bran cereal, Prune juice, Fresh fruits and vegetables, Dried fruits such as dried apricots and prunes, Legumes, Nuts/seeds. * Take Colace stool softener ___ times daily. * Use Dulcolax suppository daily as needed. * Take Miralax laxative powder daily as needed. * Stop constipation medications if you are having loose stools or diarrhea. To reach medical records to get the records from this hospitalization sent to your doctor at home, call ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 60 mg SC BID RX *enoxaparin 60 mg/0.6 mL 1 syringe subcutaneous twice a day Disp #*14 Syringe Refills:*0 2. Warfarin 4 mg PO DAILY16 RX *warfarin 2 mg 2.5 tablet(s) by mouth daily Disp #*75 Tablet Refills:*0 3. Outpatient Occupational Therapy 434.91 Acute Ischemic Stroke Outpatient Occupational Therapy, please evaluate and treat 4. Outpatient Physical Therapy 434.91 Acute Ischemic Stroke Outpatient Physical Therapy, please evaluate and treat 5. Outpatient Speech/Swallowing Therapy 434.91 Acute Ischemic Stroke Outpatient Speech Therapy, please evaluate and treat Discharge Disposition: Home Discharge Diagnosis: -L caudate/putamen stroke Discharge Condition: Mental Status: Clear and coherent, slight dysarthria, slightly halting speech Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Querida ___, Fuiste ___ hospital ___ a tus dificultades al producir ___ en ___ ___ demostraron un ___ ___ de ___ y movimiento. ___, tus signos vitales demostraron ___ ___ saturacion de oxygeno. ___ de tus pulmones no demostraron un coagulo como ___ oxigenacion. Por lo tanto, es muy propable ___ to ___ oxigenacion sea en ___ de Ebstein. ___ piernas no demostro ___. Sin embargo, ___ anticonceptiva, ___ comenzaste a tomar recientemente, es probable ___ ___ a formar un coagulo. Este coagulo ___ ___ cardiaco.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Verapamil SR 120 mg PO Q24H RX *verapamil 120 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Acetaminophen 650 mg PO Q8H:PRN Pain - Moderate 3. biotin 5,000 mcg oral DAILY 4. Calcium Carbonate 1200 mg PO DAILY 5. Citalopram 10 mg PO DAILY 6. Docusate Sodium 100 mg PO DAILY:PRN constipation 7. Gabapentin 300 mg PO TID 8. meloxicam 15 mg oral DAILY:PRN pain 9. Methimazole 2.5 mg PO DAILY 10. Senna 8.6 mg PO DAILY:PRN constipation 11. Vitamin D 400 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: -Supraventricular tachycardia -Paroxysmal atrial fibrillation -Hypertension -Hyperlipidemia -Type 2 diabetes mellitus -Subdural hematoma -Hyperthyroidism -Osteoarthritis -Rheumatoid arthritis -Gait instability Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You came to ___ with a fast heart rate that caused palpitations. It improved with starting a new medication called verapamil. Please followup with your outpatient doctors. It was a pleasure taking care of you. Your ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ertapenem Sodium 1 g IV 1X Duration: 1 Dose Patient should take 1g every 24 hours (course complete on ___. 2. Vancomycin 1500 mg IV Q 8H 3. Bisacodyl 10 mg PO BID:PRN constipation 4. Cyanocobalamin 1000 mcg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. Famotidine 20 mg PO BID 7. Ferrous Sulfate 325 mg PO DAILY 8. Gabapentin 600 mg PO TID 9. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Mild 10. Sarna Lotion 1 Appl TP QID 11. Zolpidem Tartrate 5 mg PO QHS:PRN sleep Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Wound dehiscence 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>You were admitted to the ___ on ___ for a wound dehiscence. You received IV antibiotics and placement of an irrigating wound vacuum and were seen by Dr. ___ recommended antibiotic and wound vac therapy initially. However, given the depth of your wound, you were taken to the operating room on ___ for irrigation and debridement of your wound and placement of an incisional vac. Postoperatively you were restarted on antibiotics and an infectious disease consult was placed. They recommended an antibiotic course scheduled to end on ___. The incisional vac was changed on the day of discharge and replaced with a new vac sponge. This will be changed again by the KCI representative on ___ and based on the appearance of the wound at that time will likely stay in place until ___.</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/fever 2. Aspirin 325 mg PO DAILY RX *aspirin 325 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*3 3. Bisacodyl 10 mg PO/PR DAILY 4. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 5. Docusate Sodium 100 mg PO BID 6. Levothyroxine Sodium 112 mcg PO DAILY 7. MethylPHENIDATE (Ritalin) 60 mg PO BID 8. Nortriptyline 150 mg PO HS 9. OLANZapine 10 mg PO DAILY 10. Senna 8.6 mg PO BID 11. Simvastatin 20 mg PO DAILY 12. Venlafaxine XR 450 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Subacute stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Resume your normal medications and begin new medications as directed. · You may be instructed by your doctor to take one ___ a day and/or Plavix. If so, do not take any other products that have aspirin in them. If you are unsure of what products contain Aspirin, as your pharmacist or call our office. · You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. When to Call Your Doctor at ___ for: · 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</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. HYDROmorphone (Dilaudid) 2 mg PO Q6H:PRN Pain - Severe Reason for PRN duplicate override: Alternating agents for similar severity RX *hydromorphone 2 mg ___ tablet(s) by mouth every 8 hours Disp #*5 Tablet Refills:*0 2. diclofenac sodium 1 % topical DAILY:PRN 3. DICYCLOMine 5 mg PO TID:PRN abdominal pain 4. Docusate Sodium 100 mg PO DAILY:PRN Constipation - First Line 5. Lidocaine 5% Ointment 1 Appl TP DAILY:PRN pain 6. LORazepam 0.5 mg PO Q6H:PRN anxiety 7. Multivitamins 1 TAB PO DAILY 8. naloxegol 12.5 mg oral DAILY 9. Omeprazole 40 mg PO BID 10. OxyCODONE SR (OxyconTIN) 30 mg PO Q12H 11. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First Line 12. Prochlorperazine 25 mg PR Q12H:PRN Nausea/Vomiting - Second Line NOT relieved by Ondansetron 13. Promethazine 12.5 mg PO BID:PRN nausea 14. Ranitidine 150 mg PO QHS 15. Senna 8.6 mg PO DAILY 16. Sucralfate 1 gm PO QID 17. Sumatriptan Succinate 50 mg PO PRN headache 18. Zolpidem Tartrate 5 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Polycystic kidney disease complicated by cyst rupture Polycystic liver Chronic neck pain Chronic abdominal pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted for abdominal pain in the setting of a likely ruptured kidney cyst. We treated you with pain medications. Follow up is scheduled at your PCP ___ (should you wish to keep this appointment) and the nephrology and GI offices will call you to schedule follow up as well. 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. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Cyanocobalamin ___ mcg PO DAILY 3. Lisinopril 40 mg PO DAILY 4. Multivitamins 1 TAB PO DAILY 5. Simvastatin 20 mg PO DAILY 6. Vitamin D 50,000 UNIT PO 1X/WEEK (SA) 7. FoLIC Acid 1 mg PO DAILY 8. Hydrochlorothiazide 12.5 mg PO DAILY 9. MetFORMIN (Glucophage) 500 mg PO DAILY 10. Thiamine 100 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY: Delirium Vascular Dementia SECONDARY: Hypertension Type II Diabetes Mellitus Excessive Ethanol Use Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at ___ ___. You were admitted to the hospital because you were having confusion and were incontinence. You had many normal studies (normal electrolytes, urinalysis, head imaging, etc.) without apparent reversible causes of your confusion and you were discharged to rehab. Best of luck to you in your future health. Please take all medications as prescribed, attend all doctors ___ as ___, and talk to a doctor if you have any questions or concerns. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain 2. Alendronate Sodium 70 mg PO 1X/WEEK (MO) 3. Amlodipine 10 mg PO DAILY 4. Azathioprine 50 mg PO TID 5. Losartan Potassium 100 mg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. Omeprazole 40 mg PO DAILY 8. PredniSONE 5 mg PO DAILY Tapered dose - DOWN RX *prednisone 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 9. Pregabalin 50 mg PO QHS 10. TraMADOL (Ultram) 50 mg PO TID:PRN Pain 11. arformoterol 15 mcg/2 mL Inhalation BID 12. Budesonide 0.25 mg/2 mL INHALATION BID 13. Outpatient Lab Work ICD-9 453.3 Renal Vein thrombosis ICD-9 581.9 Nephrotic Syndrome Please check INR and chem-7 on ___ 14. Warfarin 4 mg PO DAILY16 Discharge Disposition: Home Discharge Diagnosis: Primary: Lower back pain, weakness Asymptomatic Pericarditis Secondary: Nephrotic syndrome ___ to membranous nephropathy Renal Vein thrombosis on warfarin Hypertension Diastolic Heart Failure EF > 55% Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital because you had sudden onset lower back pain and weakness and your primary care physician asked you to go to the Emergency Department. While in the hospital you had a fever and developed confusion. All causes of infection were ruled out and your mental status improved. It is possible that you had a condition that causes inflammation of the surrounding layer of the heart called "pericarditis." You were without symptoms for this however and we did not treat you. For your back pain and weakness it will be important for you to continue with physical therapy and to follow up in clinic with your appointments below. We held your lasix on discharge because you were dehydrated. It is very important that you weigh yourself every morning and call your doctor if your weight goes up more than 3 lbs. If you start to notice that you are gaining weight and your legs are getting swollen, then you should restart your lasix (furosemide). It is very important that you have your labs drawn at Dr. ___ office on ___. Dr. ___ will follow up these results and adjust your coumadin dosing if needed. It was a pleasure being involved in your care. Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO TID 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. TraMADol 25 mg PO Q6H:PRN pain RX *tramadol 50 mg 25 mg by mouth q6hr prn Disp #*30 Tablet Refills:*0 4. Atorvastatin 10 mg PO QPM 5. Calcium Carbonate 500 mg PO TID 6. Losartan Potassium 100 mg PO DAILY 7. Multivitamins 1 TAB PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Vitamin D 800 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Elbow fracture-dislocation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - NWB RUE. ROMAT in ex fix. MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add tramadol as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: Take 1 tablet every 3 hours as needed x 1 day, then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter andmay be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - No chemical anticoagulation needed WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. For patients discharged with external fixators in place, the initial dressing may have Xeroform wrapped at the pin site with surrounding gauze. Often, the Xeroform is used in the immediate post-op phase to allow for control of the bleeding. The Xeroform can be removed ___ days after surgery. If the pin sites are clean and dry, keep them open to air. If they are still draining slightly, cover with clean dry gauze until draining stops. If they need to be cleaned, use ___ strength Hydrogen Peroxide with a Q-tip to the site. 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. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB/Wheeze 3. ARIPiprazole 20 mg PO DAILY 4. Diazepam 5 mg PO Q6H:PRN muscle spasm RX *diazepam 5 mg 1 tab by mouth every six (6) hours Disp #*30 Tablet Refills:*0 5. Divalproex (DELayed Release) 500 mg PO BID 6. Docusate Sodium 100 mg PO BID 7. Duloxetine 60 mg PO DAILY 8. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Cervical stenosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Surgery •Your dressing may come off on the second day after surgery. •Your incision is closed with dissolvable sutures underneath the skin and glue. You do not need suture removal. •Please keep your incision dry for 48 hours after surgery. •Please avoid swimming for two weeks. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •No contact sports until cleared by your neurosurgeon. •Do NOT smoke. Smoking can affect your healing and fusion. Medications •Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •Do not take any anti-inflammatory medications such as Motrin, Advil, Aspirin, and Ibuprofen etc… for 2 weeks. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. •It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q8H 2. Omeprazole 40 mg PO BID 3. PredniSONE 2.5 mg PO DAILY RX *prednisone 2.5 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 4. Cyanocobalamin 1000 mcg PO DAILY RX *cyanocobalamin (vitamin B-12) 1,000 mcg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 5. Fludrocortisone Acetate 0.1 mg PO DAILY RX *fludrocortisone 0.1 mg 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 6. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth once daily Disp #*30 Tablet Refills:*0 7. Potassium Chloride 20 mEq PO DAILY Duration: 24 Hours RX *potassium chloride [Klor-Con] 20 mEq 1 tablet by mouth once daily Disp #*30 Packet Refills:*0 8. Repaglinide 0.5 mg PO TIDAC 9. Outpatient Lab Work Please draw CBC, Chem 10 on ___ Fax results to: Name: ___. Location: ___ PRIMARY CARE Address: ___ Phone: ___ Fax: ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: ___ syndrome Mineralocorticoid deficiency Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure to take care of you at ___ ___. You were admitted for weakness and lightheadedness. The most likely cause of your slow decline is long term steroid use. We treated your weakness and lightheadedness with IV fluids, vitamin supplementation and a medication to increase your blood pressure (fludrocortisone). We decreased your dose of prednisone to 2.5 mg daily. You are now safe to go home. Please take your medications as prescribed and follow up with the appointments listed below. The following changes were made to your medications: DECREASED prednisone to 2.5mg daily STOPPED atenolol because you blood pressure was low STARTED fludrocortisone to increase your blood pressure STARTED B12 for B12 deficiency STARTED multivitamin for supplementation STARTED potassium supplement because fludrocortisone lowers your potassium</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN fever/pain 2. ALPRAZolam 0.5 mg PO TID:PRN anxiety 3. Atorvastatin 40 mg PO QPM 4. Bisacodyl 10 mg PO/PR DAILY 5. Cyclobenzaprine 5 mg PO TID 6. Fluoxetine 20 mg PO DAILY 7. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 8. MetFORMIN (Glucophage) 500 mg PO BID 9. Metoprolol Tartrate 25 mg PO DAILY 10. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 11. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q4H:PRN pain RX *oxycodone-acetaminophen 5 mg-325 mg ___ tablet(s) by mouth Q4 hours Disp #*30 Tablet Refills:*0 12. Pantoprazole 40 mg PO Q12H 13. TraMADOL (Ultram) 50 mg PO TID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Severe spinal stenosis L1-L2 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 severe L1-L2 spinal stenosis. You were offered surgery but declined and requested to wait until after the holiday. Activity •You must wear your brace at all times when out of bed. You may apply your brace sitting at the edge of the bed. You do not need to sleep with it on. •You must wear your brace while showering. •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •No contact sports until cleared by your neurosurgeon. •Do NOT smoke. Smoking can affect your healing and fusion. Medications •***Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •Do not take any anti-inflammatory medications such as Motrin, Advil, Aspirin, and Ibuprofen etc… until cleared by your neurosurgeon. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. •It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: •Fever greater than 101.5 degrees Fahrenheit •New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Aspirin EC 81 mg PO DAILY 3. Calcitriol 0.25 mcg PO DAILY 4. Docusate Sodium 100 mg PO BID 5. Ferrous Sulfate 325 mg PO DAILY 6. Metoprolol Tartrate 50 mg PO TID 7. Multivitamins 1 TAB PO DAILY 8. Omeprazole 20 mg PO DAILY 9. Phenytoin Sodium Extended 130 mg PO TID 10. Pravastatin 40 mg PO QPM 11. Aranesp (in polysorbate) (darbepoetin alfa in polysorbat) 100 mcg/0.5 mL injection 1X/WEEK 12. Acetaminophen 650 mg PO Q4H:PRN pain 13. HydrALAzine 25 mg PO Q6H RX *hydralazine 25 mg 1 tablet(s) by mouth four times a day Disp #*120 Tablet Refills:*0 14. Senna 8.6 mg PO BID RX *sennosides [senna] 8.6 mg 1 by mouth twice a day Disp #*30 Capsule Refills:*0 15. Warfarin 1 mg PO DAILY16 dose to change daily per Dr. ___ goal INR ___, dx: AFib RX *warfarin 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 16. Amiodarone 200 mg PO DAILY RX *amiodarone 200 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: pericardial effusion with tamponade Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Tylenol Incisions: Sternal - healing well, no erythema or drainage Edema - trace Followup Instructions: ___ [/INST] </s><s>Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive No lifting more than 10 pounds for 10 weeks Please call with any questions or concerns ___ Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 2.5 mg PO BID 2. Atorvastatin 20 mg PO QPM 3. Furosemide 20 mg PO DAILY 4. Omeprazole 20 mg PO DAILY 5. Paroxetine 10 mg PO DAILY 6. Digoxin 0.0625 mg PO DAILY 7. Metoprolol Succinate XL 100 mg PO DAILY 8. Colchicine 0.6 mg PO EVERY OTHER DAY 9. Cefpodoxime Proxetil 100 mg PO Q12H 10. Fluocinonide 0.05% Ointment 1 Appl TP BID 11. Ketoconazole Shampoo 1 Appl TP DAILY 12. Lactulose 30 mL PO BID:PRN constipation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS Atrial flutter with rapid ventricular response Acute on chronic systolic cardiac heart failure Lactic acidosis due to metfromin overdose Acute kidney injury Acute liver failure Urinary tract infection SECONDARY DIAGNOSIS Coronary artery disease Type II diabetes mellitus Dyslipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___: It was a pleasure taking care of you at ___ ___. You came to the hospital for fatigue and shortness of breath. You were found in atrial flutter, which is an irregular rhythm of the heart that increases your heart rate. You also presented an exacerbation of your heart failure, an acute injury of the kidney and liver, and a urinary tract infection. You were given medication to slow your heart beat, and were put on diuretics to decrease fluid retention. You also received IV antibiotics for your urinary tract infection. You responded adequately, and were then transitioned to your regular oral medication. You will be sent home with a new medication for your heart, digoxin 0.0625 mg daily and an antibiotic to take for two days (cefpodozime). Your home metformin has been suspended since you had an adverse drug reaction. You will continue to take the rest of your medications as usual. Please remember to take your medications, follow a healthy diet and go to your cardiologist on the scheduled date. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. Once again it has been 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. Fluticasone Propionate 110mcg 4 PUFF IH BID 2. LaMOTrigine 300 mg PO DAILY 3. Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing/sob 4. Ondansetron 8 mg PO Q8H:PRN migraines 5. Enoxaparin Sodium 30 mg SC Q12H Duration: 3 Doses Discharge Disposition: Home Discharge Diagnosis: Acute on Chronic migraine Diarrhea Discharge Condition: Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came to the hospital with 1. a severe migraine headache, 2. pain of your right knee, and 3. diarrhea. 1. We treated your migraine with pain medication and anti-nausea medication, as well as IV fluids. Please continue your outpatient treatment of migraines, including lamotrigine for migraine prevention. You may take the anti-nausea medicine (zofran) by mouth if you continue to have nausea. Take pain medications for your headaches as recommended by your primary care doctor. 2. We took an x-ray of your R knee which was normal. We asked our orthopedics colleagues to evaluate your knee, and in consultation with your outpatient orthopedist decided not to tap the small amount of fluid in your knee. They felt your knee was stable and was very unlikely to be infected. However, you have an appointment with your orthopedist Dr. ___ on ___ below), and you should follow-up with him regarding your knee infection that happened in ___. 3. Your diarrhea might have been by the IV antibiotics you received for your infected knee. All of your stool studies in the hospital were negative. Please follow-up with your primary care doctor regarding your diarrhea, especially if it persists. If your diarrhea worsens, please make sure you are able to hydrate yourself adequately, and seek medical attention.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ascorbic Acid ___ mg PO BID 2. Benzonatate 150 mg PO TID 3. Bethanechol 25 mg PO Q12H 4. Diazepam 5 mg PO QPM 5. Fish Oil (Omega 3) 1000 mg PO BID 6. FoLIC Acid 1 mg PO DAILY 7. Ondansetron 8 mg PO Q8H:PRN nausea 8. Prochlorperazine 10 mg PO Q6H:PRN nausea 9. Sulfameth/Trimethoprim DS 1 TAB PO DAILY 10. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Primary: Hypovolemia, lightheadedness, hypotension Secondary: Bacteruria, paraplegia, metastatic bladder cancer Discharge Condition: Mental Status: Clear and coherent. Activity Status: Out of Bed with assistance to chair or wheelchair. Level of Consciousness: Alert and interactive. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ with lightheadedness and low blood pressure. You were found to have bacteria in your urine and were initially treated for a urinary tract infection; however, the culture showed that the urine was likely contaminated and since you had no other evidence of infection your antibiotics were stopped. Your labs and blood pressure were consistent with dehydration, which may be related to your recent chemotherapy, so you received IV fluids. Your blood pressure and lightheadedness improved with fluids. Please follow up with your outpatient doctors as below. If you have fevers, chills, or feel very unwell, please return the ED. It was a pleasure caring for you, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. clindamycin HCl 150 mg Capsule Sig: Three (3) Capsule PO Q6H (every 6 hours) for 10 days. Disp:*120 Capsule(s)* Refills:*0* 2. oxycodone-acetaminophen ___ mg Tablet Sig: ___ Tablets PO every ___ hours as needed for pain. Disp:*50 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Right hand / long finger surgical wound infection with foreign bodies Discharge Condition: stable A&Ox3 independent ambulation Followup Instructions: ___ [/INST] </s><s>******SIGNS OF INFECTION********** Please return to the emergency department or notify MD if you should experience severe pain, increased swelling, decreased sensation, difficulty with movement; fevers >101.5, chills, redness or drainage at the incision site; chest pain, shortness of breath or any other concerns. -Wound Care: Please keep wounds clean and dry. Any suture removal will occur at your follow-up visit. - Keep wounds clean. ___ shower letting soap and water run over the wound. Pat dry and cover with clean/dry dressings. Do not submerge in hot tub, pool, ocean, lake, river, dishwater, or any standing water. -Keep right hand elevated above the level of the heart as much as possible. ******WEIGHT-BEARING******* nwb rue, finger ROM as tolerated ******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 ___. -Antibiotics per ID _______________ *****ANTICOAGULATION****** - None ******FOLLOW-UP********** Please follow up with Dr ___ in ___ days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your PCP regarding this admission and any new medications/refills. Follow-up with Behavioral Health Services at ___ Women's Hospital with ___ as scheduled. Physical Therapy: non-weight bearing right upper extremity, finger range of motion as tolerated. Try to move each finger (including long finger) through full extension and flexion 4 times a day. Treatments Frequency: -Keep right upper extremity elevated as much as possible. - ___ shower daily letting soap and water run over wound. Pat dry and replace clean, dry, bandages.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 800 mg IV Q8H Duration: 14 Days RX *acyclovir sodium 1,000 mg 0.8 cc IV every eight (8) hours Disp #*42 Vial Refills:*0 2. LeVETiracetam 750 mg PO BID RX *levetiracetam [Keppra] 750 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Naproxen 500 mg PO Q8H:PRN headache RX *naproxen [Naprosyn] 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*20 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: HSV ENCEPHALITIS Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were admitted with headache and fever consistent with HSV ENCEPHALITIS. ___ had a lumbar puncture at ___ that showed inflammation and suspicion for infection. ___ were started on broad spectrum antibiotics and acyclovir. ___ had a MRI that showed swelling of your right temporal lobe. ___ were transferred to ___ for further management. ___ were started on Keppra to help prevent seizures. The bacterial cultures were negative so ___ were taken off antibiotics. ___ were kept on the acylovir to continue a 21 day course. ___ had an EEG that showed slowing on the right side but no seizure activity. ___ had a repeat MRI on ___ that was stable. ___ had a repeat LP on ___ that showed improvement in the white blood cell count. ___ were deemed stable for discharge on ___ with home acyclovir dosing. ___ should follow up with neurology as scheduled below. The following changes were made to your medications: Start: Acyclovir 800mg every 8 hours, to be completed on ___ Keppra 750mg twice a day</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 400 mg PO BID BID until ___ then ONCE a day RX *amiodarone 400 mg 1 tablet(s) by mouth twice a day Disp #*30 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. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 4. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID RX *fluticasone-salmeterol [Advair Diskus] 250 mcg-50 mcg/dose 1 puff inhaled twice a day Disp #*1 Disk Refills:*0 5. Metoprolol Succinate XL 100 mg PO DAILY RX *metoprolol succinate 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Nepro Carb Steady (nut.tx.impaired renal fxn,soy) 1 can oral TID W/MEALS 7. Warfarin 1.5 mg PO DAILY16 RX *warfarin [Coumadin] 1 mg 1.5 tablet(s) by mouth daily Disp #*20 Tablet Refills:*0 8. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 9. Allopurinol ___ mg PO EVERY OTHER DAY 10. Ascorbic Acid ___ mg PO DAILY 11. Calcitriol 0.25 mcg PO DAILY 12. Cyanocobalamin 1000 mcg PO DAILY 13. Gabapentin 100 mg PO DAILY 14. Lidocaine-Prilocaine 1 Appl TP THREE TIMES A WEEK WITH HD 15. Nephrocaps 1 CAP PO DAILY 16. TraZODone 100 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: Acute Systolic Heart Failure Atrial Fibrillation with Rapid Ventricular Rate ESRD SECONDARY DIAGNOSIS: COPD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ after you were found to have low blood pressure and a fast heart rate at dialysis. You were given a medication to help slow your heart rate and keep you in a normal rhythm. You also had a few sessions of dialysis here to removal extra fluid. You had a repeat echocardiogram of your heart which shows that your heart is not pumping as well as it was a year and a half ago which is likely due to your history of high blood pressure and dialysis. WHAT TO DO NEXT: - Take all of your medications as prescribed. - Keep all of your dialysis appointments. - Weigh yourself daily and call your doctor if your weight increases by more than 3 pounds in one day. - Avoid eating more than 2g of salt per day and drinking more than 2L of fluid per day. - Please follow up with your cardiologist and primary care physician as scheduled for you. Please seek immediate medical care if you develop chest pain, trouble breathing, or pass out. We wish you the best in health moving forward, Your ___ Care 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 changes in your behavior and concern about your temperature being a little higher than usual WHAT HAPPENED TO ME IN THE HOSPITAL? - While you were in the hospital, we found that you were dehydrated and the salt level in your blood was too high. We gave you fluid to fix this. - You also had some kidney injury which was also improved by the fluids. - We found that your INR level was too high, so we held your warfarin. On the day of your discharge was 3.1. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Continue to take all your medicines and keep your appointments. - Continue to try to drink in fluids and eat soft foods as much as possible - Restart your Coumadin only after your INR level is less than 3. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 4. Baclofen 5 mg PO BID 5. Docusate Sodium 100 mg PO BID 6. Doxycycline Hyclate 100 mg PO Q12H 7. Fluconazole 200 mg PO Q24H 8. metaxalone 800 mg oral DAILY 9. OxyCODONE (Immediate Release) 60 mg PO Q6H 10. OxyCODONE (Immediate Release) 15 mg PO Q3H:PRN BREAKTHROUGH PAIN 11. Vesicare (solifenacin) 5 mg oral DAILY 12. Vitamin C With Rose Hips (ascorbic acid (vitamin C);<br>ascorbic acid-ascorbate sodium) 500 mg oral BID 13. Warfarin 4 mg PO DAILY16 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: NSTEMI Secondary Diagnosis: History of DVT/PE Paraplegia with chronic pain Sacral and heel pressure ulcers 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 has been a pleasure caring for you at ___. Why was I here? -You were here because you had chest pain. What was done while I was here? -We looked in your arteries and we found that there is some blockage but not enough to require a procedure. -Your heart artery problem will be managed by medicines. What should I do when I get home? -You should follow up with your cardiologist. -Please look at your medication list for any new meds and changes. 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. Colchicine 0.6 mg PO BID 2. Cyclobenzaprine 10 mg PO BID 3. Hiprex (methenamine hippurate) 1 gram oral BID 4. Rivaroxaban 20 mg PO DAILY 5. Zolpidem Tartrate 10 mg PO HS:PRN Insomnia 6. TraMADOL (Ultram) 50-100 mg PO QID 7. Ondansetron 4 mg PO Q8H:PRN Nausea 8. Outpatient Physical Therapy 9. Outpatient Speech/Swallowing Therapy 10. Nitrofurantoin Monohyd (MacroBID) 100 mg PO Q12H Please discuss this with the provider who manages your urinary difficulties RX *nitrofurantoin monohyd/m-cryst 100 mg 1 capsule(s) by mouth twice daily Disp #*14 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Right-sided weakness Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to the Stroke Service at ___ ___ after presenting with right-sided weakness. MRI of your brain was negative for evidence of stroke. Your were noted to have a large number of white blood cells in your urine, suggesting the possibility of a urinary tract infection. You had recently completed a 7 day course of Macrobid. You were restarted on another 7 day course of Macrobid. However, you should discuss this with the physician who manages your urinary difficulties to see if this is the treatment he/she would like you to have based on your prior urine culture results. A urine culture is pending at ___ at the time of discharge.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Medical Equipment One hospital bed for aspiration pneumonia. ICD-10-CM J69.0 2. Aspirin 81 mg PO DAILY 3. Donepezil 10 mg PO QHS 4. Finasteride 5 mg PO DAILY 5. Latanoprost 0.005% Ophth. Soln. 1 DROP RIGHT EYE QHS 6. Timolol Maleate 0.5% 1 DROP RIGHT EYE QHS 7. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 tablet(s) by mouth at bedtime Disp #*60 Tablet Refills:*3 8. Acetaminophen 650 mg PO BID:PRN pain 9. Ascorbic Acid ___ mg PO DAILY 10. Cyanocobalamin 100 mcg PO DAILY 11. docosahexanoic acid-epa 1 g ORAL DAILY 12. melatonin 1 mg ORAL QHS 13. Multivitamins 1 TAB PO DAILY 14. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp #*60 Tablet Refills:*3 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: -hypoxia secondary to aspiration pneumonia -possible COPD exacerbation -global systolic dysfunction, unclear etiology -acute on chronic subdural hemorrhage SECONDARY: -bulbar dysfunction -dementia 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 ___ because of problems breathing. Based on your history and imaging, we think you may have aspirated, or choked, leading to an infection of your lungs. You were started on IV antibiotics and assessed by our speech and swallow pathologists. They felt you were having significant problems swallowing. You should continue to be very careful when you eat because you are at risk for aspirating which can lead to pneumonia and even death. You are now on a modified diet for your safety. You were also noted to have an old bleed on the CT scan of your head. Most of this was old, although there were some signs of a new bleed. Please be careful on your feet, as every fall may put you at risk for worsening bleed. You should call your doctor immediately if you have any worsening weakness or other concerning symptoms. Finally, you were also noted to have decreased heart function. Please call your doctor if you have chest pain, gain >3lb or notice worsening swelling of your legs. It was a pleasure taking part in your care, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Glucerna Shake (nut.tx.gluc.intol,lac-free,soy) 3 bottle oral TID W/MEALS RX *nut.tx.gluc.intol,lac-free,soy [Glucerna] ___ BOTTLE by mouth TID with meals Disp ___ Milliliter Milliliter Refills:*3 2. Glargine 10 Units Breakfast Glargine 10 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 3. Lactulose 30 mL PO QID RX *lactulose 10 gram/15 mL (15 mL) 30 ml by mouth four times a day Disp #*180 Bolus Refills:*0 4. Spironolactone 50 mg PO DAILY 5. Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing 6. Betamethasone Dipro 0.05% Cream 1 Appl TP BID 7. BuPROPion (Sustained Release) 150 mg PO QAM 8. Calcipotriene 0.005% Cream 1 Appl TP BID 9. Fluticasone Propionate 110mcg 2 PUFF IH BID 10. Fluticasone Propionate NASAL 2 SPRY NU DAILY 11. Loratadine 10 mg PO DAILY 12. Montelukast 10 mg PO DAILY 13. Multivitamins 1 TAB PO DAILY 14. Ondansetron 4 mg PO Q4H:PRN nausea 15. PALIperidone Palmitate 410 mg IM Q10WEEKS 16. Rifaximin 550 mg PO BID 17. Ursodiol 300 mg PO TID 18. Vitamin B Complex 1 CAP PO DAILY 19. HELD- ammonium lactate ___ % PRN PRN This medication was held. Do not restart ammonium lactate until you see your primary care provider 20. HELD- Ascorbic Acid ___ mg PO DAILY This medication was held. Do not restart Ascorbic Acid until you see your primary care provider 21. HELD- Furosemide 20 mg PO DAILY This medication was held. Do not restart Furosemide until you see your primary care provider 22. HELD- Tolvaptan 30 mg PO DAILY This medication was held. Do not restart Tolvaptan until you see your primary care provider 23.Outpatient Lab Work ICD-9: 571.2 provider: ___ MD ___ Address: ___ Phone: (___) Test: LFT, albumin, coagulation profile, chem 10, CBC. 24.Radiology test ICD-9: 571.2 provider: ___ MD ___ Address: ___ Phone: (___) Test: chest x-ray Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: -___ Cirrhosis ___ B/C) -Hepatic hydrothorax -Pancytopenia -Coagulopathy -Hepatocellular carcinoma Secondary: -Bipolar vs. schizophrenia disorder -Asthma -Umbilical hernia -Type 2 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. ___, WHY WAS I ADMITTED? -You were admitted for shortness of breath and chest pain due to accumulation of fluid around your lungs. WHAT WAS DONE FOR ME WHILE I WAS IN THE HOSPITAL? -Your shortness of breath and chest pain was due to the fluid that accumulated around your lungs which is a complication of your liver disease. -Our colleagues in interventional pulmonology placed a tube in your chest to drain the fluid around your lungs which resulted in improvement of your breathing. They removed the tube once your breathing improved. -Your kidney function was worse than normal for you when you were admitted. We gave you a medication called albumin and held your diuretics ("water pills") in order to improve your kidney function. - Once you kidney function improved, we gave you diuretics ("water pills") as needed to reduce any re-accumulation of fluid around your lungs after the chest tube was removed. -Our colleagues in interventional radiology later performed a TIPS procedure to help decrease the pressure in your liver that is causing fluid to accumulate in your lungs and abdomen. WHAT SHOULD I DO WHEN I LEAVE THE HOSPITAL? - Please take all of your medications as prescribed. - Please follow up with your primary care physician ___ ___ days of discharge. Please call as soon as possible to schedule a follow up appointment. - Please follow up with ___ interventional radiology for your radio-frequency ablation procedure for treatment of your liver cancer. - Please follow up with your specialist providers at the ___ ___, with your hematologist in ___, and with any appointments listed in this summary. - If you haven any fever, chills, nausea, vomiting, weight gain, increased swelling, or shortness of breath please call your PCP or come to the emergency department. It was a pleasure caring for you at ___. Best Wishes, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Multivitamins W/minerals 1 TAB PO DAILY 2. Fludrocortisone Acetate 0.1 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: Generalized weakness NOS Malaise NOS 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 dysphagia and weakness. WHAT HAPPENED IN THE HOSPITAL? - You underwent electromyography (EMG) which was normal, meaning that your muscles are nerves are working normally. - Your labs including electrolyte, thyroid, adrenal, vitamins and minerals were normal. - Speech and swallow evaluation showed that your swallow function appears safe and functional. WHAT SHOULD YOU DO AT HOME? - Advance your diet as tolerated. - Increase your activity with physical therapy and exercise. 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. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for anxiety. 2. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 3. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO BID (2 times a day). 4. doxycycline hyclate 100 mg Capsule Sig: One (1) Capsule PO DAILY (Daily). 5. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) packet PO DAILY (Daily) as needed for constipation. 7. ferrous sulfate 300 mg (60 mg iron) Tablet Sig: One (1) Tablet PO DAILY (Daily). 8. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain or HA. 9. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q3H (every 3 hours) as needed for pain. Disp:*70 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Right colon lower gastrointestinal bleed 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 a lower GI bleed. You were taken to the operating room and had part of your colon removed. You have no further evidence of bleeding and are recovering well from the procedure. Your incisional staples will be removed at your follow up appointment listed below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for 6 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap.) You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. Heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. HOW YOU MAY FEEL: You may feel weak or "washed out" for 6 weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. You could have a poor appetite for a while. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Your incision may be slightly red around the staples. This is normal. You may gently wash away dried material around your incision. It is normal to feel a firm ridge along the incision. This will go away. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. Ove the next ___ months, your incision will fade and become less prominent. YOUR BOWELS: Constipation is a common side effect of medicine such as Percocet or dilaudid. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. After some operations, diarrhea can occur. If you get diarrhea, don't take anti-diarrhea medicines. Drink plenty of fluids and see if it goes away. If it does not go away, or is severe and you feel ill, please call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription from your surgeon for pain medicine to take by mouth. It is important to take this medicine as directied. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the folloiwng, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q12H:PRN pain 2. Aspirin 81 mg PO DAILY 3. Atorvastatin 80 mg PO DAILY 4. Cinacalcet 60 mg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. Fluticasone Propionate 110mcg 2 PUFF IH BID 7. LeVETiracetam 500 mg PO QHS take additional tab after dialysis ___ 8. Levothyroxine Sodium 75 mcg PO DAILY 9. Lidocaine 5% Patch 1 PTCH TD DAILY 10. Lorazepam 0.5 mg PO Q6H:PRN anxiety 11. Metoprolol Tartrate 100 mg PO DAILY 12. Omeprazole 20 mg PO DAILY 13. OxycoDONE (Immediate Release) 5 mg PO DAILY:PRN pain 14. sevelamer CARBONATE 800 mg PO TID W/MEALS 15. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN sob RX *albuterol sulfate 2.5 mg/3 mL (0.083 %) 2.5 mg INH Q6H:PRN Disp #*30 Vial Refills:*2 16. Albuterol Inhaler ___ PUFF IH Q4H:PRN sob 17. Losartan Potassium 50 mg PO DAILY 18. Nitroglycerin SL 0.4 mg SL PRN chest pain 19. Nebulizer machine Nebulizer machine 20. LeVETiracetam 500 mg PO DAYS (___) 21. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID RX *fluticasone-salmeterol [Advair Diskus] 250 mcg-50 mcg/Dose 1 puff INH twice a day Disp #*3 Inhaler Refills:*0 22. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY RX *isosorbide mononitrate [Imdur] 30 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: pulmonary hypertension Secondary: ESRD on HD, systolic congestive heart failure Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted for shortness of breath. This was likely due to worsening of your pulmonary hypertension as well as some excess fluid in your body. You underwent dialysis to remove fluid and were given inhalers and were feeling better. Please see the attached list for changes to your medications.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN pain do NOT exceed 3gm in 24 hours 2. Vitamin D 1000 UNIT PO DAILY 3. ProAir HFA (albuterol sulfate) 1 PUFF INHALATION DAILY:PRN SOB 4. Omeprazole 20 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Colonic mass with liver metastasis 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 presented to ___ on ___ ___ concerns of increasing redness and drainage from your prior abdominal debridement site. You had a CT scan and an ultrasound of your liver which were concerning for a cecal mass and new mass on your liver. You were admitted to the Acute Care Surgery team for further medical evaluation. On ___, you had a biopsy of your liver. The pathology report showed you to have adenocarcinoma. The Medicine and Hematology/Oncology teams are aware of your diagnosis and you have follow-up appointments scheduled with them as an outpatient (please see below). You also a follow-up scheduled with Dr. ___ in the ___ Care Surgery clinic. You are now medically cleared for discharge. Please note the following discharge instructions: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID 2. Bisacodyl 10 mg PO DAILY:PRN Constipation - First Line 3. CeFAZolin 2 g IV Q8H bacteremia/septic arthritis Last day of therapy is ___ 4. Diazepam 5 mg PO Q8H:PRN Spasm RX *diazepam 5 mg one tablet by mouth every 8hrs as needed Disp #*15 Tablet Refills:*0 5. Digoxin 0.25 mg PO DAILY 6. Diltiazem Extended-Release 480 mg PO DAILY 7. FoLIC Acid 1 mg PO DAILY 8. Gabapentin 200 mg PO TID 9. Ibuprofen 800 mg PO Q8H:PRN Pain - Moderate Duration: 10 Days Reason for PRN duplicate override: Alternating agents for similar severity 10. Metoprolol Succinate XL 300 mg PO DAILY 11. Multivitamins 1 TAB PO DAILY 12. Omeprazole 20 mg PO DAILY 13. OxyCODONE (Immediate Release) ___ mg PO Q3H:PRN Pain - Moderate RX *oxycodone 5 mg ___ tablet(s) by mouth every 3hrs as needed Disp #*30 Tablet Refills:*0 14. Ranitidine 150 mg PO DAILY 15. Senna 8.6 mg PO BID 16. Acetaminophen 1000 mg PO Q8H 17. HELD- adalimumab 40 mg/0.8 mL subcutaneous every 10 days This medication was held. Do not restart adalimumab until you are seen by rheumatology and the infection has cleared 18. HELD- AzaTHIOprine 150 mg PO DAILY This medication was held. Do not restart AzaTHIOprine until until you are seen by rheumatology and the infection has cleared 19. HELD- Hydroxychloroquine Sulfate 400 mg PO DAILY This medication was held. Do not restart Hydroxychloroquine Sulfate until until you are seen by rheumatology and the infection has cleared Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: L prosthetic joint infection, MSSA Sepsis from ___ blood stream infection Atrial fib with RVR 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 was I admitted to the hospital? -You were admitted because you had a severe infection of the left knee with spread of bacteria to your bloodstream. What happened while I was in the hospital? - You underwent washout of the left knee and then removal of all the joint hardware. There is now an antibiotic spacer and you will need 6 weeks of IV antibiotics to ensure clearance of the infection. You required brief ICU stays because of rapid heart rates and are doing much better with additional medications. 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 AVOID weight bearing on the left leg. 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. FoLIC Acid 1 mg PO DAILY 2. Multivitamins 1 TAB PO DAILY 3. Thiamine 100 mg PO DAILY 4. Escitalopram Oxalate 10 mg PO DAILY 5. Lisinopril 5 mg PO DAILY 6. Simvastatin 20 mg PO QPM Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSES: Hallucinations Likely underlying dementia SECONDARY DIAGNOSES: History of alcohol 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 Mr. ___, It was a pleasure caring for you at the ___ ___. WHY WAS I SEEN IN THE HOSPITAL? -You were confused and having hallucinations. WHAT HAPPENED WHILE I WAS IN THE HOSPITAL? -We treated you for alcohol withdrawal with medications through the IV. -You were persistently confused, and had been for some time. Some of this was likely related to the medicines for your withdrawal; some was likely slower and more gradual in onset. -We ruled out reversible causes of confusion, including tests for an infection of the brain. WHAT SHOULD I DO WHEN I LEAVE THE HOSPITAL? -Please take your medicines as prescribed. -Please follow up with your doctors as listed below. We wish you the best, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID RX *chlorhexidine gluconate [Peridex] 0.12 % Swish and spit 15mL Twice a day Disp #*500 Milliliter Refills:*0 RX *chlorhexidine gluconate [Peridex] 0.12 % Mouth rinse twice a day Disp #*1 Bottle Refills:*0 2. Cephalexin 500 mg PO Q6H RX *cephalexin 250 mg/5 mL 10 mL by mouth Four times a day Disp #*300 Milliliter Refills:*0 RX *cephalexin 250 mg/5 mL 280 Suspension for Reconstitution(s) by mouth every six (6) hours Disp #*1 Bottle Refills:*0 3. OxycoDONE-Acetaminophen Elixir ___ mL PO Q4H:PRN pain RX *oxycodone-acetaminophen [Roxicet] 5 mg-325 mg/5 mL ___ cc by mouth every four (4) hours Disp #*400 Milliliter Refills:*0 4. Docusate Sodium (Liquid) 100 mg PO BID hold for loose stool Discharge Disposition: Home Discharge Diagnosis: Bilateral Mandible Fracture 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 acute care surgery service after suffering a jaw fracture in order the Oral and Maxofacial Surgery (OMFS) could repair your jaw. They left the following instructions for you: 1. Take antibiotics for 1 week 2. Wash your mouth with Peridex 2x a day for 2 weeks 3. Please review jaw instructions placed in your chart. Wound care: Do not disturb or probe the surgical area with any objects. The sutures placed in your mouth are usually the type that self dissolve. If you have any sutures on the skin of your face or neck, your surgeon will remove them on the day of your first follow up appointment. SMOKING is detrimental to healing and will cause complications. Bleeding: Intermittent bleeding or oozing overnight is normal. Placing fresh gauze over the area and biting on the gauze for ___ minutes at a time may control the bleeding. If you had nasal surgery, you may have occasional slow oozing from your nostril for the first ___ days. Bleeding should never be severe. If bleeding persists or is severe or uncontrollable, please call our office immediately. If it is after normal business hours, please come to the emergency room and request that the oral surgery resident on call be paged. ___: Normal healing after oral surgery should be as follows: the first ___ days after surgery, are generally the most uncomfortable and there is usually significant swelling. After the first week, you should be more comfortable. The remainder of your postoperative course should be gradual, steady improvement. If you do not see continued improvement, please call our office. Physical activity: It is recommended that you not perform any strenuous physical activity for a few weeks after surgery. Do not lift any heavy loads and avoid physical sports unless you obtain permission from your surgeon. Swelling & Ice applications: Swelling is often associated with surgery. Swelling can be minimized by using a cold pack, ice bag or a bag of frozen peas wrapped in a towel, with firm application to face and neck areas. This should be applied 20 minutes on and 20 minutes off during the first ___ days after surgery. If you have been given medicine to control the swelling, be sure to take it as directed. Hot applications: Starting on the ___ or ___ day after surgery, you may apply warm compresses to the skin over the areas of swelling (hot water bottle wrapped in a towel, etc), for 20 minutes on and 20 min off to help soothe tender areas and help to decrease swelling and stiffness. Please use caution when applying ice or heat to your face as certain areas may feel numb after surgery and extremes of temperature may cause serious damage. Tooth brushing: Begin your normal oral hygiene the day after surgery. Soreness and swelling may nor permit vigorous brushing, but please make every effort to clean your teeth with the bounds of comfort. Any toothpaste is acceptable. Please remember that your gums may be numb after surgery. To avoid injury to the gums during brushing, use a child size toothbrush and brush in front of a mirror staying only on teeth. Mouth rinses: Keeping your mouth clean after surgery is essential. Use 1 teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking 5 min to use the entire glassful. Repeat as often as you like, but you should do this at least 4 times each day. If your surgeon has prescribed a specific rinse, use as directed. Showering: You may shower ___ days after surgery, but please ask your surgeon about this. If you have any incisions on the skin of your face or body, you should cover them with a water resistant dressing while showering. DO NOT SOAK SURGICAL SITES. This will avoid getting the area excessively wet. As you may physically feel weak after surgery, initially avoid extreme hot or cold showers, as these may cause some patients to pass out. Also it is a good idea to make sure someone is available to assist you in case if you may need help. Sleeping: Please keep your head elevated while sleeping. This will minimize swelling and discomfort and reduce pain while allowing you to breathe more easily. One or two pillows may be placed beneath your mattress at the head of the bed to prop the bed into a more vertical position. Pain: Most facial and jaw reconstructive surgery is accompanied by some degree of discomfort. You will usually have a prescription for pain medication. Some patients find that stronger pain medications cause nausea, but if you precede each pain pill with a small amount of food, chances of nausea will be reduced. The effects of pain medications vary widely among individuals. If you do not achieve adequate pain relief at first you may supplement each pain pill with an analgesic such as Tylenol or Motrin. If you find that you are taking large amounts of pain medications at frequent intervals, please call our office. If your jaws are wired shut with elastics, you may have been prescribed liquid pain medications. Please remember to rinse your mouth after taking liquid pain medications as they can stick to the braces and can cause gum disease and damage teeth. Diet: Unless otherwise instructed, only a cool, clear liquid diet is allowed for the first 24 hours after surgery. After 48 hours, you can increase to a full liquid diet, but please check with your doctor before doing this. Avoid extreme hot and cold. If your jaws are not wired shut, then after one week, you may be able to gradually progress to a soft diet, but ONLY if your surgeon instructs you to do so. It is important not to skip any meals. If you take nourishment regularly you will feel better, gain strength, have less discomfort and heal faster. Over the counter meal supplements are helpful to support nutritional needs in the first few days after surgery. A nutrition guidebook will be given to you before you are discharged from the hospital. Remember to rinse your mouth after any food intake, failure to do this may cause infections and gum disease and possible loss of teeth. Nausea/Vomiting: Nausea is not uncommon after surgery. Sometimes pain medications are the cause. Precede each pill with a small amount of soft food. Taking pain pills with a large glass of water can also reduce nausea. Try taking clear fluids and minimizing taking pain medications, but call us if you do not feel better. If your jaws are wired shut with elastics and you experience nausea/vomiting, try tilting your head and neck to one side. This will allow the vomitus to drain out of your mouth. If you feel that you cannot safely expel the vomitus in this manner, you can cut elastics/wires and open your mouth. Inform our office immediately if you elect to do this. If it is after normal business hours, please come to the emergency room at once, and have the oral surgery on call resident paged. ___ Instructions: If you have had a bone ___ or soft tissue ___ procedure, the site where the ___ was taken from (rib, head, mouth, skin, clavicle, hip etc) may require additional precautions. Depending on the site of the ___ harvest, your surgeon will instruct you regarding specific instructions for the care of that area. If you had a bone ___ taken from your hip, we encourage you to ambulate on the day of surgery with assistance. It is important to start slowly and hold onto stable structures while walking. As you progressively increase your ambulation, the discomfort will gradually diminish. If you have any problems with urination or with bowel movements, call our office immediately. Elastics: Depending on the type of surgery, you may have elastics and/or wires placed on your braces. Before discharge from the hospital, the doctor ___ instruct you regarding these wires/elastics. If for any reason, the elastics or wires break, or if you feel your bite is shifting, please call our office.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. FoLIC Acid 1 mg PO DAILY 3. LeVETiracetam 500 mg PO BID 4. Nicotine Lozenge 4 mg PO Q1H:PRN withdrawl 5. Propranolol 20 mg PO BID 6. Thiamine 100 mg PO DAILY 7. methylphenidate 50 mg oral daily 8. Multivitamins 1 TAB PO DAILY 9. Sildenafil 100 mg PO PRN sexual activity Discharge Disposition: Home Discharge Diagnosis: primary: EtOH dependence secondary: h/o seizure disorder 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 to the hospital for alcohol withdrawal, and requesting assistance with sobriety. During your stay you did not require many doses of medication for withdrawal, and you had no sign of instability or seizure. It is important for your recovery that you work with your Social Worker, Psychiatrist, and Psychologist to help you have a sustained sobriety. You were given a list of locations for possible partial programs by social work on discharge. We have made no changes to your medications. Please follow-up with your primary care physician as listed below. Best of luck on your recovery and sobriety.</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 [Adult Low Dose Aspirin] 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Albuterol Inhaler 2 PUFF IH Q4H:PRN Shortness of Breath 3. Cyclobenzaprine 10 mg PO TID:PRN Back Spasm 4. TraMADOL (Ultram) 50 mg PO Q4H:PRN Pain Discharge Disposition: Home Discharge Diagnosis: Sensory Changes of Unknown Etiology, likely cervical muscle tension vs. cervical radiculopathy. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted for concern of carotid dissection. However, on review of your imaging and of your symptoms, you do not have a carotid artery dissection. It is likely an artifact on imaging. We recommend you continue aspirin for primary prevention of stroke and to have repeat imaging in ___ weeks. There were no other changes to your home medications. Please follow up with neurology after your repeat brain imaging. Your symptoms of sensory changes are likely due to muscular neck tension or cervical radiculopathy. Sincerely, Your ___ Neurology Team</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 #*60 Tablet Refills:*0 2. Lisinopril 2.5 mg PO QHS RX *lisinopril 2.5 mg 1 tablet(s) by mouth at bedtime Disp #*60 Tablet Refills:*0 3. Rosuvastatin Calcium 20 mg PO QPM RX *rosuvastatin [Crestor] 20 mg 1 tablet(s) by mouth at bedtime Disp #*60 Tablet Refills:*0 4. Multivitamins 1 TAB PO DAILY 5. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*60 Tablet Refills:*0 6. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN Chest pain RX *nitroglycerin 0.4 mg 1 tablet(s) sublingually as needed if chest pain Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: -Acute Myocardial Infarction (NSTEMI) s/p 2 DES to RCA/PDA -Hypertension Secondary Diagnosis: -Hyperlipidemia -Asymptomatic Leukocytosis 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 ___ on ___ after you experienced some nausea and an EKG showed changes concerning for heart injury. You underwent catheterization which found a block on one of your main arteries, so 2 stents were placed. Your heart rates were also initially slow, but have improved with the stents placed. You were ordered for a Holter Monitor to monitor your heart rate after your hospital discharge. You are able to pick up this monitor at this hospital tomorrow (___). You should call them at ___ before you come to find out their location and to schedule your appointment. You were started on Aspirin and Plavix, and it is extremely important that you take both these medications every day. Missing a single dose can cause a life-threatening blood clot to form in your stent. If you experience any new chest pain, shortness of breath, arm or jaw pain, or nausea, please contact your physician or come to the nearest Emergency Room. You should also notify your doctor if you feel lightheaded or dizzy as these might be signs of your heart rate slowing down. We wish you the best Your ___ Care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, WHAT BROUGHT YOU INTO THE HOSPITAL? You were referred from clinic as a result of high blood pressure and a headache. WHAT DID WE DO FOR YOU IN THE HOSPITAL? In the hospital, we checked your sodium level, and it was low (123). We think your sodium was low as a result of the indapamide medication. You had stopped the indapamide medication prior to coming to the hospital. We restricted your water intake to 1L and gave you salt tablets. Your sodium level was 131 upon leaving the hospital. WHAT SHOULD YOU DO AFTER LEAVING THE HOSPITAL? -You should maintain fluid restriction of 1 L at home until you see Dr. ___. -You should check your blood pressure prior to taking your clonidine. You should not take your oral clonidine if your systolic blood pressure (top number) is less than 110. -You should follow-up with your primary care doctor, ___ on ___. We wish you the very best. It was a pleasure taking care of you in the hospital. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing/sob 3. ARIPiprazole 10 mg PO DAILY 4. Benzonatate 200 mg PO TID 5. Docusate Sodium 100 mg PO BID 6. Fluoxetine 20 mg PO DAILY 7. Gabapentin 300 mg PO BID 8. Heparin 5000 UNIT SC TID 9. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*40 Tablet Refills:*0 10. Pantoprazole 40 mg PO Q24H 11. Pilocarpine 4% 1 DROP RIGHT EYE QID 12. Salmeterol Xinafoate Diskus (50 mcg) 1 INH IH Q12H 13. Simvastatin 40 mg PO QPM 14. Timolol Maleate 0.5% 1 DROP RIGHT EYE BID 15. Tiotropium Bromide 1 CAP IH DAILY Discharge Disposition: Extended Care Facility: ___ 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>Ms. ___, You were admitted to ___ for abdominal pain. You were found to have acute cholecystitis. Based on the duration of your symptoms and your past medical history, it was decided that you under go a percutaneous cholecystostomy instead of having an operation to remove your gallbladder at this time. You tolerated the procedure well and now you are ready to be discharged from the hospital. Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. JP Drain Care: *Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *Maintain suction of the bulb. *Note color, consistency, and amount of fluid in the drain. Call the doctor, ___, or ___ nurse if the amount increases significantly or changes in character. *Be sure to empty the drain frequently. Record the output, if instructed to do so. *You may shower; wash the area gently with warm, soapy water. *Keep the insertion site clean and dry otherwise. *Avoid swimming, baths, hot tubs; do not submerge yourself in water. 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. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID-TID as needed for anxiety. 2. metformin 500 mg Tablet Extended Rel 24 hr Sig: One (1) Tablet Extended Rel 24 hr PO once a day. 3. venlafaxine 150 mg Capsule, Ext Release 24 hr Sig: One (1) Capsule, Ext Release 24 hr PO once a day. 4. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 5. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 6. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable PO DAILY (Daily). Disp:*30 Tablet, Chewable(s)* Refills:*2* 7. warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 ___. Disp:*30 Tablet(s)* Refills:*2* 8. metoprolol succinate 100 mg Tablet Extended Release 24 hr Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily). Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2* 9. spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). Disp:*30 Tablet(s)* Refills:*2* 10. enoxaparin 100 mg/mL Syringe Sig: One (1) Subcutaneous DAILY (Daily). Disp:*7 7* Refills:*0* 11. furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a day). Disp:*30 Tablet(s)* Refills:*1* Discharge Disposition: Home Discharge Diagnosis: Primary: New severe systolic congestive heart failure Secondary: Hypertension Diabetes Mellitus Type 2 Hyperlipidemia Obesity 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 the hospital because you were short of breath. This was due to fluid in your lungs. We worked you up for different causes of this problem. On echocardiogram, we determined that your heart is enlarged and that it was not pumping as well as it should be (we call this "heart failure"). We performed a stress test to find if there were any blockages in the arteries, but were unable to find any. We also had you sent for a cardiac catheterization in order to determine the pressures in the chambers of your heart, and to look for any hidden blockages in the vessels of your heart. We did not find any problems in the vessels of your heart, but foudn that you still had some extra fluid that should come out. We gave you some more diuretics and will send you home with daily diuretic therapy. As we discussed, it is VERY important that you quit smoking. This is the most important thing that you can do for your health. Also, we think it would be best if you did not exert yourself at work physically. We understand that part of your job description is to restrain some patients, but we do not think it is in your best interest to strain yourself in this way. Please discuss with the people at your work about limiting this role. You should weigh yourself every morning and record the result. If your weight goes up by more than 3 pounds you should call your cardiologist Dr. ___ this is a sign that you are keeping extra fluid in your body. Please speak with your primary care physician, ___, ___ a sleep study. Here are the changes we have made to your medications: ___ taking aspirin ___ taking metoprolol ___ taking spironolactone ___ taking atorvastatin ___ taking warfarin - you will need your INR checked regularly to determine the appropriate dosing ___ taking lovenox until instructed by Dr. ___ the ___ anti-coagulation nurses ___ taking lasix (furosemide)</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 headache 2. LeVETiracetam 1000 mg PO BID RX *levetiracetam 1,000 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Sertraline 150 mg PO DAILY AM Discharge Disposition: Home Discharge Diagnosis: Left frontal brain lesion 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 seizures and new finding of left frontal brain lesion. You were started on Keppra, this medication prevents seizures, you should continue to take this medication. Continue your home medications You may take tylenol as needed for headaches. Do not take any products containing aspirin do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, and Ibuprofen etc. Exercise should be limited to walking; no lifting, straining, or excessive bending. Clearance to drive and return to work will be addressed at your post-operative office visit.</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 daily Disp #*30 Tablet Refills:*3 2. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*3 3. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 4. Atorvastatin 40 mg PO QPM 5. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 6. dextran 70-hypromellose 0.1-0.3 % ophthalmic BID 7. Docusate Sodium 100 mg PO BID 8. Pantoprazole 40 mg PO Q24H Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: TIA Secondary diagnosis: Left supraclinoid internal carotid artery occlusion. Filling of the left hemisphere via pial collaterals from the left anterior cerebral artery. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of temporary difficulty speaking and a right facial droop resulting from an TRANSIENT ISCHEMIC ATTACK or "TIA", a condition where a blood vessel providing oxygen and nutrients to the brain is temporarily blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Fortunately, the MRI of your brain did NOT show a NEW stroke so these symptoms likely represented a TIA. TIA 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: -Blocked blood vessels in the brain due to atherosclerosis or plaque -High cholesterol Please take your medications as prescribed: -Aspirin 81mg daily, Plavix 75mg daily, Lipitor 40mg daily Please also allow your blood pressure to run high (goal SBP 110-140, may run up to 180). Please ensure you stay hydrated and eat a normal amount of salt, as your blood pressure dropped slightly while standing on your day of discharge from the hospital. 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. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron HCl 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*10 Tablet Refills:*0 2. levonorgestrel-ethinyl estrad 0.15 - 0.03 - 0.01 oral DAILY Discharge Disposition: Home Discharge Diagnosis: Primary: Abdominal pain Nausea and Vomiting Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted to ___ because you were having abdominal pain and nausea with vomiting. You were observed while you were here and your symptoms improved. We do not know exactly what caused your symptoms but we do not think it is something dangerous or life-threatening. When you go home, please follow-up with your primary care doctor and ___ urologist. 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. Allopurinol ___ mg PO DAILY 2. Atorvastatin 10 mg PO QPM 3. Hydrocortisone Acetate Suppository ___ID:PRN pain/itching 4. Levothyroxine Sodium 88 mcg PO DAILY 5. Lisinopril 10 mg PO QHS Please give in evening. 6. Metoprolol Succinate XL 50 mg PO DAILY 7. MetFORMIN XR (Glucophage XR) 500 mg PO DAILY 8. MetFORMIN (Glucophage) 500 mg PO DAILY 9. Omeprazole 20 mg PO DAILY 10. Polyethylene Glycol 17 g PO DAILY 11. Simethicone 80 mg PO QID:PRN gas/epigastric pain 12. Fluticasone Propionate NASAL 2 SPRY NU DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Constipation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>___, we believe your severe pain in your rectum was due to constipation. After you were disimpacted and you had the enema you felt better. Stopping some medications and taking a fiber every day will help prevent this from happening in future. You were very weak and we have sent you to a rehab to become stronger.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Multivitamins 1 TAB PO DAILY 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*10 Tablet Refills:*0 4. Tamsulosin 0.8 mg PO HS 5. Vitamin D 1000 UNIT PO DAILY 6. albuterol sulfate *NF* 90 mcg/actuation Inhalation q4 PRN dyspnea 7. Ondansetron 8 mg PO Q8H:PRN nausea 8. Metoprolol Succinate XL 75 mg PO DAILY RX *metoprolol succinate 25 mg 3 tablet extended release 24 hr(s) by mouth daily Disp #*90 Tablet Refills:*0 9. Sildenafil *NF* 100 mg ORAL DAILY PRN sex ___. Levofloxacin 750 mg PO DAILY please stop taking this medication after ___ RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: 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>Dear Mr. ___, You were admitted to the hospital for high fevers, headaches, neck pain, and overall because you were feeling unwell. We initially placed you on several antibiotics and tested your blood for several infections. None of these tests showed the specific infection you may have. We also took several CT scans of your head, neck, chest, and abdomen, none of which showed anything concerning for infection. Because of an abnormality on your CT head, we also got an MRI of your head and performed a lumbar puncture, which were all reassuring. We think you had a viral illness, from which your body is slowly recovering.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lansoprazole Oral Disintegrating Tab 30 mg PO BID 2. PHENObarbital 129.6 mg PO HS 3. Phenytoin Sodium Extended 400 mg PO HS 4. AtroVENT (ipratropium bromide) 0.06 % nasal TID: PRN PND 5. Morphine Sulfate (Concentrated Oral Soln) ___ mg PO Q2H:PRN pain 6. OLANZapine (Disintegrating Tablet) 5 mg PO Q4H:PRN delirium/restlessness RX *olanzapine 5 mg 1 (One) tablet,disintegrating(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 7. Scopolamine Patch 1 PTCH TD Q72H RX *scopolamine base [Transderm-Scop] 1.5 mg/72 hour Apply to dry area of skin Q 72 hours Disp #*30 Each Refills:*0 8. Lidocaine 5% Patch 1 PTCH TD QAM painful area RX *lidocaine [Lidoderm] 5 % (700 mg/patch) apply to painful area once a day (12 hours on, 12 hours off) Disp #*30 Each Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY: -Breast cancer most likely metastatic to liver and lung -Urinary tract infection -Hyponatremia SECONDARY: -Factor V ___ -History of DVTs -Seizure disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure to take care of you at ___ ___. You were admitted to the hospital because of falls and difficulties with your balance. You were found to have breast cancer that was most likely metastatic to the lung and liver. You declined a biopsy of your liver to further characterize the mass and evaluate you for treatment. You had a urinary tract infection which was treated with antibiotics. After discussion with your family and oncology doctors, you decided to return home with hospice care. You should also talk to your primary neurologist about your seizure medications. The neurologist you saw here recommended the following changes in order to reduce sedation but prevent seizures: - stop Phenytoin Sodium Extended 400 mg PO HS - start Phenytoin 150mg in the morning and 200mg at bedtime</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetylcysteine 20% ___ mL NEB Q12H 2. Albuterol Inhaler 2 PUFF IH BID 3. Guaifenesin ER 1200 mg PO Q12H 4. Hydrochlorothiazide 12.5 mg PO DAILY 5. HydrOXYzine 50 mg PO QID:PRN allergies 6. Omeprazole 40 mg PO BID 7. Sertraline 100 mg PO DAILY 8. TraZODone 50 mg PO QHS:PRN sleep 9. budesonide-formoterol 160-4.5 mcg/actuation INHALATION BID 10. sodium chloride 0.9 % inhalation Q6H 11. Sodium Chloride 3.5 % INHALATION Q12H Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: - Idiopathic Tracheal Stenosis Secondary Diagnosis: - Asthma - Depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you during your hospitalization. You were admitted with shortness of breath. We feel this is due to your known tracheal stenosis. You were closely monitored in the ICU given your risk for airway compromise. You underwent tracheal dilitation with the interventional pulmonologists. You will need to follow up with the interventional pulmonologists for a repeat bronchoscopy with posible cryo therapy or stenting in the near future. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Rivaroxaban 15 mg PO BID bid with food for 21 days, then 20mg tablet with dinner for 6 months RX *rivaroxaban [___] 15 mg (42)- 20 mg (9) 1 tablets(s) by mouth use as directed on packet Disp #*1 Dose Pack Refills:*0 Discharge Disposition: Home Discharge Diagnosis: acute pulmonary embolism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>you were hospitalized with pulmonary embolisim (blood clot in blood vessel to lungs) this is caused by period of immobility when blood clot can form in lung or other risk factors that lead to more clotting of blood. it is treated with medication to thin the blood to make it less able to clot so that with time the blood clot can break up on its own. the medication you are taking should be taken with food. for the first 21 days take it twice a day (15mg tablet), then you will be taking 20mg tablet once a day with evening meal. you will take this medication for 6 months. PLEASE TELL ANY DENTIST, DOCTOR, OR NURSE THAT YOU ARE ON RIVAROXABAN BEFORE YOU HAVE ANY PROCEDURE, BIOPSY, OR SURGERY. IT CAN CAUSE EXCESS BLEEDING FROM THOSE PROCEDURES. YOU MAY NEED TO TAKE ANOTHER MEDICATION AS A SUBSTITUTE BEFORE SUCH PROCEDURES IF THEY ARE NEEDED IN THE NEXT 6 MONTHS. this medication interferes with your bodies ability to clot, so there is risk of serious bleeding. bleeding can even be fatal if you have head injury and bleed into brain or other trauma and severe blood loss from gastrointestinal bleeding. please seek medical help right away if you have bleeding from any part of the body or feel weak, tired or out of breath omeprazole is anti-reflux medicine over the counter</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Nafcillin 2 g IV Q4H 2. Torsemide 30 mg PO DAILY RX *torsemide 10 mg 3 tablet(s) by mouth once a day Disp #*90 Tablet Refills:*0 3. Allopurinol ___ mg PO DAILY 4. Ferrous Sulfate 325 mg PO BID 5. Fluticasone Propionate NASAL 1 SPRY NU DAILY 6. Levothyroxine Sodium 25 mcg PO DAILY 7. Lisinopril 5 mg PO DAILY 8. Metoprolol Succinate XL 100 mg PO DAILY 9. Pravastatin 40 mg PO QAM 10. Rivaroxaban 15 mg PO DAILY 11. Tamsulosin 0.4 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Suspected infection of left external iliac to femoral bifurcation bypass graft Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for management of sepsis and bacteremia with a possible endovascular graft infection. You were monitored and treated conservatively with intravenous antibiotics. You have now recovered from your infection and are ready to be discharged. Please follow the instructions below to continue your recovery: WHAT TO EXPECT: 1. It is normal to feel tired, this will last for ___ weeks • You should get up out of bed every day and gradually increase your activity each day • You may walk and you may go up and down stairs • Increase your activities as you can tolerate- do not do too much right away! 2. It is normal to have a decreased appetite, your appetite will return with time • You will probably lose your taste for food and lose some weight • 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 healing and recovery • To avoid constipation: eat a high fiber diet and use stool softener while taking pain medication MEDICATION: • Continue your intravenous antibiotic for 6 weeks, as instructed • Follow your discharge medication instructions ACTIVITIES: • No driving until post-op visit and you are no longer taking pain medications • You should get up every day, get dressed and walk • You should gradually increase your activity • You may up and down stairs, go outside and/or ride in a car • Increase your activities as you can tolerate- do not do too much right away! CALL THE OFFICE FOR: ___ • A sudden increase in pain that is not controlled with pain medication • Temperature greater than 100.5F for 24 hours</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. ALPRAZolam 0.25 mg PO TID:PRN anxiety 2. Fentanyl Patch 300 mcg/h TD Q48H 3. Furosemide 40 mg PO DAILY 4. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN wheezing or shortness of breath 5. Lactulose 15 mL PO Q8H:PRN constipation 6. Lidocaine 5% Patch 1 PTCH TD 12 HOURS ON/WE HOURS OFF 7. Morphine Sulfate ___ 15 mg PO Q6H:PRN dyspnea 8. OxycoDONE (Immediate Release) 40 mg PO Q3H:PRN pain 9. Polyethylene Glycol 17 g PO DAILY:PRN constipation 10. Prochlorperazine 10 mg PO Q8H:PRN nausea 11. Senna 8.6 mg PO BID:PRN constipation 12. Dexamethasone 2 mg PO Q12H RX *dexamethasone 2 mg 1 tablet(s) by mouth twice a day Disp #*40 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Metastatic Renal Cell Carcinoma Brain Metastases Hemoptysis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, It was a pleasure taking care of you here at ___ ___. You were admitted to the hospital because you were coughing up blood. This improved when your blood thinner was stopped. The underlying cause is the cancer in your lungs. For now we will keep your blood thinner on hold. You were also evaluated for the cancer in your brain and spine. You were given steroids to help with the swelling around the tumor. We are working on arrangements for radiation for this.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ondansetron 4 mg PO Q8H:PRN Nausea/Vomiting - First Line RX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 2. Acetaminophen 650 mg PO Q8H:PRN Pain - Mild 3. albuterol sulfate 90 mcg/actuation inhalation ASDIR 4. Allopurinol ___ mg PO EVERY OTHER DAY 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 80 mg PO DAILY 7. Cinacalcet 60 mg PO DAILY 8. Clopidogrel 75 mg PO DAILY 9. Docusate Sodium 100 mg PO BID 10. Guaifenesin-CODEINE Phosphate 10 mL PO Q4H:PRN cough 11. Ipratropium-Albuterol Neb 1 NEB NEB Q4H:PRN cough/wheeze/chest/congestion/SOB 12. Isosorbide Mononitrate (Extended Release) 60 mg PO DAILY 13. Lactulose 30 mL PO TID:PRN constipation 14. Lisinopril 5 mg PO DAILY 15. Metoprolol Succinate XL 25 mg PO DAILY 16. Montelukast 10 mg PO DAILY 17. Naphazoline-Pheniramine Ophth. Solution 1 DROP BOTH EYES QID:PRN pruritus 18. Nepro Carb Steady (nut.tx.imp.renal fxn,lac-reduc) 0.08 gram-1.8 kcal/mL oral DAILY:PRN 19. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 20. OxyCODONE--Acetaminophen (5mg-325mg) 2 TAB PO DAILY 21. Pantoprazole 40 mg PO Q12H 22. Ranitidine 300 mg PO QHS 23. Senna 8.6 mg PO BID 24. sevelamer CARBONATE 2400 mg PO TID W/MEALS 25. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation BID 26. Tetracaine 0.5% Ophth Soln 1 DROP BOTH EYES Q4H:PRN pruritus 27. Triphrocaps (B complex with C#20-folic acid) 1 mg oral DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES #Nausea, vomiting #Coronary artery disease #Elevated troponin SECONDARY DIAGNOSES #End-stage renal disease on hemodialysis 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 our pleasure taking care of you at the ___ ___! WHAT BROUGHT YOU TO THE HOSPITAL? - You were having recurrent nausea and vomiting after eating. WHAT HAPPENED IN THE HOSPITAL? - The Cardiologists saw you in the Emergency Department. They do not think the nausea and vomiting were related to your cardiac issues. However, they do think you would benefit from a stress test in the future. - Our Gastroenterologists saw you for your nausea and vomiting with meals. - You underwent a CT scan of the abdomen and pelvis, which did not show any significant abnormality. - Overall, the reason for your nausea and vomiting could not be determined; there is some concern that it may be related to your digoxin. You will need to come back for an esophagogastroduodenoscopy (EGD), which is when a special camera is inserted down the esophagus to examine your stomach and small bowel. This will help determine the cause of your nausea/vomiting with eating. - You were given medications to treat your nausea and vomiting, which helped you eat without vomiting. This can be taken as needed. - You underwent dialysis based on your regular schedule. WHAT SHOULD YOU DO ONCE YOU GO HOME? - Please take your medications as prescribed and attend your doctor's appointments. Please DO NOT TAKE your digoxin. - Please follow up with the Gastroenterologists. You can call ___ to make a follow-up appointment for the EGD. - Please follow up with the Cardiologists for a repeat stress test. 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. Amlodipine 2.5 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. BuPROPion (Sustained Release) 150 mg PO QAM 4. Fish Oil (Omega 3) 1000 mg PO BID 5. Levothyroxine Sodium 25 mcg PO DAILY 6. Multivitamins 1 TAB PO DAILY 7. Pramipexole 0.125 mg PO DAILY 8. Tamsulosin 0.4 mg PO QHS 9. Vitamin D ___ UNIT PO DAILY 10. Acetaminophen 650 mg PO QID RX *acetaminophen 325 mg 2 tablet(s) by mouth four times a day Disp #*100 Tablet Refills:*0 11. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*40 Capsule Refills:*0 12. Enoxaparin Sodium 30 mg SC Q24H Duration: 14 Days Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 30 mg/0.3 mL 30 mg once a day Disp #*14 Syringe Refills:*0 13. Calcium 600 (calcium carbonate) 600 mg (1,500 mg) oral DAILY 14. TraMADOL (Ultram) 25 mg PO Q12H:PRN pain 15. OxycoDONE (Immediate Release) 2.5 mg PO DAILY:PRN 30 minutes prior to physical therapy RX *oxycodone 5 mg 0.5 (One half) tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 16. Labetalol 100 mg PO TID 17. Artificial Tears Preserv. Free ___ DROP BOTH EYES BID eye itching 18. Ferrous GLUCONATE 324 mg PO DAILY 19. Finasteride 5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY: Right acetabular fracture SECONDARY: Chronic Kidney Disease, Anemia, Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ after a fall where you suffered a fracture of your right hip joint. You were seen by our orthopaedic surgeons who felt that you should be able to recover without surgery as long as you follow the precautions below. While in the hospital you developed issues with your kidney function. You had an ultrasound of your kidneys which showed no obstruction. You were given IV fluids with stabilization of your kidney function. It is important that you follow the instructions below and followup with your orthopaedic doctors in order to aide your recovery. ORTHOPAEDIC INSTRUCTIONS: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Touch down weight bearing right leg MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 30mg daily for 2 weeks</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Cinacalcet 30 mg PO DAILY 3. Doxazosin 2 mg PO HS 4. Labetalol 300 mg PO TID 5. Nephrocaps 1 CAP PO DAILY 6. sevelamer CARBONATE 800 mg PO TID W/MEALS 7. Lisinopril 20 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Endstage renal disease requiring HD 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 seen at ___ for Dialysis. You had your dialysis session in the hospital and you are scheduled for repeat dialysis on ___. Best Wishes, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice daily Disp #*60 Tablet Refills:*0 2. Atorvastatin 20 mg PO QPM 3. bisoprolol fumarate 1.25 oral DAILY 4. Carbidopa-Levodopa (___) 0.75 TAB PO BID 5. Pramipexole 4.5 mg PO DAILY 6. Rasagiline 1 mg PO DAILY 7. HELD- Aspirin 81 mg PO DAILY This medication was held. Do not restart Aspirin until you have your blood counts rechecked 8. HELD- valsartan-hydrochlorothiazide 80-12.5 mg oral DAILY This medication was held. Do not restart valsartan-hydrochlorothiazide until you talk to your doctor Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis - acute blood loss anemia, ___ upper GI bleed Secondary Diagnoses - acute kidney injury, likely prerenal - lower extremity edema - Parkinsons disease - hypertension - hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to be a part of your care team at ___ ___. You were admitted to the hospital because your blood count was very low. You had an endoscopy, which showed some ulcers in your stomach, which is probably where the bleeding was from. You should continue to take a new medication called pantoprazole, which will help to heal your stomach. We also think that you should be tested for a bacteria called H. pylori which can cause these ulcers, and that you should have another endoscopy in 2 months to see if these ulcers are healing. Please see below for your medications. Again, it was very nice to meet you, and we wish you the best. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PR Q4H:PRN pain/fever 2. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO QID:PRN indigestion 3. Bisacodyl 10 mg PR HS:PRN constipation 4. Docusate Sodium 100 mg PO BID 5. Fleet Enema ___AILY:PRN constipation 6. Milk of Magnesia 30 mL PO Q6H:PRN constipation 7. Morphine SR (MS ___ 15 mg PO Q12H 8. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain 9. Pindolol 5 mg PO BID 10. Polyethylene Glycol 17 g PO DAILY 11. Senna 2 TAB PO HS 12. TraZODone 25 mg PO HS 13. Aspirin 81 mg PO DAILY 14. Multivitamins W/minerals 1 TAB PO DAILY 15. Ciprofloxacin HCl 500 mg PO Q12H Duration: 5 Days RX *ciprofloxacin 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*10 Tablet Refills:*0 16. MetRONIDAZOLE (FLagyl) 500 mg PO TID Duration: 5 Days RX *metronidazole 500 mg 1 tablet(s) by mouth three times a day Disp #*15 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: cholangitis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted for an infection of the gallbladder duct (cholangitis) related to your gallbladder cancer causing a blockage. You previously had a stent put in for this, and on this admission had another procedure (ERCP) to help open up this blockage. You have been on antibiotics for this infection and will be given a prescription to continue for several more days at home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 200 mg PO DAILY 2. Atorvastatin 40 mg PO DAILY 3. Carbidopa-Levodopa (___) 1 TAB PO TID 4. Losartan Potassium 50 mg PO QHS 5. Metoprolol Succinate XL 25 mg PO DAILY 6. pramipexole 3 mg oral QDAILY 7. Torsemide 10 mg PO DAILY RX *torsemide 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 8. Warfarin 1.5 mg PO DAILY16 9. Outpatient Lab Work Please draw DAILY INR from ___. Results should be sent to ___ Anticoagulation Clinic Discharge Disposition: Home Discharge Diagnosis: Primary: - Right arm hematoma - Supratherapeutic INR Secondary: - Chronic systolic CHF - Atrial fibrillation, s/p PVI and Maze with ___ ligation ___ - Mitral regurgitation, s/p mechanical MVR (27 mm St. ___ - Parkinsons disease - Hypertension - Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ for evaluation of arm pain. We found that your arm had started bleeding again. You had procedures by the plastic surgery team to help stop this bleeding. During your hospitalization, we also stopped your warfarin to help control your bleeding. This was restarted before you left, and your INR was 2.3. Please recheck your inr on ___ You should follow up with your primary care doctor after you leave. Please call him to set up an appointment this week. You should also follow up with Dr. ___, a plastic surgeon. Please call him at ___ to set up an appointment this week. When you leave, you should take 1.5mg of warfarin each day. You should check your INR on ___. We also decreased your dose of torsemide. It was a pleasure to help care for you during this hospitalization, and we wish you all the best in the future. Sincerely, Your ___ Team Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild/Fever 2. Amoxicillin-Clavulanic Acid ___ mg PO/NG Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth twice a day Disp #*20 Tablet Refills:*0 3. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation - Second Line 4. Docusate Sodium 100 mg PO BID 5. Senna 17.2 mg PO HS 6. Atorvastatin 40 mg PO QPM 7. Gemfibrozil 600 mg PO BID 8. Isosorbide Mononitrate (Extended Release) 45 mg PO DAILY 9. MetFORMIN (Glucophage) 500 mg PO BID 10. Metoprolol Succinate XL 25 mg PO BID 11. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: intraventricular hemorrhage Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Hemorrhage without Surgery Activity • We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. • You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. • No driving while taking any narcotic or sedating medication. • If you experienced a seizure while admitted, you are NOT allowed to drive by law. • No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications • Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. - You may restart your Aspirin on ___ and may restart your Coumadin on ___. • You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: • You may have difficulty paying attention, concentrating, and remembering new information. • Emotional and/or behavioral difficulties are common. • Feeling more tired, restlessness, irritability, and mood swings are also common. • Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Headaches: • Headache is one of the most common symptom after a brain bleed. • Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. • Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. • There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: • Severe pain, swelling, redness or drainage from the incision site. • Fever greater than 101.5 degrees Fahrenheit • Nausea and/or vomiting • Extreme sleepiness and not being able to stay awake • Severe headaches not relieved by pain relievers • Seizures • Any new problems with your vision or ability to speak • Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: • Sudden numbness or weakness in the face, arm, or leg • Sudden confusion or trouble speaking or understanding • Sudden trouble walking, dizziness, or loss of balance or coordination • Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Duloxetine 60 mg PO DAILY 2. Indapamide 1.25 mg PO DAILY 3. Levothyroxine Sodium 75 mcg PO QAM 4. Mirtazapine 7.5 mg PO HS 5. Omeprazole 20 mg PO DAILY 6. Verapamil 240 mg PO QAM 7. Acetaminophen 650 mg PO TID 8. Vesicare (solifenacin) 10 mg oral QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: left parafalcine subdural hematoma 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>•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. CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE FOLLOWING •New onset of tremors or seizures. •Any confusion, lethargy 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. •New onset of the loss of function, or decrease of function on one whole side of your body.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO BID (2 times a day). 3. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) Tablet PO DAILY (Daily). 4. medroxyprogesterone 150 mg/mL Syringe Sig: One (1) syringe Intramuscular q 3 months. 5. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: ___ puffs Inhalation Q4H (every 4 hours) as needed for SOB/wheezing. Disp:*1 inhaler* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis: shortness of breath Secondary Diagnosis: anxiety Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted to the hospital with shortness of breath for 2 months with concern that your symptoms could be due to tuberculosis. A chest xray showed some consolidation in the right upper lobe which may be due to an old infection. You had a ppd placed which was negative, making it very unlikely that you had been exposed to tuberculosis in the past. We have given you an albuterol inhaler to use as needed for shortness of breath. You will need to have a repeat chest x-ray in ___ weeks to ensure that your x-ray has improved. You will also need to have lung function tests to help us determine why your breathing has been difficult</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Docusate Sodium 100 mg PO BID 3. Hydrochlorothiazide 25 mg PO DAILY 4. Acetaminophen 650 mg PO Q6H:PRN pain RX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet extended release(s) by mouth every 8 hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Motor vehicle crash resulting in right parietal scalp laceration and underlying subgaleal hematoma 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 brought to the hospital by ambulance after the unfortunate accident where you where hit by another car and then bumped into a tree. You were evaluated in the Emergency Department and thoroughly examined for life-threatening injuries. Upon physical examination and imaging studies, we only found a laceration to your head. Fortunately, no major intracranial or neck injuries were found. You were kept in the hospital overnight for further workup regarding the possibility that you may have passed-out prior to the accident, a sign that could sometimes mean something is wrong with your heart or the vessels in your neck. For this reason, the medicine team evaluated and determined that it was unlikely this happened, and deemed suitable for you to go home. Instructions: 1. Please resume all your home medications. 2. You may take tylenol or NSAIDs for pain if need be. 3. Please follow-up with your primary care provider for ___ routine medical checkup. Your creatinine levels were found to be borderline high, a finding that should be known by your PCP. 4. Please call our office or come to the emergency department in case: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. 5. Wound Care: You may shower, no tub baths or swimming. If there is clear drainage from your cut, cover with clean, dry gauze. Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision sites.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atenolol 25 mg PO DAILY 2. Amlodipine 5 mg PO DAILY 3. Azathioprine 50 mg PO DAILY 4. Baclofen 10 mg PO BID:PRN spasticity 5. DiphenhydrAMINE 12.5 mg PO Q6H:PRN itching 6. Omeprazole 40 mg PO BID 7. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain 8. Tacrolimus 1.5 mg PO Q12H 9. Zolpidem Tartrate 10 mg PO QHS 10. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 11. Acetaminophen 650 mg PO Q6H:PRN pain 12. Nystatin Oral Suspension 5 mL PO QID thrush Duration: 7 Days RX *nystatin 100,000 unit/mL 5 mL by mouth four times a day Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Viral syndrome Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for observation after presenting to the ED with a low grade fever, abdominal pain, and headache several days following your parathyroidectomy. Your labs were reviewed and cultures from your blood and urine and pending, all of which are normal to date. Please resume all of your regular home medications, unless specifically advised not to take a particular medication. Please get plenty of rest, continue to walk several times per day, and drink adequate amounts of fluids. Please call your surgeon or go to the emergency department if you have increased pain, swelling, redness, or drainage from the incision site. You may shower and wash incisions with a mild soap and warm water. Avoid swimming and baths until cleared by your surgeon. Gently pat the area dry. You have a neck incision with steri-strips in place, do not remove the steri-strips, they will fall off on their own. Thank you for allowing us to participate in your care. We look forward to seeing you at your follow-up visit.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lidocaine Viscous 2% 15 mL PO Q3H:PRN sore throat RX *lidocaine HCl [Lidocaine Viscous] 2 % take 15 mL every 3 horus as needed Refills:*0 2. Nystatin Oral Suspension 5 mL PO QID:PRN thrush RX *nystatin 100,000 unit/mL 5 ml by mouth every 4 horurs Refills:*0 3. ValACYclovir 1000 mg PO Q12H RX *valacyclovir 1,000 mg 1 tablet(s) by mouth every 12 hours Disp #*36 Tablet Refills:*0 4. Sirolimus 1 mg PO DAILY Daily dose to be administered at 5pm RX *sirolimus 1 mg 1 tablet by mouth daily Disp #*30 Tablet Refills:*1 5. ALPRAZolam 1 mg PO TID:PRN anxiety 6. Aspirin 81 mg PO DAILY 7. Atorvastatin 20 mg PO QPM 8. Cyclobenzaprine 10 mg PO TID:PRN spasm 9. DULoxetine 60 mg PO DAILY 10. Furosemide 40 mg PO DAILY 11. Furosemide 40 mg PO 3X/WEEK (___) 12. Glargine 20 Units Breakfast Glargine 20 Units Dinner Insulin SC Sliding Scale using HUM Insulin 13. Metoprolol Tartrate 25 mg PO BID 14. metroNIDAZOLE 0.75 % topical BID 15. Mycophenolate Mofetil 500 mg PO BID 16. Omeprazole 20 mg PO BID 17. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 18. Vitamin D 1000 UNIT PO DAILY 19.Outpatient Lab Work Please check sirolimus level at 5PM on ___. Fax results to Dr. ___ ___. ICD-10 Z94.0 History of renal transplant. Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Candidiasis Throat pain Acute kidney injury SECONDARY DIAGNOSIS: Renal transplant End-stage renal disease s/p transplant 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 Mr. ___, You were admitted to ___ due to throat pain and lesions on your tongue. You were treated with antifungal medication called fluconazole and a medication called valacyclovir. We sent off a number of tests and a biopsy that were still in process at time of discharge. - Please follow up below as recommended with your doctors: call Dr. ___ to have an appointment in the next week. - Please continue taking valacyclovir as prescribed for 3 weeks. Take all of the prescription even if you are feeling better. - We restarted your sirolimus at 1mg daily. Please get your level checked at 5pm on ___. Otherwise continue the rest of your medications. - You will be called at home with follow-up appointments to see Infectious Disease. - Your tongue sutures can be removed on ___. Any healthcare provider can take the stitches out. - You already have an appointment to see Dermatology in a few weeks. 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. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Cefpodoxime Proxetil 200 mg PO Q12H RX *cefpodoxime 200 mg 1 tablet(s) by mouth Q12 Disp #*28 Tablet Refills:*1 3. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*1 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth Q4 hrs Disp #*45 Tablet Refills:*0 5. Humira (adalimumab) 40 mg/0.8 mL subcutaneous Q WEEKLY UC 6. Mesalamine ___ 1200 mg PO TID Discharge Disposition: Home Discharge Diagnosis: Penile hematoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>-You had a foley catheter in place while in the hospital so you may expect intermittent amounhts of small blood in the urine. If foley remains upon discharge, please care as instructed by nursing staff. -The hematoma at the penis will resolve over the next few to several weeks. Try and elevate penis as much as possible and lay down when possible rather than sitting. -You may experience some pain associated with spasm/fullness of your penis and scrotum; This is normal. Take the narcotic pain medication as prescribed if additional pain relief is needed. -Do not lift anything heavier than a phone book (10 pounds) -Resume all of your pre-admission medications, except HOLD aspirin and NSAIDS (motrin, ibuprofen, etc) until you see your urologist in followup -You MAY be discharged home with a medication called PYRIDIUM that will help with the "burning" pain you may experience when voiding. This medication may turn your urine bright orange. -Colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. Discontinue if loose stool or diarrhea develops. Colace is a stool softener, NOT a laxative, and available over the counter. The generic name is DOCUSATE SODIUM. It is recommended that you use this medication. -Do not eat constipating foods for ___ weeks, drink plenty of fluids to keep hydrated -No vigorous physical activity or sports for 4 weeks and while Foley catheter is in place (if left with catheter) you should not engage in strenuous activity - Absoultely no sexual activity of any sort until cleared by urologist in follow up Apply dressing as follows: - Once daily remove prior dressing by unwrapping gauze. - Can shower at this time. Let water drip gently over penis and pat dry afterwards. No baths until area heals - Reapply small square of xeroform or petroleum gauze over skin defect. Wrap ___ of kerlex gauze around penile shaft, applying gentle compression to penis. Ensure gauze encompasses up to the head of the penis but does not block urethral opening.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. Milk of Magnesia 30 mL PO Q6H:PRN constipation 3. Nicotine Patch 14 mg TD DAILY 4. Polyethylene Glycol 17 g PO DAILY:PRN constipation 5. Senna 8.6 mg PO BID 6. Lorazepam 0.5-1 mg PO Q4H:PRN dyspnea, anxiety RX *lorazepam 2 mg/mL 0.5-1 mg by mouth every four (4) hours Refills:*0 7. Morphine Sulfate (Concentrated Oral Soln) 20 mg PO Q4H RX *morphine concentrate 100 mg/5 mL (20 mg/mL) 20 mg by mouth every four (4) hours Refills:*0 8. Morphine Sulfate (Concentrated Oral Soln) 10 mg PO Q1H:PRN pain, dyspnea RX *morphine concentrate 100 mg/5 mL (20 mg/mL) 10 mg by mouth q1h Refills:*0 9. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN Dyspnea/wheezing Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: PRIMARY: metastatic pancreatic adenocarcinoma, cholangitis Secondary: Hepatitis C, Alcoholic Cirrhosis, OSA Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Lethargic but arousable. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure treating you at ___ ___. You were admitted with concern for recent fevers and abdominal pain in the setting of your known pancreatic cancer. Your abdominal pain was evaluated via an endoscopic procedure which unfortunately showed advancement of your cancer. After discussion with you, your family, and your outpatient provider, the decision was made to admit you to hospice care at a rehabilitation facility. We wish you the best going forward, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you in the hospital. WHAT BROUGHT YOU INTO THE HOSPITAL? You came into the hospital with chest pain. WHAT DID WE DO FOR YOU IN THE HOSPITAL? We ordered labs and examined you and felt that there was no cardiac cause for your chest pain. We think that your chest pain is musculoskeletal in nature. WHAT SHOULD YOU DO AFTER LEAVING THE HOSPITAL? -You can take diclofenac sodium topical gel for the chest pain. -You should follow-up with your primary care physician in two weeks. -Weigh yourself every morning, call a physician if your weight goes up 3 lbs in one day or 5 lbs in one week. Sincerely, Your ___ Team</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 radiation burn L. upper back 2. Lidocaine 5% Patch 1 PTCH TD QPM R chest wall pain RX *lidocaine 5 % Please apply new patch every night QPM Disp #*30 Patch Refills:*0 3. MetroNIDAZOLE 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*23 Tablet Refills:*0 4. OxyCODONE (Immediate Release) 15 mg PO Q4H:PRN Pain - Severe RX *oxycodone 15 mg 1 tablet(s) by mouth every four (4) hours Disp #*15 Tablet Refills:*0 5. Vancomycin Oral Liquid ___ mg PO Q6H RX *vancomycin 125 mg 1 capsule(s) by mouth every six (6) hours Disp #*30 Capsule Refills:*0 6. Torsemide 20 mg PO DAILY 7. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 8. Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN SOB 9. ARIPiprazole 10 mg PO DAILY 10. Aspirin 325 mg PO DAILY 11. Atorvastatin 20 mg PO QPM 12. Darunavir 800 mg PO DAILY 13. Emtricitabine-Tenofovir (Truvada) 1 TAB PO QPM 14. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN wheezing 15. Pantoprazole 40 mg PO Q24H 16. Potassium Chloride 20 mEq PO DAILY 17. Potassium Chloride 40 mEq PO QHS Hold for K > 18. Prazosin 1 mg PO QPM 19. QUEtiapine extended-release 200 mg PO QHS 20. Ranitidine 150 mg PO DAILY 21. RiTONAvir 100 mg PO QPM 22. Tiotropium Bromide 1 CAP IH DAILY 23. Venlafaxine XR 75 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: health care associated Pneumonia severe C. diff colitis Secondary: Stage II squamous cell carcinoma of the lung Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because of shortness of breath and diarrhea. Your shortness of breath was because of pneumonia, which was treated with antibiotics. Your diarrhea was due to a recurrence of an infection called C. difficile. Your C. diff was also treated with antibiotics (vancomycin and flagyl). While here you also continued to receive radiation for your lung cancer. Physical therapy also worked with you while you were here to help improve your strength. Your pneumonia and your C. diff improved, so you were discharged home. The following medications were added: - Vancomycin 120mg every 6 hours (last day is ___ - Flagyl 500mg every 8 hours (last day is ___ Thank you for choosing ___ for your healthcare needs. It was a pleasure caring for you. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID Constipation DO NOT TAKE IF YOU HAVE DIARRHEA RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 2. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain RX *oxycodone 5 mg 1 tablet(s) by mouth every 6 hours as needed Disp #*10 Tablet Refills:*0 3. Polyethylene Glycol 17 g PO DAILY DO NOT TAKE IF YOU HAVE CONSTIPATION RX *polyethylene glycol 3350 [Miralax] 17 gram 1 powder(s) by mouth daily Disp #*1 Packet Refills:*1 4. cane 1 Cane miscellaneous AS DIRECTED RX *cane 1 straight cane use as directed Disp #*1 Each Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Multiple Myeloma Secondary: Back Pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted due to increasing back pain. Further workup did not show that your myeloma is worsening. We gave you some pain medications and your pain has relatively improved. We also did not find any infectious cause for your back pain. We plan to discharge you today because overall you are doing well. We are concerned however about your lack of suitable housing. Our social worker has been helping you with this issue. Please follow up with the department of transitional assistance as advised for emergency shelter. Take all of your medications as prescribed. Please refer below for your outpatient appointments with Dr. ___. 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. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 (One) tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 2. Atorvastatin 40 mg PO QPM RX *atorvastatin 40 mg 1 (One) tablet(s) by mouth once a day Disp #*30 Tablet Refills:*1 3. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 (One) tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 4. Multivitamins 1 TAB PO DAILY Discharge Disposition: Home Discharge Diagnosis: acute ischemic stroke Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were hospitalized due to symptoms of difficulty with speech and writing 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. We are changing your medications as follows: -START aspirin 81 mg daily -START Plavix 75 mg daily -START atorvastatin 40 mg daily Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You came in with pain in your back and ribs. We found that you were having a pain crisis from sickle cell. We treated you with IV fluids and pain medication. At home please make sure to stay well hydrated. You can take Tylenol for pain. If your pain is not relieved by Tylenol you can take oxycodone as needed. Please do not drive after taking oxycodone, as this medication can make you drowsy. We also found that had a pneumonia. We treated you with antibiotics. You will need to take antibiotics for two more days after leaving the hospital (last day ___. Please see below for your follow up appointments. It was a pleasure taking care of you, and we are happy that you're feeling better!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Citalopram 30 mg PO DAILY 2. Glargine 6 Units Dinner Insulin SC Sliding Scale using HUM Insulin 3. Acetaminophen 650 mg PO Q6H:PRN fever 4. Aspirin 325 mg PO DAILY 5. Benzonatate 100 mg PO TID 6. Betamethasone Dipro 0.05% Cream 1 Appl TP BID Duration: 3 Weeks 7. Ciprofloxacin HCl 500 mg PO Q12H last day at this dose is ___, then 250mg q24h for life 8. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H last day is ___. Miconazole Powder 2% 1 Appl TP BID 10. Neutra-Phos 2 PKT PO DAILY 11. OxycoDONE (Immediate Release) 2.5 mg PO Q6H:PRN pain RX *oxycodone [Oxecta] 5 mg half tablet, oral only(s) by mouth every six (6) hours Disp #*14 Tablet Refills:*0 12. Pantoprazole 40 mg PO Q12H 13. Rifaximin 550 mg PO BID RX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*60 Tablet Refills:*0 14. everolimus 10 mg oral daily Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY #Influenza A #Prevotella Sp. spontaneous bacterial peritonitis #Prevotella Sp. bloodstream infections #Acute tubular necrosis #Acute interstitial nephritis #Hepatic encephalopathy SECONDARY #NASH cirrhosis #Refractory ascites #Protein-calorie malnutrition #Pancreatic neuro-endocrine tumour Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you during your recent admission at ___. You came in with the flu and we treated you for that. Once you were getting better you unfortunately developed an infection in your bloodstream that may have originated in your abdomen. We treated you for that too and drained the fluid from your abdomen a couple of times. Your kidney have suffered a little in the process of fighting these infections and they should hopefully get better over time. Also, you may eventually feel strong enough to go through the TIPS so you won't need fluid taps that often. We have placed a feeding tube to improve your nutrition which is the first step to get stronger. We wish you a quick recovery, 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 2. Levothyroxine Sodium 25 mcg PO DAILY 3. Megestrol Acetate 400 mg PO DAILY 4. Metoprolol Tartrate 25 mg PO Q6H 5. Mirtazapine 15 mg PO QHS 6. Modafinil 100 mg PO DAILY 7. Pantoprazole 40 mg PO Q24H 8. Polyethylene Glycol 17 g PO DAILY 9. Senna 8.6 mg PO BID:PRN constipation 10. TraZODone 25 mg PO QHS 11. Warfarin 5 mg PO DAILY16 12. Acetaminophen 650 mg PO Q6H:PRN pain 13. Dronabinol 2.5 mg PO BID 14. Aquaphor Ointment 1 Appl TP TID:PRN dry skin 15. OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*25 Tablet Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Abdominal abscess Acute sepsis Acute on chronic malnutrition Discharge Condition: Level of Consciousness: Lethargic but arousable. Mental Status: Confused - sometimes. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for evaluation of your wound. You were found to have an abscess in your abdomen/pelvis and underwent a procedure to drain your abscess. You required a brief stay in the intensive care unit, and are now ready to go back to your rehabilitation facility. Please follow the instructions below to help with your continued recovery: - Your nutritional status was found to be suboptimal during your hospital stay. You should try to increase the amount you eat and drink, including adding ensure or similar supplemental nutrition shakes. Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry. *If you have staples, they will be removed at your follow-up appointment. *If you have steri-strips, they will fall off on their own. Please remove any remaining strips ___ days after surgery. General Drain Care: *Please look at the site every day for signs of infection (increased redness or pain, swelling, odor, yellow or bloody discharge, warm to touch, fever). *If the drain is connected to a collection container, please note color, consistency, and amount of fluid in the drain. Call the doctor, ___, or ___ nurse if the amount increases significantly or changes in character. Be sure to empty the drain frequently. Record the output, if instructed to do so. *Wash the area gently with warm, soapy water. *Keep the insertion site clean and dry otherwise. *Avoid swimming, baths, hot tubs; do not submerge yourself in water. *Make sure to keep the drain attached securely to your body to prevent pulling or dislocation.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Lorazepam 0.5 mg PO Q6H:PRN nausea/insomnia RX *lorazepam 0.5 mg 1 tablet by mouth every four (4) hours Disp #*60 Tablet Refills:*0 2. Morphine SR (MS ___ 45 mg PO Q12H RX *morphine [MS ___ 15 mg 3 tablet(s) by mouth every twelve (12) hours Disp #*84 Tablet Refills:*3 3. Morphine Sulfate ___ 15 mg PO Q2H:PRN Pain RX *morphine 15 mg 1 tablet(s) by mouth every two (2) hours Disp #*96 Tablet Refills:*0 4. Morphine Sulfate (Concentrated Oral Soln) ___ mg SL Q1H:PRN pain RX *morphine concentrate 100 mg/5 mL (20 mg/mL) ___ mg SL every one (1) hour Disp ___ Milliliter Refills:*2 5. Docusate Sodium 100 mg PO BID 6. Gabapentin 400 mg PO TID 7. Ibuprofen 600 mg PO Q8H 8. Nystatin Oral Suspension 5 mL PO QID:PRN thrush 9. Ondansetron 8 mg PO Q8H:PRN nausea 10. Prochlorperazine 10 mg PO Q6H:PRN nausea 11. Senna 1 TAB PO BID 12. Miconazole Powder 2% 1 Appl TP QID:PRN rash RX *miconazole nitrate [Lotrimin AF] 2 % Apply to rash four times a day Disp #*1 Bottle Refills:*0 13. FIRST-Mouthwash BLM *NF* (___) 200-25-400-40 mg/30 mL Mucous Membrane QID:PRN Mouth Pain RX ___ [FIRST-Mouthwash ___] 400 mg-400 mg-40 mg-25 mg-200 mg/30 mL ___ mLby mouth three times a day Disp #*1 Bottle Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Breast Cancer 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 ___ ___ ___. We are pleased to have been a part of your transition to home hospice and comfort focused care. We have adjusted your medications to mimimize those that are uncessessary and to maximize your ongoing comfort. Please feel free to contact your hospice service for any of your needs regarding pain, nausea, or any other symptoms that concern you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Meropenem 500 mg IV Q24H Duration: 3 Weeks RX *meropenem 500 mg infuse 500mg once daily daily Disp #*10.5 Gram Refills:*0 2. Calcitriol 0.25 mcg PO DAILY 3. Docusate Sodium 100 mg PO BID 4. Epoetin Alfa 40,000 U SC ___ 5. Ferrous Sulfate 325 mg PO DAILY 6. Fluoxetine 20 mg PO DAILY 7. Heparin Dwell (1000 Units/mL) 1000 UNIT DWELL UNDEFINED Dwell to CATH Volume, each 1 liter dwell IP for fibrin 8. Lithium Carbonate 150 mg PO BID 9. MetRONIDAZOLE (FLagyl) 500 mg PO TID Q8H Duration: 14 Days Start date ___ RX *metronidazole [Flagyl] 500 mg 1 tablet(s) by mouth three times a day Disp #*114 Tablet Refills:*0 10. OLANZapine 10 mg PO BID 11. Omeprazole 20 mg PO BID 12. Senna 1 TAB PO BID:PRN constipation 13. Topiramate (Topamax) 25 mg PO HS 14. Fluconazole 200 mg PO Q24H RX *fluconazole [Diflucan] 200 mg 1 tablet(s) by mouth Daily Disp #*24 Tablet Refills:*0 15. sevelamer CARBONATE 800 mg PO TID W/MEALS RX *sevelamer carbonate [Renvela] 800 mg 1 tablet(s) by mouth TID W/ Meals Disp #*90 Tablet Refills:*0 16. Atenolol 25 mg PO DAILY 17. DIALYVITE 800 *NF* (B complex-C-folic acid-Zn) 0.8 mg Oral Daily 18. Lactulose 30 mL PO BID Please hold for loose stools 19. Lorazepam 1 mg PO QHS:PRN insomina 20. Miconazole Powder 2% 1 Appl TP BID 21. OLANZapine 5 mg PO ASDIR Please assess patient for leg tingling, restlessness and give this additional dose. Will likely need while doing CAPD 22. Tucks Hemorrhoidal Oint 1% 1 Appl PR PR hemorrhoidal pain 23. Vitamin D 50,000 UNIT PO 1X/WEEK (___) Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnosis: Pelvic abscess Enterovesicular fistula . Secondary Diagnosis: End Stage Renal Disease on Dialysis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You are being discharged from ___ ___. It was a pleasure taking care of you. You were admitted to the hospital for evaluation of pus in your urine and bloody stools. While you were here it was discovered the the pelvic abscess was draining into your bladder. You were put on the right antibiotics and seen by the surgeons, kidney doctors, infectious disease doctors. ___ was felt you needed to be started on hemodialysis so we placed a hemodialysis line and removed your PD line. You also were given a PICC line so we could give you long term antibiotics. A drain was also placed in the abscess and a Foley catheter was placed and needs to remain in place at the time of discharge. You will have follow up with all your specialists. Please see the medication list for a detailed list of your medications and any changes that were made.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Oxygen 2L nasal cannula with ambulation for saturations of 79%. Patient recovers to 92% with 2L oxygen. Resting room air saturation 98% Pulse dose for portability Dx: Metastatic renal cell carcinoma 2. Amlodipine 5 mg PO DAILY 3. Citalopram 40 mg PO DAILY 4. Finasteride 5 mg PO DAILY 5. Methadone 20 mg PO BID 6. Tamsulosin 0.4 mg PO HS 7. ALPRAZolam 0.25 mg PO QHS:PRN insomnia 8. Megestrol Acetate 40 mg PO DAILY 9. Senna 2 TAB PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a day Disp #*60 Tablet Refills:*0 10. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 11. Levothyroxine Sodium 12.5 mcg PO DAILY RX *levothyroxine 25 mcg 0.5 (One half) tablet(s) by mouth once a day Disp #*15 Tablet Refills:*0 12. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 13. Cyanocobalamin 250 mcg PO DAILY RX *cyanocobalamin (vitamin B-12) 250 mcg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 14. Dexamethasone 2 mg PO DAILY RX *dexamethasone 2 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: metastatic renal cell carcinoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted with dyspnea on exertion. A chest x ray did not show any infection or fluid collection. You will need to go home with oxygen. You were also seen by palliative care who recommended diet modifications to try to increase your weight. Medication changes: Please start home oxygen to maintain saturation >92% START senna an dcolace as needed for constipation START cyanocobalamin (vitamin B-12) for deficiency START dexamethasone 2 mg daily to help with your appetite and energy START levothyroxine 12.5 micrograms ___ tab) daily START multivitamin to supplement diet STOP axitinib STOP lisinopril</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. cefPODOXime 200 mg oral DAILY Duration: 2 Days Take ___ and ___ RX *cefpodoxime 200 mg 1 tablet(s) by mouth Daily Disp #*2 Tablet Refills:*0 2. Carvedilol 6.25 mg PO BID 3. HELD- Warfarin 2 mg PO 2X/WEEK (___) This medication was held. Do not restart Warfarin until hematuria resolves and you've discussed with your primary doctor 4. HELD- Warfarin 1 mg PO 5X/WEEK (___) This medication was held. Do not restart Warfarin until hematuria resolves and you've discussed with your primary doctor 5.Outpatient Lab Work CBC around ___ to monitor for acute blood loss anemia (D64.9). Follow up with Dr. ___ ( ___ ). Discharge Disposition: Home Discharge Diagnosis: Pre-syncope Presumed UTI Paroxysmal atrial fibrillation HTN BPH Severe mitral regurgitation CKD 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 for presyncope (dizziness). You already had workup as outpatient which was unrevealing. During hospitalized telemetry only revealed rate controlled atrial fibrillation. Cardiology consult was called and they felt the presyncopal episode was unlikely to be cardiac. We think the original episode was either due to urinary infection or urinary retention from enlarged prostate. Antibiotics were started to treat for possible urinary infection and will be continued for 7 days total. Flomax was stopped due to decrease in blood pressure. We decided to discontinue all blood pressure meds except for Coreg and your goal systolic blood pressure is 140s-170s. You had some trauma from attempts to insert Foley catheter, and warfarin was stopped so bleeding can be controlled. Urology was consulted for hematuria and felt catheter placement was an option, but you were urinating alright and declined catheter placement. Please do not restart warfarin until you've discussed with your primary doctor. Follow up with your PCP, ___, and your cardiologist within the next ___ weeks. You will need a repeat CBC (blood count) drawn early this week.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Hydrocortisone 30 mg PO Q8H Taper to 20mg on ___ and 10mg on ___ and off on ___ RX *hydrocortisone 10 mg 3 tablet(s) by mouth every 8 hours Disp #*90 Tablet Refills:*0 2. Levofloxacin 750 mg PO Q24H RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 3. Benzonatate 100 mg PO TID 4. Ferrous Sulfate 325 mg PO DAILY 5. FoLIC Acid 1 mg PO DAILY 6. Gabapentin 300 mg PO QHS 7. Glucosamine (glucosamine sulfate) 500 mg oral DAILY 8. Guaifenesin-CODEINE Phosphate ___ mL PO Q6H:PRN cough 9. Lisinopril 10 mg PO DAILY 10. Ondansetron 4 mg PO Q8H:PRN nausea 11. Simvastatin 20 mg PO QPM 12. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Non-small cell lung cancer Adrenal Insufficiency Post-obstructive pneumonia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came in with a pneumonia due to an obstruction of your airways caused by the lung cancer. You had a stent placed and this helped clear the obstruction. We are sending you home with hospice services to make sure you have the best quality of life moving forwards. Please return if you have intractable pain or symptoms not relieved by medications. It was a pleasure taking care of you at ___ ___ ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB RX *albuterol sulfate [Ventolin HFA] 90 mcg ___ PUFF INH q4 hrs Disp #*1 Inhaler Refills:*0 2. Amiodarone 200 mg PO BID RX *amiodarone 200 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 3. Apixaban 5 mg PO BID RX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 4. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID RX *fluticasone-salmeterol [Advair Diskus] 250 mcg-50 mcg/dose 1 PUFF INH twice a day Disp #*1 Disk Refills:*0 5. Nicotine Patch 21 mg/day TD DAILY RX *nicotine 21 mg/24 hour apply patch to arm q24 hrs Disp #*28 Patch Refills:*0 6. Tiotropium Bromide 1 CAP IH DAILY RX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 cap INH daily Disp #*1 Capsule Refills:*0 7. Anastrozole 1 mg PO DAILY 8. Metoprolol Succinate XL 100 mg PO DAILY 9. Simvastatin 40 mg PO QPM Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS ================= HYPERCARBIC HYPOXIC RESPIRATORY FAILURE COMMUNITY ACQUIRED PNEUMONIA COPD EXACERBATION CHF EXACERBATION WIDE COMPLEX TACHYCARDIA ACUTE KIDNEY INJURY TYPE 2 NSTEMI SECONDARY DIAGNOSIS =================== CORONARY ARTERY DISEASE Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___! You were admitted for difficulty breathing and low oxygen levels. You had a breathing tube in the ICU, and received antibiotics for a pneumonia, steroids to treat the COPD flare, and diuretics (water pills) to remove fluid out of the lungs. Your lungs improved with this treatment, and eventually transferred to the regular medicine floor where you continued to do well. Your heart was initially in an abnormal rhythm, but you were started on some medicines and your heart is now in a normal rhythm. The most important thing you can do when you leave the hospital is to quit smoking. I have provided you with nicotine patches, please obtain the nicotine gum and use in the way we discussed. Please get the flu vaccine and pneumonia vaccines with your primary care physician when you next see him/her. Otherwise, use your inhalers and other medicines as prescribed. Lastly, please see your cardiologist given the abnormal heart rhythm. 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. HydrOXYzine 25 mg PO Q6H:PRN itching RX *hydroxyzine HCl 25 mg 1 tablet(s) by mouth Every six hours as needed Disp #*120 Tablet Refills:*0 2. Ursodiol 300 mg PO BID RX *ursodiol 300 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. OxyCODONE (Immediate Release) ___ mg PO Q12H:PRN Pain - Moderate RX *oxycodone 5 mg ___ capsule(s) by mouth Twice daily as needed Disp #*10 Capsule Refills:*0 4. Torsemide 80 mg PO BID RX *torsemide 20 mg 4 tablet(s) by mouth twice a day Disp #*120 Tablet Refills:*0 5. Acetaminophen 500 mg PO DAILY 6. camphor-menthol 1 0.5% topical DAILY:PRN itching 7. Cholestyramine 4 gm PO BID 8. Ciprofloxacin HCl 500 mg PO DAILY 9. DiphenhydrAMINE 25 mg PO Q6H:PRN itching 10. FoLIC Acid 1 mg PO DAILY 11. Lactulose 30 mL PO TID 12. Multivitamins 1 TAB PO DAILY 13. Sarna Lotion 1 Appl TP DAILY:PRN itching 14. Thiamine 100 mg PO DAILY 15. TraZODone 100-200 mg PO QHS:PRN insomnia Discharge Disposition: Home Discharge Diagnosis: PRIMARY: -Hypervolemic hyponatremia SECONDARY: -Alcoholic liver cirrhosis 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 WERE YOU IN THE HOSPITAL? - You were admitted to the hospital for low sodium levels. WHAT HAPPENED WHEN YOU WERE IN THE HOSPITAL? - You were treated with a medicine called albumin to help improve your sodium levels. - An imaging study of your liver showed a new, small mass in the right side of your liver. This will require re-evaluation in ___ months. - You were maintained a sodium and fluid-restricted diet to improve your sodium levels. - Your diuretic medication dose was adjusted. WHAT SHOULD YOU DO AFTER YOU LEAVE THE HOSPITAL? - Weight yourself daily. Call your liver doctor if your weight increases by more than 3 pounds. - Continue to take all your medicines as prescribed below. - Show up to your appointments as listed below. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear ___, You were admitted to the hospital for shortness of breath. You were treated for a pneumonia with antibiotics. While you were in the hospital, we managed your abdominal distension supportively by supporting your symptoms of nausea and pain. A G tube was placed to help with your abdominal distention. Please follow up with your PCP and Dr ___ (oncologist) as scheduled. 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 TID 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation - Second Line 3. Docusate Sodium 100 mg PO BID 4. Ferrous Sulfate 325 mg PO DAILY 5. Lidocaine 5% Ointment 1 Appl TP TID 6. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Breakthrough pain OR ___ minutes prior to planned ambulation or LLE activity 7. OxyCODONE (Immediate Release) 5 mg PO Q6H 8. Polyethylene Glycol 17 g PO DAILY 9. Ramelteon 8 mg PO QPM Should be given 30 minutes before bedtime 10. Senna 17.2 mg PO BID 11. Apixaban 2.5 mg PO BID 12. Levothyroxine Sodium 75 mcg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: # Sarcoma, metastatic # Malignancy-related DVT # Pathologic left tibial plateau fracture # Hyperkalemia Discharge Condition: stable. Continuing to work with ___. Currently, 2 person assist to chair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege to care for you at the ___ ___. You were admitted for worsening leg pain and swelling in the setting of a recently found thigh mass. While you were here, you were transitioned to a new blood thinner at the recommendation of our clot experts. You also underwent a biopsy of the thigh mass for pathology which is suggestive of sarcoma. You were also found to have a fracture of the area below your left knee. You were seen by orthopedic oncology who recommended a surgery to help with pain and stability in that leg. You are now being discharged to rehab in order to work on your strength and coordination. Please take all medications as prescribed and follow up with all appointments as detailed below. We wish you the best. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Senna 8.6 mg PO BID 2. Simethicone 40-80 mg PO QID:PRN bloating 3. Clozapine 225 mg PO ONCE Duration: 1 Dose 4. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild/Fever 5. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB/wheezing 6. Aluminum-Magnesium Hydrox.-Simethicone 30 mL PO Q4H:PRN GI upset 7. Artificial Tears Preserv. Free 1 DROP BOTH EYES BID 8. Aspirin 81 mg PO DAILY 9. Bisacodyl 5 mg PO DAILY 10. ClonazePAM 0.5 mg PO QHS:PRN Anxiety 11. Cyanocobalamin 500 mcg PO DAILY 12. Divalproex (DELayed Release) 750 mg PO QHS 13. melatonin 3 mg oral QHS 14. Polyethylene Glycol 17 g PO DAILY 15. Tamsulosin 0.4 mg PO QHS 16. Venlafaxine XR 112.5 mg PO DAILY 17. Venlafaxine XR 37.5 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: # Urosepsis # Obstructive uropathy secondary to nephrolithiasis # hypoactive delirium Discharge Condition: Activity Status: Ambulatory - requires assistance or aid (walker or cane). Level of Consciousness: Lethargic but arousable. Mental Status: Confused - sometimes. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a priviliege to care for you at the ___ ___. You were admitted for treatment of a severe urinary tract infection caused by a stone blocking your kidney from draining properly. You required placement of a PCN tube to drain the kidney and will need several more days of IV antibiotic to treat the bacterial infection. After your infection is treated, you will need to have a procedure with the urologist to remove the stone and then the PCN tube can be removed. You had some episodes of not wanting to eat or interact in the setting of being sick in the hospital and missing some medications, and this improved with assistance of our psychiatry team and restarting some home medications. Please continue to take all medications as prescribed and follow up with all appointments as detailed below. We wish you the best! Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium (Liquid) 100 mg PO BID 2. Hydrocortisone Cream 0.5% 1 Appl TP BID:PRN rash 3. Multivitamins 1 TAB PO DAILY 4. Pantoprazole 40 mg PO Q12H 5. Senna 1 TAB PO BID:PRN Constipation 6. Sucralfate 1 gm PO QID Duration: 2 Weeks 7. Vancomycin 1500 mg IV Q 12H, end date ___, then begin penicillin G 8. Vitamin D 1000 UNIT PO DAILY 9. Hydroxychloroquine Sulfate 200 mg PO BID 10. Miconazole Powder 2% 1 Appl TP QID:PRN rash Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Primary: Upper GI bleed Secondary: fluid overload, right knee septic arthritis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during this admission. You were admitted from a rehab facility on ___ after developing an upper GI bleed. You were on coumadin after your knee surgery which likely contributed to the bleeding. You were admitted to the ICU and received blood transfusions. Multiple endoscopies were completed that showed ulcers at the gastro-esophageal junction. They were ablated to try to stop the bleeding. In addition, interventional radiology embolized the left gastric artery to stop the bleeding. The procedures were successful and your bledding resolved. You were transferred out of the ICU once you were stabilized. You did well without further bleeding. Your hematocrit remained stable. Another endoscopy was performed to examine the stomach, and it showed no bleeding. While in the ICU you received IV fluids and blood products, which caused significant swelling. You are being treated with lasix to get some of the fluid off. Your electrolytes will need to be monitored every other day while on this medication. In addition, you are being treated for septic arthritis in the right knee. You had a right knee washout during a previous admission on ___. You will need to be on long-term IV antibiotics for that infection until ___. You will be getting the antibiotics through your PICC line.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You were admitted to ___ due to chest discomfort. You were found to have a dangerously high potassium and so you were admitted to the ICU. The treatment for this high potassium is dialysis. However, your dialysis fistula is non functioning correctly, and you were unable to undergo dialysis successfully. We wanted to place a dialysis line into your vein to give you dialysis, but you refused. We alternatively were interested in completing a short session of dialysis but you also refused this. The plan was to have the dialysis fistula evaluated by our interventional radiologists. However, you refused and wanted to go home to your regular dialysis unit. We called your dialysis unit who is unable to take you today. We are very concerned about you leaving and it is against medical advice. We think there is a high risk of sudden death and you may not feel any symptoms prior to death, which is very worrisome. You vocalized that you were ok with this risk, and repeated back that you were willing to take on the risk of dying suddenly. You also refused medication called kayexalate which helps remove potassium by having a bowel movement. Although you refused this medication here, please consider taking this once you leave. We have called it into your pharmacy for you. Please return to the hospital as soon as you are amenable. You need dialysis and you need your dialysis fistula clot fixed. We wish you the best in health. Sincerely, Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q8H 2. Lorazepam 0.5 mg PO/IV Q6H:PRN nausea, insomnia, anxiety 3. Multivitamins 1 TAB PO DAILY 4. Voriconazole 300 mg PO Q12H 5. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation Inhalation prn wheezing Discharge Disposition: Home Discharge Diagnosis: right lower extremity nodule 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 ___ in ___. You were readmitted for pain in your right lower leg with new swelling. We performed an ultrasound of your right lower leg, which did not show a clot, but revealed a nodule that was hard to characterize, but may have been a resolving pool of blood or an infection or leukemia. We decided to obtain an MRI of your right lower leg to further characterize the lesion. Since you were feeling better, and ready to go home, we discussed that you could leave after the MRI with the plan that if anything abnormal was seen on the MRI that required you to return to ___, that we would contact you and you would return.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever 2. Glucose Gel 15 g PO PRN hypoglycemia protocol 3. Glargine 8 Units Breakfast Glargine 8 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 4. Metoprolol Succinate XL 100 mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. BuPROPion (Sustained Release) 150 mg PO BID 8. ClonazePAM 0.25 mg PO QHS 9. Docusate Sodium 100 mg PO BID 10. DULoxetine ___ 80 mg PO DAILY 11. Losartan Potassium 100 mg PO DAILY 12. Multivitamins W/minerals 1 TAB PO DAILY 13. Omeprazole 40 mg PO DAILY 14. Vitamin B Complex 1 CAP PO DAILY Discharge Disposition: Extended Care Facility: ___ 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>Dear Ms. ___, You were admitted to the hospital with abdominal pain and found to have an infection in your gallbladder. You were taken to the operating room and had your gallbladder removed laparoscopically. You tolerated the procedure well and are now being discharged home to continue your recovery with the following instructions. Please follow up in the Acute Care Surgery clinic at the appointment listed below. ACTIVITY: o Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. o You may climb stairs. o You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. o Don't lift more than ___ lbs for 4 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. o You may start some light exercise when you feel comfortable. o You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: o You may feel weak or "washed out" for a couple of weeks. You might want to nap often. Simple tasks may exhaust you. o You may have a sore throat because of a tube that was in your throat during surgery. o You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. o You could have a poor appetite for a while. Food may seem unappealing. o All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: o Tomorrow you may shower and remove the gauzes over your incisions. Under these dressing you have small plastic bandages called steri-strips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). o Your incisions may be slightly red around the stitches. This is normal. o You may gently wash away dried material around your incision. o Avoid direct sun exposure to the incision area. o Do not use any ointments on the incision unless you were told otherwise. o You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. o You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: o Constipation is a common side effect of narcotic pain medications. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. o If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: o It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". o Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. o You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. o Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. o Your pain medicine will work better if you take it before your pain gets too severe. o Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. o If you are experiencing no pain, it is okay to skip a dose of pain medicine. o Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. oxycodone 20 mg Tablet Extended Release 12 hr Sig: One (1) Tablet Extended Release 12 hr PO Q12H (every 12 hours). 2. oxycodone 5 mg Tablet Sig: ___ Tablets PO every ___ hours. Disp:*90 Tablet(s)* Refills:*0* 3. Keppra 750 mg Tablet Sig: One (1) Tablet PO twice a day. 4. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for Nebulization Sig: One (1) neb Inhalation every four (4) hours as needed for shortness of breath or wheezing. 5. nystatin 100,000 unit/mL Suspension Sig: Five (5) cc PO four times a day: swish and swallow. 6. Zofran 8 mg Tablet Sig: One (1) Tablet PO three times a day as needed for nausea. 7. prochlorperazine maleate 10 mg Tablet Sig: One (1) Tablet PO every six (6) hours as needed for nausea. 8. quetiapine 25 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) as needed for insomnia/anxiety. 9. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. Disp:*60 Capsule, Delayed Release(E.C.)(s)* Refills:*2* Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: primary diagnoses: anemia, lung cancer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you while you were admitted to the hospital. You were admitted because you were found to have a low blood count. You were treated with multiple blood transfusions. There was concern that you may be bleeding from your gastrointestinal tract and you were evaluated by the gastroenterology team. They felt that you did not need an urgent procedure and recommended that you start a new medication called omeprazole. You were monitored overnight on the oncology service and your blood counts remained stable. . The following changes have been made to your medication regimen: Please START taking - omeprazole 40 mg twice daily . Please STOP taking - ranitidine - ibuprofen . Please take the rest of your medications as prescribed and follow up with your doctors as ___. .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID Discharge Disposition: Home With Service Facility: ___ ___ Diagnosis: small bowel obstruction Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, . It is always a pleasure to take care of you and we are glad you are feeling improved and ready to go home. You were admitted to the gynecology oncology service for management of a small bowel obstruction. You were managed conservatively with antiemetics, pain medications, and an NG tube. You had return of bowel function and your diet was advanced. You have recovered well and the team feels that you are safe to be discharged home. Please follow the instructions: . * Take a stool softener to prevent constipation. You were prescribed Colace. If you continue to feel constipated and have not had a bowel movement within 48hrs of leaving the hospital you can take a gentle laxative such as milk of magnesium. * Do not take more than 4000mg acetaminophen (tylenol) in 24 hrs. * Please continue a low residual diet (avoid high-fiber foods, like whole-grain breads and cereals, nuts, seeds, raw or dried fruits, and vegetables). If symptoms resume such as pain and cramping, please resume low residual diet and call office. * It is safe to walk up stairs. . To reach medical records to get the records from this hospitalization sent to your doctor at home, call ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 2.5 mg PO BID RX *apixaban [Eliquis] 2.5 mg 1 (One) tablet(s) by mouth twice a day Disp #*30 Tablet Refills:*0 2. Atorvastatin 10 mg PO QPM RX *atorvastatin 10 mg 1 (One) tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Dorzolamide 2% Ophth. Soln. 1 DROP RIGHT EYE BID 4. Latanoprost 0.005% Ophth. ___. 1 DROP RIGHT EYE BID 5. Metoprolol Tartrate 25 mg PO BID 6. Torsemide 20 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. Left middle cerebral artery ischemic infarct 2. Atrial fibrillation Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ for evaluation of speech disturbance and weakness on your right side. CT and MRI scans of your head and neck showed that your symptoms were due to a stroke. It is likely that your stroke was due to a blood clot arising from your atrial fibrillation, so we started you on a blood thinner (apixaban/Eliquis) to reduce your risk of future strokes. Please follow up with your primary care provider within one week of discharge from your acute rehabilitation facility. Please also follow up with a neurologist within the next ___ months; your primary care provider can help refer you to a neurologist. It was a pleasure taking care of you at ___. Sincerely, Neurology at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q12H 2. Citalopram 20 mg PO DAILY 3. colestipol 5 gm oral BID 4. Omeprazole 20 mg PO DAILY 5. Vancomycin Oral Liquid ___ mg PO Q6H 6. Ciprofloxacin HCl 500 mg PO Q12H Duration: 3 Doses RX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth twice a day Disp #*3 Tablet Refills:*0 7. LORazepam 0.5 mg PO Q6H:PRN nausea, anxiety and insomnia 8. Prochlorperazine 10 mg PO Q6H:PRN nausea 9. Simvastatin 20 mg PO QPM Discharge Disposition: Home Discharge Diagnosis: Primary: # Biliary Obstruction: ___ choledocholithiasis s/p ERCP on ___ # Post-ERCP pancreatitis Secondary: # C. diff # Lymphoma # Type II DM - diet controlled Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Gen: Comfortable sitting up in bed HEENT: EOMI, sclera anicteric, MMM Cards: RR, no m/r/g Chest: CTAB Abd: soft, not distended, very mild tenderness in epigastrium and RUQ, otherwise non-tender throughout, BS+, no rigidity or rebound tenderness Ext: WWP Neuro: AAOx3, clear speech Psych: calm, cooperative Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ were admitted to the hospital with abdominal pain and underwent a procedure called an ERCP, which found that ___ had obstruction of your bile ducts causing the pain, and the obstruction was relieved. After the procedure, ___ had temporary inflammation of your pancreas, causing additional abdominal pain, which resolved with IV fluids and gradual advancement of your diet. ___ were also treated with antibiotics to reduce the risk of infection after the procedure. Do not take aspirin, Plavix, Coumadin, NSAIDs (e.g. Advil, Motrin, Aleve, ibuprofen, etc.), or other anticoagulant medications for 2 more days. Please follow-up in ___ surgery clinic (as scheduled below) to be evaluated for removal of your gallbladder to reduce the risk of having recurrence of the problem that brought ___ to the hospital (bile duct obstruction from gallstones). It was a pleasure caring for ___ while ___ were in the hospital and we wish ___ a full and speedy recovery. Sincerely, The ___ Medicine 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 Q4H:PRN wheezing 2. Heparin 5000 UNIT SC BID 3. Miconazole Powder 2% 1 Appl TP BID:PRN vaginal irritation 4. Multivitamins W/minerals Chewable 1 TAB PO DAILY 5. Senna 8.6 mg PO BID 6. Acetaminophen 500 mg PO Q8H 7. Levothyroxine Sodium 100 mcg PO DAILY 8. Pantoprazole 40 mg PO Q24H 9. Rosuvastatin Calcium 10 mg PO QPM 10. HELD- Aspirin 81 mg PO DAILY This medication was held. Do not restart Aspirin until told to resume by your doctor Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Non traumatic intraparenchymal hemorrhage Pulmonary edema Pancreatitis Dysphagia s/p PEG UTI Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Bedbound. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You came to the hospital because you had abdominal pain, right sided weakness and difficulty speaking. You had imaging which showed a large bleeding stroke in the left side of your brain. You also had a possible stroke or mass on the right side of your brain. For your bleeding stroke, we controlled your blood pressure to prevent more bleeding. Neurosurgery saw you and recommended no surgery as the bleed was too large. You also had blood work which showed your had inflammation of your pancreas. We tested you for common causes of pancreas inflammation which were all negative. The pancreas inflammation may have been caused by a medication or supplement. For your pancreatitis, you were given fluids and you improved. Because of your stroke, you were not able to swallow and a feeding tube was placed to help your get nutrition. Now that you are leaving the hospital, you will go to rehab where you will continue to work with physical therapy. You will need to have repeat imaging of your pancreas in 2 weeks. Then, in about 1 month you will repeat imaging of your brain to see if the mass on the right side of your brain has changed. Please take all of your medicines as prescribed and follow up with your doctors as listed below. We wish you the best! ___ Neurology</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID hold for loose stool 2. Senna 1 TAB PO BID:PRN constipation 3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain may cause drowsiness, avoid driving while on this medication RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*25 Tablet Refills:*0 4. Acetaminophen 650 mg PO Q6H pain Discharge Disposition: Home Discharge Diagnosis: appendicitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital abdominal pain. You underwent a cat scan of the abdomen and you were found to have appendicitis. You were taken to the opertating room to have your appendix removed. You are recovery nicely from the surgery and you are preparing for discharge home with the following instructions: You were admitted to the hospital with acute appendicitis. You were taken to the operating room and had your appendix removed laparoscopically. You tolerated the procedure well and are now being discharged home with the following instructions: Please follow up at the appointment in clinic listed below. We also generally recommend that patients follow up with their primary care provider after having surgery. We have scheduled an appointment for you listed below. ACTIVITY: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for ___ weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap. You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. HOW YOU MAY FEEL: You may feel weak or "washed out" a couple weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You could have a poor appetite for a couple days. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Tomorrow you may shower and remove the gauzes over your incisions. Under these dressings you have small plastic bandages called steristrips. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay. Your incisions may be slightly red around the stitches. This is normal. You may gently wash away dried material around your incision. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing or clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. YOUR BOWELS: Constipation is a common side effect of narcotic pain medicaitons. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription for pain medicine to take by mouth. It is important to take this medicine as directed. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Do not drink alcohol or drive while taking narcotic pain medication. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. If you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the following, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild/Fever RX *acetaminophen 500 mg 1 tablet(s) by mouth four times per day Disp #*120 Tablet Refills:*0 2. CefTRIAXone 2 gm IV Q24H 3. Miconazole Powder 2% 1 Appl TP TID:PRN groin rash RX *miconazole nitrate 2 % please apply to groin rash three times per day Disp #*1 Spray Refills:*0 4. Torsemide 40 mg PO DAILY RX *torsemide 20 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 5. Vitamin D ___ UNIT PO 1X/WEEK (WE) Duration: 8 Weeks RX *ergocalciferol (vitamin D2) 50,000 unit 1 capsule(s) by mouth on ___ Disp #*6 Capsule Refills:*0 6. Ferrous Sulfate 325 mg PO DAILY RX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Lactulose 30 mL PO TID RX *lactulose 20 gram/30 mL 30 mL by mouth three times per day Disp #*2700 Milliliter Refills:*0 8. Levothyroxine Sodium 75 mcg PO DAILY 9. One Daily For Men (multivit with min-FA-lycopene) 1 TAB oral DAILY 10. Pantoprazole 40 mg PO Q24H 11. Propranolol 20 mg PO BID 12. Rifaximin 550 mg PO BID 13. HELD- aMILoride 15 mg PO BID This medication was held. Do not restart aMILoride until you speak to your liver doctor Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Left knee prosthetic joint infection Hepatitis C cirrhosis Group B strep bacteremia Secondary: PICC associated non-occlusive thrombus Nephrolithiasis Acute kidney injury Pancytopenia 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 admitted to the hospital? - You were having left knee pain concerning for an infection of your knee replacement What happened while I was in the hospital? - You underwent surgery to have the infection drained from your knee. - You received antibiotics for your infection - Excess fluid was removed from your body with diuretics - Your fevers eventually improved after a second wash out of your knee What should I do when I get home from the hospital? - Be sure to continue to take your antibiotics for a total of 6 weeks; you will have a visiting nurse that is going to help you with this - Make sure to have your labs checked while you are taking antibiotics - Please go to all of your follow-up appointments with the infectious disease doctors, orthopedic surgeons, liver doctor, and your primary care doctor - Make sure to take your new diuretic every day; please weight yourself in the mornings before eating and taking your medications; if your weight increases by 3 pounds in one day or 5 pounds in one week, please call your liver doctor - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - Splint must be left on until follow up appointment unless otherwise instructed. - Do NOT get splint wet. - If you have fevers, chills, worsening knee pain, increased wound drainage, leg swelling, problems breathing, or generally feel unwell, please call your doctor or go to the emergency room Sincerely, Your ___ Treatment Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN sob/wheeze 2. Amlodipine 5 mg PO DAILY 3. Tiotropium Bromide 1 CAP IH DAILY 4. TraZODone 50 mg PO HS:PRN insomnia 5. Cyclobenzaprine 5 mg PO TID:PRN muscle spasm 6. Rifaximin 550 mg PO BID RX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 7. Simethicone 40-80 mg PO QID:PRN gas or bloating 8. Spironolactone 25 mg PO DAILY RX *spironolactone [Aldactone] 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 9. FoLIC Acid 1 mg PO DAILY 10. Multivitamins 1 TAB PO DAILY 11. Ondansetron 8 mg PO Q8H:PRN nausea 12. Oxazepam 10 mg PO HS:PRN insomnia 13. Thiamine 100 mg PO DAILY 14. Zolpidem Tartrate 10 mg PO HS:PRN insomnia Discharge Disposition: Home Discharge Diagnosis: symptomatic abdominal ascites liver cancer hepatitis C cirrhosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your stay at ___ ___. You were admitted for abdominal bloating. Initially there was a concern that you may have a bowel obstruction, but a CT scan showed that you do not. It did show that you had some fluid building up in your belly, and you had some of this fluid removed which resulted in improvement of your symptoms. You met with Dr. ___ discussed that your liver cancer and your hepatitis C cirrhosis are progressing, and that treatment with chemotherapy is not likely to help. We discussed that getting an abdominal catheter may help you drain fluid regularly to help with your bloating, but that these catheters are generally only put in for patients who are on hospice care. You indicated that you would like to get a second opinion from Cancer Treatment Centers of ___. As such we did not put in the catheter. Your bloating symptoms may return, in which case we would need to consider a repeat procedure to remove fluid.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amoxicillin-Clavulanic Acid ___ mg PO Q12H RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth twice a day Disp #*8 Tablet Refills:*0 2. Zonisamide 200 mg PO DAILY RX *zonisamide [Zonegran] 100 mg 2 capsule(s) by mouth daily Disp #*60 Capsule Refills:*2 3. Baclofen 10 mg PO TID 4. Citalopram 40 mg PO DAILY 5. Docusate Sodium 100 mg PO BID:PRN constipation 6. Levothyroxine Sodium 88 mcg PO DAILY 7. LORazepam 2 mg PO QHS 8. Multivitamins 1 TAB PO DAILY 9. Pantoprazole 40 mg PO Q24H 10. Phenytoin Sodium Extended 300 mg PO DAILY 11. Vitamin D 1000 UNIT PO DAILY 12. HELD- Acyclovir 200 mg PO DAILY This medication was held. Do not restart Acyclovir until you follow up with your PCP 13. HELD- Calcium Carbonate Dose is Unknown PO Frequency is Unknown This medication was held. Do not restart Calcium Carbonate until you follow up with your PCP ___: Home Discharge Diagnosis: Cardiac arrest Seizure 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 transferred to ___ after a cardiac arrest after falling into water. We think this happened because you had a seizure. You were intubated at ___ and then transferred here. Here, you became more and more awake and were extubated on ___. You were monitored on EEG for seizure, and while we didn't capture any seizure activity, we did decide to start you on Zonisamide 100mg daily because we think you had a seizure while taking Dilantin. You also had an MRI, which was normal except for a 6mm meningioma unchanged from your most recent MRI in ___. You were also treated for possible aspiration pneumonia since you fell in water. We stopped IV antibiotics before your discharge, and you should continue taking oral antibiotics for 4 more days. You should follow up with Dr. ___ as an outpatient for more changes to your seizure medications, and with your primary care physician. You cannot drive until you are seizure free for at least 6 months. You should not swim or bathe unsupervised because of the risk of having a seizure. If you experience any new concerning symptoms (listed below) please contact your primary care doctor for follow up or present to the ED. It was a pleasure taking care of you and we wish you the best! Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcitriol 0.25 mcg PO DAILY 2. Calcium Carbonate 500 mg PO TID W/MEALS 3. Multivitamins 1 TAB PO DAILY 4. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain Do not drink alcohol or drive while taking this medication. RX *oxycodone 5 mg ___ tablet(s) by mouth Q4H: PRN Disp #*30 Tablet Refills:*0 5. Polyethylene Glycol 17 g PO DAILY:PRN constipation 6. Vitamin B-12 (cyanocobalamin (vitamin B-12)) 1,000 mcg sublingual DAILY 7. Acetaminophen 325-650 mg PO Q6H:PRN pain 8. Vancomycin 1000 mg IV Q 12H RX *vancomycin 500 mg 2 vials IV every twelve (12) hours Disp #*28 Vial Refills:*0 9. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 7 Days to start after vancomycin is complete RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: infected seroma 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 treatment for an infected seroma. Your wounds required incision and drainage as well as ___ drain placement. Please follow these discharge instructions:</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB 3. Aspirin EC 81 mg PO DAILY 4. Atorvastatin 20 mg PO QPM 5. Calcium Carbonate 500 mg PO QID:PRN heartburn 6. Docusate Sodium 100 mg PO BID 7. Furosemide 60 mg IV TID 8. Heparin 5000 UNIT SC TID 9. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 10. Levofloxacin 750 mg IV Q48H Citrobacter in BAL last dose: ___ 11. Metoprolol Tartrate 25 mg PO TID 12. Multivitamins W/minerals Liquid 15 mL PO DAILY 13. Omeprazole 20 mg PO BID 14. Polyethylene Glycol 17 g PO DAILY 15. Potassium Chloride 20 mEq PO TID 16. Folic Acid-Vit B6-Vit B12 (Ca) (calcium-vitamins B6-B12-FA) 1 oral DAILY 17. Centrum Silver (multivit-min-FA-lycopen-lutein;<br>mv-min-folic acid-lutein) 0.4-300-250 mg-mcg-mcg oral DAILY 18. Vitamin D 1000 UNIT PO DAILY 19. HELD- glucosamine-chondroitin 500-400 mg oral DAILY This medication was held. Do not restart glucosamine-chondroitin until directed by PCP ___: Extended Care Facility: ___ Discharge Diagnosis: Type A Aortic Dissection Aortic Insufficiency Ascending Aortic Aneurysm Chronic Fatigue Syndrome Follicular Lymphoma of the neck s/p RT Hemorrhoids Hyperlipidemia Hypertension Intertrigo Obesity status post left thigh panniculectomy in ___ Discharge Condition: Alert and oriented x3 non-focal Max assist, lift to chair Sternal pain managed with Tylenol Sternal Incision - healing well, no erythema or drainage right groin- healing well with staples Followup Instructions: ___ [/INST] </s><s>Please shower daily -wash incisions gently with mild soap, no baths or swimming, look at your incisions daily Please - NO lotion, cream, powder or ointment to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics Clearance to drive will be discussed at follow up appointment with surgeon No lifting more than 10 pounds for 10 weeks Encourage full shoulder range of motion, unless otherwise specified **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours** Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge ***Has right groin staples that need to be discontinued in 2 weeks</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 #*7 Tablet Refills:*0 2. Cephalexin 500 mg PO Q6H RX *cephalexin 500 mg 1 capsule(s) by mouth four times daily Disp #*16 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PIMARY ====== Cellulitis Mixed arterial and venous vascular insufficiency SECONDARY ========= Right Ankle fracture s/p open reduction internal fixation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You were instructed to come to the hospital by orthopedic surgery due to persistent right leg cellulitis. WHAT HAPPENED TO ME IN THE HOSPITAL? - You were treated with IV antibiotics for an infection in your leg - The Infectious disease specialists evaluated you and believed that some of the redness and skin changes in your leg are due to poor blood supply, rather than infection. They recommended that you stop the IV antibiotics and that you could go home with continued oral antibiotics. - You were found to have a urinary tract infection, which was treated with an oral antibiotic. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? -Please continue to take all of your medications and ___ with your appointments as listed below. -You should watch for any signs of infection, including fevers, chills, worsening redness or pain in your leg, and drainage of pus. -You should follow up with a vascular surgeon to evaluate the blood supply to your leg. 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. Levofloxacin 750 mg PO DAILY Duration: 6 Days RX *levofloxacin 750 mg 1 tablet(s) by mouth daily Disp #*7 Tablet Refills:*0 2. Guaifenesin ___ mL PO Q6H:PRN cough RX *guaifenesin [Adult Tussin Chest Congestion] 100 mg/5 mL ___ ml Syrup(s) by mouth every 6 hours Disp ___ Milliliter Refills:*0 3. Fluticasone Propionate 110mcg 2 PUFF IH BID 4. Levothyroxine Sodium 75 mcg PO DAILY 5. Fluticasone Propionate NASAL 1 SPRY NU DAILY 6. ProAir HFA *NF* (albuterol sulfate) 90 mcg/actuation INHALATION Q4HR wheezing ___ puffs as needed Discharge Disposition: Home Discharge Diagnosis: Primary: community acquired pneumonia Secondary: history of lymphoma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure participating in your care at ___. You were admitted to the hospital for likely lung infection. Please continue the prescribed antibiotics. Otherwise, it is very important that you take all of your usual home medications as directed in your discharge paperwork.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q4H:PRN shortness of breath or wheeze RX *albuterol sulfate [ProAir HFA] 90 mcg ___ puffs inhaled every 4 hours Disp #*1 Inhaler Refills:*1 Discharge Disposition: Home Discharge Diagnosis: #Alcohol intoxication #Acute hypoxic respiratory failure #Fever Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, Why was I here? - You were admitted to the hospital because you were found to be intoxicated with alcohol and there was concern that you might have alcohol withdrawal and seizures. What was done for me here? - You received a medication that reduced your chance of having a seizure and helped to manage the symptoms of alcohol withdrawal. - We also provided you with important vitamins and started medications to help your liver disease What should I do when I go home? - We recommend that you follow-up at the ___ ___ and ask for a case manager there. - We recommend that you follow-up with your primary care provider ___ 1 week. Please call your doctor if you have any changes in body temperature (fevers, chills), heart palpitations, tremors, seizures, hallucinations, or any chest pain or shortness of breath. It was a pleasure taking care of you! We wish you the best of luck. Your ___ Inpatient Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Enoxaparin Sodium 120 mg SC Q12H Duration: 7 Days Start: ___, First Dose: Next Routine Administration Time RX *enoxaparin 120 mg/0.8 mL 120 mg SubQ every 12 hours Disp #*14 Syringe Refills:*3 2. Gabapentin 600 mg PO DAILY 3. Gabapentin 600 mg PO NOON 4. Gabapentin 900 mg PO QHS 5. Methylprednisolone 5 mg PO DAILY 6. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 7. Tizanidine 4 mg PO QHS Spasm 8. Venlafaxine XR 150 mg PO DAILY 9. Warfarin 5 mg PO DAILY16 10. ClonazePAM 0.25 mg PO BID RX *clonazepam 0.25 mg 1 tablet(s) by mouth twice a day Disp #*6 Tablet Refills:*0 11. Vitamin E 400 UNIT PO DAILY RX *vitamin E 400 unit 1 capsule by mouth daily Disp #*30 Capsule Refills:*0 12. Humira (adalimumab) 40 mg/0.8 mL subcutaneous weekly 13. LOPERamide 2 mg PO TID:PRN loose stool 14. Metoprolol Succinate XL 150 mg PO DAILY 15. Testosterone Cypionate 100 mg IM 1X/WEEK (___) Low testosterone Discharge Disposition: Home Discharge Diagnosis: PRIMARY ======= Anxiety Panic disorder Rule out ACS SECONDARY Pulmonary embolism Hematuria Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, Thank you for choosing to receive your care at ___. You were admitted with dizziness and chest pressure. You were evaluated by neurology and underwent an MRI scan of your head, which did not reveal any concerning cause of your dizziness. You were also evaluated extensively with nuclear and treadmill stress testing of your heart, which did not reveal any heart disease. You also had a rapid heart rate, with no concerning cause such as repeat clots in your lungs or heart disease. We think that your dizziness, fast heart rate, and chest pressure is likely related to anxiety and possibly panic attacks. You were seen by psychiatry, and started on two medications to help treat your anxiety and panic attacks. You were noted to have fluctuating INRs during this admission. You were continued on your Coumadin while in hospital, and are being discharged with lovenox injections to keep your blood thinned while your Coumadin reaches a therapeutic level again. We wish you the best with your ongoing recovery. Sincerely, your ___ care team</s>