Datasets:

Knowtex-ai

/

Knowtex-Transcript-Type-Check

like 0

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hey Paul, sorry about the delay. Okay so we scanned it into your chart. You don't want to have the images with you by any chance. No I'm doing those tomorrow. Okay that's totally fine. So we did the x-ray for you here. We do see that scapular fracture is coming right over here. Looking at your... report they call it minimally displaced so most of the time probably 90 something percent of the time um as long as it's minimally displaced we actually don't do any surgery for a scapula fracture but kind of walk me through exactly what happened because of isolated scapula injury it's pretty rare third doctor didn't say that yeah yeah so what happened playing soccer a guy was going in for one-on-one i dove to get the ball i landed on this shoulder I'm crawling up to get the ball. He, knee or shin or something is straight into my scapular. Oh, going full speed. So it was just both of us climbing full speed. So you were trying to like... Yeah, I was down on the ground like this and just came in and like... Just directly knee'd you right there. Yeah. Okay, got it. Pain immediately. Immediate pain, no pain in my scapular though. All the pain was like, maybe this was just referred pain, but it felt like it was just deep inside my shoulder. Yeah. Itself. Gotcha. But the first thing I did, like even when I was on... I'm riding in pain was to make sure I could move my shoulder in every direction. So I didn't have any loss of movement at all. Okay, good. You didn't feel like your shoulder popped in and out, anything like that. I didn't feel it popping out. I heard a lot of pop. I put it in my scapula, just been the collision. Yeah, yeah. I heard a lot of noise, but I didn't know what it was. I didn't feel it go in and out and then I could move it the whole time. Yeah, there was just a shooting pain there. The pain went away after about two hours. Are you still asleep? No. Okay. I can't lift my arm above it here without major pain. Okay. Bye. I went to the ER after the game. The pain went away after about a week. The leg after two hours. Now it only hurts. If I don't have the sling on, and I'm bathing or something, and I move my arm a little bit too fast, then I'll have pain. Otherwise, there's no pain. Let's take a look on Jay's. We're going to do a very limited exam today. Just because of the fracture. I'm going to go ahead and just push it. in some areas. Is that kind of tender? Nope. That's okay? Mm-hmm. That's still fine. Yep. Okay. You actually don't have that much discomfort with me pushing on your scapula. No, that's why I was shocked the scapula was broken. Yeah, that's okay right? Yep. Okay. And nothing along the clavicle itself. Nope. That's okay. Right here. But AC joint. Yep. Slightly lower than that is where it was hurting. Like right here, right deep inside the socket is where I felt the initial pain. But now there's no pain. Okay. All right. Yeah. The pain looks otherwise pretty good. You know, usually we try to check to see whether or not there are any other injuries, usually like a clavicle injury, AC joints, things like that shoulder dislocation, but you don't really have much pain over there. Um, so let's. For something like this, typically we keep people in a sling for comfort for about two weeks. At which point we're going to see you back. If everything still looks good, if you still have minimal pain, then we actually can discontinue the sling and we're going to get you to physical therapy pretty soon. So we can start with an early range of motion, usually about six to eight weeks. Most people do recover pretty well with this. Okay. Yep. I have a question on the sling for comfort. What's that? I mean, in the sense of like, if I'm, obviously when I'm walking around, where the sling, if I'm just sitting on the sofa, is it where the sling is? Does it take the sling off? That's totally fine if you're sitting, you know, like a computer chair or a sofa, you can just rest your arm and you're feeling totally fine, that's okay. Okay. You can get out of the sling. Okay. All right. Let me give you a couple of things, right? First and foremost, we're gonna give you a PT referral. So you can try to start scheduling for an appointment. So that as soon as you get out of the sling, you can actually start doing some gentle range of motion. Okay, because really what happens is that when you when we kind of immobilize you for For a little bit your shoulder gets really really stiff and people start losing range of motion So about two weeks out, you know Once you're starting with to move your arm a little bit better Then you can start doing this extra range of motion exercises going forward external rotation things like that And then they will start working on strengthening your arm or shoulder so that you can back go back to doing things that you want to do All rightalk … TLaughs Here you go, so that's yours. Okay, so any questions about everything that's going on so far? No, one real question I have is about if I'm allowed to take the center off while I'm sitting on the sofa. Yeah, that's totally fine. Okay, so let's go ahead and see you back in two weeks. Perfect. Just give this to a lady up front so that they can make you fall off. plan for you in two weeks. Okay? Awesome. Well good to see you and sorry. Please insert a left shoulder forward view x-ray that shows a fracture line noted to the inferior of the scapular spine. Please insert a limited left shoulder exam with no focal tendons palpation over the scapula and inferior to the scapula. No tendon is palpation over the clavicle or over the AC joint. So that's not a plan, this is a 35 year old male patient presenting for initial consultation of a minimally displaced left scapular body fracture that occurred after he got knee directly in the scapula while playing soccer. on 3-9-24 period. Patient was evaluated at the ER and had a CT done that is notable for minimally displaced fracture of the left scapular body and period to the scapular spine period. A few patients left shoulder x-ray today which showed the fracture line. But otherwise, no clavicle fracture or other fracture or dislocation noted, period. With a consultation that isolated scapula, fracture are rare but can usually be treated conservatively. minimally dyslexia period but it's just about placing him in the sling for two weeks followed by early range of motion and we'll provide him with a physical therapy referral to help with his range of motion when he gets out of the sling in two weeks period. We plan to see patient back in two weeks for repeat x-rays. and... evaluation. Period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 32 year old female with history of lumbar microdiscectomy presenting for follow-up regarding acute back pain and ridiculous symptoms. Alessandra? Hello Lindsay here. Hi. Good to see you again. How are things going? Not much better. Okay. Yeah I'm still just like in a lot of pain. Today I woke up and like my leg is been tingling and so I'm forced to believe that it's definitely not... getting any better and you know it's just taking a while for the MRI and stuff so I was just hoping to get like the med pack really really did help. Okay. A lot with the pain like right away. Okay. So I was hoping to get another one just in the interim and I did mention to the receptionist that they had said that they didn't know I had back surgery when I called my insurance so then I had my surgeon send over you. Yes. I wrote on this morning. Information, so hopefully they said that if they know that there's back surgery, they'll approve it right away. Okay, and I have that in my note. So they just don't read the note, which is so atrociously annoying. It's like, if you just read it, they won't tell you all the information. Yeah, let me discuss that. And then when I did call your office, they said that, I think I spoke with somebody else, they said they needed the denial of. the denial of the claim first before they could send it. But I was just hoping that you guys could send it because they provided the correct fax number and stuff. And they said, just send it over and we'll just apply it to the file. There's a claim number. So like they have to send us the claim number. They have to add the service orders. Oh, okay. Okay. We just called Eugene our rough there. And he said that he's going to find it and send it over to us. So he's looking for it right now. Yeah, because I've like, I've like spoken to the, you know, the whole like. you know, insurance and stuff. Like it's just hard to get in touch with the right people, but I'm like giving them your fax number. They're saying they faxed it over, so I'm like, at this point I'm like, I'm just so, you know, I just wanna get it done. So I'm like, I just am like, if you could help with the just pushing it along, cause I'm just like at my wits end, I'm like, you know, how much longer? And it's very painful. I'm like, I just have to like live with it now, you know? Which sucks, but yeah. Yeah, so I'm just a little bit concerned with, you know, it not getting better. I've been seeing a chiropractor for a couple weeks. You know, it's like provides kind of like temporary relief for like the day, or not even really the day, for like a minute, like just to feel like it was stretched or something, but honestly, like, I don't think anything's really like changed except for today. You know, it's been like literally tingling down my leg. So I think hopefully it's not getting worse. but I know it's certainly not getting better. Did that tingling go away with the mental health? It still, no. I mean, it's still like, I can feel it down my leg to here. I mean, when I woke up, it felt like my whole leg was asleep. And you know, now when I'm walking, I can almost feel it down to my knee. So it's pretty significant pain. I mean, as much as that pain can be, and then every time from sitting to sitting, there is no comfortable position. to sit in, like I feel it. If I put my knee up, if I sit this way, I can't sit on my back, I can't sit on my stomach, I sort of lay, and then like sitting is uncomfortable no matter how I sit, but every time I sit to stand, it's like an intense cramp, like down my leg. And unless I like press here while I stand up, but still like sometimes it's like after the fact, it'll just radiate. So it's just, yeah, I mean at this point, it's just like living with it. which is annoying but but yeah so anything that I could kind of have just for the interim while they kind of sort out this MRI stuff and just to kind of get through the next week or so would be great. When did you finish the mental dose pack? Within like I took it like all I took the first dose that night okay 19th and I think I finished it on a Sunday. Okay so you've had two weeks off of it? Yeah. Okay. Yeah, I would say like this last couple days is when it's like really escalated But it's never it never like went away just kind of yeah more manageable and the only time I was like really bothering me Again sitting always is painful and I can only sleep on my side with my leg propped up with the pillow On each side but like I typically sleep on my back and I just can't sit on my back Massage I was just very uncomfortable because I'm on my back or on my stomach. So yeah, I'm just trying to, you know, without, you know, it's hard to convey how much pain without, you know, just kind of being like it just really hurts. So yeah, anything you can do to help would be great. I'll send the refill then that goes back. I don't want to do a third if we can avoid it, but yeah, let's do a refill. Maybe take off your shoes. I just want to see if there's any strength deficits that are showing up. Um, and is there. I guess it's just like, hopefully it will impact you a little bit. Yeah and then let me just have you sit for me. Okay push out against me and hold good and then pull back towards you. Good bring this foot up don't let me push down. Good push into me like a gas pedal. And then push in the knee. And then bring the knee up for me. Let me push down. And then on this side. And then sensation wise, does me touching here feel different than over here? No. How about down here versus here? No. Or on the inside here? No. How about like right here compared to right here? No. Anything here? Or are you just touching both? Yeah. Yeah. OK. And then on the outside? I mean, I've lost some feeling in my right side a little bit. So I don't know if they do feel different. I don't know how exactly. OK. Is that new, or is that from? That was from my previous video. OK. OK. Yeah, let's send Meddle those back. Eugene is super, super responsive about Simon and stuff, so he should call us back very soon. If they need me to do a prior op, I'll have him now. I'll call them, and I'll try to do it by the end of the day. OK. So that I can send them over to you. give me an off number. Yeah. And if you could send the, uh, I have to run to another appointment at like four 30. So if there's any way you could put in the prescription, y'all do it right now for you. Any change of pharmacy or pharmacy? Um, actually, yeah. Can I, I'll have Amelia do it upfront. Cause she inputs it with a big iPad for me. Um, the only thing like strength wise is like when I'm lying down, I feel like I can't like lift my leg because about, I don't know, it's probably, it's just stretching that nerve. if you wanna go in there. So, but I have to move my leg like that. Not that it's literally, obviously you can see it's not like, it's literally non-usable, but it's like I can't, yeah. It's just probably also I'm trying to avoid pain, so it's probably just me. But yeah, I haven't been able to do that in a month, probably over a month. So yeah, but otherwise, yeah, I mean, I can like survive. but it's like it's definitely getting to a point where it's like, you know, just the day to day just sucks. Yeah. Yeah. So just hopefully we can sort it out or like, I don't know what hopefully we'll figure out from them. Right. But I think that at least really some stuff will do. I will send that to you right now. Okay. And then we'll work on figuring out what needs to be done for them. Right. For you. All right. Thanks. Of course. Yes. Thanks for coming in so we can get it all sorted out. Thank you. Bye. She's going to change her pharmacy. So can we confirm that? And then, yeah, let me know what we need to do via MRI. Oh, is that him? Please copy forward prior examination. And add that there is four out of five strength to the FHL. Please, for assessment, this is a 32-year-old female presenting for a follow-up regarding. acute low back pain who has a history of a lumbar micro disectomy of bilateral l5 s1 that occurred on march 30th of 2017. Patient had acute pain with a radicular symptom and is now starting to show neurovascular deficit. I would like to order stat MRI however this has been struggled to get through insurance. I am going to send her a refill. of her medral dose pack to hopefully aid in symptomology and we are going to resubmit for MRI. She will follow up for review once the report is ready. Please then, stat lumbar spine MRI without contrast. Evaluate for disc herniation. This is going to go to Simon Med." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " The colon is 2 weeks 5, 3 days post-op, 2 weeks 3 days post-op. Plus arm, proximal humerus, cast fracture, history of metastatic melanoma." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " The patient is a 29-year-old male who presents a clinic for initial complaint of intermittent right knee pain over the past two months, exacerbated with squatting and bending movements, period. The patient denies having a knee-specific injury to his knee and reports he's had difficulty returning to activities such as squats due to a dull ache located around his kneecap, period. He reports he's able to commit other activities such as biking and walking without any discomfort, period. He denies having any prior history of right knee pain. Please enter a right knee physical exam with, or sorry, right knee x-ray series with benign findings. Please enter a right knee physical exam with benign findings. For assessment and plan, patient is a 29-year-old male who presents a clinic with an initial complaint of ongoing intermittent right knee pain over the past two months, exacerbated with squatting and bending movements, period. Both x-ray imaging and physical exam are relatively benign today, period. Discuss with the patient that I believe he's dealing with patella femoral syndrome likely exacerbated with his squatting exercises at the gym, period. discussed with the patient that I'd like to trial a course of conservative treatment including activity modification, comma physical therapy, comma and a course of anti-inflammatories period. The patient agreed to this plan and will return for follow-up in six weeks to evaluate his progress period. Please send a general referral for physical therapy for right knee patella femoral syndrome. Please send education on patella femoral syndrome." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " So if I understand correctly, kind of a maybe a diabetic foot checkup and also some issues with a couple of the nails give you trouble? Yeah, just anyone, but I told the nurse that I'm sorry, like fake toenails, I don't know what you mean. Okay. So you probably won't be able to see it today. Okay. Well, how often do they get? Is it a common issue or? Yeah. What do you do? forward anything? I'm not supposed to but I'm just trying to take it out. You've cloped them out of there? Okay. Are you usually able to get it? Yeah. Yeah. Okay. Is it just the big toenails primarily? Or? Yeah, mainly the big toenails. Okay, gotcha. And let's see, you've been diabetic 10 years? So, okay, I was a teenager. You're diagnosed. And your A1c is 5%. Good for you. That's awesome. And we'll see that in a number two. much. How now any issues with burning or tangling or numbness in the feet? Before I started my chin. Okay. Okay, good. Good. Yeah, that'll that'll make a difference. Good. So that might be a lot of nice to have it. I'm very gross in motion, but on the heels especially, it gets really bad. Okay, I'll take a look. Does that ever crack open? Sometimes. Yeah, okay, does it bleed? No. No, okay. Sometimes I just need to pick and edit. You just get, oh my gosh. That's why I cranked someone. Have you had any issues with wounds or infections or anything? No. No, okay. Any issues with weakness that you're feeling is new? ankles. Can you push against me? Good. This one too. Good. And then let me know, this there's a little wire here. It doesn't hurt. I just want to know if you feel it. Very similar, except this vibrates. I just want to know if you feel the tension. Okay. It hit it harder on the side of the time, so it's probably stronger. No issues with like athlete's foot infections or anything like that. I never had a speech before. Okay. I love that. Awesome. Don't be trying to lie like that. All right. So on the good news, and it's all good news pretty much, but from a diabetic standpoint, you're doing really good. Yeah. Meaning as far as the feet are concerned, I know your A1C was 5%, which is good, but what I was getting at is you have good feeling in your feet. So that wire and that little shooting fork. So if you can't feel those things, which you can, so there's not a worry. It's good. It's likely telling us that there's some nerve damage and you could damage your foot and not know it. For example, that's where some people with diabetes get in trouble. Their feet are numb, maybe they rub a sore or a wound, they don't know because it doesn't hurt and then it gets infected and they end up in trouble. In this case, in your case, if something's harming you, you're going to feel it because you can feel those things and you're going to look down and go, oh, what's going on there? Come in and take a look. Like you had mentioned. You're doing the best thing you can is getting those sugars under, I mean, five's not even in the pre-diabetic range anymore. So good for you. That reduces the risk of you having issues with that down the road. Still not a bad idea to check over the feet every once in a while just to make sure that there's not a blister or a sore or something that you need to recognize. But everything looks really good in that standpoint. Your pulses are also really good which means that... there's blood getting down to the feet so if you ever were to get a cut or something like that they're typically going to heal. The heals, if it's okay with you, I'll send in, there's a prescription lotion or medication that's a little stronger than you'd get over the counter but it has some acid in it, not that it will burn you but it will help get rid of some of that dry skin on the heels and moisturizer. So I'll send that in. And then as far as the ingrowns. There is a procedure that can be done to remove them if it's something that's bothersome enough for you. Meaning, what we can do is cut the ingrown piece of nail out. So basically, you cut all the way down and cut that side out. And then you can put a chemical on the nails at the base. Those are where the cells that make the nail are. So you put a chemical on there, it kills those cells, it doesn't grow. grow back, at least 95% of the time it doesn't grow back. Will that qualify for something like that? So I would say yes in the sense that if you have a history of ingrown toenails that cause pain, sure. If you feel like you're able to manage it and you want to keep doing what you're doing, that's okay. We can always do it down the road if you needed to or if there are any issues. But sometimes people, it's just enough of a nuisance or a pain in the neck for them that they're like, I'd just rather have something. that don't keep dealing with this. Well that, and I just love it, but see, sugar's like more under control. Yeah. So like the sugar, you know, only being there for healing, right? Yes, so I agree with you 100% in the sense that right now, and hopefully they'll stay at this level, but your sugars are at a good level. So, you know, someone who's up over 8% or so, you'd say, oh, we definitely don't wanna, we wanna try to maximize things. But yeah, which sides I saw you point to this side This is not Okay Okay. Yeah, so the lateral side of both big toes sure so we can schedule that if you want you can do them both at the same time What's up? Yeah, so typically what you do the way we? where you get a shot here and a shot here. The toe is numb, you don't feel anything after that. We take out that side of the nail, put a chemical on there. We wrap it, but all you'll need after is a band-aid and antibiotic. There's about a 5% chance that the nail could grow back, so 95% of the time we're good and it doesn't grow back. There's about a 2% chance of infection, so we'll have a follow-up appointment just to make sure it's healing okay. I keep getting it on my feet. So there's an infection, you're right. So that ended, and to your point, that that's, you know. Really, I'm a nail tech, so I do sterilization. Yeah, so you understand the process. Yeah, yeah. Oh, we'll get you, we'll have them get it set up for you. Yeah, I think that's. I don't even know how to say it. Yeah, yeah, yeah. And I think, you know, given you're young, so I mean, you got 60 or 70 years to keep digging that side of the nail out of there, so you might want to do it. That's what you do. No, unfortunately that's the way I have to say issues. Issues. I don't know if she's there. Yeah. So it can be a pain. A pain. Yeah. Yeah. Okay. So we'll get that scheduled. Okay. Easy enough. All right. Any other questions or concerns or anything? No? No. Okay. All right. No, no, no. Yeah. Good. And that was, I think, just a function of the sugars like you were mentioning. So good for you. I mean, that's... I'm impressed. The fiber sounds good. Yeah. Yeah. and solve it you got it through your physical exam demonstrates two such order cells penis and posterior tibial pulse to both feet sounds wise and protective sensations are detected five plus five plus to both feet five five muscle strength testing for point of luncheon door suplexion bilateral ankle there is hypercaric just there is xerosis to the heels bilaterally significant fissuring ingrowing of the lateral border both create toenails without paronychia with assessment, diabetes, insert diabetic foot precautionary to onychomycosis or ingrown toenail, does have chronic issues with ingrown toenail and has been treating with home care, would like to have these permanently removed, reviewed this as acceptable to reduce the risk of infection and chronic pain, will schedule a set of convenience to xerosis with occasional fissuring to the heels, was given prescription for ammonium lactate to improve skin quality. to actually reduce the risk of faltic disfissuring and secondary bacterial infection." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Doing okay? Yes. What's nothing new hopefully? I'm gonna leave it open. This room is pretty hard. Huh? Tired? Busy? Please leave the door open. No lumps, bumps, none of the things we talked about. Appetite changes, weight loss. No. Night sweats. Okay, great. Great. Good to hear. The blood counts are back. They look good. The rest of the numbers will be back a little bit later. I will call you if I see anything. I'm hoping there's nothing to be done. David same labs telemedicine in six months one year of his physical visit. Let me check around your neck and other stuff and see if you see anything. You know we hope this thing never comes back if and when it does you know you will see other lungs, bums, stuff show up on your blood work or you'll have symptoms but so far so good looks like right? Yeah. Okay I know you were mentioning that to me who are you seeing for the process? it. Yeah, it was here. It was a classic. Ah, that's true. Did we do radiation thing? No. But yeah, yeah, yeah, yeah. Okay. Okay. Oh, that's true. You're right. So David, order a PSA. I forgot about that part of your history completely. So that was when that was, oh, that was last year. May of 2022. So let me order a PSA too. Okay, I will get those results at the end of the day. I'm hoping everything looks good. Last time we checked in August, the PSA was still low at 0.8. Let's see what it is today. Yeah. That's okay some some urologist right? Yeah, that's okay. Yeah, you're here. Okay, good Okay, so we'll see what your PSA is the iron studies are already back and that's all good too I don't see anything else of concern here John at least not what is back yet And if you're looking good, I will if there's a problem I'll call you. Otherwise, we'll let's check back Months or more is that okay? Okay, perfect. So let me just reiterate. In impression and plan follicular lymphoma stage 3, Mr. Avila is seen in the oncology clinical privacy of follicular lymphoma. His last chemotherapy was back in 2016. He's actually done well with no evidence of active or recurrent disease. Today he's just tired, which is mostly because of his... gets up early. Rather than from his malignancy, we will check where to do microgram and LDH immunoglobulin levels as SPEP. No need for any imaging scans at this time. Next number, prostate cancer patient or John had early stage prostate cancer. He was treated and finished with definitive radiation in May of 2022. Since then, he's been doing well. PSA has been stable at less than one. We'll check it again today. He follows up. of Dr. Greval from urology. Next number, borderline neutropenia. Patient continues to have borderline neutropenia with a WBC count of 4.4 ANC stable at 2.6, which has been unchanged over the last few years. No further intervention from the same. We'll order flow cytometry. Fatigue, we'll check his iron series, working B12, folate, thio, and D levels to make sure he has no deficiency. Likely, this is due to his age." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " How are you doing? Good. Happy? Yeah. Did it fix your problem? Yeah. Good. Are you having any issues with it? Not with this, no. Good. Anything I can help on? I don't know. It's kind of bizarre. I have like some pins and needles on the top of this thigh. I don't know if something like shingles can be that isolated. I don't have any rash or anything. what would cause I mean I thought that the phone in my front pocket while we were in Florida so I stopped doing that that didn't help it. Tight belt can do that. What's that? A tight belt or tight pants. I know I... Stuff like that can do it. There's this thing called Baralgia Peristaltica which is basically just a fancy term for a sensory nerve that gets pinched in the front of the head. Okay. That can be irritating. It's usually this whole front outside part of the thigh. Where it is right here? Yeah. Okay. Could be a pincher in your back. Okay. Probably just keep an eye on it. As long as you have any other concerning symptoms at this point. No, I thought, you know, it's funny that something would migrate from the right side to the left. I don't think it's hip arthritis, but I also can't recall what your left hip looked like. Let's take a look. It wasn't as poor as the right, and I don't have any pain in the hip. Well, that's more important, that you don't have pain. That's the most important thing. Are you taking anything for pain at this point? No, I mean other than the scar, I wouldn't know that I had it done for the most part. That's wonderful. Well, yeah, you do have a little hip arthritis over there. I think the bite may actually, I mean, I texted my wife and kids, I'm like, my blood pressure this morning was spot on the best it's been in years. Good. And I don't know if the bite had anything to do with it. Yeah. That's awesome. this doctor's office usually it's you know 150 over 90 once it's usually it was 117 over 77 I believe. Wonderful. Like I say it's been years since. Good. Well John this is great I mean I think your hip is coming along wonderfully. I don't foresee any major issues with this but if you have trouble with it you know how to let me know. I expect little hiccups here. as well as you're doing right now. As you approach that one year, there will be occasional aches and pains that come out with it. It's just those soft tissues and muscles and down into the back that, hey, I can do stuff again and I can push it again. That's kind of what I want for it. But the muscles and tissues around the hip will respond in kind to, I haven't made it or done anything to not push it like a normal hip would. Okay. Florida daily biking elliptical and full. I do six stations one day six stations and that's as far as strength. So, press leg extension, leg curls. So, you know, it's a whole bit. So this summer, I was thinking of going back to Genesee Country Museum for a whole time baseball. And any, I mean I haven't done anything in terms of any explosive, you know, rotational kinds of things on that back hip. It would just be, you know, a swing. Okay. and then out of the box kind of a thing. But, um. Test it a little bit. Like just in the back area. Sure. Just take that out and swing it. See how it feels. And you know, start with a pretty stiff, stiff hand, stiff swing. And then gradually look up to something that's more flexible and is more natural. And the hip will tell you if it's short, if it's a little too much. Okay. Or if you're doing something it doesn't like. Okay. But I believe we get there. Okay. Alrighty. Good. Awesome. No, I. This is what I want and expect. Yeah, no, I've said, you know, granted my age probably helped some, but. I've had no qualms whatsoever. I do it again in a heartbeat, and it's worked out really well. Wonderful. Well, let's keep that going. And again, like I said, I expect little ups and downs. Again, especially as you're pushing back the stuff you haven't done in a while. So as long as you expect that, and it's stuff that is truly little, it happens, it aches, it goes away after a day or two or an hour, a couple hours or less, that's okay. Anything you're really concerned about, let me know. Okay, okay. Our last kind of routine follow-up for this in the recovery period is at the one year mark. Okay. and just kind of say, okay, that's what it is. We'll shoot one more round of x-rays and then we'll open it up to long term follow up. In between now and then, oftentimes I will schedule people an optional appointment, but you're doing so well, I just, it'd be a waste of your time. I think I'm gonna wait now for you to come walk in for five minutes. So in that regard, that said, if you're having any trouble or any problems at any time, just give me a call. Okay, all right, we'll get you in. Otherwise, enjoy. I'd like you aboard to see me for one year, okay? Sure. All righty, good. But anything else you need, just give me a ring. Okay. Alright. Okay, I think I got everything in there for you. I think we're good to go. Yeah, you're about four months. Yeah, because we weren't back until Sunday night. Gotcha. So we flew once in January and I used the socks and the baby aspirin. In first weekend in March, I'm trying to think, I may have worn the socks up but forgot to put them on on the way back down because we had other stuff going on before we went to the airport. But that wasn't initiated, I mean I didn't know that this was happening to me. At this point you probably don't. It's never the wrong thing to be overly cautious. Sure. But being more than three months out you're probably safe. From a risk standpoint you're probably back at where you were before. And then the only other thing in between, well while we were... the first week in February I had my cleaning for my day and I was like seven days shy of the 90. Okay. So I got to the office and they were in a panic like oh didn't they give you any instructions or anything? I said well I just figured I was close enough to them. Oh no we can't do anything. They're not asking you to take anybody out. I said no. Because my wife used to have to for a murmur and my mom and so on and of course they changed their thinking on that and everything because I'm like well I'm just here for you. for cleaning I'm not getting anything true like no we're gonna be on every surface of every tooth so so anyway I'll do that on April 1st now yeah so that had to be rescheduled but otherwise tell me don't you yes on your paperwork today actually there will be some instructions that will print off that says that very okay so you can bring that okay no they were fine with because I actually I sat in their parking lot and gave a call and got a call back and so I I called them very immediately because we were only home for like four days and thought I wanted to get that rescheduled without having to call from Florida. So yeah I reassured him at that time." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " The patient is a 14-year-old male who presents the clinic with his father today due to left knee pain that occurred after a fall while playing lacrosse yesterday 10-29-23 period. The patient denies having any traumatic injury and states he was simply running in a straight line when he felt a sharp pain in his knee and fell period. ACT has been able to walk without... any discomfort, but has yet to try a return to sport period. He denies having any prior knee injury or pain in the past period. Please insert a left knee x-ray series with normal findings except for the patient being skeletal, skeletonly immature. For left knee physical exam, patient has tenderness to a patient of a quadriceps tendon, MCL, and LCL. Tenderness with valgus stress or positive pain with valgus stress for assessment plan. Patient is a 14 year old male who presents a clinic with his father for new onset of left knee pain that occurred after playing lacrosse yesterday 10 slash 29 slash 23 period. X-ray imaging did not demonstrate any fracture injury period. At this time I'm not concerned for any ligamentous or meniscal tears period. Discussed with the patient, I believe he had a sprain, a strain of his knee that occurred while running. The patient does have tenderness to the quadriceps tendon, MCL and LCL. Discussed with the patient and his father that I believe his knee condition should gradually improve with the course of conservative treatment. I advise that the patient try low course of anti-inflammatories for the next 10 days, comma, rest from lacrosse. I will also send a referral for physical therapy today to work on overall knee strengthening period. I will then have the patient and his father return for additional follow up in two weeks to follow up on his progress and see if he can return to sport period. Please send a general referral for physical therapy for left knee sprained period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hello. Hello, how are you? I'm good, how are you? Good. How's it coming along? Oh, good. I feel like I have a bit of a setback though. That's okay, it happens. Um, I was going, you know, set. Going very well. And then at the end of March, I went out with a friend of mine for her birthday. And um, I don't like to sit on stools anyway. And, well, long story short, I ended up being a DD for an extremely late night. Haha. And after that my knee really bothered me, but I sat on a bar stool We ate dinner at a place and then for an extended period of time So what kind of was hurting and bothering me and well and that was like very end of March last week in March and then April 12 10th April 10th. I went to California. Well, let me tell you that's what hurts It doesn't really hurt until I try to bend it past 90 degrees. And where do you get the pain? And it's usually right here. Right in the back of the knee? Yep. Okay. Right there and right here. Okay. When I feel the pain it's right here and right here. But let me tell you when I went to California it was three flights to get there and my knees swelled up like a basketball. Yeah. And I hadn't done that in quite a while. Okay. And so like I was in the airport hobbling around and I... I went to a restaurant and they gave me ice so I put it up. So when I got home I called your nurse because I was so concerned. Now I had like a negative hohman sign and everything. There was no redness. There was no, you know, I didn't feel like there was a clot or anything. It's just, it kind of went backward to where it was when I first started working and it would swell up so much. But it really has kind of bothered me since. As far as, so I asked your nurse, I said, I don't know if. Because one thing I'm very guilty of is when I went back to work I said, oh, I'll go to the gym and do therapy on my own. Uh-huh Well, the first couple weeks were awful And so I didn't and I just I've only been to the gym three or four times since I went back to work So I said to her I don't know whether I need to push it or Not push it and she said at that point just put it up more put ice on it when I get home from work And if I rest right now does it feel better with time? Yes, okay, so But I'm I was worried that maybe I just like when my therapy stopped I stopped Doing it because I feel like I still like putting my shoes on when I go to work and I change my shoes you know, I put my shoe up here and then I Still can't okay, and I'm like is that normal? Yeah Can be it definitely can be at six months Absolutely because a lot of those little things especially that final stretching that terminal flexion It takes quite a while to get back to. That said, at this phase, it's not uncommon for people to say, the same thing happened. I was so attentive to this in the first phases of the recovery, and I just turned my attention to other stuff as I worked back into work, started traveling again, living life again. I realized now it's started to set back. Maybe what that tells us is, okay, I turned my focus back to it again. Sometimes that's as simple as just bouncing back into PT. There's a lot of people that generally want to do that at about this stage or six months. month mark. So, A, yeah it's not uncommon. It's not abnormal. Nothing seems damaged. We could check some x-rays just to be sure but I wouldn't expect that. And so I would say what you're doing is probably the right stuff and giving you a little bit of rest but yeah I agree maybe it's maybe it would help to bounce back into physical therapy for a little while for a couple of weeks and see how it goes. Yeah. Okay. They can help work on the stretching. They can help work on some TPN symptoms on the outside part of the knee. Not a bad idea. Yeah. What do you think? Cause I was like, and I was promised myself, well right now so many things are, I'm looking at leaving my job. Okay. I applied for another job, I shadowed yesterday. Well I've been at the same place for 31 years. Same hospital, I mean. So I'm gonna go back to the cancer center, I think. I haven't been offered the job yet, but. Okay. So, I've just been so, and move. I've been staying with. my mother for two years because I was going to leave and go travel nursing. Well now that kind of path is changing a little bit at least for a couple of years. So I've just been so busy and stressed and I was really worried. I thought I'd gain more. I stayed away from the scale for like a month because I knew but at least it was only three or four pounds and not more than I thought. I don't know. I mean do you think I need to go? to like structured physical therapy. Yeah but I don't think you need to go like three times a week. Okay. Okay good because I just don't know what I can do with work you know what I mean? And they can work around it. Okay. I mean what I would recommend is just get a good regimented home program that you can do diligently every day. Work with a therapist and then follow up with them like every couple of weeks. Okay. Make sure they can update it for you. Okay. Um. And I have this. the spot it feels like there's glass in there where right there well it feels kind of deep but man and I didn't notice it but I was rubbing my scar with vitamin E right about well that I don't have like maybe a stitch it could be that and I'm like sure but I mean it or just right there it just went over it it could be a little scar tissue in the bursa in that pre-patellar bursa Okay, so do you just put in an order? for PT? Yep. Okay. But you're going to be doing it afar so what I'm going to do is print out. Okay. Have that printed out. Okay. All right. That's in. That's good. Are you taking anything right now for pain? I'm still taking probably at least one dose of Advil and one dose of Tylenol a day. Sometimes too. but definitely one. All right so we'll see the x-ray show with the trapezius and physical therapy now are you still generally feeling better than before surgery? Yes the the everyday normal pain is gone and the one thing and I love doing it every day because it makes me when I do stress tests I have to let it stress test I have to we have an old stretcher so you got to pump it up okay now that used to kill me I couldn't do it I had to do it with my other foot and I can do that I can pump up that stretcher even with a big ol heavy person on it and it doesn't hurt at all okay it's mainly just this flexion that that flexion going and I just picked up my motorcycle from the shop okay and rode it for the first time and getting on and off it was still rough yeah Give it some time. It'll come. It'll come. This is why New York question takes a whole year. Okay. Because it just takes a whole year. And you told me that. I guess I just need to hear it again. It takes a whole year and that's what half of these visits are is reassuring people, no it's coming along. It's coming along. It takes time. It takes time. It truly takes a whole year for your body to just accommodate to it. And again, think about saying this like three months ago. Right. Oh, I'm checking on my motorcycle or I travel across the country or I did this, I did that stuff you wouldn't have even thought about. but you were having the same symptoms. The issue isn't that you're having the same symptoms, it's that you're gradually, where you're getting better is you're doing more and more and more. And that's gonna push the symptoms, but that's because you're telling that knee, hey, you gotta tolerate this. And it's like, I'm not ready, but I'm gonna push you. You know, it doesn't have to be ready. I mean, as long as it's not crippling you, you can push into it a little bit. It's like weight training. And I guess that's what I needed. I didn't wanna do something that was going to hurt it. No, it'd take a lot. I mean, you can use your symptoms to gauge ya, but it's like the way I think about it is. It's like weightlifting in the gym. I wanna get to a point of being able to bench 200 pounds. I can't start with 200 pounds. And when I start with 100, and then I slowly work my way up, I have to push it past what I can comfortably do, otherwise I'll never actually go further. And there will be some days where I can push really high, and there'll be some days even afterwards I can't quite get there. And it's frustrating, because it's like, well, I just did this. Same kind of thing. It's just the biology. Notice that I still don't seem to be able to do. is go downstairs. Foot over foot. PT will help. Yeah. This is the kind of thing people get back, all these things are the kinds of things people jump back into PT for a little while for at six months. Yeah. Okay. My friend that you did both her knees, she's in Santorini, Greece going up and down and everything. So I'm like. She's a lot further ahead. I'm hoping. A lot further ahead. You'll get there. You'll get there. All right. So sit here. You can go ahead and get changed if you want. Okay." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " And just something didn't feel right. So I ended up going to Urgent Care and they did the x-rays and nothing broke and will give you a referral to orthopedics and I thought, well, maybe the bumps will go away. They haven't. The pain is mostly subsided except when I wear shoes that are almost all my shoes, push right on this spot. So you have pain on the outside of your ankle with bumps that have been there. since I noticed them after I twisted my ankle or something. Honestly, it felt like I sprained my ankle. I was twinging some things around the house. How long ago was that? Monday before Thanksgiving. Okay. And so I've had something that happened when I was hiking this summer where my foot was incredibly sore right up in here. And that would come and go. I don't know if it's related, but I... I have to mention it because it's bothering me now. Whereas the ankle is only bothering me if I put on shoes that push against these bumps. So it does feel, I did ice, ibuprofen, elevation, and the, I can still feel some tightness when I rotate my ankle, but I feel like if it wasn't spring, that's resolving. But the outside of your foot bothers you as well, and that's been bothering you for a longer period of time. It has been. off and on again I first noticed it on after a long hike probably in June let's see here sure so that's the spot right there so on examination you have a large bump that's likely firm slightly mobile Is it tender? It's, yeah, it's tender underneath, not on the outside. So this is all on the lateral aspect of his ankle. And I honestly don't know if it was there before. He has very good ankle range of motion. The pain here in your foot is over in this area? Yeah, right about there, right about there. Yep, right where he is. Dorsolateral foot tenderness. Otherwise, goodaby. Pulses, sensation okay, push up, down, bring on up, and good motor function. So you had an ankle sprain and then you noted this bump. Yeah. Okay. And if I hadn't noticed the bumps I probably wouldn't have gone to urgent care. I had difficulty driving. Just the flexing was... troublesome and that's all gone. It did make it difficult to wrap the ankle because that was just putting in agony for those few days. So x rays of his right foot. Personally reviewed and interpreted. Show an intact ankle mortis. No evidence of fracture. He does have a cavus foot. There's no obvious midfoot arthritis or fractures. Other What all that means, I'm just talking to the machine here. It actually makes its AI technology and all this miscellaneous conversation we have, it gets rid of. And it does a really good job of interpreting what we're going to, putting it into what's like a note. That's cool. Yeah. So, but you don't have any arthritis out there, which you do have though is pretty high arch foot. And sometimes that means you're just putting too much pressure on the outside of your foot. Oh, okay. And your ankle, which you feel like is occasionally unstable, could be because of, could very well be. So let me see your ankle here. Sure. So back to the examination of the ankle. There may be some slight, yeah, there may be some slight instability to varus stressing. So this, so I do, you've rolled this ankle a bunch. before. I think your ankle ligaments are a little loose. I think you tend to put more pressure on the outside of your foot, which causes this. And this is a ganglion cyst, I think, just because you've injured your foot. So I think that's what we call a ganglion cyst there. That's actually what the person who examined me at urgent care thought it might be. Yeah. And I think it's from ganglion cysts are cysts that come from synovial fluid and they you know joint fluid or tendon injury okay and they can build up in there and cause that but I think you have some chronic ligament injury okay that's a ganglion cyst and then you have you know your foot I think you have some little or you don't really have arthritis but I think you overload the outside of your foot how long is the outside of your foot been bothering you I would say since about June off and on but it may have done that before I I went through plantar fasciitis years ago. I ended up doing insoles on all my shoes. I do prefer a stiffer soled shoe. I mean, how well do you tolerate this ankle rolling on you? In what's- I mean, how often does it happen? How often does it roll? Not often, but I do like to run. If I lost like 20 pounds, probably be a lot nicer on my ankles here. But- And if it starts to bother me, I'll lay off running for a few days or you know, I'll just I'll just take it easy I do like to cycle a lot Usually doesn't bother me when I'm cycling. Okay So treat so some of the treatment options are one, you know You could we could try it with some PT and see if they can help you work on some exercises to strengthen your ankle Okay, and that's more for the rolling Yeah, we could get you an insert in your shoe to try to build it up a little bit on the outside Okay So maybe you won't put so much pressure towards the outside, which also maybe keep you from rolling your ankle. And for the ganglion cyst, I try to put a needle in it today and drain it. Sometimes they'll come back though because the irritation doesn't go away, but sometimes they'll come back smaller or they won't come back. So it's likely that was there and I just didn't notice it? No, it might've been because you injured your ankle and fluid build up and it actually gets out somewhere. It gets out through this almost little balloon thing and then it gets trapped. in there. Okay. But we could try it you know the one good thing if we put a needle in it today and then it tells us it's a ganglion cyst. Okay. And then we don't have to worry about it and then we could try you know some PT and some inserts and see if that can get you because the other options I mean there's surgical options you know one of the surgical option is to solve your ankle ligaments and make them tighter you know but it doesn't sound like it's that much of a problem. Okay. Where you tell me maybe it is that much. No and you know I try to stay active and And when things hurt, I take a break. I have a slight meniscus tear, and that was the advice. They were like, if you don't want surgery, when things hurt, stop doing that. All right, so I think what we'll do is we'll aspirate your cyst today, and that will give us a diagnosis of that, and then we'll put you in a script for PT and some inserts for your shoes. All right, sounds good. Thank you. Ah, I'm relieved." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " How are we doing Mary since we last saw you? Same house, yeah. Which is what? Good, bad, stable? You know, on your scans, for the most part, at least the CT part of it, you know, we are not seeing much going on on the liver. They keep talking about just that spot which... is growing but nothing else happening. You know so like before this was about three and a half centimeters now it's 3.7 so this area is is that area is growing yeah I mean on the liver frankly we are not seeing much going on the good thing is or the other thing is on when we look at your blood work also remember it's a little hard to tell. your disease we've been usually focusing on this and the liver. On the liver part of it things are actually pretty decent. Your bilirubin, the jaundice remember which is very high which is a reflection of your disease has been actually very stable. The other measure of your disease the alkaline phosphate just to give you an idea this is basically again this is how much how it's a surrogate for how much disease you had in a liver And this is basically earlier in this year when it was very high when I was like, oh, I think we are in trouble In the summer, this is around April Since then it's been actually much better same thing with the jaundice Okay, so this is the same thing which is going on so it's not close to normal But it's as good as it can be. Okay I think I don't know if we can do anything about this The easiest would be all this to do surgery. I know we had you see the surgeon, but they weren't too keen on doing anything Correct. You saw dr. Narahari at one point or you never saw Yeah Yeah, that's true. We did do tri-radiation. I mean, I don't know how many times have we done radiation once or twice? twice already I mean, that's the only spot that I'm seeing Mary. I'm not seeing anything else which is you know I feel in a way remarkable I this is not something I expected this disease to do as with these with this medicine but somehow you're you're chugging along pretty fine okay so so the only thing that you're we are seeing is this fatigue of yours which I understand the more chemo we give you the more fatigue will happen but you're not super anemic what about the stingling numbness anything? Um, stairs just a little bit though. But not a whole lot? No, but um, my balance is not good. Balance is not good? David when was the last MRI we did for her? I think it has been weeks. I think it was, yeah. I think it was a year ago. You know, so let me just confirm, you know, obviously what we worry about Mary is on your scans things look good. I am. I'm very worried. Just not worried. I'm worried about. the brain okay I thought we did that MRI in August let me order one again by the time you order it will be it'll be December when's her pets can they would do? and 12 so October November December January so let's order for January and then I can see her then okay so we'll probably do it around here and then I can see her there in a month the we can let her go let's see if she can see same on here on 11 12 28. If not we can just leave it be what you were saying. No I can't think so I mean you know that's why I'm checking the MRI just to be super sure the last few times I've not seen anything I mean your electrolytes are slightly off like a potassium calcium but there's nothing really bad here okay. So, I mean, all I can say is there is that growth in that side lesion. We can see when was the last time we did fatigue panel for her. It's actually due now. Let's go ahead and order one. At this point, if we, they were over here, they would see if you want to move it here. At this point, let's see. I don't know I can ask the radiation doctor again if there's any point in doing zapping you again or not I just don't know if they will do it you know the whole issue here is if that's the only spot everything else in the liver especially looks good I don't know if anything else will be better is it bleeding okay I mean I can try have you see the surgeon again but with your insurance it's a little challenging I don't know what they will let us do insurance wise you have no option are you not two years into this that you should get Medicare what are they saying when did we diagnose you it's been two years yeah so usually when you have cancer and it's been more than two years you get Medicare they didn't say anything talk to your social worker yeah because you are technically on lifetime disability right yeah basically for like we know for dialysis and other patients it's like two years they get Medicare just because if it does then it makes my life a little easier because the surgeons I know there's insurances no one is going to see unless we send you to the ER and I don't want to send you to the ER just because of this I can have you talk to the radiation doctor again when was the last time you did radiation on it I can see if they'll agree to that. Okay? But as I said, so far so good. Let's get a copy of this and then I'll check back with you in two weeks. You keep up with your routine. We'll check back with you again with a scan in January. I will see if I can have you see my nurse practitioner. Okay? You're good to go. I'm just gonna work on your. Okay, can we just go upstairs? Mary had a CT scan of the abdomen pelvis in HbA, please add Mary had the CT abdomen pelvis in 11-21-23 which shows enlarging lesion in the left flank measuring 3.7 times 2 versus 3.2 times 1.7 before liver densities are relatively stable. Maybe there's one lesion which appears to be new in the left liver. moderate intrahepatic and extrapatic biliary dilatation due to prior cholecystectomy, stable sclerosis of the vertebral bodies from metastatic disease. Continue with assessment plan or impression and plan. Metastatic melanoma, BRAF mutant, Mary E.C. dermatology for metastatic melanoma. She continues on carbotaxol. Fortunately, she's actually doing relatively well. Gage's complaint has been fatigue, which is not unexpected. Her CT of the abdomen does not show a significant change disease in her liver. Her skin lesion continues to enlarge. Unfortunately, that is, she's not been able to get surgery on the same. We will try and see if we can have her see the surgeon. I think she will continue on the same treatment given her liver function is otherwise okay and she has no other areas of distant disease. She's been complaining some non-specific dizziness and headaches, ulcerative and MRF of the brain again. Last one was done in August of 2017. 23. Next paragraph in case she has disease progression in the future we will consider we can consider putting back on immunotherapy since it's been close to more than six months since the last immunotherapy treatment. Next PET scan is due in January 2023 at which time I'll take a look at her." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hi! Hello, hello! Good afternoon! Maria, right? Yes! How are you feeling today, Maria? I'm feeling good, but I'm just coming here to... concern about my right ear. So you think your neck or this area? This right here. And I'm going to, you know, where's my ear? That's a salivate line. And the other area? The other one it's... See? You think it's asymmetric, huh? Yeah. Now go straight with me. Look at me straight. It's just a little bit more swollen on the left side. Yeah, this one is smaller and this one is big. Are you dry? A little bit. It's dry, my salivary gland. So, like, I went to ENT, and then they do me a biopsy, and also I have a CT scan, and everything's okay. Well, I just kind of worried because my mom, she passed away from lymphoma cancer in her leg. The ENT, Dr. Sheff, there's nothing not to worry? The doctor told me there's nothing, all the results are all good. But I'm just curious why it's getting big. When did you notice that? I noticed this a long time ago because my coworker told me that it's my face, right here, my jaw is getting bigger. Who told you that? My coworker. My coworker, hey, you can leave it surely on that side. Yeah, even my friend told me. But I noticed that when I go work out, my electrical and I got headache but you know I got migraine and I have my sinusitis, my chronic sinusitis and also I have my allergy. Do you feel uncomfortable in your mouth or that feels normal? My mouth is comfortable. Do you feel a dry mouth? Sometimes. Like when I'm swallowing salami I don't have nothing. Do you have pain? meaning your jaw? My jaw, it's a little bit, I don't know, it's like a sharp, it's rubbing me. And you're a dental hygienist, right? I'm a dental, I work in dental, so I... I was going to suggest you need to go to dental exam, I see there's nothing with your gums. Did you see the dentist? I did. And there's nothing in your gums, or your tooth? No, the only thing is... Do they take edge-wires? I do, I don't have my panoramic, everything's normal, and I just have my extraction for my teeth because they're doing impact. I even eat some bread and it's just rupture. So the only things I notice this like sometimes like today it's cold a little bit and I compare like it's sharp right here. It bothers you a little bit more. It's wanting like rain. I see in your records an ultrasound that was completely normal. You said there is also a catch-can? I didn't really embrace everything's normal. They said I have a... They said I have a... I just... I just... That's why I've been... I got choke on because that one in the very place. But anyway... What is it? I just googled this and forgot what the doctor telling me. I cannot remember. I got a salivary gland enlarged. See? I just keep go-go all the time, and I just kind of worried. You know, I don't want to be like my mom, My mom, she has lymphoma cancer and it only takes one month and she just pass away. And of course I just worry. Parotid gland, that's the one I have, parotid gland enlarged. So I notice that because I'm grinding when I sleep, right, but I'm wearing my nightguard since I know. So... Let me see here. Let me see. Have you been diagnosed with anything else in the past? No. No diabetes? No. No arthritis? No heart disease? No. I... Well, I want to... This is my result for... They take me to the... They take me to the specialty after A&T, right? This is the one I have for... They send me to... Rheumatology. Why did they send you to Rheumatology? I think a couple months ago. Why did they send you there? Well, to make sure everything, when the A&P sent me to Rheumatology to make sure I'm okay. So the only things they know is that I have like, probably for my bones, but like a little bit of rheumatism in my neck. So this is my result here. So that's why I think that's the reason. Do you take any medications? I am taking some, right now I'm taking some, uh, Serpic and Cholesterol, uh, Lopitor for 10 milligram, I think. Okay, take a deep breath. Okay, again. Deep breath. Out. And again. Another deep breath. Okay. I want to go from back here, feel some, some notes in this area right there. And then I want to feel your neck. It's very, very close to the same, but yeah, it's just a little bit swelling here. It's not completely abnormal. Nobody's completely symmetric. And yes, I can see that your coworker told you that maybe there's a bit of swelling here. Is this swelling getting worse? Yeah, I noticed that it's swelling a little bit, but when I touch right here, I can feel like hard. Yeah, and of course you have a CT scan all normal, you have an ultrasound all normal, so we need to trust that, right? Do you have any swelling in your legs? No, I don't have swelling in my legs. Okay, have a seat here, we can talk a little bit more. Are you married? Yes. Kids? I have one sister, Tito. And you smoke or drink? Never drink, never smoke. Very good. My daughter is not practicing any. So I definitely, I agree that if you check the right side with the left side, the left side has maybe 2-3% more volume. When I feel with my hands, I don't feel anything bad. Cancer, feels like if you have glass or rope under the skin like this. Or you, it feels the same on both sides. It feels rubbery, it feels soft. Because it will feel like your knee, you feel more like soft. I would make sure that there is nothing in the dental area of things. You already went over there, you work over there, and there is nothing dental. The surgery already looked at me, like two surgery doctors. When I was in my office, I was planning to order either an MRI or a CAT scan. But you already don't know for sure, and a CAT scan. So if I was going to do something, it's like I would like to see you again in three months, and if this looks any different or the same I can do an MRI but MRI is going to show the same normal. I can make you go all the way to ENT oncology which is at UCSD but I'm not going to want to do anything to you. Nobody's going to want to hurt you with the biopsy. You don't have any relevant symptoms about the function of the salivary gland. It is normal for people to be a little bit asymmetric. Maybe now that you know you've just paid too much attention on it and you're obsessed with it and that way you work but there's nothing to worry about. Everybody is a little bit asymmetric. Maybe you look at your legs and you measure one might be a little bigger than the other. That doesn't mean that there is cancer. Something that I think is very important for you to know is the following. One, lymphoma is not genetic. Two, having lymphoma at age 80 is like garden variety anything because at age 80, anybody can develop lymphoma. And lymphoma is not genetic. And lymphoma is a disease of growing lymph nodes. Now lymphoma, we actually cure like 90% of people. Maybe your mother because she was 80, maybe the subtype of lymphoma she had. But this is not lymphoma. Because you are like significantly younger than your mother. So I know that you worry because you have lymphoma and she didn't do well. But I don't even know why. Maybe you bring me a breakfast if you want. Because lymphoma we can treat and make people live 20 years or we cure them. So something happened connected to the lymphoma. But it's not genetic, has nothing to do with salivary gland. Yes, what is enlarged is not the lymph node, it's the salivary gland. But I don't think it's malignant. So maybe I'll see you again in three months. If we're still worried, we'll get an MRI done. But I don't think you should worry. You are wasting your time being worried because being worried takes away your well-being, right? Yeah. No reason to be worried. The only thing I'm worried, because I know before my face is a little bit smaller and now everybody thinks that my face is getting big right here. Sometimes when I touch right here, I don't know if that's normal how I touch, like how you feel it. See like right here, I touch right here, I can feel it. And it's true. It's a little bit larger over there. But that doesn't mean, I can see it. You are right. It's a little bit bigger than the other side, definitely. It's maybe 3-5%, but it's not cancer. It is not. So do you think that I got infection or what? I don't think I have infection. I think it's just normal. So I've been taking sometimes because you know ibuprofen it's good for inflammation right and I take that sometimes but the only things I cannot tolerate because when I'm taking I have a stomach upset even though I'm drinking some milk or either I eat before I taking some medication so I just kind of worried I thought the dog and I know my face is not like that and I mean time like I would be today is bigger because when I go to work it's cold like I live at 5.30 in the morning so I just and I've been searching a lot all the time that's what I do I keep searching I said man where this this come from yeah the best I can tell you is like you don't have lymphoma you don't have cancer sometimes there is asymmetry to give an example I'm sure you have friends that maybe one breast is a little bigger than the other but they both are normal and the mammogram and MRI is normal but that friend of yours thinks she has cancer because one is bigger than the other she's gonna drive herself crazy it's normal to have one breast bigger than the other and it is what it is. How about right here though? Do you look right here? This one right here? Yeah I agree with you it's a little bit asymmetric but you don't have cancer. Okay. Oh my god. It's not cancer. That's why my vital signs go up this time because I never sleep. I said okay my god. It's not cancer. It's not lymphoma. Now, I'm going to see you again in March. And you're going to do blood work and I'm going to check things for lymphoma and I'm going to see you again. If there is anything change, a very good memory, I may order an MRI, but that would be ultrasound, CAT scan, an MRI showing normal. So this is a point in time that we need to believe in the reality and not your emotional fear because you don't have cancer. Okay. I just kind of worry like last night I kind of I wake up 12 and I cannot sleep so when I take my vital signs in my work I said oh my god my vital signs go up because I've been worried too much. I understand why you're worried this is why in three months we're gonna repeat studies and see you again but you need to relax you can't be worried about something that is not alright. Yeah I know. It's not cancer you already held it for the third time exam doesn't show it. Cats can't, forget what I say I'm just a human being. The cats can't show anything. You need to believe what the CAT scan shows, right? I know. Just kind of worried. Just all these people said, why you, why you, your jaw is getting bigger. Like, like the... Make sure that the vent is also find anything there. And I think that jaw is going to be bigger than the other side forever. But it's not cancer. Yeah. Well, I just, I just curious though, why my face is not like this before. Like I got very tiny, but this one it's getting big. So I keep I'm getting my ear right here by my jaw under the ear. If I get an MRI in March, it will describe the same thing that I will see. But it's not going to show malignancy. All right? Make sure your health in your jaw is very, very good there. That's it. For my jaw? Make sure that your mandible. Mandibular. Your lower mandible has no gum problem, no bone disease. If the dentist says your health is perfect, don't worry about this. Yeah. Every day when I see the oral surgery dog, I always ask him, this dog can you look at my... stop touching it, it's not cast, it's nothing. Two months ago he came back, there was nothing in there. So stop grabbing in there, stop paying attention, believe the cast can be really off the sun, believe the doctors, there's nothing in there. Stop squeezing it, stop trying to make it go away, you're gonna be a little bit bigger there forever. Leave it alone until I see you again. Because if you keep holding like that all day long, you're making it bigger. I know, I just... You understand? Yeah, thank you, but... That's why when I worked out, I said, I feel like this one is like different like this rubbing me. It's nothing. What? In March? I'm going to do the same thing. Okay, thank you so much. Okay, thank you now. So I'm good to go? Yeah, make a promise to see me in March. But also don't work, okay? For March? Okay. Then wait before you see me. Okay. Okay, thank you so much. I'm going to do blood work in March and then a week later to change. So I'm going to show you how to install the new USB-C port. I'm going to show you how to install the USB cable. I'm going to use a little bit of water. I I'm sorry. I'm sorry. I don't hear you, is your microphone on? Let me go for my volume, see if I can hear you better. Okay, go ahead and talk. Okay, can you hear me now? Now I can hear you. Can you hear me and you can see me? Yes, I can. Very good. Michelle Mafra, right? Yes, you are correct. Very good. You know the reason why I wanted to see is because I talked to Dr. Flores this morning. He asked me to make sure that you are okay. I wanted also a little bit to review what happened with my office. It was yesterday that you were very upset with the day before? The day before. What happened? It was probably, it was on Monday actually. Monday, and what happened? Well basically, first issue that has been happening to me On the previous Monday, I've called the office to request some renewals on my medication. One is Keppra, which is an anti-seizure medication. And the other one is Ativan. And after I request the medication, I of course, the other girls say, oh, we're going to send it right away. Then I call on Tuesday morning, I call the pharmacy. and they didn't receive. So I call you guys back, oh no we're gonna send it, we're gonna send it. Well it's been a full week process. Only Thursday I was able to have the Keppra, which I stayed without Keppra antiseizure medication for two days. And they were able to send the Keppra in to my pharmacy. And I received the Keppra that day, which was great, but they didn't send the other my anti-anxiety medication because they said, oh, it needs doctor approval. And I'm like, you know, it's been requested since Monday. How come the doctor doesn't approve until Friday? You know, so I've been fighting the whole week. Like I call NICE the first time, I call NICE the second time, I call NICE the third time. I have the pharmacy contact the guys and request and yet things just don't move. So they fall through the cracks and I don't get what I need. So as a result I stayed more than a week plus the weekend without anti-anxiety medication because no one did their job and sent it out for me. And then on Monday and this is, to be honest with you, I'm going through another stress because Medi-Cal had an error and they denied my policy as of November 30th. So I've been escalating with them so I didn't lose my my medical which got instated on the 4th so I have my medical back but since October I've been working with them to maintain my medical because I've been at risk of losing my medical so that's already something that is aggravating me and creating a lot of anxiety and then I call medical I wake up at 6.30 a.m. I drop my little girl in school and I've been on the line with medical while my cases standing, begging them to pay for my Quest lab tests because I already had scheduled way in advance an appointment on Monday because they always like for me to be on Monday, really close to my treatment, which is on Wednesday. And I arrived to the lab on Quest and basically they told me, oh, your order has expired and that it was only one girl working on The room is full of stand by people. Okay, and I told her, I said, I beg you. She's like, are you gonna lose your appointment because we can't wait for you to get it. I said, please, I beg you. I'm gonna call the office right now and I'm gonna text you right now. She's like, stay on room number one and make your phone calls and I'm gonna take people in and I'll try my best to detroy your blood as soon as you finish, you know. I get to the office, I talk to a girl named Christo, and I told her, we have the lab, the order has expired, would you please fax another order to the lab? Gave her the fax number, and she's like, oh yeah, I'm gonna send it right away, it's gonna take about 10 minutes maximum. They send the order in, okay, and I go in all excited, and I tell the girl, I finally got the order, can you please squeeze me in? It will be amazing if you squeeze me in, because my treatment and that's the only chance I have to get the results from you guys. And she squeezes me in, but she takes my blood from this arm, telling me that my arm already is building a lot of scar tissue and that I'm lucky that my vein hasn't bursted yet, okay? And when she draws my blood, she draws just one vial. And then I'm like, well, that's really strange because normally every time I come here, you guys pull out three to four bios and it's a lot of other tests. And I'm like, can you look at my test order and see if everything is in there because I don't think one bio is enough. And then she goes and she's like, oh yeah, they send an incomplete order. And then she's like, you know, independently if they send it again or not, we cannot see you today because I'm so overwhelmed. I have too many people, as you can see, the office, we need some staff. And then I'm like, okay, I called the Ensenada's office, they don't have any time. I called the VISTA office, they don't have any time. And I called the girl, and I said, you know what? You guys are playing a game with me, because I've been fighting with Medi-Cal to get everything done and properly, and everything goes smooth so I can do this treatment on Wednesday. You know what I mean? Now you guys sent me an incomplete order. You know what I mean? The lady on Medi-Cal told me they should have gone into your file, consent the order, you know what I mean? And then I lost it. And then I yelled on the phone and I said, you know what? I'm gonna die right there, right now, hyperventilating, you know what I mean? Because it's the only way to get things done in this office, you know what I mean? And you guys are gonna draw my blood independently from my insurance covers or not, because I'm not gonna miss the treatment that I fought three months to medical to maintain the treatment for me. Okay. And I drove there like hyperventilating. Like I literally was sweating profusely. You know what I mean? And I couldn't stop yelling. It's like I had panic attack because I felt like these people I never felt so much disregard for my life in my life, you know, and it's like I'm fighting for my life. And basically that's what happened. The girls luckily were able to accommodate the blood test for me. And then I said, I'm waiting on this medication. I was shaking. I'm like, I'm without my anxiety medication for over 10 days now because you guys can't do your job. Why are things falling to the cracks? I should be focusing on nutrition, taking care of my seven year old girl, my stretches, therapy, and by the way, I'm missing therapy that I'm taking out of my pocket to be here right now, because I have a therapist in Brazil that is helping me to cope with the issues of having terminal cancer. So you have a psychotherapist or a psychiatrist? It's just a therapist. Yeah, just a therapist, and it's fairly new. I had four sessions with him, and I'm texting him saying, I'm gonna miss the session, I'm here, you know, trying to get the blood test and everything for my treatment. So it's just like that level of aggravation, like if I could call one time and make sure that things are gonna get fixed to the pharmacy, it would be great. But every month, I have several medications, so I'm calling you guys constantly and having to double check, triple check, call the pharmacy. The pharmacy helps me try to get to you guys. And nothing happens unless I throw a fit. I throw a fit, then things work out. And then they called the cops on me and all this big word deal and I told the cops, I said, you know what? And the cops told me, like, you are fighting for your life. You are a strong woman. You shouldn't go through this. They gave me a ton of resources so I can find help, therapy, for restrictions in case I don't get from you guys. You know what? You shouldn't be treated this way. You know what I mean? You have no problem. You know what I mean? They saw that my frustration was real. Did you tell them why they called the cops? Huh? Did they tell them the cops? What did they call the cops? Yeah, because when I yelled on the phone and I was aggravated, I told them, you know, you guys can call the security because they called the security once for You know what I mean? Because I was having problem with EDD and there was a girl there that would never send the papers to EDD. You know what I mean? And I got a little agitated in the front office and they're like, how are we gonna call the security? And I said, call the security, call the cops, call the freaking Pope. You know what I mean? I'm gonna get this done, you guys gonna get this done because of your guys in my life. You know what I mean? And I don't care. You know what I mean? I'm a well-educated woman. I have a master's degree. I'm an MBA, I know administration, I ran businesses, you know what I mean? And I can completely understand that there are a lot of newbies all the time. Every time I come, there's somebody else new in the front desk or something. But this is people's lives. This is literally people's lives. And you can't jeopardize and add additional stress in a situation that is already stressful. I am over the top disappointed. And that's what I told Marty. I said, you know, I'm the type of person that, you know, I fight for my rights. And, you know, but don't keep me sending like to give you guys review because right now, you know what I mean? I prefer not to feel nothing. You know, I don't want to feel, I don't want to give you guys any bad reputation on the content. You know what I mean? I love the doctors. Dr. Flores saw how I was in the hospital and how much I have progressed, so I would hate to abandon a doctor that I like so much. However, if this administration issues keep on happening, and I mean, it's not like, there are people that are in worse condition than I am, I have brain cancer, I can have issues and not have good memory at any time with some sort of inflammation that happens in my brain, and how can I rely on if you guys are doing, Okay. When I have a ton on my plate with a seven year old, dropping off from school, picking her up at three, like right now to make a phone call, I have to show it to someone to pick up my daughter for me. You see, my life is not as simple. It's very delicate. And this year has been a rough year for me. But what I expect is everybody, if they do their job, jobs, things won't fall to the cracks and then I can trust the treatment that I am actually receiving right now. But if I have to triple check, quadruple check, triple check, don't expect me to be nice on the fifth phone call. You know what I mean? Trying to get the same thing, one simple fact to be sent to a pharmacy, for example. And literally this is where I stand right now. I love everybody there, even the people that, Gina, sometimes I'm irritated with her, but I love her, I love Marty, I love everybody that takes care of me, but I just feel there is some sort of disorganization there that are preventing things from running smoothly. And that is not beneficial for patients that really can't be receiving this amount of stress cortisone healings and you know we should be focusing on all the healing possibilities you know I could be in a compulture I could be you know all this time wasted on the bureaucracy of it is driving me bananas you know. So Michel I'm gonna talk about two things one your situation I'm very happy the way Dr. Flores been treating you you did great treatment practically the last scan everything looked great. You're taking maintenance treatment that is very, very good with immunotherapy and a single drug, a link that we call it Premetrex. You're doing great. I noticed that your last scan was done at the end of August. So I want to do one now to see exactly that you're still in a very good place. I think it's time to do another scan. I think the brain, you're doing fantastic. I just want to repeat the MRI to make sure there's nothing in the brain. And I believe that if everything looks good, if everything who looks good will continue the same treatment that Dr. Flores gave you. Now, in regards to all these other things that make you upset, I want to let you know, number one, I am sorry that you suffer stress through this because you have cancer, you have your family, you have to take care of everything, and it's very stressful. So I apologize that my office made you suffer and caused this severe anxiety. That being said, this is the second time that the office gets very stressed with your reaction. I understand why you are very upset. I think anybody would be upset, but not to that level. What happened yesterday is that my staff had to go out on leave of absence for three weeks for the level of communication you have with her. And of course, this is something that we have to deal with. You told my staff that you were going to kill her coming to the office. And this is why they call security, because she heard that you were going to kill her. She got all scared because you were so mad. And you told her you were going to kill her, right? Because you were so upset. Anyway, but I understand why you got upset and I understand that you need to get your prescription, but this is the thing. I can't fix getting this sativan perfectly right for you. We're not anxiety doctors. We're not the psychiatrists. I would like you to connect with your therapist and your primary care doctor to see who can take over the treatment of this level of anxiety and getting upset. Because I know that it affects your not just here with us, it may affect other areas of your life. I noticed that you are taking an anxiety drug called Lexapro. Are you still on Lexapro? No. They need to give you something that can control this in a better way other than Ativan. Of course, when you are on Ativan and also the Ativan is not there, you get very anxious, right? And I think this office, we have got to this level of size that clearly we're not serving you well for your needs. So number one, I would like to talk primary care physician about this, how we can help you never missing your drugs, how we can get you to better drugs than Ativan. Ativan is not the right drug. Ativan should be only needed when you are not well and they should be the drugs that control you all the time. And clearly I would like to talk to your primary care doctor about which office can serve you better for your well-being because maybe this office is not it. But who's your primary care doctor? Who do I call? Her name is Gabriella. Let me find her last name. Is that the PA? Gabriella Sutton? Yeah. She's on True Care on Ocean Side Boulevard in Ocean Side. And her name is Gabriella. I keep forgetting her last name, you know, partially because, you know, my brain doesn't function really well. But her name is Gabriella, and she is in True Care. Okay. Let me see if I can find her name here. Yeah. Gabriela. And I talked to Doctor Doctor Flores earlier. I pulled her out of her conference because she's your doctor and I just wanted to make sure that that she's aware that I was going to see you and call you. Uh huh. And I know that I saw the name Gabriela somewhere. So, what's gonna happen is that I'm gonna talk to them, I'm gonna ask them for their health to make sure that you always have the Ativan. I think they need to put on some more of the anxiolytic in addition to Ativan. And then we'll talk to them about what is the best way to care for you. I'm very happy that you are doing well. We're responsible for your cancer. So we're getting a CAT scan. We're getting an MRI. You're going to stay on treatment in my office. Like the next time you get treatment is going to be December 27. But then after that treatment on December 27, when you come to get your immunotherapy, and that is in maintenance chemotherapy drug, then the primary care doctor will decide how is best to care for you. But I don't want my staff to have to be threatened and afraid. And more importantly, I want your well-being because I understand how you felt and you don't need to feel this way. But my office doesn't have to feel threatened either way. So I'm going to talk to your primary care office and see how we can fix that. our care, I want you to let us know 10 days before you run out of a drug, but more importantly, call TrueCare because maybe TrueCare will do a better job than my office to get you these drugs. Okay? Okay. And another thing is when you say I am receiving chemo and immunotherapy, correct? Those are the two treatments that I'm receiving currently, correct? Correct. And yesterday I was talking to the girl who was helping me with the chemo and immuno. And she said that the chemo has changed, that I initially had one type of chemotherapy that was a little bit more aggressive. And then it was moved to a chemotherapy that is a little bit more, less aggressive. Does that sound familiar to you? Yeah. So from day one, you've been on the same immunotherapy. It's called checkpoint immunotherapy. However, the chemotherapy after six treatments, we reduce it to what we call maintenance. So you are taking two drugs, carboplatin and a drug called adimptan, two drugs. But after six treatments and with a very good results, we simplify the treatment to only give you one drug instead of two. So we're taking just one drug. It's the same drug as always, but it's a non-toxic drug. It's very well tolerated. That's why we keep it for maintenance for one year. So what she meant is exactly what I'm saying. telling you, yes, the chemotherapy change from two drugs to just one drug of chemotherapy and that is significantly easier for you. Okay. And so there is no real difference between the two, right? You guys didn't downgrade the... We went from two drugs to one drug. And what we do is the National Cancer Institute guidance. By this National Cancer Institute guidance, we went from two drugs to one drug. So the treatment you are taking now is significantly easier than what you got it and uh how like this is a treatment that is supposed to last one year two years three years because doctor flores says as long as my body tolerates but because you have stage four disease we are supposed to keep treating you until non-stop however after one year i would consider just giving you immunotherapy and the immunotherapy would give for maybe one or two more years after that you're still in remission we will consider stopping because there are miracles where people just do well without treatment but for now is what Dr. Flores says. That being said around August next year we may remove the chemotherapy and after that immunotherapy can stop a year or two years later. Got it. Something will happen that you're not going to be on treatment forever I don't think so. Okay do you think do you have any recommendations for other oncologists that would be be willing to follow doctor Flores plan that it's. Yes, you know there are very the good things that in San Diego there are very very good doctors and I would like to send you to somebody that you can trust the office and what you felt yesterday or on Monday, you don't wanna feel again that level of upset stress is just not good for you and I can't tell you that's not gonna happen again because of course we didn't do that to you. We've done that also to other people and with your level of I didn't know. Yeah. Very good. I'm going to send you to a doctor called Dr. Singh. She's a very nice lady. I would like her to be part of our team. She's just great. Okay. Okay. Sounds fantastic. Very good. They're going to be called for her office. But I think you should keep the treatment with us on December 27. And if you decide to switch, which you might decide to switch because closer to your home actually, I would like you to do that in January so the treatment doesn't get affected. Okay? And do talk to your primary care doctor about helping you with the Ativan. And I'm telling you there are some drugs you can use that you're not going to need the Ativan. Okay? Yeah. Do you think this could be from withdrawal of not having the medication for a while? Yeah, when you are withdrawn from the Ativan, you just feel that your body is crawling out of your skin. It's horrible anxiety. You cannot run out of the Ativan, but there are other drugs that they should give you. Okay? Okay. Gotcha. Gotcha. Well, thank you for talking to me today. I think we're going to talk to you again about the CAT scan and the MRI. I'm going to talk to Dr. Flores will decide when she wants to see you or talk to you about these results. I think she's coming back next week. So I'm going to have you talk to Dr. Flores about the MRI and the CAT scan. Okay? Yeah. Okay. Sounds fantastic. And let's go from there, you know? I apologize for causing havoc and creating problems situations. But like I said, sometimes the ultimate way to get something done is to actually be there and make it happen. Because the amount of frustration builds up over time. That's something I can't really control. And I can understand that you guys are overwhelmed and doing maybe too much by diving into other realms that are not oncology in a way. Very, very good. Well, it was nice talking to you and I'm sure Dr. Flores will connect with you next week after the MRI on the CAT scan, okay? Okay, all right. Thank you very much. Very good, thank you. Bye-bye. Have a good one. Bye-bye. I'm going to show you how to use the app. I'm going to go ahead and click on the button. I'm going to show you how to do it. I'm going to go ahead and show you how to do this. I'm going to make a cup of coffee." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 37 year old female patient presenting for initial consultation of left thumb injury after she fainted and fell in her pain two months ago. Hello, how's it going? Good, how are you? Is Leah? Yeah. Okay, nice to meet you. My name is Eugene, I'm one of the PAs here, I'm originally ortho. What's going on today? How can I help? Um, yeah, I just like... fell and injured my thumb a couple months ago and in the beginning like I couldn't open jars very well like it was very weak and I just never did anything about it I kind of just let it like heal on its own but it's still it still hurts sometimes it's kind of it's more of a dull pain and like I mean I can open jars now but it's not it's not a hundred percent yeah and like I just want to make sure it's like healing okay and or make sure I don't like need anything special. Sure. How exactly did you enjoy it the first time? Uh I fainted. You fainted? And I was trying to I think I was trying to catch myself on the counter or the kitchen counter and I think I just like bent it a weird way or something like that. Gotcha. And then when you woke up you were like what's going on with the hands? Yeah yeah yeah I was like on the floor crying. Oh sorry. I was just like I was like oh god like making sure it's okay. Yeah, I just think that it just hurts really bad. Where was the pain initially? I think it was... I mean I feel like it's in the base, but it does... When I bent it, I was trying to get it to feel weird. I feel like it feels a little tight. So it's always a twisting motion that you feel like there's a lot of pain? Yeah. I guess so. I mean it's just I mean you know you're using your hands all the time for everything so I think uh I mean anytime I have to put like a lot of pressure on things then it's it just kind of hurts a little bit it's not terrible like it's. Was there any bruising that showed up? No it didn't show up. I'm using it and I don't remember any swelling at all. So I think I had to put any ice, or I don't know if I put ice on it or anything. Okay, let's see you give me a thumbs up. Okay, and moving in circles. Any pain with that? Not very low. Very low, okay. That wasn't an injury, right? No. Okay. Anything here? No. There's no sharp pain with you pushing on it, right? Or me pushing on it? No, I mean, I felt like I felt a little more like anything. Right here? Or something? Is there pain here? No. Did you ever have pain like right here? I don't know. It's not like very direct. I guess. Yeah. You okay with this? Mm-hmm. You have that motion? No. No? Yeah. I don't feel anything here though. No, not really. So what are the things that you do to replicate the motion? pain? I mean I get well I mean this like bending it all the way that way kind of hurts but when you do this it hurts. I know my I mean I do have pretty flexible fingers like you know like I feel like I have a lot of range in my fingers so like I feel like I have to be doing you know like pulling something or for it to hurt. But it's like I said, it's pretty minimal. I just... Not quite back down. Yeah, and it's just taking a long time. So I'm like, should I be like wearing something? Or I don't know what. And maybe that's just normal with this kind of thing. Where it just is a slow, slow recovery, you know. I'll do this. Are you spending up and pushing out against my finger? Any pain with that? No. No? No. Okay, not pushing out? I mean, it hurts my face, like when I lock my... It's always here, that hurts, huh? Yeah. Right? Yeah. And does it hurt right now when I'm pushing on it? That's the most I can feel when, like that's the most pain I can feel when you like kind of push it right there. But it's, yeah. Okay. I don't know what starts. I feel like I didn't really feel it that time. I don't think it's that far down. Yeah. I think it's like in the middle. Okay. Try to extend it out. Okay. Pushing. Push, push, push. No. Not really. Okay. And when does this injury happen? In November. November. Beginning of November. Right. End of November. I think beginning. Okay. I think it's like in November. Yeah. Listen, we're not really able to see exactly where the pain is coming from. The X-ray looks fine too. Sometimes, if it's like a finger sprain, that can just take a little longer for it to completely resolve. Now, a lot of times, there are several key things that are very important, which is more of the UCL ligament right over here. When you rupture that ligament, it makes it very difficult to grip onto things, to hold things. Just because we basically require this. to provide stability. You don't have any pain with me stressing that in this way, do you? No. Yeah, and then the other one is the RCO which is over here. You don't have any pain with that either. No. There's a possibility that this just, you know, if you feel like this is mostly gotten a lot better and just a little bit lingering, there might be just a lip valve finger sprain. Okay. Which can take three months or so to get better. How much better would you say you've gotten in the last two weeks? I mean definitely significantly better. Like 90% better? Yeah. Okay. I just want to, yeah, I just I mean I figured yeah I probably I mean obviously if I couldn't like hold things that would be an issue but yeah I mean I can still do things and I can like sometimes I'll switch what hand I'm doing something with just because it's It's like a little tender. Yeah, but yeah. Okay. So so how about this? Let's give it like another month or so and see if there's still any like significant issues. Okay, if you're still having quite a lot of pain at the point of doing things, you know, you find that you're not able to do certain things because of the pain that make it know that let us know we can double check and then maybe we can always order an MRI. Right now everything looks good for kind of. really able to reproduce the pain right here so let's just keep a close eye on it okay okay yeah yeah sorry i don't have an answer for you no it's okay but at least everything looks good yeah yeah yeah okay yeah i just want to make sure everything in turn like with an x-ray it looks so good yeah there's nothing like feeling weird or something like that yeah i don't see anything right now the reason for the x-ray right here the area that you're talking about that you have a lot of pain is more like a... over here at this part of the finger. Looking at it this way, don't see any pieces of bone that's fractured off or anything like that. So all in all, it looks pretty good. Okay, cool. Okay? Good. Yeah. Good, good. Alrighty. Please insert a left thumb through the X-ray, that's normal. Please insert a left thumb. So left hand exam. That's normal. This has been planned. This is a 37 year old female patient presented for initial consultation of left thumb injury after she fainted and fell on her hand two months ago. Patient overalls noticed approximately 90 to 95 percent improvement and... wanted to get an evaluation due to still having some intermittent soreness in the thumb but otherwise no significant discomfort in our normal day-to-day activity period. Our patients left thumb x-ray today which did not show any acute findings period. On exam, common patient also has no reproducible pain But as note, some soreness. After testing, an examination of the left thumb that's non-specific period. We discussed with patients that we did not see anything acute at this time and that she might have had a finger sprain which can sometimes take up to several months to completely resolve period. We discussed about giving a close eye and monitoring the left thumb to see whether there are any reproducible pain or lack of improvement over the next month period. We'll see her back then for repeat evaluation. Period of patient continues to exhibit. If you have significant left-hand discomfort, we can consider ordering MRI, period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'm seeing Mrs. Hernandez at a one month interval follow-up. Delete that. I'm seeing Mrs. Hernandez at a two week interval follow-up regarding a history of iron deficiency anemia and MGUS. Period. She also has a comorbid rheumatoid arthritis that has been stung. stable for her, period. At the time that I last saw her, I ordered follow-up laboratory studies to assess the of her iron status and MGUS parameters. She was last given injectifer on 7 slash 7 and 7 slash 19 slash 23 period. Her MGUS is characterized as an IgG kappa monoclonal protein. 19 period. Next line, 10 slash 19. 19 slash 23 colon, hemoglobin 12.9, MCV 97, ferritin 541, IgG 1095, and the K slash L ratio 2.39 period. Next line. The secondary studies were obtained prior, but were obtained on 4-23. Next line. 4 slash 23 slash 24 colon WBC 5.5 comma H slash H 13.1 slash 39.2 comma platelet 211 period. CMP is completely normal period. Ferritin 454 nanogram per ml. Parenthesis compared to 10 on 5 slash 6 slash 22, close parenthesis period. Reticulous site count 3.3 percent period. Beta 2 microglobulin 2.2 period. IgG, 1,199 period. K slash L ratio 2.53 period. Thank you, thank you. I just wanted to confirm. No, no, of course. This is Hernandez in room three. Doctor, should I pull you out once I get him on the phone? Yeah. This is Hernandez. Welcome back. I'm glad you came back so we could have these lab studies. As I said, I was concerned. We gave you intravenous iron last year that we have to be sure you're stable. And I'm happy to report that you are. Good. You have plenty of storage iron in your body. Your hemoglobin is 13.1. And let me. What should it be? Well, that's normal. Normal range is 11.1 to 15.9. The reason I was saying I was going back is last October it was 12.9, now it's 13.1. Virtually the same number. Your immune globulin levels for MGUS, virtually the same. So everything. looks stable. As you may remember, I've told you before, an adult who becomes iron deficient is losing blood. So I'm worried about that. The ferritin level, which is storage iron, was 541 last October, and now the ferritin level is 454. Very, very good, but it's decreased. So my concern is, and I don't know this is true, is that iron is being used to make blood. As I... Iron is used to make blood that ferritin, which is storage iron, decreases. So you've got an excellent hemoglobin that's stable, but you may be keeping it stable by using up your iron available. So I still worry you may be losing some blood. So I need to see you, and I'm gonna suggest I see you by the end of August. And we check these numbers again. But you leave here today knowing they're all stable. Okay, that's very good. Yes, just a sec. I'll be right. Okay, so my plan is you're fine, don't do anything different. If you see blood leaving your body, I mean it looks like you may be losing blood somewhere, that's important to let us know. Because without seeing it, I'm just looking for evidence that it may be going on. And it's a treatment plan. I'm gonna set things up for what I want. Just one second here. Okay. D47, glenogemopathy, right D50.8, right D64.89. Okay, testing. So I want a CBC, CMP, ferritin, binding capacity. Retic. Hey, poo. All right, globulins. So I'm going to look at your immune proteins, which have been stable, but most significantly to make sure your iron is stable and your blood count is. And if it's stable, that's great. But I'm looking for trouble, okay? And if everything looks okay, we can take a longer interval after that. Okay. All right. Thank you. Thank you. So we'll get lab August 30th. I'll see you September 6th, all right? Now I think you're doing fine, and I don't think you're going to feel different. I'm just looking for changes in your labs that will tell me how stable things are. Do you have any questions for me? It just doesn't tell you if I'm so tired. No, no. I'm not tired for your blood at all. Not at all. The most common reason for tiredness during the day is sleep deprivation. Not getting enough sleep at night. Well, I don't know if you get up frequently. Do you get up frequently? Yes. Well that you may not get deep sleep. You may not get the kind of sleep that gives you rest. It's possible. If you're if you would like more information or to evaluate it you can actually have a sleep study to see how you sleep at night. But you're not tired during the day for any of the blood issues at all. Not at all. So my impression today is number one, a history of iron deficiency anemia with no past observation or current observation of bleeding. Two period, IgG Kappa M Gus period, the protein values are stable. Three period, reported tired during the day. I have attributed to sleep deprivation. discussion. I'm very pleased to note the normal and stable hemoglobin, comma, iron studies and immune proteins regarding stability, period. However, the ferritin, comma, albeit being very good, comma, is decreased from the previous measurement in October of last year period. It will be important to observe looking for stability of... and of course I counseled Mrs. Hernandez regarding any observation of blood loss, period. I attribute her tiredness during the day to sleep deprivation, period. She gets up frequently at night and this may be the reason, period. However, comma, a sleep study may be important at some point, period. I did reassure her that her hematologic picture is not a cause of tiredness, period. Plan number one, follow up in approximately three months with lab prior colon CBC comma CMP comma reticulocyte count comma erythropoietin level comma ferritin comma I slash TIBC comma quantitative immunoglobulins and free light chains, period. Any questions? No. Good." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Hi, how are you doing? Good, good. How are you? Hi doctor. Good. Okay, so you're taking two twice a day, right? Yes. Okay. So everything is good. The white count has dropped down a little bit. So we may have to adjust the dose. So it's no big deal. Otherwise platelets are okay. Let me, here you are. Okay. 3.1 is the white count, but hemoglobin is good. platelets are okay. 1.9. Okay. So that's common with that medication. Yes. So what I would have you do, one day you take four or two twice a day, right? Yeah. And we take one in the morning and one at night. Oh, that's it. Oh, okay. Okay. Not two. That's okay. So one day you take two. One in the morning, one at night. Okay. Or you can take two together. Oh, okay. Yeah, it's no problem. Okay. So you take one day two other day one then two then one. Okay like that So it will make the white count. Oh, so it can make the white count go up. Yeah. Yeah So on the platelets we'll watch and see if as long as they don't go up too high then they're okay What are they now? 477. Okay. Yeah, so you're okay. Okay. All right. Two and one, two and one. Two and one. Check in two months. Okay, two months. Will we see you or the girl? Okay. I'll put it in here. Sometimes they switch it, but I put it for my group. Thank you so much. Take care. Have a good day. Bye bye. They'll help you. Take care. all questions answered, comma, reassurance was given in counseling with impaired." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 28 year old returning patient, sorry, a 28 year old female returning patient with a new complaint of right knee pain that began approximately two months ago, a traumatically. Leah? Hello, my name is Lindsey. I'm one of the other physician assistants here. Good to meet you. Tell me a little bit about what's going on with this knee. So it's gotten a lot more painful. I usually run a lot and it kind of just slowly started getting more and more painful and usually I just run through which is probably not good but like a few weeks ago it was really bad so I stopped and was trying to get ibuprofen, just let it rest to not impact stuff so more like yoga and things like that. But there's like, there's definitely a bump there. And I don't know if it's like what it is, but it really hurts when like, now when I walk downhill or upstairs or something, it really hurts. Like I was hiking and it was pretty painful. If I like kneel, I kind of like stretch that part out like that, that hurts. So yeah, it's just kind of to the point where like when it's, aggravated to, it's really painful to do anything. So I just walk flat. So yeah, just... I think the rusting didn't help. I should probably come get it checked out. And has this ever happened before? No, I mean I've had patellar tendonitis. I've had knee stuff, but not... for a while, not anything super crazy. Just something that PT and kind of off of it helped with so okay and any symptoms on the other side really I'll just right here okay I think it's like the month else about concerns they are repressing right here anything here no Or here. No. Anything here? Nope. Going back to that spot. Anything right in here? Yeah. And that's the worst kind of right there? Yeah. Push out against me. Is there pain with that? Do you feel that? No. Anything farther down in here? I guess it makes this sore. Kind of like my shin. Anything right in here? Okay. Now you do lie down for me. I should be putting that in there. Let me have you raise the leg straight up and then resist me. So push into me. Any pain with that over that area? Okay. And then relax for me. Any pain here? Just got it right kind of in this area. Push your knee down into the bed to kind of hyper extend your knee. Like they're kind of contractor quads. Yep, yeah. Is there any pain with that? No. Okay. You can sit on up. So your tibial tubercle is what kind of sits, oh, don't touch it. Is what is right here. And that's where your patellar tendon inserts. And so we know that when you get bad enough, basically like what we call insertional tendinosis, so right where that tendon touches, usually the tendon becomes inflamed first. Because your insertional tendinosis over time is actually it's worse, it's actually gonna start inflaming the bone and you'll start getting fluid or inflammation in the bone. And so you're definitely tend over that patellar tendon, but also kind of right over that bone and that's where you see a little bit of that swelling. So that you're kind of having that secondary component to it where the bone is now getting inflamed. It looks healthy here on x-ray. Sometimes if you have kind of actual bony prominence here, that's indicative of having oscars and schlatters. Did you have that? No, but I... I did a lot of webmd-ing and I was like, I hope it's not. It didn't sound like it was, I don't know, how that would have randomly. Yeah, often slaughter only happens before your growth plates close. But it then can lead to a lot of development of patellar tendinosis and stuff like that. So you can't develop that now at this point. But sometimes you still see evidence of it actually. I don't see that here. This all looks fine. It doesn't look like you have that as a kid. I think this is more just patellar tendinosis developed by itself. and it's now really inflaming that bone. I think taking a break from activity was the right thing. I just don't think it was long enough. Typically when you start having that actual bony edema and injury, it takes sometimes a couple months of no high impact activity to go away. It takes a long time for bony edema to resolve. So what happens if I got obviously arrested? What would happen if I didn't? It would just be painful or like? It typically just doesn't resolve. or it takes much, much longer to resolve. And so I've been getting you back into PT to kind of work on this. I would say, have you tried a patellar tendon strap? Some people like them, some people don't think they do anything. They're a pretty benign kind of easy thing to use. So I say, let's potentially try that, just a strap like this. You can buy them on Amazon. But it basically doesn't sit over the bony part, it sits right over the tendon there and it helps I was just taking like ibuprofen but it didn't really, like I guess it helped with the pain a little but like it didn't like stop the pain so I just, yeah, I've been taking that. And do you take any other daily medications? Just birth control. Okay, I would say let's bump you up to diclofenac, it's kind of like a brother to ibuprofen but it's a little stronger. This is prescription only. And I would say let's have you take it every day for two weeks. Because those things work best when you take them consistently. Let's see if that really helps calm us down. It would be icing two or three times a day for 20 minutes. Lots of activity modification. If it's causing pain, modify or stop that activity. It's kind of like having tibial stress syndrome or any other kind of stress injury. You just have to kind of do a little bit of trial and error and just give this time to resolve itself. So if it hurts it, don't do it basically. And then as it gets better, it's that kind of slow progression back into things. I'll put in the PT referral to also do a return to running program of making small steps and kind of building back up to things so it doesn't re-aggravate it. Do you know if there's any other underlying issues that trigger? I just feel like I keep getting injured one thing after another. It hasn't been this, but it's been a million other things from running. Do you think it's all connected somehow? I feel like I should get frustrated because yeah, like I'll heal from one thing and then something like this happens and it's like a whole other, but it's like a whole other part of my body and like, I don't know, I'm just wondering if like I'm just doing something wrong or like if I should just like be PT like constantly to try to like, or if it's like something like with your hips that causes it, like knee stuff. What other kind of injuries or things have bothered you with running? Definitely like my hips, like I've had some hip Like I said, that was like the latest thing. I was having some pain here, so I was in PT for that. I ruptured this tendon, my posterior tibial tendon, twice on this foot. Stress fractures on the feet from running, because I used to run track, so it's a lot more. But yeah, so it's just been like a continuous thing on the heel, and I don't know, I just, I want to keep running, but I also feel like every time I try to train for something or I'm running a lot, something breaks down. So I'm just trying to figure out if it's like, OK, maybe I should not be running, if I should be doing PT if I'm going to keep doing impact type stuff just because I have run for so long. Yeah. So we do have a lot of our runners who are typically just in PT on and off for almost just for advice kind of when things pop up. And so I do think there's a whole function of just making sure everything is conditioned in the body so that if one thing's not conditioned, it's not kind of taking the brunt of things. One thing I think about is that sometimes we see and we know that stress injuries occur when people have low vitamin D status. So I'm happy to send blood work to test your vitamin D to see if that's potentially causing kind of these bone injuries or stress injuries. We could see if that is maybe a culprit. Otherwise, we know we just know that high impact stuff is hard on the body, like running and that it may just be some kind of constant tuning up to make sure the body can handle it. Do you think this could be a couple months? If you're that tender right over that bony area, I'm thinking it may take a little while to resolve. Hopefully not. Maybe just, again, anti-inflammatories, lots of icing, just kind of staying on it will resolve it quicker. But yeah, when I see this, it does usually take a little while. What PT place do you like to go to? Yeah, I'm gonna be at some like movie on SF. Okay, basically I'm going back to New York. Okay, so I'm PT that I don't know if they're covered on my insurance. I guess I'll just have to figure that out. But maybe I could still just get a slip or something like some sort of referral or prescription. Maybe I can try to get it taken care of. If not, then I'm coming back in the new year and moving to New York. to LA, basically. So I don't know all the places. All the big cities? Right. So I don't know if all the other lists started here, unless there's a place that does virtual, maybe. But I don't know if anyone does any more. I know some used to with COVID, but I don't think they do any more. Yeah. Because I literally am leaving Thursday morning out of the state. So it might just be something that I have to find out but I just wanted to know if I should, what it was. Yeah, I think it's all related to that extensor mechanism. You don't want any swelling in the knee. I don't want this coming from anything inside the knee. It's all probably external to the joint. We do most of our PT referrals and pretty much everything by fax. And so I'll send you, it's going to give you the PT prop to pick out a place here. But you can just respond to it. If you find a place in New York, just send us the fax number and the name, and then we can send it for you. OK. Awesome. I'll pick up this prescription maybe tomorrow or something. Yeah, I'll have them confirm your pregnancy and I'll send it tonight. Okay, awesome. All right. I'm sorry about this. Do you want me to send blood work requests for vitamin D? It's okay. Okay. Just because I won't be able to do it here for a little bit. So maybe it'll just be something I do in the next year, in the new year, I'm looking to. Sounds good to me. All right. It was good to meet you. You too. I'll send you. I think I have some patellar tendon extra sites. So I'll send that to you via email. All right. Thank you. Of course, I don't have time when you're ready. For Leah, we need pharmacy and help is needed. Please add a right knee examination. There is tenderness over the patellar tendon and tenderness over the tibial tubercle with mild edema. There is no pain or weakness elicited with resistive knee extension. Please add a three view non-weight bearing Great knee x-raying today in clinic and reviewed which shows no acute fracture dislocation, common skeleton, common normal alignment, common no overt joint space narrowing. Please send PT referral for right patellar tendinosis and tibial tubercle stress injury. Please work on knee conditioning and pain resolution and then incorporate a return to running program engagement evaluation. Please send a teller tendinopathy education. Patient's going to follow up as needed as she will be moving out of state. Sorry, moving out of San Francisco." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Oh, room seven. I'm sorry. Hola! Welcome back. Okay, so how are you? I know I'm back with the translator. So the numbers are better. 112,000. So normal is between 150 and 400. Normal is 150 and 400 in my opinion. And 200 for the whole family that I have. So she just wants to know maybe possibly because he wasn't feeling good that it was dropping? Maybe. Possibly. Maybe. It's hard to know for sure. It's very hard to know what happened in the beginning. So I think what we'll do is keep him on the schedule of every two months. instead of coming in every two weeks because I think the platelet counts are okay. But I want to educate you guys on symptoms of low platelets. So when platelets drop really low, people can start getting bruising on their legs or their arms like big bruises or they can start getting little dots like little tiny red dots and they're called petechiae. So if you ever notice that you have... to call us. So this is what you want to call symptoms of when the skin has been cut. Normally they are small, large, in all the hair. Because the hair is very small. Yes, they are very small. Also they are like small, like small roaches in all the hair. That also means when you are small, that the hair is not as small as the roaches. So you have to have the efficient hair or small roaches. bleeding. Does that make sense? Yes. Because I think you know if we keep checking it every two weeks of course there's going to be some fluctuation but as long as the platelet counts are not very very low we don't need to do any treatment. Sí, yimos monitoriendo la sangre cada dos hermanas, siempre vamos a vir y bajar porque es muy pronto. Pero si no miramos cada, vamos a mirar si sube no baja. Porque hasta mOS estará no más tiempo, socada dos meses, y lesa camos sangre miramos, sí, as normal, como los tienen un solo número, o sí, empahando su diendo. Um... Is that okay? Okay. Okay, perfect. Any other questions, sir? He is a doctor but I don't know if he is a doctor at his primary care. He has a lot of pain in his back. Does he just have pain in the lower back? No, he has a lot of pain. Is he a doctor? No, he has not been diagnosed with this. He is not too sure because he has never been diagnosed with sciatica. Do you have a primary care doctor? Is he a doctor at his primary care? Yes, yes. He is following up with them. I'm with your doctor, first of all, because I'm a chicken. We know that here, as a specialist, we don't have much time to do the doctor's work, but we do it with the doctor. Sorry. Okay. I'll read it to you. Okay. So, how do you say sorry in Spanish? Pero. Pero? Okay. Any other questions? No, thank you. Okay, alright. Nice to see you as always. I would like to thank you for coming. We will see you soon. We will take care of you. Thank you. Bye." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " For Peter Green, ultimately we are able to, with multiple efforts, draw 60 or sufficient ML, sufficient blood to make up for 60 MLs to centrifuge and the PRP was, the Verizon PRP was injected into the right knee aseptically without difficulty after pre-injection of the skin only with 1% lidocaine and .25% epiphytocaine. Triple follow for after this needed period of Dogs, this isps destroys Dhhhhhhh This is Amb valves of space what you have to calculate the width the thickness What you have to find is that the temperature of the ground surface or subject goals not very close to the ground is increasingly" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'm seeing Mr. Wilmot today for the first time as part of a transfer of care regarding chronic lymphocytic leukemia period. He was last seen by Dr. Eisenberg on June 7th of this year. Dr. Eisenberg noted a rise stage one CLL and discussed ongoing followup in to six months. Six months have passed. This follow-up is part of that plan. Most recent CBC, well I should say most recent laboratory data showed a white count of 39,000, an absolute neutrophil count of 5,300, absolute lymphocyte count of 30,800. His creatinine is 1.16 with a EGFR of 61, total protein 6.0, albumin 4.5. Of note is from March 2019, a flow cytometry showed CD5 positive B cell chronic lymphocytic leukemia, ZAP70 and CD38 negative. I'm going to use a little bit of the same color to make the eyes." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 37 year old male who presents her follow up of a fifth metacarpal fracture that occurred approximately six weeks ago period. He was last seen in clinic one week ago to have his cast removed one week early because he was leaving on vacation to Hawaii period. The patient reports he's been complying with non-laboring recommendations as discussed at his last visit and it's been protecting his fracture and a brace for an adjustment. additional week period. Reports that he no longer has pain over the fracture site period. Please copy over prior right-handed and wrist physical exam. Please insert a right-hand x-ray series with a fifth metacarpal shaft fracture with no interval displacement and good overall alignment period. Significant callous formation, demonstrating fracture healing visualized period. Processment plan. Patient is a 37 year old who presents her fall above a fifth metacarpal shaft fracture that occurred approximately six weeks ago period. The patient did have his cast removed one week earlier than recommended as he was flying to Hawaii for vacation period. He has continued to maintain a non-warping status with his right hand and utilizing a brace for protection for an additional week period. He no longer has tendinitis to palpation over the fracture site today period. Discuss with the patient that I would like to initiate him in hand therapy to work on overall hand strengthening period. The patient will return to follow up in three weeks. evaluate his progress. Period. Please send our full for hand therapy for healed fifth metacarpal shaft fracture. Period. Please work on right hand strengthening and range of motion. Period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Who presents today for MRI review to his left knee. He saw me as a new patient in September. He was a referral from Dr. Anderson period. He has had surgical procedures with her including an open osteochondral allograft period. Unfortunately, he has had continued pain from... his cartilage damage period. He has grade three and grade four changes known throughout the knee period. As a result, the patient was sent to me to discuss potential partial versus total knee replacement period new paragraph. MRI reviewed with the patient today shows no significant cartilaginous or meniscal damage to the lateral compartment. to the patellofemoral compartment. There are the already known grade three and grade four changes to the medial compartment with full thickness chondral loss and significant truncation of the meniscus, all consistent with his prior injury. Period new paragraph. Please copy for a prior left knee exam, period new paragraph assessment and plan. Who presents today for MRI review to his left knee? Period. MRI confirms that both the lateral and patellofemoral compartments are fully intact with no significant chondral disease. As such, we discussed at length today that we can proceed with a partial knee replacement versus the total knee replacement as we had discussed at his last appointment period. He will follow up at the time of his previously scheduled surgery period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Who presents today for a follow-up on his left knee period overall. He has been actually doing a little bit better more recently. He was on a trip to Japan where he was walking up to 10 miles a day for over a week and he actually did quite well and had pretty minimal soreness. He knows that since then he has been feeling a little bit optimistic about the knee. He still notes that there are twinges. He still does not feel like he could ever get back to running. Period. At this point, he has tried both cortisone and PRP injections with limited improvement. Period new paragraph. Left knee exam is deferred due to virtual visit today. Period new paragraph assessment and plan. Anthony is a 44-year-old gentleman. Status post to medial meniscal debridement in July of 2022. He never fully recovered, but we did find him. signs of some full thickness chondral disease during his surgery as well. Period. We have tried both cortisone and PRP with limited results. He does seem like he has improved slightly over the last few weeks. Period. We discussed that at this point, I really do not see any immediate role for revision surgery. He has a recent MRI from October, which shows maybe a little bit of recurrent undersurface tearing, but no real interval changes in the knee. Period. We'll see if you'd like to try how your. acid injections as such we'll bring him back for that and we will go from there." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Well, hello. Hi, how you doing? Good. How are you? Great. Passed the six year mark from finishing treatment. Really? I'm done. Yeah. No, I'm saying you passed the six year mark from finishing the treatment. That's awesome. I know. Pretty good. It is. Thanks to you and knowing what to do. I'm part of the process. So, it's a combined effort. I know but sometimes I send you to the right person. That's right. Thank you. Yes, no, no, everything is looking fantastic. Oh, good. The scans look great. Vision is the same. And blind in one eye. But I mean, no changes in the other eye or this obviously. No, no, this is gone, so no. Yeah. When you were getting treatment, it was kind of going away at that time. What? The vision on the left eye. No, what happened was, when I went to Dr. Char, he told me to only do four. So they'll... When you said to this other guy, Dr. Munson, because Dr. Char sent me down here, so I thought he didn't want to treat me no more. Well, he told me I don't want to take four treatments, but this guy gave me 20. So I'm, you know, and I think what happened, it just, then he eats it out, eats it more and more. Yeah, I don't know. I think what he was talking about four treatment was just directly to the disease process. And it's extremely difficult to do pinpoint because there's risk for a recurrence. So that's why I think he made. have given you full treatment which means that the cancer doesn't come back and thank goodness when that's what's happening but the vision obviously is gone. I think if I had told him to call Dr. Char because that's the fourth treatment I could see perfectly well. But yeah if I had told him but I thought you know Dr. Char sent me here so I thought well. Yeah well unfortunately what I've seen is it's not when you're getting the treatment but it's in in months that the vision or you know things get Just like people get radiation for prostate cancer. The control, it takes a year for them to have the control affected. It doesn't happen right away, for example. Well, what happened later on, I mean, the retina tore out my eyes. We had to replace the retina. It was just a mess. And then, now I can't see. I know. I'm sorry. It makes it... At first, everything just goes flat. You can't... nothing. You can't tell the difference. Yeah. But eventually, this eye seems to take over pretty good. Yeah. Yeah. So, what I would do, because it's six years, you know, the chances of it coming back extremely low, I'm okay doing a chest x-ray once a year. If the chest x-ray shows something, then I will do the PET scan. Not 81 years old, how old are you? No, 81, wow. Yeah, I mean, what? Well, what I'm saying is, these days, thank goodness, the treatment is much easier. Oh, good. So, even if you see something, we can give like just immune therapy to control it. Yeah. Okay. Thanks. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. Bye. So, you know, that's why I'm saying that I will next year do a chest texture before I see you. If the chest texture shows something, then I will do a PET scan. The chest texture being lateral in one year, but annual screening slash restating lung cancer. And follow up in one year. I had some bone in my bones, my ribs I had cancer. Did they show up anything? On the PET scan, no. It's completely clean. I like the small readings. His undermark was scanned. No suspicious uptake in lungs or anywhere else. Symmetric uptake in the orbits and globes. No bony evidence of metastatic disease. Everything is clear. There you go. Yeah. So that's what we will do. A chest x-ray and see you in a year. Are you up to date with your, well, mammograms, now you can do every other year. I got an appointment from June. Okay. I already got the referral a long time ago but I can't get one every year. Breathing is okay, no cough? I have to clear my throat all the time. Better than that. Okay. How about calling us? I think you're up to date. Yeah, I am. I don't think I can get another bowl. Let me get that. You will not do it beyond 80 anyway. Usually they like not to do it. Good, I ought to drink that crap. I hate that stuff. Deep breath. Okay, all right. See you in a year. A year? Yes. Bye. I got that port for you, think they can take that out now. Interval history. Sandra has been doing really well period, as we know that she's had non-small cell lung cancer, which was metastasized to the ribs and orbit coma. It has been six years now that she finished her treatment with ketrogirida period. There's no witness of any active disease. Pet scan is negative, completely period. She wants the Metaport out period plan. Sondra's doing well period of this wind coma. There's no witness of any active disease period plan. Is to from now on do just chest x-ray annually. I will do that x-ray in one year and see her back at the... that point period we will arrange for Mediport to be removed period unfortunately she cannot see from the left eye since the treatment period all questions about accommodations for the women in counseling and then we're copied over doctors" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "This is a 32-year-old female presenting today for the follow-up. She was last seen in July of 2023 regarding a low back injury that had happened in May. She had a disc bulging on MRI, but it overall responded well to anti-inflammatory. She says that she's been doing well. However, about two months ago, likely from working very long hours, she began getting worsening pain and significant tightness extending down the left leg.She's also now getting more severe pain on the left side of her hip. She's hoping for treatment recommendations as well as would like to discuss potential work accommodations. She notes that she would like to potentially do some short-term disability so that she can focus on physical therapy again and anti-inflammatories. She works as a consultant currently. Please add a, sorry, please copy forward a prior low back examination. Note a negative straight leg test.left hip examination which shows tenderness over the greater trochanter and a positive over. For assessment, this is a 32-year-old female presenting today for follow-up regarding low back pain that began after lifting injury in May of 2023. She's overall been doing well since she was last seen in July but has had return of pain over the last couple of months. This seems to be likely related to her prior back injury but she'salso exhibiting signs of greater trochanteric bursitis. She responded well to an oral medull dose pack before, so I'm going to send this to her as well as a muscle relaxer. She's requesting short-term disability. Discuss that I'm okay with doing this for a month while we get her back into physical therapy and try to get her symptoms under control. If she needs any further accommodations in that, I am going to send her to a spine surgeon for further consultation and accommodations. We will approve disability from May 6th, 2024 to June 3rd, 2024. Please send a generalPT referral. Follow-up two weeks." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 25 year old female presenting for follow up now six weeks status post a left knee ACL reconstruction with quad autographed and medial meniscus repair. Patient states that she's been doing well and has been working on range of motion as well as started strengthening exercises with physical therapy. She states that she has been wearing her brace at all times however this is getting quite annoying as it tends to be slipping down her leg. She also presents today with one crutch. She states that at home she's walking without it but always has it with her outside of the house. Please add a right knee examination extension. Five flexion, 85, one plus. No, sorry, small. No, sorry. Trace knee effusion incisions are clean, dry, and intact. There's a resolving. faint maculopapular rash. Near the incision sites, there is no erythema surrounding the incisions. There is dry scab formation over one incision with no expressible exudate. There's no tenderness to palpation at any of the incisions. For assessment, this is a 25-year-old female presenting for follow-up now six weeks status post-a left knee ACL reconstruction with quad autographed and medial meniscus repair. The patient states that overall she feels she is improving. However, I'm unfortunately disappointed with her range of motion on examination today. She's still significantly lacking inflection as well as extension. We had a long discussion that she needs to be working very aggressively at range of motion exercises and I would like her to discontinue her crutch and brace at this time as I think this is limiting her from making some of her improvements. She will be doing some travel, but we are going to follow up in three weeks to discuss that if she's not had any significant improvement in range of motion, we are likely going to have to proceed with a manipulation under anesthesia. Patient gives her a full understanding of this. And we'll also inform her physical therapist of this. She will follow up in three weeks, no imaging needed." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " To see you because of your Blood issues is that right? I'm trying to figure out your blood counts have been a little low, huh? And how long have you known about this? Your numbers are not bad today, so I don't know what your guys are doing Like 120 is not bad And I'm looking at your numbers from last year David CBC same before take one please Laura, so again, I'm looking at your labs and the other stuff, your numbers today are really not bad. It's borderline. Okay. It's 120, which is not completely normal, but it's not very low. Okay. I'm going to run some blood tests today just to see if there's any other problem going on. I'm looking at your chart here. Last time you had blood counts done back in, this is May of 2023, the blood counts are 134. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. Okay. it was not bad from June, I'm sorry, blood work from September 2023 was borderline low. So really your numbers are not bad at all. I'm not sure why they are worried about it. We'll however check a few labs and if there's any problem, I'll let you know. I mean, they keep saying your blood counts are 130, but lower limit of normal is 150. So there's nothing to be done. So I probably I wouldn't have even seen you. I think you're on the list to be seen for the last year. But this, which means it's a good thing, right? Which means you are not worried about you. Okay, so let's check your labs again today. We'll check some other iron vitamins, thyroid, see if there's anything low to worry about. Hopefully there's nothing low, then we don't need to worry about you at all. Okay, today's numbers, you're at 115, our low limit of normal. is 140, very close. Okay, the most common reason, Nora, we are seeing issues with women your age, especially Hispanic origin, is we worry about fatty liver. Do you have any history about fatty liver? Yeah. Okay, so I'm gonna order an ultrasound of your liver. If it's not already done, do you have a GI doctor or anyone who does that? If not, let's do that ultrasound. If there's an issue, your primary care can refer you to a GI doctor. Again, there's not much to be done. other than maybe lose a hundred pounds. Do what you can. Do what you can but again it's just a matter of eating healthier, less carbs, less sugar, all the good stuff goes away. Just how do I say just green vegetables boiled not fresh. All the thing in your life, no alcohol. Yeah but whatever I mean you know it's a matter of a bit of those things. If there's anything else, I'll let you know, Laura, but I'm actually not too worried about this. So my feeling is I'm going to run these tests. I'm going to do the ultrasound. If there's a problem, I will even call you back. Otherwise my feeling is there's nothing, a blood problem for me to do. And your primary care doctor needs to watch it and maybe try and get you to a liver specialist in case we see that happen. Okay. If there's anything on our end of concern, I'll call you, but I'm really thinking there's nothing to worry about. OK, this is very commonly seen that 45, 50 fatty liver starts to happen. It's the most common cause of liver failure now. I'm not sure you're doing. You're not like a very heavy drinker. I don't know that. Yeah. Maybe that's the other thing you need to do. All the things which give you joy in life need to get rid of it. That's OK. You know, it's just just being aware of it, at least you can be a little bit more conscious. OK. So I'm just going to quickly talk about you if you want to listen listen if you don't want to listen you want to go that's okay too Okay, then Chief complaint thrombocytopenia is representing unless Laura seen in metallurgy for the fall of a borderline thrombocytopenia. She's apparently known to have Had blood work done in May 2023 at which time her plate at Congress 134,000 No other abnormalities noted. She was a photohematologist for further evaluation No increased leading of bruising is noted next paragraph on blood work in March of 2024 patient Not to have borderline thrombocytopenia plate of 115. Metabolic panel include liver function test, total bilirubin within normal limits. Very likely she has metabolic steatohepatitis, continuing with the interim instability, otherwise doing well next paragraph, past medical history. Negatives, other than hypercholesterolemia, social issues, negative occasional smoking, occasional beer, about six bottles a week. This is some negative physical examination, negative. What? Continue, No, no, I said continuing the recent thrombocytopenia Laura is in hematology for borderline thrombocytopenia she does not have any evidence of bleeding will check iron vitamin B 12 levels to make sure no deficiencies appeared given her age and slightly being overweight I feel this is most likely metabolic steatohepatitis I'll order an ultrasound of the liver to further evaluate again her numbers are very borderline at this time. without changing the underlying blood disorder. She does not need any further follow up with hematology, at least unless her platelets drop below 75,000. I will have her be seen by a primary care physician. Again, if her ultrasound does show liver, fatty liver, she needs to follow up with the GI doctor. We discussed eating habits, including trying to lose weight exercise to help with the same." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] This is me recording the first conversation chunk.\n[DICTATION START]\nNow I am on the first dictation chunk.\n[DICTATION END]\n [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Physical exam demonstrates two social worker styles. Posturetibial pulse to the left, but there is no tendinous palpation of the posterior tibial tendon. Maximum tendinous palpation of the origin of the plantar fascia to the medial calcino-tubercle. Ankle joint demonstrates 13 degrees of dorsiflexion with the knee bent and seven degrees with the knee straight. GS5 slash five muscle strength less than the plantar flexion. Dorsiflexion of the left ankle, no tendinous palpation Achilles tendon, posterior tibial tendon, parainal tendon, or sinus tarsi. Assessment planner, if I show you this plan. She has had two steroid injections, has tried a night splint, has worn a brace, and also has had a Medrolidase pack, reviewed other options to include potential repeating these, physical therapy, immobilization, or potential orthotic therapy was fitted with and dispensed or was placed in a low-night taping today. Should she respond fairly considered orthotic? Should she have continued pain, consider potential orthotic therapy? physical therapy, or immobilization." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'm seeing Mrs. Hobbs at a four-week interval follow-up regarding history of medicine. Metastatic breast cancer. She's now on plugins. And... Philvestrant period. Cycle 3 of Philvestrant begins today and Ibrans continues 3 weeks out of every 4 weeks. So for the 21st of June I have a 1040 or a 1015 right there. I'll take the 1040. 125 milligrams daily for those 21 days. Period. Laboratory studies were obtained prior to this visit. Period. Next line. 5 slash 6 slash 24 colon. WBC 1.5 comma ANSI 0.9 comma H slash H 10.8 slash 32.2 comma platelet 165. Period. Okay, I'll be out front. I'm just going to sit down. CMP is normal. Period. CEA 0.7 nanogram per ml. Period. 27 dot 20. 974 unit per ml period this compares to 98.8 on 4 slash 4 slash 24 period. I mean of your eye brands because you had the lab drawn on the 6th of May how does that relate to when you yes so yes my last pill of the eye brands was on Was Friday night or Saturday night? Wait, hold on. My last one was on Friday night. Friday night. Yeah. Last Friday. That's a week ago. Yes. That's a week ago. Let's see. My calendar was May the third. and you had labs on May 6th. Yes. So you had the labs on day 24 of the fourth cycle of Ibrans. Yes. I had inadvertently, and I, when I, my first cycle, I was taking the Ibrans at noontime, and I was finding that that was really difficult because after I take it, it makes me so weak. So then my second cycle, I figured. I would take it at dinner time. And I was under the misunderstanding that you had to take it with food. Later on I figured out it doesn't matter. But anyways, in that week I had missed one pill. And I didn't know which day it was, but I knew that when Thursday came along, I still had one pill left versus being done on Thursday. So I called Eddie Friday morning and I said, should I go get my blood done Friday, even though I still have one more pill to take, or should I do it in medicine? day and he said Monday would be fine so you're getting Vasilidex today yes and typically that's when we would start eye brands yes one week off of eye brands yes yes so are you prepared to start your eyebrows yes okay good your lab that we had drawn at the end of the therapy showed that the white count was decreased although low not so low that I don't want to continue the eye brands because the CA 2729 is decreasing. Yes, I saw that. Okay. I did notice that when I look at LabCorp website it shows me the test results for April 4th but the C-corp website doesn't show me the April 4th so I was hoping that that could be fixed so that I could track the trends. Well I won't be able to fix it for you but I don't know what you want it fixed. Oh, just have that report there on the screen. C-Care website because the April 4th test isn't there. Well, that's software and I'm not sure how to manage that, but you can mention that to Ed. Sure, sure. But we won't be calling in software engineers at $400 an hour to make it compatible with LabCorp. I do not know what the software arrangement is. You should be able to see all of your labs there, I assume. Yeah. If you want them lined up against each other, that's a software development development. Well, normally you can see because they're all there, but for some reason the April 4th test is not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. It's not there. is not showing up on CCARE at all? Well, they won't show up until I sign off, but I've signed off on things, usually within 24 hours of getting it back to me. At any rate, so the white count is low, that's Ibrans. If it drops lower in subsequent evaluations, then we will need to change the dose. But right now, you're getting a benefit by these numbers. I don't need to do any imaging studies with the tumor marker falling, it's very gratifying, that's what I wanna see. So that's my plan is to commence Faslidex today. This is cycle five, I believe cycle five beginning today. Is the Faslidex the one that's an infusion or the butt shots? It's your injection. My injection, okay. What infusion are you talking about? Ibrans is a pill. Yeah, but there was another drug that you had me do an infusion of. You're getting that now? Well, I got it once, but I've never gotten it again. And so I kept asking Eddie, when is that gonna happen? I don't know what we're talking about. So we have the injections, and then there were three drugs. So in my original plan. Infusion. Well, you've had Xgeva in the past. That's what it was then. But Xgeva, is that, I guess so. But no, you have not had Xgeva. some time. When was your last bone density? I don't remember. Okay and I should also think of your studies. Let's see we go back here your last X-Jiva was some time ago. How long ago do you recall because it doesn't look like you've had one. I haven't had one since that one. Okay let me see how far back that is. I think that was there at the beginning of the first cycle. Yes, you had a... Oh, I think it was denied. That's why it wasn't given again. I have no... It says denied. We don't deny it, so it would be from health plans. I assume. And I think it was done because of metastatic disease. So that's probably why it was not been given. So we can look at the bone density and see what's happening. The last, let me just look and see the last imaging. We have a PET scan from February. Yes, you have bone metastases. I want you to have X-Giva. That was on there. So I'm going to request it and we'll see what happens again. Okay. I want to set it... up every every month. So hopefully we have it authorized and we can do it one month from now. Okay that would be a way of setting it up so let's one two three four June 7th okay okay that's when I'll be seeing you next everything should be set so I trust we'll have that available. But you have bone metastases on the PET scan we treat for that disease. I don't know. Sharp may say we can give you medicine, but we don't want to give you X-Giva. They may not want that. That's what I would choose to give you, but I have no idea. That's all speculation on my part. I just don't know. Let's see, and we want a follow up. Your next. is six, seven, is that four weeks? I guess it is. Yep, okay. So I will see you on six, seven, and we'll get lab prior, and we'll get lab on the, about the last day or around the last day of your eyebrows. Okay, okay. I have a list of questions. Let me know when you're ready. Okay. Okay, what are your questions? First one, my general fatigue and weakness, is that something that's going to get worse or is that something that's going to get better or is that something that I should expect to be a kind of a static thing? I don't know, but I would anticipate with counts a little bit below normal that people can be a little fatigued and not feel up to par. Your hemoglobin is not a level that would cause any of those symptoms. So I would have to say it's probably going to be about the same. I don't see it changing. Kidney function decrease? Is it so bad that I should be taking an ACE inhibitor? Well I'm surprised by your question, such a specific question about taking an ACE inhibitor. I would not be planning any specific medicines for that. Okay. Weird symptom that I've noticed, and it's where when I lay down to go to sleep, I can hear my pulse in my ears. And I looked it up and it's like a form of tinnitus where you can hear your pulse, you can hear the blood flowing. And there. There could be different causes of that. Should I be talking to my cardiologist about that? Is that something you prefer? Well, you can be, but usually that symptom is pretty non-specific. You can certainly ask your cardiologist about it. Okay. But I don't know that there's a specific answer. Okay. And I don't think, is it all the time? Are you having it all the time? Every day when I go to sleep, but it's new. I mean, I don't remember it before. And then you don't have it during the day, just before you go to sleep. Yes. I'd ask your cardiologist, but I think that's non-specific. Okay. Okay. And... Okay. Oh, now... Oh, sorry. Maybe this is it. I ordered X-Jiva again, but you're getting a drug called Zometa every 12 weeks. And that probably is in place of the X-Jiva. I suspect that it is. I haven't gotten any. You haven't? Well, whatever they gave me that first time, maybe it was... Course number two was do... is due on June 7th, dose number two. Dose number one was on March 15th. I believe that was ordered because X-Jiva was denied. Okay, is that okay? I mean, is that in your opinion? My opinion is I wanted something to stabilize your bone. Got it. I would prefer X-Jiva. So call up your insurance plan and complain. I mean, I don't know what else to say, but there's an alternative and I'm using that. Got it. And so I need to cancel an ex-Jiva because it's I've ordered it again. It makes no sense. I mean, I didn't realize I was so supplanted with that. Any other questions? Yes When I can feel my lymph nodes in my neck and I noticed the lymph nodes were discussed in the PET scan results When do we do PET scans now when we're doing treating metastatic breast cancer as long as the tumor markers decrease I'm not going to repeat the PET scan. That's a sign to me there's less tumor mass, and I think we should just watch that until there's a maximum benefit, and then we can look at the PET scan again. Okay. And I noticed that in my blood results, the lymphocytes, monocytes, and neutrophils were down really low. Should I be concerned about, I know you mentioned bacterial infections last time, but should I also be concerned about viral infections? I don't think so. And I mentioned... to you already that your white count is low and I don't think there's a concern about that. It's low and that's something that eye brands will do but it's effective for you. So unless it's more significantly decreased I wouldn't change it. But as far as like social choices that I make as far as like being around large groups of people or anything like that. You can do whatever you wish to do but you shouldn't be intentionally exposing yourself to someone. You don't have any specific immunity or increased risk of viral infections. Okay and um Oh yes, okay, so the last one, I'm using up my sick time, so I need a new letter that extends my work release to June 6th. Okay, well Eddie can help with that. Yeah, and then sometime this summer, depending on how I feel, then I may continue my sick leave in the fall. fall. Well, we'll deal with it when we make a decision. Yeah, because we have a special program in our union for people that have severe illness that we can extend our leave. So we think that we've all contributed to. So yeah, I think—oh, bruising. I forgot to write that down. Anything I should be doing, because I noticed I'd be getting a lot of bruises. Anywhere else besides your legs? Just my legs whenever I bump up against something. No I don't think so. There's nothing about your labs that strike me as an issue. So I was pleased to see my tumor markers went down. Right, well that's the intent of treatment. That indicates to me less tumor mass." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] "presents for requesting bilateral knee injection with cortisone period. The last injection performed four months ago has lasted until the present, but it's beginning to fade. Period of prefrontal examination she has.bilateral synovial hypertrophy of the knees without marked effusion period there's crepitation with general range of motion period uterine after giving for procedure colon after giving informed consent completelybilateral needs were aseptically injected with 1% lidocaine slash 0.25% marcaine slash 40 milligrams of Kenalog after ethylchloride slash beta-9 prep paired this with well-tolerated periodine para bilateral diagnosis bilateralosteoarthritis period where she stated she'll be defending her proposal at school before December period she'll likely return to see me about four months for a pete injection period and dictation" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'll visit for a name a second that I and efficiency Okay, that's a cool way. Okay. Hey Anna. I haven't seen you since December. And. And. Did you get the iron infusion? No. Okay. I thought that was what I was going to get today. Some kind of infusion or something. Well, you definitely need the iron infusion because your iron level was extremely low. We may try to schedule that back in December. I don't know what happened. What did you do to get a hold of you? I think this was for this one. Yeah, today I was supposed to get something done. I don't see anything. But yeah, today was supposed to be the foul walk after that infusion to see if it's back to normal, your iron levels, but... They haven't gone up on it. They haven't gone up because you haven't gotten the iron infusion. When we check all the other labs, when you were here back on December 27th or like December 27th... everything came back okay. You did not have any sign of B12 deficiency. They checked for certain kind of bone marrow cancer called multiple myeloma and that was clear. There was no sign of multiple myeloma. They also checked for any kind of leukemia or blood cancer or lymphoma. We did not find any evidence of that. It was really just low iron which I'm not sure why they... were not able to provide you sometimes they get bogged down by authorizations but you shouldn't have any issue because you have Medicare in the secondary. So I'm not sure why but I'm going to talk to them and try to see if they can get you an iron infusion today. If not today then they'll schedule that as soon as possible. It's gonna you're gonna need doses because it's really running on empty now. So we'll get you the two doses of the IV iron as soon as possible and then I'll schedule you for another visit in a couple of months and recheck everything at that point. I'm sorry you had to wait this long to get the iron but sometimes it happens. I'm not sure why but we'll get that to you as soon as possible. The only good news is I did not find any other Oscar Denim. Now I referred you to Dr. Padama, the gastroenterologist. Did you get an appointment? No. No, they were back. Yeah, let me talk to Lira and see where we're at in terms of that. And we'll go from there. Follow me. you" [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Please insert a normal right ankle three-view x-ray and please insert an MRI request to Simon Med with comments MRI of the right ankle without contrast period please evaluate for Achilles inflammation slash partial tear. due to persistent posterior ankle pain without improvement with physical therapy." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Patient presents for follow-up of right wrist pain that has been ongoing since punching a wall on 10-28-23 period. CT imaging completed on 11-16-23 did demonstrate a 2 millimeter calcification suggestive of an age determined avulsion fracture of the tricute jump period. The patient has been weight-bearing as tolerated since his last initial visit, since his last visit period. However, coming he does continue to have some limited range of motion. due to some mild pain on the lateral aspect of his wrist and some continued associated swelling period. Please copy of a prior right wrist and hand physical exam period. For assessment, patient presents for follow-up of right wrist pain that occurred after punching a wall on 10-28-23 period. CT imaging was ordered to evaluate for a potential occult fracture and demonstrated a 2-millimeter calcification suggestive in age to determine evolution fracture of the tricrete jump period. The patient has continued to have decreases in overall pain and has been able to wait barers tolerated with the right upper extremity period. However, coming he does know that he continues to have pain along the distal ulna with associated swelling period. Prior x-ray imaging taken at the patient's last visit continues to not demonstrate any other occult fracture injury along the distal ulna or other midocarpal bones period. However, as has been over three months of the patient's initial injury, I would like to order MRI imaging to evaluate for any potential soft tissue TFCC or ECU injury period. The patient agreed to this plan and will follow up in clinic after completion of MRI imaging period. Please send an order to Simon Med for MRI right wrist without contrast period. Please evaluate for potential TFCC or ECU injury at the right wrist period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " Government had an idea before they even met. I'm convinced everything is just not pleasant. We're talking about something the next thing you know my wife's on her phone and Facebook offers are what we were talking about. And I'm like, you didn't Google that, so I think the last thing is must be pleasant. We have seven. Oh, that's so weird. So, correct me if I'm wrong, but partially... a diabetic foot checkup but some issues with some other issues. Yeah, that's really why I told Dr. Edward, I had one injury in the Marine Corps jumping out of a vehicle and then a week later fast-broken out of a helicopter. They said, because I landed on a rock, you plantar fasciitis. They gave me a tennis ball and some medicines. I got through it probably six months, it stopped turning completely. That was 30 years ago. But now, just like at Camp Bend, I've got a rod from here down to my ankle, a second is this lump right here and I think it's building fluid to protect something but I don't know if there's a fracture but I don't think so. The more I play with it and watch when I move it, it looks like there's a tendon right by the shark's head and fin. I don't know if anything goes like that but I retired this year and then she sent me back after a couple weeks. The wagon was after 31 years because they sent a letter, we need help. I'm like, no, next time on the ladder. And so after like an eight hour day, that top of that foot hurts. And I think the other thing is I feel it like a callus, but just not really a callus. I got a numbness here. It's not pain. Yeah, but I thought diabetes wasn't easy to cut your toes off. My toes are fine. Both out steps. The blisters you see, I just got them on Saturday from a new pair of Birkenstocks. I wear Birkenstocks religiously. Shoot, I probably have four pair. She got me a new pair. to match another outfit. And the first time I wore them, I got blisters. I put them up for a month, wore them with socks. That's fine. I wore them again. So, she's going to take them back. I think the bed in it must be formed different than all of them because I've never gotten blisters. And Saturday at the public market, just walking around both insteps, I came home and I had a problem and I soaked them. But they were raw for a couple days, but they don't grow now. Okay. Gotcha. But at least you know what they were from and know what. what caused them. And so you're telling me about that you get some numbness on the outside. Almost like it's a callus and that's where I go, I get pedicures once a month. Don't judge me. But if the grandkids around, yeah, I get my children on spain, my granddaughters. But I go and I soak my feet a couple times a week just to see, I know Epson salt doesn't do anything but that or a bath bomb and that. I scraped this foot with a cheese grater. The reason I'm peeling so much is she just ended up, she got these booty foot wraps you put on and they soften out all your stuff and all that. And then for like two or three days I'll peel. But I can never work on this foot because I can't bend it more than that. They've told the five surgeries on this leg now since I've been recording for a month. Gotcha. You get any burning or tingling in the feet? Every now and then I will say that my toe. and then it scares me and I put the cookies away. Okay. But I don't know if that really is probably where it's from. Well, the sugars can affect the nerve endings, yeah. And I'll test those and this doesn't hurt. I just want to know if you feel it. I feel it. Not as much. Yes. Yep. Yep. I feel this pressure. You know something's touching. So, what we know from the standpoint of having a diabetic foot issue like an ulcer or a wound, if you can feel that it's very low that anything's going to happen because you're going to feel the pain from whatever's harming you and stuff. The people who can't feel that are... ones that get into trouble. Because they don't know. He says I'm having a heart attack. I went, I'm pending, I'm detached by a shot and two torn rotators on this side. And I had neck surgery because this arm didn't work and I didn't understand it. But the minute, it was like a kink guard nose. The minute they did the surgery, the next day I moved my arm. So, it was something pinched, I guess. And they said it's happening again. So, I went to sort of work up for all these surgeries and they wouldn't do it because my A1C was better. So, he put me on rubels. I don't test regularly, he doesn't have me testing regularly. I don't do, my brother has to give himself insulin or something. I don't do any of that. I've lost 30 pounds in nine months and he says that's because of the rubelluses. I'm still eating pizza and cookies. If I really worked on it, I think it could be better. But you're getting there in the literature as long as you're going in the right direction. But the grandkids just avoid it today. Never been there. It's a cookie shop right off the road. Italian pastry and stuff. Oh yeah. Don't tell me those things. I live right around the corner. Can you push me? Good. This one. Good. Yeah, you got it. Any weakness or anything? No. No? Okay. Any issues with cramps and the legs when you're walking that make you stop walking? No. Leg cramps and trolley horses when I don't drink enough and then I over-insert myself of meaning. We hunt a lot and do a lot of walking. When you're drinking beers and stuff, you don't have to come home at night and not get enough and walking around the bedroom and say, I got to turn on your horses. But that's just because you're not drinking enough water. You gotcha. Yeah. And this, so what you've got here is how we can take an x-ray to confirm some of the other things as well. But you, you've, I can feel some spurring under there. So you, you definitely have some arthritis in this joint here. Oh, there's a joint there. Yeah. I didn't like you were mentioning. I get like a liquid bubble, but nothing like a blister you think you can pop. It's way under his skin. I'll call it a bursitis where you get this inflammatory fluid sac that responds secondary to the arthritis. And I go away, and the last thing was on this foot. I thought he would send me to a... What's a skin doctor? A dermatologist. A dermatologist. It's not a wart, I don't think. But unfortunately it's right where all my... my shoes cup and it rubs and it gets irritated. Then my wife took the cheese grater for your feet and she says, well here, and she started scraping it, but then it just started bleeding. So I don't, I don't think it's a skin tag. I don't know what that little lump is, but it's not painful. It's painful when it rubs. It's irritating because all my shoes rub, rub, rub, and even my Percocet straps go around and these are not good for my feet. We can do a little procedure and cut it out if I bother to. Yeah, three years now it's freaking annoying. Yeah, I would love that. Yeah, well are you swimming in the summer or anything? My brother's pool with the grandkids but I don't get it. I don't have to get in. Okay, yeah. Or my swimsuit while we're at the cottage. Alright, yeah, we'll have it scheduled. In the office just now. What would you call that? Yeah, so it could be a wart, but it doesn't have that exact appearance that you would expect. It hasn't gotten bigger. It just appeared and then that's the next I want to say, a couple years now. Yeah, I'm guessing it, so we'll send it to the pathologist, but I'm guessing we'll call it a dermatofibroma, which is a benign skin lesion. If I know what working shovel is in a row, I put a bandaid on it. just so I can wear my work shoes because we have to wear specific non-slip shoes. That means that they give us every six months, we get a free pair of shoes, but they're the worst. There's no arches at home or anything. I used to buy Dr. Seuss. You stood on a machine at Walmart and you calculate what you need. I thought I felt they helped, but they're expensive and I stopped buying. Well, we could go because... Typically, with a history of diabetes, most insurances will cover orthotics or inserts. If you want, I can get you set up. That would be awesome. Yeah, let me, I'll put the order in right now. So the U of R, they'll actually get a hold of you, but we'll give you their information. They have a lab, orthotics and prosthetics, where they'll make a mold and make an insert for you. I know, I should go to the quick feed store. You should go there. Well, I'm sure it takes it and then you just don't. Right. I buy some of it when it's off the shelf. My foots hurt and I didn't go to the bathroom and put them in but they don't last. Yep. They may help but they do break down quickly. Yeah. Note will get you I can click the right button and be all set. Yeah, she intercepted the letter from Vytman's Hasky to come back for the holidays. We can't find people who work here, nobody wants to work. You're going to shred that all up in your pocket. I called them and said, you know, and I put in a bunch of my retirement package stuff and she went through it and found the letter. Just, are you going to go back? I said, no, I told them, next day she says, you need to go back. We sat on the couch and plus she works from home. So she's in a lot of debt. My days off are like, what are you going to do today? What are you going to accomplish? What's on your agenda? I'm not seeing a sneak trip. Get along. She's not a fan of that. She's been here for years. So, um, do you, so we could do more with this if you want meeting. Um, we could get. you you It sounds like we'll see each other again." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " I'm sorry to hear that. Now, did you grow up here or are you from Florida? I've been in the area since the 60s. Gotcha. And obviously still people down there. Yes. Okay. Well, what's going on with the feet? I don't know. I started out with a gallon in my big toe. In the... Okay. And then I got on the upper ventricle and I used 100% tardure juice. Okay. That works. But then I started back here. Boy, thank you. Yeah, and then it would swell when I walk around. It swells like a pig's. More on the side, the outside over here? Oh, yes it would swell. I need that. Gotcha. Just on the left side? Yeah, the other one tickles, but it doesn't swell. It doesn't swell. Okay. And when did that, not the gout part, but when did this start? After I got sit down. I looked a little more than just like now but I was fine when I went to bed. I didn't know what I wanted. I couldn't walk. Okay. Is it seem to be getting better or is it the same? Yes, the same. The same. Yeah. Do you get any weakness? Do you feel like it's going to give out? No. Am I hurting? Yes, it needs to know that's not going to do. Please. Can you push against me? Maybe this will turn to you. Still? A little bit, yes. About down on your head. Right there too. Yes. It's right there. Sure. Yeah. Yeah. How about the ankle bone? So? Yes. Yeah. Cool. Well, let me have Crystal get a couple pictures of the ankle bone, a couple x-rays, and see if anything's going on there. Yeah, we certainly have a few areas that hurt, huh? Thank you." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

CONVERSATION

Knowtex-Llama3-Transcript_Type

You are a doctor writing a SOAP note. Identify if this transcript is a dictation or conversation. If dictation, output DICTATION. if conversation, output CONVERSATION. If it's a mix of dictation and conversation, output CONVERSATION. Do not output anything except DICTATION or CONVERSATION. [TRANSCRIPT START] " This is a 44 year old male patient presenting for CT review and follow up of a left knee pain that started on 2-17-24 after being hit by a car. Patient was sent for CT due to concern for a non-displaced patellar fracture at the initial visit period. Patient was placed. in a knee immobilizer which he states has caused additional knee discomfort as he is applying pressure over the patella itself period. Patient otherwise states that he has been mostly maintaining in the knee immobilizer and has avoided bending of the knee period. Please copy over to prior left knee exam. Assessment plan, this is a 44 year old male patient presenting for CT review and follow up of a left knee pain after being hit by a car on 2 slash 17 slash 24 period. Patient was sent for CT due to concern for a non-displaced patellar fracture at the initial visit period. Review his CT today W- The potency of the lateral patella facet that is suspicious for a nondisplaced fracture. Period. Patient on repeat examination today continues to exhibit. Exquisite tendons palpation to the lateral side of the patella. Period. Discuss patient that given the exam and. the area of lucency that is suspicious for fracture, we'll treat this conservatively and we'll continue to place patient in a, transition patient to a post-op brace, knee brace, with extension locked at zero. period. Patient advised to continue to maintain in the brace for additional three weeks at which point he'll come back for a repeating examination period. If he no longer has any pain without patient, at that point, we made this continue to brace period. In the meantime, we also provide a patient with a physical therapy referral as well so that he can start physical therapy. to get out of the brace period. We'll see him back in three weeks for a repeated examination. An x-rays period." [TRANSCRIPT END]

You are a medical scribe checking the text transcript of a Doctor Patient Conversation, you need to identify if the transcript is Conversation or Dictation

DICTATION

Knowtex-Llama3-Transcript_Type