X7-qP2-mN9-v4/MTS_Dialogue-Clinical_Note huggingface dataset:
Doctor: Hello Mister Strange, can you please confirm your age and ethnicity for the records.
Patient: Hi Doctor, I am fifty five now and would identify myself as a white male. 
Doctor: Let's first talk about your medical condition. There has been a diagnosis of polycythemia vera with secondary myelofibrosis. Also, you are J A K two positive. Do you remember when you were diagnosed?
Patient: It was sometimes between two thousand and five and six. 
Doctor: They did phlebotomy and then subsequently you got yourself transferred here in our healthcare. 
Patient: Yes.
Doctor: You have been on hydroxyurea and interferon, right?
Patient: Oh, it was a terrible time, I could not deal with anyone of them. I had numbness and tingling with burning pain in my hands.
Doctor: You do not have any siblings that we can try for transplant match?
Patient: That's right! 
Doctor: You were also considered for the Matched Unrelated Donor Transplant, but you couldn't be on the list due to social support and also health was in reasonably better state than other candidates normally on that transplant list.
Patient: We had some medications here as well when I first started my care here, I forgot the name. 
Doctor: Yes, here we started you on a trial of lenalidomide and prednisone for some time. You were doing great on that for a while, but then you developed intolerance to lenalidomide. 
Patient: Yes, I had severe diarrhea and I always felt tired like I have no energy left in me. Eventually it all stopped. 
Doctor: Yeah, here it says that you injured your leg? Tell me what happened. 
Patient: It all happened last week, I injured this left leg and got swelling. I had some prescribed steroids, so I took them for about three days only. The swelling is eventually gone now.
Doctor: Any other related complaints?
Patient: No.
Doctor: Do you smoke or drink?
Patient: I take marijuana. I feel really hungry after smoking it, so I eat a lot. In just the last few weeks I have gained a few pounds. 
Doctor: Okay, your overall performance status in the E C O G scale is one.

Clinical note:
Symptoms: swelling in the left leg (resolved), severe fatigue, diarrhea
Diagnosis: polycythemia vera with secondary myelofibrosis, JAK2 positive
History of Patient: Diagnosis made between 2005 and 2006, underwent phlebotomy initially, transferred care to current healthcare institution, intolerance to hydroxyurea and interferon, considered for Matched Unrelated Donor Transplant but not a candidate due to social support and relatively good health, trial of lenalidomide and prednisone with subsequent intolerance to lenalidomide, injury to left leg with swelling (resolved)
Plan of Action: N/A
Doctor: Do you have any family history of neurological disorders, such as multiple sclerosis, Parkinson's or dementia? 
Patient: Nope. Fortunately, no one in my family has neurological problems.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: How long have you had this rash? 
Patient: Not long. Less than a day if I had to guess. 
Doctor: Is it causing you any pain? 
Patient: No, it's just really itchy. I tried applying Cortisone to it, but it didn't help much. 
Doctor: Is the rash localized to the left arm? 
Patient: Yeah. I've only noticed it on my left arm.

Clinical note:
Symptoms: itchy rash
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Hello. How are you both doing today? 
Guest_family: We're doing great. The E D told us to come here. We're here to see if we could get the stuff in his leg taken out. 
Doctor: I see. Did he have a fracture before? 
Guest_family: Yeah, he did. Here's the report from the surgery from October two thousand and seven. 
Doctor: Great. Let me take a look. It looks like he had a distracted left lateral condyle fracture. He then underwent screw compression to fix the fracture, correct? 
Guest_family: That's correct. 
Doctor: Perfect. So, now we just have to remove the hardware that was used to fix the fracture, right? 
Guest_family: Yeah, that's correct. What are the risks of the surgery? 
Doctor: The risks include the risk of anesthesia, infection, bleeding, changes in sensation and motion of extremity, failure of removal of hardware, failure to relieve pain or improved range of motion.  
Guest_family: Oh, wow. That's a lot. Could you go over the benefits?
Doctor: Of course. Before I do, I just need to confirm your son's age. 
Guest_family: He can tell you. 
Patient: Hi. I'm five years old. My birthday is in four months. 
Doctor: Thank you. Happy almost birthday. 
Guest_family: He gets excited about birthdays. I just have a few more questions, but it looks like we're going to go through with the surgery.

Clinical note:
Symptoms: N/A
Diagnosis: distracted left lateral condyle fracture
History of Patient: Underwent screw compression for the fracture in October 2007, now presents for hardware removal
Plan of Action: Risks and benefits of surgery discussed, including risk of anesthesia, infection, bleeding, changes in sensation and motion of extremity, failure of removal of hardware, failure to relieve pain or improve range of motion; family agreed to the plan
Doctor: I am looking at her x ray report and she had a sternotomy in the past.
Guest_clinician: Yes, and we placed an I C D implant and an aortic valve mechanical implant. Her pleural effusion was really worrisome causing left sided opacification of her diaphragm.
Doctor: Oh I see!

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Previous sternotomy, ICD implantation, aortic valve mechanical implant, left-sided opacification of the diaphragm worrisome for pleural effusion
Plan of Action: N/A
Doctor: What happened to your right leg?
Patient: I had a little accident with a dog, he bit me. I got really scared.
Doctor: Don't worry we will take care of this.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Dog bite to the right lower leg
Plan of Action: N/A
Doctor: We've been following you for several conditions for a while now. What seems to be the problem today, sir? 
Patient: Um, I was peeing blood, it's back again. 
Doctor: Did you do anything that could have provoked it to come back?
Patient: No, not that I know of. 
Doctor: Have you been taking the Flomax for your B P H? 
Patient: Yes, I have been. 
Doctor: What about the Coumadin?
Patient: Yes, I've been taking that too. It has been held recently, but I ususally take it.
Doctor: Remind me, I don't have my chart with me. What conditions have you been taking the Coumadin for?
Patient: I have A F I B and stroke.
Doctor: Thank you. Isn't this your second occurrence of gross hematuria this month?
Patient: Yes, doctor.  
Doctor: Are you sure you haven't experienced any falls or anything recently? 
Patient: Yeah, actually I fell about a week ago. 
Doctor: Where is your pain from that fall? 
Patient: It's in my butt and leg. 
Doctor: Have you had your x rays taken yet? 
Patient: Yeah, the x ray tech just brought me back. 
Doctor: Okay, these x rays of the hips, knees, and ankles show severe degeneration in all areas. 
Patient: What does that mean, doctor? 
Doctor: I see some pretty significant arthritis in these areas. 
Patient: Can you tell me some good news, please? 
Doctor: Well, I don't see any fractures. 
Patient: I guess that's something. 
Doctor: When is your pain worst?
Patient: It's so severe, and it's worst first thing in the morning. 
Doctor: Okay, I know you are, but be sure to keep taking the Coumadin, that helps with the stroke and A F I B. 
Patient: Yeah, I will. I'm having problems with my sinuses today too. Can I get some nasal spray too?

Clinical note:
Symptoms: gross hematuria, buttock and leg pain, sinus problems
Diagnosis: BPH, atrial fibrillation, stroke, severe degeneration in hips, knees, and ankles
History of Patient: Developed gross hematuria twice this month, Coumadin held, fell a week ago resulting in buttock and leg pain, x-rays showed significant degenerative disease in hips, knees, and ankles with no fractures noted, pain worse in the morning
Plan of Action: Continue monitoring, consider nasal saline spray for sinus problems
Doctor: Good morning. 
Patient: Good morning, Doctor. 
Doctor: Are you married? 
Patient: No sir, I'm happily single. 
Doctor: Good for you, what do you do for a living? 
Patient: I'm actually not working right now, I go to college full time. 
Doctor: Even better for you, so do you drink or smoke? 
Patient: No, I don't.
Doctor: What about more illicit substances? 
Patient: Absolutely not, nothing like that.
Doctor: Do you like to work out?
Patient: I play tennis and swim every week, I love it. 
Doctor: That's very good, you're keeping very healthy.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: The patient is single.  She is a full-time student at University.  Uses no tobacco, alcohol, or illicit drugs.  She exercises weekly, mainly tennis and swelling.
Plan of Action: N/A
Doctor: Has anyone in your family suffered from dementia? 
Patient: Not that I'm aware of. 
Doctor: Is there any other medical history in your family? Any other medical issues? 
Patient: My mom died of a stroke. 
Doctor: How old was your mom when she died? 
Patient: She was sixty two.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Negative for dementia.  Her mother died of a stroke at the age of 62.
Plan of Action: N/A
Doctor: When was the last time you had a cigarette?
Patient: Seventeen years back.
Doctor: Okay, and how much did you used to smoke?
Patient: About one pack per day. I smoked for forty four years.
Doctor: Okay, how about any I V drugs?
Patient: No I have not done that.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: The patient quit smoking 17 years ago; prior to that had smoked one pack per day for 44 years.  Denies any alcohol use.  Denies any IV drug use.
Plan of Action: N/A
Doctor: What brings this little guy in today? 
Guest_family: He's been complaining of a sore throat since last night. I noticed his eyes were really puffy before he went to bed and that's when I gave him some Benadryl. At that time, he also seemed nasally. 
Doctor: Sorry to hear that. Did he have a fever? 
Guest_family: When I took his temperature last night, it was one O one.
Doctor: And did you give him anything for the fever? 
Guest_family: I was worried about giving him something on top of the Benadryl. 
Doctor: I see. And how has he felt otherwise? 
Guest_family: He appears more sluggish than usual. Fortunately, he's eating and drinking well. 
Doctor: Has he been coughing at all? 
Guest_family: No, but his voice has been a kind of raspy. 
Doctor: Any shortness of breath? 
Guest_family: Um no. 
Doctor: How about any episodes of vomiting, diarrhea, or stomach pain? 
Guest_family: No, I don't think so.

Clinical note:
Symptoms: sore throat, puffy eyes, nasal congestion, low-grade fever (101°F), sluggishness, hoarse voice
Diagnosis: N/A
History of Patient: Symptoms started suddenly yesterday, took Benadryl for congestion, no coughing, shortness of breath, vomiting, diarrhea, or abdominal pain
Plan of Action: N/A
Doctor: Do you have any major medical conditions that I should know about, sir?
Patient: Maybe, I might. What exactly do you mean by that, doctor?
Doctor: Well, it's broad, but it could be anything from depression to high blood pressure, to cancer. 
Patient: Okay, that's what I thought. I have high blood pressure. 
Doctor: What about your mental health, is there anything of note there? 
Patient: Um, yeah, I have anxiety, too.

Clinical note:
Symptoms: N/A
Diagnosis: hypertension, anxiety
History of Patient: N/A
Plan of Action: N/A
Doctor: Are you a student? 
Patient: Yes, I am. I go to the University. 
Doctor: What are you majoring in? Or do you know yet? 
Patient: Yes! I am studying biology.  
Doctor: Excellent! Do you live in the dorms? 
Patient: Yes. 
Doctor: Are you from the area? 
Patient: I am from Breckenridge. That is where my parents live. 
Doctor: That is a beautiful place to be from. Do you use any tobacco, alcohol, or recreational drugs? 
Patient: I have smoked weed with friends, off and on but not much. I have a few beers at the occasional dorm party.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: The patient is a student at the University majoring in biology.  He lives in a dorm there.  His parents live in Breckenridge.  He admits to having smoked marijuana off and on with friends and drinking beer off and on as well.
Plan of Action: N/A
Doctor: Do you have any history of surgical procedures?  
Patient: No, none.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Hello Hello!
Patient: Hi there, how are you? I have a bad headache so can you please switch off the lights, it's too bright and uncomfortable.
Doctor: Sure thing. Let's see what is going on here. How about that?
Patient: Much better.

Clinical note:
Symptoms: headache
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Okay, let's talk about your family history. 
Patient: Oh, I have very disturbing family history! 
Doctor: Why do you say so?
Patient: Well, my mother passed away due to heart attack in her late sixties and my father had liver cancer and he passed away from that. 
Doctor: Oh-
Patient: Oh, that is not all. My one son suffers from hypothyroidism and my daughter's two kids have cerebral palsy from being born prematurely.
Doctor: Oh, that is so unfortunate.
Patient: Yeah.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Positive for mother passing away in her late 60s from heart attack, father had liver cancer, and passed away from that.  One of his children suffers from hypothyroidism, 2 grandchildren has cerebral palsy secondary to being prematurely born.
Plan of Action: N/A
Patient: Hey, man. 
Doctor: Hey, how's it going? It's been a while. 
Patient: Yeah, it's been a while that's for sure. 
Doctor: So anything new I should know of? 
Patient: Uh I had some stuff on my chest that I saw a dermatologist for. 
Doctor: What type of stuff? 
Patient: I think they were cysts. 
Doctor: Any cause for concern? 
Patient: Nah, the dermatologist said everything came back alright. 
Doctor: Glad to hear that.  
Patient: Me too. I'm actually here to see if you can write me up a P P D slip.  
Doctor: Is this for a job?
Patient: Yeah, my last one was negative, but I need to get another one. Last one I did was in nineteen ninety four.

Clinical note:
Symptoms: chest wall cysts
Diagnosis: N/A
History of Patient: recent PPD negative in August 1994
Plan of Action: N/A
Doctor: Have you notied her behaving strangly in any way? 
Guest_family: No. She is acting perfectly normal. 
Doctor: Has she been gagging, coughing, vomiting or any other symptoms? 
Guest_family: No. The only thing that I noticed is that she spilled the liquid all over her clothes, the ground and on her hands.
Doctor: Did you see her ingest any of the fluid? 
Guest_family: No. We didn't see her put it in her mouth. I looked inside her mouth and didn't see anything.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No abnormal behavior noted, no coughing, gagging, vomiting, or other Symptoms observed; child spilled liquid on clothes, ground, and hands, but no ingestion witnessed
Plan of Action: N/A
Doctor: Any past medical problems I should know of?
Patient: No, ma'am. I am forty three and this is the first time I have had a major issue. It's only been this past month where I've felt weaker than usual. I'm much more tired and short of breath whenever I move around.  
Doctor: Any recent weight loss? 
Patient: Yeah, I actually lost about fifteen pounds in less than two or three months. 
Doctor: How's your appetite? Any nausea, vomiting, diarrhea? 
Patient: Appetite is pretty fine. No nausea, vomiting, or diarrhea.
Doctor: How about fever, chills, sweats, cough? 
Patient: No, ma'am. 
Doctor: And any chest pain with your shortness of breath? 
Patient: No, ma'am.

Clinical note:
Symptoms: weakness, malaise, dyspnea on exertion, weight loss
Diagnosis: N/A
History of Patient: Symptoms present for approximately one month, denies fever, chills, sweats, cough, diarrhea; mild anorexia reported
Plan of Action: N/A
Doctor: Do you have any allergies?
Patient: No I do not.
Doctor: Are you sure?
Patient: Yes I am.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No known drug allergies
Plan of Action: N/A
Doctor: What is your family medical history?
Patient: Nothing that I know of.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Did you have a full term delivery?
Guest_family: No, he is premature born.  
Doctor: Was he hospitalized? 
Guest_family: Yes.
Doctor: Was he on any machine like the ones that help breathing?
Guest_family: No.
Doctor: Was he ever hospitalized afterwards?
Guest_family: No.
Doctor: Did he have any surgery?
Guest_family: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Baby was born premature and he required hospitalization, but was not on mechanical ventilation.  He doesn't have any hospitalizations after the new born.  No surgeries.
Plan of Action: N/A
Doctor: Do you have any allergies?
Patient: No I do not.
Doctor: Okay.
Patient: Okay.
Patient: Are you only asking for medical allergies?
Doctor: No, I want to know about all allergies.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Anyone smokes in the house?
Guest_family: Yes, we do.
Doctor: Both of you?
Guest_family: Yes, but outside, not inside.
Doctor: Okay.
Guest_family: We are careful.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Parents do smoke around the house.
Plan of Action: N/A
Doctor: Do you use any tobacco, inhalation or recreational drugs? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: How're you feeling today? 
Patient: Not great. 
Doctor: I'm sorry, why is that? 
Patient: I've had a headache all week along with neck and lower back pain. 
Doctor: How would you describe the headache? 
Patient: Throbbing pain. 
Doctor: Is it constant? 
Patient: It comes and goes for the most part. 
Doctor: How would you rate it on a scale of ten with ten being the worst? 
Patient: A seven or eight. 
Doctor: Do you have a headache currently? 
Patient: No, not right this second. 
Doctor: Have you taken- 
Patient: Anything for the pain? 
Doctor: Yes. 
Patient: I took some Ibuprofen, but it doesn't seem to be helping much. 
Doctor: Any other symptoms associated with the headache, such as fever, chills, nausea, vomiting, blurred vision, or sensitivity to light? 
Patient: No, not really. I don't feel like I have a cold or anything. 
Doctor: Any recent injuries to the head? 
Patient: No. 
Doctor: And your neck and lower back pain, is this new? 
Patient: Eh I can't say. It's been bothering me for some time now, but the pain feels a bit different. 
Doctor: How so? 
Patient: I don't really know. It's more pronounced.

Clinical note:
Symptoms: headache (throbbing pain, intermittent, rated 7-8/10), neck pain, lower back pain
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Do you have any other problems?
Patient: I do actually, I have back disc degeneration.
Doctor: Oh really?
Patient: Yeah.
Doctor: When were you diagnosed with it?
Patient: Maybe twenty ten?

Clinical note:
Symptoms: N/A
Diagnosis: degenerative disc disease in the back
History of Patient: N/A
Plan of Action: N/A
Doctor: Any family history of disease? 
Guest_family: To be honest, I'm not sure. Possibly? I'd have to check and get back to you.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
.
Doctor: Do you have any history of surgical procedures? 
Patient: I remember having surgery as a child, but I don't know what the surgery was for. It was so long ago.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Surgery as a child with no recollection of the procedure
Plan of Action: N/A
Doctor: Who all are there in your family?
Patient: Well, it's just me and my brother now. My mom passed away due to stroke at the age of seventy nine. 
Patient: My father had a good life with no medical conditions. He passed away due to old age, he was ninety one.
Doctor: Wow! Any family history of heart disease or diabetes?
Patient: My other brother had prostate cancer but that's just it. No diabetes or heart issues.
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Mother died at age 79 of a stroke, father died at age 91 of old age, one brother had prostate cancer, one living brother, no family history of heart disease or diabetes
Plan of Action: N/A
Doctor: And are you allergic to any drugs?
Patient: Oh yes, I am allergic to what you call Cipro-
Doctor: Ciprofloxacin?
Patient: Yes! And also, Asprin but that coated one, what is called?
Doctor: Oh, you mean enteric coated Aspirin?
Patient: Yes, yes, that one!

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Allergic to ciprofloxacin and enteric-coated aspirin
Plan of Action: N/A
Doctor: Hi, I am Doctor Chandler. 
Patient: Hello Doctor. 
Doctor: So, tell me what's going on? 
Patient: I am having a headache.

Clinical note:
Symptoms: headache
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Patient: In the past I have been treated for osteomyelitis of my right fifth toe with I V antibiotics therapy.
Doctor: Oh, how long back was that?
Patient: Ah, about five years back! I was treated for six weeks. 
Doctor: Oh, Okay. You also have a history of diabetes mellitus?
Patient: That is correct.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Diabetes mellitus, history of osteomyelitis of the right fifth toe treated with IV antibiotics therapy 5 years ago for 6 weeks
Plan of Action: N/A
Doctor: Do you have any major medical conditions that I should know about? 
Patient: Oh, yeah, I have a whole list of things going on, doctor. 
Doctor: Like what, ma'am? 
Patient: Well, I have high blood pressure, hypothyroidism, arthritis, and G E R D.
Doctor: I see, what about any mental health, or neurological diseases? 
Patient: Um, I have an anxiety disorder, and I had migraines about thirty years ago. 
Doctor: Thank you, I also see on my chart that you've had Morton's neuromas before, is that true? 
Patient: Yeah, I have one on both feet.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Hypertension, hypothyroidism, arthritis, GERD, anxiety disorder, Morton's neuromas in both feet, history of migraine headaches 30 years ago
Plan of Action: N/A
Doctor: I will ask you a few questions about your past medical history. Were you ever diagnosed with anything medically related? 
Patient: No. 
Doctor: Were you ever diagnosed with diabetes or any heart conditions? 
Patient: No.
Doctor: Did you ever take medications for any long-term disease? 
Patient: No. 
Doctor: Did you ever have any surgery? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: So, who is in your family?
Patient: Well, my mom, dad, and I have four brothers aged eighteen, sixteen, fourteen and twelve and I also have a younger sister. She is only three. 
Doctor: Wow, and you all stay together? 
Patient: Yes, and we also have two dogs and two cats. 
Doctor: Okay. And everyone at home is doing fine? 
Guest_family: No, not really. Everyone at home is sick with a cough, cold and runny nose, except-
Patient: Except for my mom!
Guest_family: Yeah, except for me thankfully.
Doctor: Hm, and did you travel anywhere recently, especially during the holiday season? 
Patient: No, right mom? 
Guest_family: Yeah, we didn't travel anywhere recently. 
Doctor: Okay. Anybody in your house smokes? 
Guest_family: No. 
Doctor: No exposure to smoke, right?
Guest_family: No.

Clinical note:
Symptoms: cold, cough, runny nose (all family members except mom)
Diagnosis: N/A
History of Patient: Family composition includes mom, dad, 18-, 16-, 14-, 12-year-old brothers, and a 3-year-old sister; 2 dogs and 2 outside cats also reside in the home; all family members except mom currently sick with cold, cough, runny nose; no recent travel history, no smoke exposure
Plan of Action: N/A
Doctor: So, are you on any medication currently? 
Patient: Yes, I am taking Atenolol and Mevacor.
Doctor: Hm, and no allergy to any medicine? 
Patient: Not that I know of.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Currently taking Atenolol and Mevacor, no known drug allergies
Plan of Action: N/A
Doctor: I think you are good to go home. I am going to prepare your discharge paper. 
Patient: That's great!

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: Discharged home
Doctor: So how long have you two been married?
Guest_family: We've been together for twenty seven years now.
Doctor: Oh wow, that's so wonderful to hear. How did you guys meet?
Guest_family: We actually met in high school. We dated for some time and then we took a break, but we ultimately got back together. 
Doctor: Aw, high school sweethearts. I have a few more questions to ask. 
Guest_family: Shoot.
Doctor: Any tobacco, hard drugs, or alcohol?
Guest_family: She doesn't do any of that.
Doctor: Great. And do you know of any medical problems that run on her side of the family?
Guest_family: Nothing major.
Doctor: I see.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Married x 27yrs. Husband denied Tobacco/ETOH/illicit drug use for her. 
Plan of Action: N/A
Doctor: I would like to get a detailed history of your inperforated anus and the curvature of the penis. It is a genetic condition. And do you know if you had surgery soon after birth? 
Patient: Yeah, my mother said that I had to have surgery after she gave birth to me. 
Doctor: Do you know all the surgeries that you have had for this? 
Patient: I don't know if I have all of them written down, but I do have most of them here. 
Doctor: Oh, good you have a list. 
Patient: Yeah. I was hospitalized in nineteen seventy for a U T I. That is when the problems started happening. It was a really bad infection. 
Doctor: Okay. 
Patient: In nineteen eighty eight I the tissue removed from the anus. There was a blockage. They also did an operation in the shaft of the penis too. 
Doctor: I bet things improved after that surgery. 
Patient: It did. I have here in January of nineteen ninety one I had a cystoscopy to remove a blockage. 
Doctor: Um hum. 
Patient: In two thousand and one I had a colonoscopy that was normal. Later that year I had a biopsy of my prostate. 
Doctor: What did the biopsy show? 
Patient: They said I had severe inflammation in the prostate. I was never told that cause of the inflammation. 
Doctor: Okay. Any other surgeries for your condition?
Patient: Oh yeah. I had that same procedure done again when I was twenty seven and twenty eight. The same one that I had as a newborn. I had a third surgery when I was seventy with just a correction of the shaft area.  
Doctor: Um hum. Any other surgeries unrelated to your condition? 
Patient: Yeah. I have it written down here. In two thousand and one there was a left rotator cuff repair with acromioplasty and distal clavicle resection and in two thousand and three I had a left inguinal hernia repair with M E S H. That is what my notes say. 
Doctor: Have you ever had any complications during any of your surgeries? 
Patient: Yeah, I did. I have a blood clot that apparently went into my lungs. I was very scary. 
Doctor: That is very scary.

Clinical note:
Symptoms: N/A
Diagnosis: inperforated anus, curvature of the penis, chronic prostatitis
History of Patient: Hospitalized in 1970 for treatment of urinary tract infection, tissue removal from anus in 1988 due to blockage, shaft operation on penis in 1988, cystoscopy in January 1991 to remove blockage, colonoscopy in 2001 (normal), prostate biopsy in 2001 showing severe inflammation (chronic prostatitis), repeat penile operations at ages 27, 28, and 70, left rotator cuff repair with acromioplasty and distal clavicle resection in 2001, left inguinal hernia repair with MESH in 2003, complications of deep vein thrombosis and pulmonary embolism
Plan of Action: N/A
Doctor: As per your chart, I see you have C O P D and hypertension.
Patient: Yes that is right.
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: COPD, hypertension
History of Patient: N/A
Plan of Action: N/A
Doctor: Do you use any tobacco products? 
Patient: No. 
Doctor: Do you drink alcohol or use any recreational drugs? 
Patient: No. 
Doctor: Any history of needle drugs or prescription drug abuse? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Denied tobacco, alcohol, recreational drugs, needle drugs, or prescription drug abuse
Plan of Action: N/A
Doctor: Hi!
Patient: Hello, how are you?
Doctor: I am good.
Patient: I think I am all well now.
Doctor: Yes, looking at your results I think your kidney failure is resolved too.

Clinical note:
Symptoms: N/A
Diagnosis: Acute renal failure (resolved)
History of Patient: N/A
Plan of Action: N/A
Doctor: How old are you, young man? 
Patient: I am twenty one. 
Doctor: Are you right handed or left handed? 
Patient: I am right handed. 
Doctor: So, tell me what brings you here today? 
Patient: Everything started on the fifth of November. Then after I saw the gradual increase in my symptoms. So it was all like numbness. I could not feel my legs. They felt numb all the time and there was no coordination between them, and it also affected my walk. All these symptoms were at their limit in just like a half day or more. It is continuing the same way since then. I also feel like somebody is putting pins and needles on my legs approximately  halfway up the calf on both sides. 
Doctor: You said that you felt decreased coordination or less coordination between your legs, right? 
Patient: Yeah, that's right. It totally feels like I'm walking in space and don't know where to put my next step. I have no up and down spatial awareness. 
Doctor: Do you have any issue with the bowel movements? 
Patient: Nope. 
Doctor: What about this weakness or the numbness anywhere else except your legs? 
Patient: No, it's only in the legs. 
Doctor: Did anything help you with those symptoms? 
Patient: Well, sometimes, you see, hot showers made me feel better, but it is like only sometimes. 
Doctor: Any recent flu like symptoms? 
Patient: Nope. 
Doctor: Did anyone in your family have anything like that or any other medical issues that was like going on in your family? 
Patient: Nope. 
Doctor: Did you have any surgery before? 
Patient: Nope. 
Doctor: What about any other major health issues in the past? 
Patient: No, no medical issues. 
Doctor: Are you taking any kind of medication for anything? 
Patient: No medications.

Clinical note:
Symptoms: gradual onset numbness and incoordination of both lower extremities, tingling in the distal lower extremities approximately halfway up the calf bilaterally, decreased coordination of both lower extremities
Diagnosis: N/A
History of Patient: Symptoms began approximately on 11/5/96, became maximal over a 12-24 hour period and have not changed since, hot showers may improve Symptoms, denied bowel/bladder problems, weakness or numbness elsewhere, no recent flu-like illness, unremarkable past medical and family histories, not on any medications
Plan of Action: N/A
Doctor: What brings you in to the clinic today? 
Patient: Well, I have had a progressive loss of my vision in my right eye. My eye doctor told me that I should come and see a neurologist. So here I am. 
Doctor: Okay. How long has the vision loss been progressing for? 
Patient: About two months. It seems like it has been progressing really fast. I have always had bad vision in my left eye. That started about two years ago. 
Doctor: Can you still see out of you left eye? 
Patient: No. I am considered blind in this eye now. 
Doctor: Have you had any other symptoms associated with your vision loss? 
Patient: No. 
Doctor: Any headaches? 
Patient: Nope. 
Doctor: What is you dominate hand? 
Patient: What do you mean? 
Doctor: What hand do you write with or use dominantly? 
Patient: Oh! I am right handed. 
Doctor: And how old are you? 
Patient: I am sixty two. 
Doctor: Okay. I would like to run some test now. 
Patient: Okay.

Clinical note:
Symptoms: progressive loss of visual acuity in the right eye over 2 months, blind in the left eye after 2 years of progressive loss of visual acuity
Diagnosis: N/A
History of Patient: Symptoms started approximately 2 months ago, denied any other symptomatology, denied headaches
Plan of Action: N/A
Doctor: Do you have any history of rheumatic fever as a child? 
Patient: No.
Doctor: Any history of anything other then usual childhood illnesses? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Negative for rheumatic fever, usual childhood illnesses reported
Plan of Action: N/A
Doctor: So, tell me a little bit more about your family history, please.
Patient: Sure, I know that my grandmother on my mom's side had pancreatic cancer, and my dad had prostate cancer. 
Doctor: Besides cancer, are there any other conditions that you know run in your family? 
Patient: Um, I know that my dad had heart disease, as well as diabetes. 
Doctor: Thank you, this is good information to know.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: His maternal grandmother had pancreatic cancer.  Father had prostate cancer.  There is heart disease in the father and diabetes in the father.
Plan of Action: N/A
Doctor: What do you do? 
Patient: I am a registered nurse. 
Doctor: That's nice. 
Doctor: And do you smoke or drink?
Patient: No sir. 
Doctor: Any history of drug abuse or anything? 
Patient: Absolutely not! 
Doctor: Okay, good.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No history of any smoking, alcohol, or drug abuse.  The patient is a registered nurse by profession.
Plan of Action: N/A
Doctor: Hello, sir. How are you doing?
Patient: I am doing well, thanks. Just trying to come to you more regularly to make sure my lungs and heart are okay. 
Doctor: That's great. The previous notes said that you quit smoking. Are you still off?
Patient: Yes, I quit in nineteen ninety six. I come yearly to the doctor's office to make sure that the damage I did to my lungs is monitored. 
Doctor: You have a great attitude. I appreciate when patient's take their health into their own hands. We can only do so much, but it is up to the patient to bring themselves in. 
Patient: Yeah. I smoked for a long time and I know it was bad for me. It was just the norm back in the day. 
Doctor: Do you drink at all?
Patient: I do. Only occasionally.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Quit smoking in 1996.  He occasionally drinks alcoholic beverages.
Plan of Action: N/A
Guest_family: Hello Doctor. I am from High Hope assisted living center. I am Mister Rath's assigned assistant. 
Doctor: Right. What brings you here?
Guest_family: I got some of Mister Rath's food diary sheets here. He has already lost fifteen pounds in the last three months. We were just wondering if he needed to lose anymore.
Doctor: Let me have a look.

Clinical note:
Symptoms: Overweight
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Your condition and all your vital signs look stable to me right now. You must be very careful as your condition can get poor or it might improve as well.
Patient: Okay, so what do you recommend? 
Doctor: Do you have any support system? Is there anyone at home to take care of you? 
Patient: Yes, my son and his family lives with me. They are very caring. 
Doctor: That is good. Do take care of yourself and let me know if your condition worsens.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: Take Rest and Re-visit if condition worsens
Doctor: Where do you work? 
Patient: I'm a truck driver. It's a big construction company. I work for them. 
Doctor: Do you smoke? 
Patient: Yeah. 
Doctor: Cigarette or something else? 
Patient: I do Cigar.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Cigar Smoker
Plan of Action: N/A
Doctor: Good morning, ma'am. I just need a few pieces of information before we get started today. 
Patient: Good morning, doctor. Absolutely, that's not a problem at all. 
Doctor: Do you smoke or drink, ma'am?
Patient: I don't smoke, and I drink, um, I'd say on occasionally. 
Doctor: What about harder drugs, do you use any of those? 
Patient: No, I don't. 
Doctor: Are you married?
Patient: Yes, to my wonderful husband. 
Doctor: That's great, what do you two do for a living?
Patient: I'm a social worker, and my husband is a high school chemistry teacher. 
Doctor: What great work both of you are doing. What kinds of people do you work with as a social worker? 
Patient: I love it, I work with adult abuse and neglect issues. 
Doctor: Yes, that's great. Do you have any children?
Patient: Yes, we have two sons. 
Doctor: Do they live at home? 
Patient: No, they're both grown and on their own now.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No tobacco use, occasional alcohol use, no illicit drug use, two grown children, married, works as a social worker dealing with adult abuse and neglect issues, husband is a high school chemistry teacher
Plan of Action: N/A
Doctor: Did both your parents have heart complications.
Patient: Unfortunately, yes. My mom passed from a heart attack at seventy three and my father at eighty.
Doctor: I'm so sorry to hear that. 
Patient: I lost my brother as well. He passed away from a brain tumor when he was nine years old.
Doctor: I can't imagine how hard that must've been.
Patient: It was a dark time in our lives, but we survived it as a family.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Father died of MI at age 80, Mother died of MI at age 73, Brother died of brain tumor at age 9
Plan of Action: N/A
Doctor: I am going write you a prescription for a stimulant. It is called Cylert.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: Prescription for Cylert, a stimulant
Doctor: Are you married? 
Patient: Yes. I have been married for twenty two years. 
Doctor: Are you working? 
Patient: No. I am unemployed. I have not completed my collage degree yet. I have been in school for the last two years. 
Doctor: Keep at it.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Unemployed, 2 years of college education, married for 22 years
Plan of Action: N/A
Doctor: Nurse, do you have a report on my patient? 
Guest_clinician: I do. She has a two year history of small cell lung cancer, which spread to both femurs, lower lumbar spine, and pelvis. 
Doctor: Oh, no. Did she get chemotherapy? 
Guest_clinician: She's had chemotherapy and radiation treatments multiple times. She can't remember how many times she had those treatments because she lost track. She also said she finished a series of ten radiation treatments for pain relief. 
Doctor: How are her symptoms now? 
Guest_clinician: She's currently having severe pain. 
Doctor: I see. Does she have any imaging done? 
Guest_clinician: She does. A C T scan was done to check for metastasis. 
Doctor: Thank you, Nurse. I'll go see her now. 
Guest_clinican: No problem. 
Doctor: Hello, ma'am. What is the reason for your visit today?
Patient: I wanted to see if I could get some treatment for my pain. 
Doctor: What kind of pain are you having? 
Patient: I feel like it's a burning feeling? I don't know. I can feel it one spot and then it spreads down. 
Doctor: I see. Where do you feel the pain? 
Patient: I feel it mostly on my lower right side of my back. 
Doctor: Do you feel it anywhere else? 
Patient: The back of my right leg and knee. 
Doctor: Would you said the pain radiates down from your back to your knee? 
Patient: That's it. Radiating. I forgot the word. 
Doctor: No problem. On a scale from zero to ten, with zero being no pain and ten being the worst pain of your life, how would you rate your back and leg? 
Patient: They're both a ten. 
Doctor: Oh, wow. Do you feel pain anywhere else? 
Patient: Yes. Could you check my feet? 
Doctor: Let me check them. I'll feel around your left foot. Let me know what you feel. 
Patient: I feel like the bottom is numb. Ouch. It also feels sharp at times too. 
Doctor: I see. The nurse stated here that you had some pain spreading to your mid back too. Let me feel it really quick. Let me know how that feels. 
Patient: Ouch! It hurts a lot. I feel a sharp and dull pain. Most of the time, it's just aching. 
Doctor: I see. When do you feel like the pain in your body gets the worst? 
Patient: I'd say when I'm sitting in a car for a long time.
Doctor: So, just sitting for long periods of time?
Patient: Yeah. When I stand and walk, too. 
Doctor: Have you ever taken anything for the pain?
Patient: I am on a load of narcotics for the pain.

Clinical note:
Symptoms: Severe pain, burning sensation, radiating pain from lower back to right leg and knee, numbness and sharp pain in bottom of left foot, diffuse mid back pain
Diagnosis: Small cell lung cancer with metastasis to both femurs, lower lumbar spine, and pelvis; history of chemotherapy and radiation treatments
History of Patient: Two-year history of small cell lung cancer with metastasis, multiple chemotherapy and radiation treatments, recent series of 10 radiation treatments for pain relief, ongoing significant pain Symptoms, exacerbated by prolonged sitting, standing, or walking
Plan of Action: N/A
Doctor: Any fever, chills or rigors? 
Patient: No.
Doctor: Any blurring of vision or history of glaucoma or cataract?
Patient: No.
Doctor: Did you experience any shortness of breath?
Patient: No.	
Doctor: Any stomach discomfort?
Patient: No.
Doctor: Did you observe blood in your stool or in vomit?
Patient: No, nothing like that. 
Doctor: Okay, good. Did you notice any increase in your urine frequency or urgency?
Patient: No.
Doctor: Do you feel any muscle weakness or tiredness? 
Patient: No, nothing of that sort.
Doctor: Any known history of arthritis? 
Patient: Nope.
Doctor: And no fever due to any fungal infection or anything, right? Like valley fever?
Patient: No, nothing of that sort.
Doctor: Any history of pneumonia?
Patient: No. 
Doctor: And I am looking at your chart, so no history of stroke, C V A, or any seizure disorder.
Patient: That's correct.
Doctor: No thyroid or hormone related problem? 
Patient: No.
Doctor: And you do not have any blood disorders, right?
Patient: That is right.

Clinical note:
Symptoms: No fever, chills, rigors; no blurring of vision, glaucoma, or cataracts; no shortness of breath; no stomach discomfort; no blood in stool or vomit; no increase in urine frequency or urgency; no muscle weakness or tiredness; no history of arthritis; no fever due to fungal infection or valley fever; no history of pneumonia; no history of stroke, CVA, or seizure disorder; no thyroid or hormone-related problems; no blood disorders
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Have you experienced any diarrhea? 
Patient: Yes. I have been having diarrhea. When I think about it, it started happening around the same time that the mouth sores started. I didn't have any diarrhea today though. 
Doctor: Have you experienced any episodes of nausea or vomiting? 
Patient: No. 
Doctor: Have you noticed any blood in your bowel movements? 
Patient: No. 
Doctor: Even though you have been taking the medications without any issue, for about ten years, the methotrexate may be the cause of the mouth sores and the inflammation in the small intestines. These are both common side effects from the use of methotrexate. I am not as familiar with NSAID's causing mouth sores. Aspirin use can cause gastrointestinal upset. I think the most likely cause of the sores is the methotrexate not the use of Aspirin.

Clinical note:
Symptoms: Diarrhea (intermittent), mouth sores
Diagnosis: Erosive stomatitis, possible enteritis secondary to long-term methotrexate use
History of Patient: Diarrhea coinciding with onset of mouth sores, no episodes of nausea or vomiting, no blood in bowel movements
Plan of Action: N/A
Doctor:  Are you on insulin?
Patient: Yes.
Doctor: Are you on metformin as well?
Patient: Yes.
Doctor: How about glucotrol? 
Patient: Yes I take that.
Doctor: Are you on lipitor?
Patient: Yes.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Medication includes Insulin, metformin, Glucotrol, and Lipitor.
Plan of Action: N/A
Guest_clinician: What was he given in the E R? 
Doctor: Epi one M G, zero point three M L subcutaneously along with fifty M G of Benadryl intramuscularly. In about fifteen to twenty minutes, he reported his itching had improved. The rash itself faded a little bit and he began to feel a lot more comfortable.

Clinical note:
Symptoms: Itching, rash
Diagnosis: N/A
History of Patient: N/A
Plan of Action: Treated with epinephrine 1:1000 (0.3 mL subcutaneously) and Benadryl (50 mg intramuscularly); itching improved, rash faded, patient felt more comfortable
Doctor: Hello, how are you?
Patient: I am good, Doctor. 
Doctor: So, what brings you here today?
Patient: Well, I have many medical issues and I see Doctor X for them, but I wanted a second opinion, so he referred me here.
Doctor: Yeah, he is a good man! Don't worry we will take care of you. 
Patient: Thank you.
Doctor: So, let me start by getting your medical history.
Patient: Sure, I had skin cancer which was treated by removal of that part.
Doctor: Okay.
Patient: Other than that, I have anemia and an acid reflux problem. I also have history of C O P D. 
Doctor: Alright. 
Patient: I also suffer from sciatica which was caused mainly due to my arthritis. 
Doctor: I see.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: History of skin cancer treated with excision, anemia, acid reflux, COPD, sciatica caused by arthritis
Plan of Action: N/A
Doctor: Welcome back to Sample Clinic, Mister Sample. 
Patient: Good afternoon, doctor. 
Doctor: What seems to be the problem today, sir? 
Patient: I'm having a lot of pain in my right heel. 
Doctor: How long have you had this pain?
Patient: Um, it's been about two weeks now. 
Doctor: When is the pain the worst?
Patient: Honestly, it starts with the first step first thing in the morning. 
Doctor: Does it get worse throughout the day?
Patient: Yes, it gets worse all day with activities. 
Doctor: What treatments have you had for this? 
Patient: Well, nothing to date. 
Doctor: Where is your heel pain? 
Patient: It's on the right heel, then it's on the inside bottom part of the heel and into the inside of the heel. 
Doctor: Do you have any change in your medical history since your last visit?
Patient: No, it's the same old same old. 
Doctor: Do you have any flu like symptoms?
Patient: Like fever or chills?
Doctor: That, or vomiting or headaches. 
Patient: Oh, no I don't have anything like that. 
 Doctor: What about chest pain or shortness of breath?
Patient: Thankfully, no nothing like that.

Clinical note:
Symptoms: Painful right heel
Diagnosis: N/A
History of Patient: Pain present for approximately two weeks, worsens with first step in the morning and with activity during the day, no current treatment, pain along medial tubercle of right calcaneus extending to medial arch
Plan of Action: N/A
Doctor: What is your family medical history? 
Patient: My family has a high blood pressure. I have a family member that had colon cancer.  My daughter has a twitch. They don't know what caused it? 
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Family history of high blood pressure, colon cancer, daughter with unknown type of dystonia (twitch)
Plan of Action: N/A