Doctor: Hello, miss. Before we begin your physical, could you verify your age and ethnicity for me, please? 
Patient: I'm forty two years old and identify as white. 
Doctor: Thank you. I also see that you're here for a follow up for your asthma, correct? How is your asthma? 
Patient: That's right. Oh, man. My asthma has been getting worse over the last three months. My allergies are also acting up again. 
Doctor: Oh, no. Has anything changed that may have made your allergies worse? 
Patient: Well, my husband has been hauling more corn in since it's busy season. I think that might have made it worse. 
Doctor: Are you taking any medications to alleviate your asthma and allergies? 
Patient: I'm using my inhaler every day for my asthma. Here are the other medications and treatments I've been using. I know I wouldn't have remembered, so I put them on a paper for you to see. 
Doctor: Let me take a look. I see you have been taking Allegra for your allergies. Has that been helping? 
Patient: Eh. It kind of helps when I do take it. 
Doctor: You don't take it every day then? 
Patient: Nope. Only when I feel like I need to. 
Doctor: I see. What about the Flonase? Has that been helping? 
Patient: I'm not taking that right now, but it helped me in the past. 
Doctor: I also see you took Advair in the past, correct? Do you still take it? 
Patient: I did, but I stopped taking it because it started to annoy my private area. 
Doctor: I understand. Speaking more on this. Let's begin your physical. Do you have anything you'd like to add that you're starting to notice more? 
Patient: Oh, yeah. I feel like I'm easily annoyed right before my period. It could also be my husband, but he likes to say it's because I'm about to start my period. 
Doctor: I see. Do you see any other increased symptoms right before your menstrual cycle? 
Patient: Yeah. I feel like I've seen an increase in all the signs before my period. I'm also getting more impatient around that time, but when I'm not on my period, I feel like my mood is better. 
Doctor: When do you see your mood change? 
Patient: My husband says it's bad the week before I start my period, but I think it gets better a day after I start. 
Doctor: Have you seen any bleeding during your cycle? 
Patient: Not as much anymore. Just some spots here and there. 
Doctor: I see. What about hot flashes or night sweats? 
Patient: Nope. I feel fine most of the time. 
Doctor: That's good. I'm looking at your chart right now and it says you showed a U T I present, correct? Your test showed blood in your urine.
Patient: Yeah, that's correct. 
Doctor: Has your urine been checked since then? 
Patient: Nope. 
Doctor: I see. I'll order another urine test along with additional lab tests so that we can complete your physical.
Patient: I actually just had some lab work done because it was required for a life insurance application. Crazy, right? Here's the form with all the details for the lab work.
Doctor: Oh, perfect. I see they looked at your cholesterol and other areas. Could you send that to me when you get the results? 
Patient: Of course. I'll get that sent to you A S A P.

Clinical note:
Symptoms: worsening asthma, allergies acting up, irritability and PMS Symptoms around menstrual cycle, occasional spotting after cycles
Diagnosis: N/A
History of Patient: asthma worsening over the last three months, daily inhaler use, allergies aggravated by husband hauling corn, intermittent use of Allegra and Flonase, previous use of Advair discontinued due to vaginal irritation, increased irritability and PMS Symptoms before menstrual cycle, shorter menstrual cycles with occasional spotting after cycles, denies hot flashes or night sweats, previous UTI with hematuria, urine not rechecked, recent lab work for life insurance application including cholesterol levels
Plan of Action: order urine test and additional lab tests for complete physical, await results of recent lab work for cholesterol levels