X7-qP2-mN9-v4/MTS_Dialogue-Clinical_Note huggingface dataset:
Doctor: Good afternoon, ma'am. 
Patient: Good afternoon, doctor. 
Doctor: So, are you married? 
Patient: Yes, happily to my husband. 
Doctor: That's wonderful, um, what do you do for a living? 
Patient: I work as an office manager right now. 
Doctor: Do you smoke?
Patient: Yes, I do. I've smoked a pack a day for the last twenty years. 
Doctor: Do you drink? 
Patient: Actually, yes, I drink daily. 
Doctor: How much do you drink every day? 
Patient: Well, it varies, but usually about anywhere from three to five drinks a day. 
Doctor: Okay, do you do any illicit drugs?
Patient: No, absolutely not. 
Doctor: What do you do for exercise?
Patient: Well, I go for walks, and like low impact cardio. But, I do like playing softball with my friends too. 
Doctor: Very nice, how often do you exercise?
Patient: I work out a few times a month.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: Married, office manager, smokes one pack of cigarettes daily for the last 20 years, consumes 3 to 5 alcoholic drinks daily, no illicit drug use, exercises monthly with walking, low-impact aerobics, and playing softball
Plan of Action: N/A
Doctor: I'm going to run down a list of symptoms and I'd like you to tell me if you've experienced any. 
Patient: Okay. 
Doctor: Headache? 
Patient: No headaches. 
Doctor: Are you coughing at all? And if yes, then are you bringing up any blood with your cough? 
Patient: No cough. 
Doctor: Any chest pain or shortness of breath that wakes you in the middle of the night? 
Patient: Nope. 
Doctor: Do you feel short of breath when you move around? 
Patient: Nope. 
Doctor: Any visual, hearing, or swallowing problems? 
Patient: None. 
Doctor: And finally any changes to your bowel movements or urinary habits? 
Patient: Nope. All normal.

Clinical note:
Symptoms: No headaches, no cough, no chest pain or shortness of breath, no visual, hearing, or swallowing problems, no changes to bowel movements or urinary habits
Diagnosis: N/A
History of Patient: No cough, no hemoptysis, no chest pain, no PND, no orthopnea, no changes in bowel or urinary habits, as stated in HPI
Plan of Action: N/A
Doctor: Looking at your medical history now. Any changes since your last visit? 
Patient: No changes.

Clinical note:
Symptoms: N/A,
Diagnosis: Heavy alcohol and tobacco use, rare form of cancer in remission,
History of Patient: Stable cancer, undergoing chemotherapy, no new Symptoms,
Plan of Action: Continue with current treatment regimen
Doctor: Hello, sir. Looks like we are here for a general wellness check?
Patient: Yes, sir. In my seventy eight years on this Earth, I have learned to take my health more seriously. I need to start catching things before they come, not after. 
Doctor: I could not agree more. From your last checkup notes, it looks like you had right knee surgery and back surgery about eighteen months ago. How is that going? Any pain?
Patient: Yes, I had a right knee replacement. I am doing great so far. Nothing to complain about. I can do almost anything I desire now. It is such a good lifestyle change from before surgery. 
Doctor: What do you do with your new body?
Patient: I travel every chance I get. I just got back from a cruise. 
Doctor: I hope to be as agile as you when I get to retirement. Now let's check the other systems. Do you feel any type of chest pain? Any heaviness, tightness or pressure?
Patient: No, nothing like that.
Doctor: How about shortness of breath?
Patient: I only get short of breath when I walk up the stairs. 
Doctor: That is decently normal. I get out of breath when walking from floor to floor in this hospital too. 
Patient: I thought so. I remember being young and still struggling with stairs. 
Doctor: Unfortunately, some things are just with us for life. Do you have any coughing fits or irregular heart beating?
Patient: No. 
Doctor: Great! You are getting a clean bill of health from me today. On the notes it says you have Crohn's disease. Are you getting regularly checked for that?
Patient: Yes. Doctor Ferguson takes care of me for that. 
Doctor: Excellent. Are you scheduled for a prostate check?
Patient: Yes, I go to Doctor Roszhart. 
Doctor: You are wonderfully on top of it. What a breath of fresh air. From all of your travelling, how are your ankles? Have you noticed any swelling?
Patient: Surprisingly, from all the walking I do, I do not have any swelling. After quitting smoking ten years ago I had to get addicted to something else and that was walking and travelling.

Clinical note:
Symptoms: N/A,
Diagnosis: Right knee replacement, back surgery, Crohn's disease,
History of Patient: 78-year-old male, active lifestyle post-surgeries, travels frequently, denies chest pain, shortness of breath except with stairs, regular check-ups for Crohn's and prostate,
Plan of Action: N/A
Doctor: And when did you had your last tetanus shot? 
Patient: Um, I don't remember correctly, but it should be in my reports. I did have one sometime back, just don't remember when exactly.
Doctor: Ah, no problem. I see it here in your reports and it's up to date. So that's good.
Patient: Cool.

Clinical note:
Symptoms: N/A,
Diagnosis: N/A,
History of Patient: Up-to-date tetanus shot,
Plan of Action: N/A
Doctor: So where do you stay? 
Patient: I stay nearby in my apartment.
Doctor: Alone? 
Patient: No, I stay with my boyfriend.
Doctor: Okay, and do you smoke and drink?
Patient: Both.
Doctor: And how much would say you smoke per day?
Patient: Well, I smoke a lot. Seven to eight packs per day. 
Doctor: Oh! And for how many years? 
Patient: I don't remember exactly but for many, many years, I have a long history of chain smoking. 
Doctor: Hm. And alcohol? 
Patient: Same, I drink heavily. I have been drinking for many years.
Doctor: Hm.

Clinical note:
Symptoms: N/A,
Diagnosis: N/A,
History of Patient: heavy tobacco and alcohol abuse for many years, lives with boyfriend,
Plan of Action: N/A
Doctor: How are you, sir? 
Patient: One less than sixty.
Doctor: So, what happened? 
Patient: I was visiting my son in Cheyenne, Wyoming, then I on October tenth when I was taking a shower, I felt a pop in my head. I don't know what happened after that. 
Guest_family: We thought he was having a long shower that day. Then about one and a half hours later my son suspected something is not right and we went up to check. There we found him unconscious on the shower floor. Our son, he then drove us back to Iowa and since then he is complaining of these headaches and that he's not feeling well. He gets unconscious or falls asleep I don't know but it is happening a lot of the time. We got him to local hospital today in the morning. It is three days after that shower incident. 
Doctor: Yeah, his report says he got a hemorrhage, I mean, blood clot in his brain. 
Guest_family: Yeah, after that report they transferred us to this hospital.

Clinical note:
Symptoms: experienced a "pop" in head while showering, recurrent headaches, fluctuating level of consciousness,
Diagnosis: subarachnoid hemorrhage,
History of Patient: 59-year-old male, incident occurred on 10/10/92 while visiting son in Cheyenne, Wyoming, found unconscious on shower floor, transferred to UIHC,
Plan of Action: N/A
Doctor: Is this your first surgery or have you had other surgeries in the past? 
Patient: This will be my second. I had a hernia repair back in O ten.

Clinical note:
Symptoms: N/A,
Diagnosis: N/A,
History of Patient: previous hernia repair surgery in 2010,
Plan of Action: N/A
Doctor: Where do you work? 
Patient: I work at the Hilton as a head chef. 
Doctor: Do you smoke or consume any form of tobacco? 
Patient: Nope. 
Doctor: Do you drink or have ever used any illegal drug? 
Patient: No, none of that.

Clinical note:
Symptoms: N/A,
Diagnosis: N/A,
History of Patient: employed as a head chef at the Hilton, denied tobacco, alcohol, or illicit drug use,
Plan of Action: N/A
Doctor: Where do you feel the most pain? 
Patient: I'd have to say at the heels of my feet. I spend a lot of time on my feet at work. 
Doctor: I see. What kind of shoes do you normally wear to work? 
Patient: Regular tennis shoes. 
Doctor: Are they cushioned? 
Patient: Eh not really, but they're pretty durable. 
Doctor: I'd advise getting an orthotic for your shoes to help with the heel pain and resting your feet when you're home. In the meantime, I'd like for you to see a specialist to make sure nothing else is going on. 
Patient: Alright, I'm good with that plan. 
Doctor: Are you having any other problems? Joint pain, difficulty walking, nausea, vomiting, or other symptoms? 
Patient: No, just heel pain for now.

Clinical note:
Symptoms: heel pain,
Diagnosis: N/A,
History of Patient: spending a lot of time on feet at work, pain at the heels of feet, wearing regular tennis shoes, shoes not cushioned, advised to get orthotic for shoes and rest feet, plan to see a specialist,
Plan of Action: N/A
Doctor: I'm here to take your social history. So, tell me about yourself. 
Patient: I was taking drugs. I tried all the methods, mainly I was using inhalation and I V drugs. 
Doctor: Right now, you are on methadone, right? 
Patient: Yes. I'm also going to the psychiatry department for my depression and these drug issues. 
Doctor: What is your living status? 
Patient: I live with my roommate.

Clinical note:
Symptoms: N/A,
Diagnosis: N/A,
History of Patient: history of inhalation and intravenous drug abuse, currently on methadone maintenance, being followed in Psychiatry for depression and substance abuse issues, living with a roommate,
Plan of Action: N/A
Doctor: I will ask you a few questions about your family history, sir.
Patient: That's okay. 
Doctor: Does anyone in your family ever have any medical problems?
Patient: Both of my parents had diabetes.

Clinical note:
Symptoms: N/A,
Diagnosis: N/A,
History of Patient: N/A,
Plan of Action: N/A
Doctor: Are you aware of any medical issues in your family? 
Patient: I don't know. 
Doctor: What about your paternal family? 
Patient: I don't know my father. No idea about his family. 
Doctor: What about your mom?  Maternal family? 
Patient: I have no idea. I'm not in contact with her.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A.
Doctor: Good morning, sir. Before we begin, how old are you?
Patient: Good morning, doctor. I'm forty one. 
Doctor: Thank you, and how long have you had this left knee pain?
Patient: It's been about two years now. 
Doctor: Is there an injury?
Patient: Yeah, I sprained my MCL while playing hockey back then. 
Doctor: What kind of symptoms have you had in this knee since then?
Patient: Well, the knee locks up on me, I can't extend it all the way, and it just hurts really bad if I try to. 
Doctor: Do you feel any instability?
Patient: No, not at all.

Clinical note:
Symptoms: left knee pain, locking of knee, inability to fully extend knee, pain on attempted extension
Diagnosis: N/A
History of Patient: Symptoms started 2 years ago after MCL sprain during hockey, no instability reported
Plan of Action: N/A
Doctor: I see here that you've been feeling more short of breath. 
Patient: Yes, for three days now. 
Doctor: Is it worse when you exert yourself? 
Patient: Um no, not really. I've had a terrible cough along with frequent headaches and chest congestion. I have also had a low fever. 
Doctor: Did these symptoms start around the same time? 
Patient: I think so. 
Doctor: Where does your chest feel most congested? And how would you rate the pain right now? Ten being the worst.
Patient: Both sides. I'd say it's at a three currently.
Doctor: Does it send pain or numbness or tingling down your arms? How about any jaw pain as a result? 
Patient: No, but it does get worse whenever I cough. 
Doctor: Is this your first time experiencing this type of congestion? 
Patient: Oh no. I had something like it about ten months ago.  
Doctor: Did that improve on its own? 
Patient: It would come and go, but over the past few days it's gotten worse. I am a strong German man so I held out coming to the doctor as long as I could. 
Doctor: You are very strong! You are sixty nine though, so I don't think anyone would see it as weak if you came to the doctor more often.

Clinical note:
Symptoms: shortness of breath, cough, frequent headaches, chest congestion, low-grade fever, bilateral chest pain (rated 3/10), worsened with coughing
Diagnosis: N/A
History of Patient: Symptoms started 3 days ago, chest congestion previously experienced 10 months ago but worsening recently
Plan of Action: N/A
Doctor: Are you aware of any medical problems in your family?
Patient: No.
Doctor: Anyone with any heart disease or diabetes?
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Besides pain in your left eye, are you having any other problems? 
Patient: No.  
Doctor: Do you happen to have a history of eye problems? 
Patient: None.

Clinical note:
Symptoms: focal left eye pain
Diagnosis: N/A
History of Patient: no changes in visual acuity or photophobia, no prior ophthalmologic problems
Plan of Action: N/A
Doctor: Hello, sir how can I help you? Looks like we are talking about snoring today.
Patient: Yeah, I need to get this loud and obnoxious snoring under control. I keep waking up my partner. I have a C P A P right now because I was told I have almost severe sleep apnea.  
Doctor: Yes, I see on your chart that you were given ten centimeters of H two O nasal pressure and that you predominately suffer from hypopnea. Hypopnea is shallow breathing. How has the device been working?
Patient: It definitely has reduced my snoring, but my partner keeps waking me up in the middle of the night because the mask pops off. I wear it around five to seven nights a week, but for some reason it falls off or I take it off randomly in the night. My wife usually must remind me to put it back on. 
Doctor: So what is your sleep pattern now? When do you usually go to bed and wake up?
Patient: Usually I sleep around eleven or eleven thirty and wake up at six or seven on the weekends. I'll sleep in until eight or nine on the weekdays. On Saturday's I might go to sleep around midnight because I usually watch a show with my family. I feel good when I wake up though. Much less tossing and turning. The sheets are always on the bed still. 
Doctor: That's some good news. I see you have lost a bit of weight too. Around fifteen to eighteen pounds is something to be proud of. 
Patient: Thanks. It has been a lot of exercising and dieting. I am motivated because I want to stop snoring. 
Doctor: How has work been? Do you think it has been stressful at all?
Patient: I still work at Smith Barney in downtown Baltimore. I work from around eight or eight thirty to five or five thirty. I deal with training on how to sell managed funds and accounts. I do not think I have been stressed because I am able to stay awake through my shift and even when I come home at night. I may get a little tired during hay fever season, but that is rare. 
Doctor: Yes, I see that you have hay fever. Fatigue is a common symptom from the allergy.

Clinical note:
Symptoms: loud and obnoxious snoring, partner waking up due to snoring, hypopnea (shallow breathing), mask popping off during sleep, occasional fatigue during hay fever season
Diagnosis: moderate-to-severe sleep apnea, allergic rhinitis (hay fever)
History of Patient: treated with CPAP at 10 cm H2O nasal pressure, occasional mask dislodgement during sleep, improved sleep quality with CPAP, weight loss of 15-18 pounds through diet and exercise
Plan of Action: N/A
Doctor: How are you feeling today?
Patient: I have a lot of anxiety.
Doctor: Anything else?
Patient: I have a lot of pain in my chest as well.
Doctor: Do you drink?
Patient: Yes, I cannot stop myself. I have tried many times but it's hard to control.

Clinical note:
Symptoms: anxiety, chest pain
Diagnosis: N/A
History of Patient: left total hip replacement many years ago, history of hysterectomy, appendectomy at a young age, difficulty controlling alcohol consumption
Plan of Action: N/A
Doctor: So, do you smoke?
Patient: No. 
Doctor: How about alcohol? 
Patient: I drink, but just normal. I don't have any alcohol problem.
Doctor: Okay. So, no history of any drug or alcohol abuse, right?
Patient: No, not at all.
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Hi, how can I help you?
Patient:  I am here for a follow up on my heart rhythm problem. I think it is atrial fibrillation.
Doctor: Oh yes. You are not on Cardizem and your heart rate is up just a little bit today. 
Patient: That's right. I misplaced it.
Doctor: Okay. Let me see. What symptoms are you experiencing right now?
Patient: I am feeling very dizzy. I do have some vertigo and lightheadedness. 
Doctor: You are on blood thinners, right? That is Coumadin therapy? Or am I wrong here?
Patient: No, you are right but please stop the Coumadin. I am tired of these regular blood draws.
Doctor: See, I understand it is hard to control it. It is difficult to regulate that.
Patient: Yes exactly. That is why I don't want it. Give me something simple.
Doctor: Okay I will investigate it. Are you experiencing any chest pain or shortness of breath?
Patient: Oh no, I am not feeling that.
Doctor: Okay great!
Patient: Actually, I am moving around a little bit better now and my arm does not hurt.
Doctor: How about your back pain?
Patient: Um, it is improving as well. 
Doctor: Okay, cool.
Patient: Yeah.

Clinical note:
Symptoms: dizziness, vertigo, lightheadedness
Diagnosis: atrial fibrillation (AFib)
History of Patient: follow-up for AFib, misplaced Cardizem, experiencing dizziness, vertigo, lightheadedness, tired of Coumadin therapy and regular blood draws, no chest pain or shortness of breath, improving mobility, arm and back pain improving
Plan of Action: N/A
Doctor: Good morning, young man.
Patient: Good morning, doctor. 
Doctor: Who is this young lady, is this your grandmother, or sister?
Guest_family: Oh doctor, yes, I am his grandmother. 
Doctor: Good, my chart says that you're fourteen years old. Is that correct? 
Patient: Yes sir. 
Doctor: Good, so what seems to be the problem today? 
Patient: I've been having pain in this knee for about a month now. 
Doctor: Can you remember a specific injury to this knee?
Patient: Um, yeah, I was playing basketball when I jumped, and then when I landed I felt this knee pop. 
Doctor: Do you remember the date of your injury, young man?
Guest_family: Um, it was on December twenty second two thousand seven. 
Doctor: Good, so how have you been treated for this so far? 
Patient: We went to another clinic first, and they put me in a splint. 
Guest_family: Yeah, and then they referred us over to Children's. 
Doctor: Have they taken x rays yet?
Patient: Yes, I got back a few minutes ago. 
Doctor: Let's have a look. Well, you broke your leg. 
Patient: What, where? Can you show me?
Doctor: Right here, this is a tibial tubercule avulsion fracture with patella alta. 
Guest_family: What does that mean, doctor? 
Doctor: Well, he's broken his leg, and pulled some bone off by doing so. We'll need to do surgery on this.
Guest_family: Oh no, what's the name of the procedure? 
Doctor: It's called an O R I F. We'll go in there with some hardware to put everything back together, and he can get on the road to healing. 
Guest_family: Let me call his father while we discuss this. What's the risk of infection from this surgery? 
Doctor: Historically, it's less than one percent. We use antibiotics to control for infection. 
Guest_family: Okay, will he be asleep for this? 
Doctor: Yes, he won't feel a thing.
Guest_family: That's good too. Will he need this hardware out in the future?
Doctor: We can remove everything once he has healed up nicely. Other risks include bleeding, changes in the sensation of the leg, hardware failure, need for post op rehab, need for hardware removal, and failure to restore extensor mechanism tension. But I would not worry about these things. I have been doing these surgeries for years and things like this rarely happen. 
Guest_family: Yes, his father agrees. We're going to do the surgery.

Clinical note:
Symptoms: knee pain for 1 month, pain and popping sensation in knee after playing basketball, difficulty bearing weight on affected leg
Diagnosis: tibial tubercule avulsion fracture with patella alta
History of Patient: knee pain started after basketball injury on December 22, 2007, initial splinting at another clinic, referred to Children's for definitive care, confirmed fracture on x-rays
Plan of Action: open reduction and internal fixation (ORIF) surgery recommended, risks discussed including anesthesia, infection, bleeding, changes in sensation, hardware failure, need for later hardware removal, failure to restore extensor mechanism tension, and need for postoperative rehab, father and grandmother agreed to surgery
Doctor: Good afternoon, ma'am. Can you confirm your age for me, please? 
Patient: Sure, good afternoon, doctor. I'm sixty one years old. 
Doctor: Great, what brings you in for a visit today? 
Patient: I have some notes here with me, but I have a history of polyarteritis nodosa mononeuritis multiplex. 
Doctor: Is this in your legs, or arms? 
Patient: Um, it's in my legs. 
Doctor: I see here that you have sleep apnea too. 
Patient: Yeah, I was involved in an overnight sleep study on C P A P and oxygen. 
Doctor: Why did they do this?
Patient: It was in order to determine why I had difficulty falling asleep and staying asleep.
Doctor: Have You had any other treatments? 
Patient: Yeah, I had a review done while I was in the hospital about two weeks ago, I have the results right here. 
Doctor: Thank you, so, how is your leg pain been managed?
Patient: Um, I take pretty substantial doses of opioids in order to control it.
Doctor: Do you have any swelling?
Patient: Yes, I take Lasix for my leg swelling.
Doctor: How do you sleep with the C P A P?
Patient: I can fall asleep with it, but I usually rip my mask off because I toss and turn.
Doctor: How would you rate your quality of sleep?
Patient: I'd, um, say it's pretty terrible.

Clinical note:
Symptoms: leg pain, difficulty falling and staying asleep, lower extremity edema
Diagnosis: polyarteritis nodosa, mononeuritis multiplex, severe sleep apnea
History of Patient: difficulty initiating and maintaining sleep, overnight sleep study with CPAP and oxygen, review of results from hospital study, use of opioids for pain management, Lasix for lower extremity edema
Plan of Action: N/A
Doctor: Hi there, what's going on?
Guest_family: I am her daughter. I brought her to the emergency. She lives in a skilled nursing home. Today, when I went to meet her, I found her with the right side of her face drooping. I immediately rushed her here. 
Doctor: Oh, you did the right thing. Ma'am, how are you feeling?
Guest_family: She has dementia, most of the time she doesn't even remember me. 
Doctor: Oh, okay.How old is she?
Guest_family: She is eighty three. She also has a history of stroke after which she developed this condition where she knows what she wants to speak but is unable to make the word or sentence.
Doctor: Oh, I see. She has expressive aphasia, correct? 
Guest_family: Yes, that. 
Doctor: Okay, let me check her. She does have a droop to her right side of the face. Ma'am, do you feel any weakness on the right side of your body?
Guest_family: She says yes. 
Doctor: She had her C T scan earlier today and I have the report. It does not show any acute attack or anything. 
Guest_family: Okay!
Doctor: But it does show that she has a new onset of a stroke.
Guest_family: Is there anything to worry?
 Doctor: I think we need to admit her for observation. We need to monitor her. We will also get her a proper treatment for her urinary infection which is not getting better due to resistance to the oral medicines. 
Guest_family: Yeah, sounds good!
Doctor: Yeah, let me talk to the nurse.
Guest_family: Thank you.

Clinical note:
Symptoms: right-sided facial droop, right-sided upper extremity weakness, expressive aphasia
Diagnosis: new-onset cerebrovascular accident (stroke), dementia, urinary tract infection resistant to oral medications
History of Patient: found with right-sided facial droop and weakness, transferred to ER for evaluation, CT scan showed new-onset stroke, recommended admission for observation and treatment of UTI
Plan of Action: admission for observation and treatment of urinary tract infection
Doctor: Hello, are you translating for the patient today? I am sorry, but I do not speak Spanish. 
Guest_family: Yes doctor. 
Doctor: My chart says this man is fifty two years old, is all of that correct? 
Guest_family: Yes doctor, that's correct. 
Doctor: Good, so, what seems to be the problem today?
Guest_family: He hurt himself a while back when he slipped on a grape while he was at the grocery store. 
Doctor: Oh no, when was this?
Guest_family: It was on October second two thousand eight. 
Doctor: Which knee did he injure?
Guest_family: Doctor, it was his left knee. 
Doctor: How has he been treated for this so far?
Guest_family: He went straight to the E D immediately, and then he saw his P C P. 
Doctor: What did the P C P recommend?
Guest_family: He only referred him to P T, and gave him a knee brace.

Clinical note:
Symptoms: left knee pain
Diagnosis: N/A
History of Patient: fell in grocery store on 10/02/08, slipped on grape, went to ED then followed up with PCP, referred to Physical Therapy, received knee brace
Plan of Action: N/A
Doctor: Do you smoke cigarettes? 
Patient: I smoke about three packs in a month. 
Doctor: Do you drink alcohol or use recreational drugs? 
Patient: No. 
Doctor: What do you do for work? 
Patient: I am an editorial assistant at the local newspaper.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Have you had any adverse reactions to medications you've taken in the past? 
Patient: No, thankfully.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Are you okay?
Patient: Yeah, yeah, I am fine.
Doctor: I am asking this as you look a little pale.
Patient: No I am okay. I have always been healthy my whole life. Just a little fatigued now.
Doctor: Okay that won't be something we can't fix.
Patient: Yeah, but I am okay.
Doctor: Yes, I do not see any issues with your past history.
Patient: As I said, I am healthy.

Clinical note:
Symptoms: pale appearance, fatigue
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Hello today I have my assistant with me, and she will be representing your case. Tell me who do we have today? 
Guest_clinician: Patient has been cared by Doctor X since two thousand and two. She had a Codman Hakim shunt set at ninety M M H two O. She last came to our clinic in January two thousand and eight. At that time, she was recommended to follow up with Doctor Y for the medical management of her chronic headaches. She was also recommended to see a psychiatrist for her depression. 
Doctor: Did you go and see a psychiatrist? 
Patient: I did. It was okay.
Doctor: What brings you here today? 
Patient: My headaches are back. They are very severe this time. It all happened that, after that scan. 
Doctor: When did she have her scan? 
Guest_clinician: She had her stunt adjusted which was after the M R I on April eighteenth. 
Patient: Yes, and after that I'm having these very bad headaches. 
Doctor: Are you able to sleep in the night properly? 
Patient: No, these headaches wake me up in the night. I haven't had a proper sleep in like ages. 
Doctor: Is there anything that elevates this pain? Or decreases it? 
Patient: Everything seems like increasing it. It just gets worse with coughing, straining, sneezing, even when I'm trying to stand. I tried all the medications, but nothing is helpful. There was Imitrex and I also tried Motrin eight hundred M G twice a day, but nothing seems to be like effective. Actually, it helps a bit when I lie down.
Doctor: Is it like specific to any particular area of your head? 
Patient: It is like all over but, uh, very much intense in the forehead. 
Doctor: Is there any nausea associated with the headaches? 
Patient: No. 
Doctor: Anything else that happens along with these headaches? 
Patient: Yeah, I get that ringing sound in my ears, and I just don't feel well. 
Doctor: Any changes in your vision? 
Patient: Yeah, it gets blurry, and I feel like lights are dimming. I will be meeting Doctor Y tomorrow. 
Doctor: Any other thing you want to add? 
Patient: No, that's it.

Clinical note:
Symptoms: severe headaches, worsening with coughing, straining, sneezing, standing up, relieved when lying down, constant pain with intensity in forehead, ringing in ears, blurry vision, dimming lights
Diagnosis: history of Codman-Hakim shunt set at 90 mmH2O, chronic headaches, depression
History of Patient: acute onset of headaches after shunt adjustment following MRI on April 18th, 2008, poor sleep due to headaches, tried Imitrex and Motrin 800 mg twice a day without relief, scheduled follow-up with Dr. Y for headache management
Plan of Action: N/A
Doctor: Tell me about the medical issues you had in the past or still do.
Patient: Well, I have asthma, sinus. I also have hives and there is a history of psoriasis. 
Doctor: Wow, okay. Any known allergies?
Patient: Nothing that I have known.

Clinical note:
Symptoms: N/A
Diagnosis: asthma, sinus issues, hives, history of psoriasis
History of Patient: N/A
Plan of Action: N/A
Doctor: Any known allergies? 
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Hello there, how are you doing? 
Patient: Sorry, I'm just not feeling well. Something is wrong. 
Doctor: Don't worry, I will check you up. We will figure it out. Do you remember when you had your last physical? 
Patient: It was sometime in early May in two thousand and eight. 
Doctor: Okay, I'm going through your chart. It looks like you have not been feeling well for about two weeks now. 
Patient: That's right. 
Doctor: Tell me what is happening exactly. 
Patient: In the beginning I was thinking that it was just the stress and anxiety, but then I become worried that it might be something really different or something bad.
Doctor: What are you experiencing exactly? What are your symptoms? 
Patient: It started with a lot of palpitations at first. My heart was beating so fast it looks like it was ready to go out. I was having this fluttering feeling in my chest. 
Doctor: Were you feeling tired or fatigued? 
Patient: Yes, very much for the last two weeks. I am worried it's my job. It is really getting to me. 
Doctor: What else are you feeling? 
Patient: Feeling very nervous an anxious actually. 
Doctor: Have you noticed anything that you are doing or anything else that kind of increasing these symptoms? 
Patient: Oh yeah, whenever I'm stressed. I feel like I have more palpitations and to the level that it causes a lot of chest pain. 
Doctor: Is it the same when you are doing a lot of physical stuff like physical activities or something like that? 
Patient: Nope. Haven't noticed it with the exertion part. 
Doctor: Do you have any history of any heart issues in the past? 
Patient: I had the same kind of symptoms like nine or ten years ago. 
Doctor: Okay. What did you do that time? How did you recover? 
Patient: Well, at that time a full work up was done but everything came out to be negative, so they just gave me something for my nerves. It kind of helped. 
Doctor: Do you remember what they gave you? Like name or anything of the medicine. 
Patient: No. It was many years ago, I don't remember. 
Doctor: Anything else going on? 
Patient: Yeah, for the last three days and I am having these tummy issues. I'm having on and off nausea and also, my stools are coming loose. 
Doctor: Have you seen any color change in your bowel movements? 
Patient: Yeah, it's been some really funny green color. I don't know what's going on inside. 
Doctor: Have you ever noticed blood in the stools? 
Patient: Nope. 
Doctor: Is there any pain in your tummy? 
Patient: Nope, it's just some nausea. 
Doctor: How's your appetite? 
Patient: Not as good as before. 
Doctor: Do you smoke? 
Patient: I never did.

Clinical note:
Symptoms: palpitations, fluttering feeling in chest, fatigue, nervousness, anxiety, chest pain with stress, intermittent nausea, loose stools with green color, decreased appetite
Diagnosis: N/A
History of Patient: feeling unwell for about two weeks, previous similar Symptoms 9-10 years ago with negative workup, took medication for nerves but doesn't remember details, nonsmoker
Plan of Action: N/A
Doctor: So just to double check, you're not on any medications? 
Patient: You got it. Nothing since last year.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: What brings you in today? 
Patient: I have this nasty cough and my nose has been super stuffy. 
Doctor: Are you bringing anything up when you cough? 
Patient: Not really, no. 
Doctor: Are you having any other symptoms, such as chest pain, headaches, nausea, or vomiting? 
Patient: No. I did have a slight headache last night but I took Advil and it's since gotten better. 
Doctor: Are you taking anything for the cough or stuffy nose? 
Patient: Just drinking tea and taking cough drops here and there. 
Doctor: Okay. Let's take a look at you. Hm it appears that you have a U R I.

Clinical note:
Symptoms: weakness, partial weakness on one side, inability to stand or care for oneself
Diagnosis: multiple seizures, hemiparesis, C. diff infection, upper respiratory infection
History of Patient: moved to nursing home after hospitalization, had two surgeries on July 6th followed by radiation treatment on August 7th, developed C. diff infection likely due to surgeries or antibiotic use
Plan of Action: N/A
Doctor: How are you feeling today, sir? 
Patient: I feel pretty weak right now, but I am doing okay at the moment. 
Doctor: I reviewed the chart notes that was sent to me by the nursing home. They also sent me your medical history. You have been going through a lot recently. 
Patient: Yes, I have. They moved me into the nursing home after I was released from the hospital. I hope that it is just temporary.
Doctor: I understand that you had a seizer and that is why you were taken to the hospital. 
Patient: I had multiple seizures. After I was stabilized from the last seizure this side of my body in not working right. 
Doctor: Okay so you are having some partial weakness on this side? 
Patient: Yes. That is why they moved me to the nursing home. I can't stand up. I am too weak. I can't take care of myself. The nurses have to help me do everything. 
Doctor: I am going to try to help you get back to doing things on your own. 
Patient: After being in the hospital I got an infection in my intestines. They put me on some antibiotic that I have never heard of and a probiotic.
Doctor: Okay. I see here in the chart that you had two surgeries on July sixth. 
Patient: Yes, and then I had a radiation treatment too. 
Doctor: Oh yes. On August seventh. 
Patient: That sounds right. 
Doctor: Your surgeries may have been the reason for the C diff. 
Patient: What is C diff?
Doctor: It is an infection in the large intestine. It is often caused by overuse of antibiotics, and you have been on them for a while due to the surgeries that you have had. Or it could be from the surgery itself. 
Patient: That make since.

Clinical note:
Symptoms: weakness, partial weakness on one side, inability to stand or care for oneself
Diagnosis: multiple seizures, hemiparesis, C. diff infection
History of Patient: moved to nursing home after hospitalization, had two surgeries on July 6th followed by radiation treatment on August 7th, developed C. diff infection likely due to surgeries or antibiotic use
Plan of Action: N/A
Doctor: How is your sleep? Are you sleeping well?
Patient: Yes, without any disturbance. I sleep like a log! 
Doctor: Good. Any mood swings or did you feel your emotions are out of control? 
Patient: Nah, just the normal mood swings around my periods otherwise no problem at all.
Doctor: Any depression like feeling, sudden mood changes or feeling sad or hopeless? 
Patient: Nope! 
Doctor: Okay.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No sleep disturbances, mood swings only around periods, no depression or emotional lability
Plan of Action: N/A.
Doctor: How's he doing today? 
Guest_family: I think he might have fifth disease with sinusitis. It's been running rampant at his school. 
Doctor: Oh, wow. Let's see what we can do.

Clinical note:
Symptoms: N/A
Diagnosis: fifth disease with sinusitis
History of Patient: N/A
Plan of Action: N/A
Patient: Help! I need help! I need to see the doctor! 
Doctor: Yes, what's wrong? Where's your pain? 
Patient: My stomach! It hurts so much! I've never had this type of pain before! 
Doctor: When did it start?  
Patient: At ten! I don't know. It started hurting out of nowhere. One second I'm driving home and the next thing I know I had to call- 
Doctor: Yes? 
Patient: The pain is so bad! It's hard for me to even think straight.

Clinical note:
Symptoms: abdominal pain, severe and sudden onset
Diagnosis: N/A
History of Patient: abdominal pain started suddenly at around 10 o'clock, described as severe and debilitating
Plan of Action: N/A
Doctor: Just want to ask you few routine questions, let me know if any of this is positive.
Patient: Sure, go ahead.
Doctor: Do you have any problems like headache, fever, rash, oral ulcer?
Patient: None.
Doctor: Any problem with vision? Like unable to see or double vision?
Patient: Um no, I can see everything.
Doctor: Okay. Do you get palpitations, like are you aware of your own heart?
Patient: No, nothing like that.
Doctor: How about breathlessness while lying down or do you have to get up in the middle of the night to catch a breath? 
Patient: No I don't feel anything like that.
Doctor: That's great. Any diarrhea, constipation, or red blood come out in stool? Or pale stool? Like any change in the color of stool?
Patient: No, it is fine.
Doctor: Okay. Any jaundice recently?
Patient: No. No jaundice.
Doctor: Do you have problems with appetite?
Patient: Yeah, I mean you can say my appetite is decreased.
Doctor: Because of that have you noticed any weight loss?
Patient: Oh no.
Doctor: Okay sounds good.
Patient: Sure.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: No headaches, fever, rash, oral ulcers, vision problems, palpitations, breathlessness while lying down, diarrhea, constipation, changes in stool color, jaundice, weight loss. Decreased appetite reported.
Plan of Action: N/A
Doctor: Good morning, ma'am. What seems to be the problem with your knee?
Patient:  I've had pain in this knee since I tripped on some ice on March tenth two thousand three. 
Doctor: How old are you now? 
Patient: I'm forty seven. 
Doctor: What kind of symptoms have you had since the fall? 
Patient: It's hard for me to stand up without significant pain, and it feels like my knee is going to give way.
Doctor: Has this knee given out before?
Patient: It has. 
Doctor: Is there any swelling in this knee? 
Patient: Yes, I also feel a popping, like when I go up the stairs.
Doctor: What kind of treatments have you had for this knee?
Patient: I've had antiinflammatories and P T, but I didn't respond well at all. 
Doctor: Have you had surgery on this knee in the past? 
Patient: Yes, but I can't remember the name of the operation.

Clinical note:
Symptoms: pain in knee since tripping on ice, difficulty standing without significant pain, sensation of knee giving way, swelling in knee, popping sensation in knee
Diagnosis: N/A
History of Patient: knee pain since March 10, 2003, failed conservative treatment including anti-inflammatories and physical therapy, underwent previous surgery on knee
Plan of Action: N/A
Doctor: How're you doing today, sir? 
Patient: Uh I'm hanging in there.  
Doctor: I see that you've recently celebrated your seventy second birthday. 
Patient: Yep. My kids and grandkids threw me a surprise party. It was really nice. 
Doctor: Aw surprises are always fun. However, I'm sorry to hear that you're not doing that well today. 
Patient: Yeah, me too. The other day, I had a lot of difficulty getting up from my chair because of weakness all over and a lightheadedness I can't seem to explain. 
Doctor: Is this new for you? 
Patient: Um I mean I've had falling spells several times a month for the past year, but I've always been able to get myself up one way or another. 
Doctor: Do you remember losing consciousness during any of those episodes? 
Patient: Not that I recall. I've noticed I'm a lot weaker than before so maybe that's why I keep falling more frequently. 
Doctor: I see. Do you experience room spinning dizziness at all? 
Patient: No. I also forgot to mention that four hours after not being able to get up from my chair, my left hand became numb for about two hours. 
Doctor: Are you right or left handed? 
Patient: Right handed. 
Doctor: And besides what you've mentioned to me so far, no other symptoms of concern? 
Patient: No.

Clinical note:
Symptoms: generalized weakness, lightheadedness, falling spells, left hand numbness,
Diagnosis: N/A,
History of Patient: difficulty getting up from chair, weakness all over, lightheadedness, falling spells several times a month for the past year, left hand numbness,
Plan of Action: N/A
Doctor: And where do you live?
Patient: Well, I live in this small town called Fayetteville in Tennessee.
Doctor: Ah, I see. And do you have lot of friends there?
Patient: I have few.
Doctor: Okay, and do you drink? 
Patient: No.
Doctor: How about smoking?
Patient: Never did!

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: How are you feeling? 
Patient: I am feeling better now. 
Doctor: What happened last night? 
Guest_family: She went out to a party last night. She came home drunk and high. 
Doctor: What did you take? 
Patient: I took Ecstasy. I only had two drinks. 
Doctor: How much Ecstasy did you take? 
Patient: I didn't take them all at once. I think I took six tabs.  
Doctor: What time did you start taking the tablets? 
Patient: We started taking it kind of late. I think it was midnight. 
Guest_family: When she came home, she was agitated and physically shaking. She was pacing all over the house. Then she threw up. That is when I got nervous and called nine one one. 
Doctor: Mom, did you notice any blood, or any yellow or green color in the vomit? 
Guest_family:  No. 
Doctor: Are you still feeling nauseous? 
Patient: No. I feel fine. Well, I feel weird but not nauseous.
Doctor: Are you experiencing any pain at all? 
Patient: No. 
Doctor: Did you or do you feel depressed? 
Patient: No. 
Doctor: Do you or have you ever had suicidal thoughts? 
Patient: No. 
Doctor: Are you seeing or hearing things that are not real? 
Patient: No. 
Doctor: Do you or have you ever had thoughts of harming yourself? 
Patient: No. I was not trying to harm myself or anyone else. I just wanted to have a little fun. 
Guest_family: She seems to be back to her usual self now. 
Doctor: Just one more question. Prior to last night have you had any recent illnesses or injuries? 
Patient: No.

Clinical note:
Symptoms: feeling wired, no nausea, no pain, no auditory or visual hallucinations, no depression, no suicidal or homicidal ideation
Diagnosis: N/A
History of Patient: went out partying, drank two mixed drinks, took six Ecstasy tablets over the course of the evening, experienced agitation, shaking, one episode of nonbloody, nonbilious emesis, called EMS, now feeling back to usual self
Plan of Action: N/A
Doctor: Do you have any support system?
Patient: No, I am single.
Doctor: Okay so live alone at home?
Patient: Yes.
Doctor: Do you smoke or drink?
Patient: Nope I do not.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: So, are you married? 
Patient: No, my wife and I got divorced a while ago. We have three children together, though. 
Doctor: Okay, and do you have someone who is managing your case? 
Patient: Yes, I have an lawyer handling everything.
Doctor: Do you smoke or drink? 
Patient: No, I never really smoke or drink.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A.
Doctor: Have you ever had surgery?
Patient: No, not that I can remember.
Doctor: No gallbladder or appendix removal, c sections, or joint replacements? 
Patient: Nope, never had anything done.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: I just need to confirm a few pieces of information from my nurse before we begin today, sir. 
Patient: Sure, no problem, doctor. 
Doctor: Great, so it says here that you are forty five years old, and you identify as Caucasian. Is that correct?
Patient: Yes, that's correct. 
Doctor: Thank you, so, what seems to be the problem today?
Patient: Well, I have this pain in my right knee, sir. 
Doctor: Where is your pain? 
Patient: It's right here, on the inside of my right knee. 
Doctor: Is there an injury associated with this pain? 
Patient: Actually, yeah. I twisted it while I was at work.

Clinical note:
Symptoms: pain in right knee, located on the inside (medial aspect), twisted knee at work
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A
Doctor: Good morning, sir. Can you confirm your age for me, please? 
Patient: Good morning, doctor. I'm fifty nine years old. 
Doctor: Great, and which hand is your dominant hand? 
Patient: Um, I use my right hand for everything. 
Doctor: Great, thank you. So, what seems to be the problem today? 
Patient: I have had this weird feeling in both of my legs for about three weeks now. 
Doctor: Have you been treated for this so far? 
Patient: Um, I went to the E R about a week ago. 
Doctor: What did they tell you there?
Patient: They said I had progressive sensory and motor deficits in both legs. 
Doctor: Can you describe your symptoms for me, please? 
Patient: Um, I have numbness, like here starting at my trunk, and then over the last month or so, it moved into my legs. 
Doctor: I'm going to apply some pressure right here at the nipple line, can you feel that? 
Patient: No, I'm numb from there down. 
Doctor: Have you had any weakness in your legs? 
Patient: Yeah, I have for the last week or so. 
Doctor: Is it getting worse? 
Patient: Yes, it is. 
Doctor: When did you start using the cane? 
Patient: Um, about five days ago, now. 
Doctor: Why did you begin using it? 
Patient: I'm having trouble walking and going up and down stairs. 
Doctor: Are you able to stand without it?
Patient: No, I'm not. 
Doctor: Have you had any loss of bowel or bladder control? 
Patient: No, thankfully not, but at the same time I haven't had a bowel movement in about three days. 
Doctor: When was the last time you urinated? 
Patient: It was about twenty four hours ago. 
Doctor: In addition to the numbness, how else would you describe your leg symptoms? 
Patient: Um, I'd say it feels cold, at least I've felt that for the last day or so.
Doctor: Do you have any back or neck pain? 
Patient: No, nothing there. 
Doctor: Do you have any shortness of breath? 
Patient: Well, I've had it chronically for a while now, but I think it's getting worse. 
Doctor: Have you had any lightheadedness or feelings of faint? 
Patient: Um, yeah, when I try to stand up. 
Doctor: How long have you had that feeling? 
Patient: I've had it for about two days now.

Clinical note:
Symptoms: weird feeling in both legs for 3 weeks, numbness starting at trunk and progressing to legs, progressive weakness in legs, difficulty walking and going up/down stairs, numb from nipple line down, cold feeling in legs, chronic shortness of breath worsened, lightheadedness upon standing for 2 days
Diagnosis: progressive sensory and motor deficits in both lower extremities
History of Patient: seen in ER 1 week prior for above Symptoms, started using cane 5 days ago, difficulty standing without cane, no loss of bowel/bladder control but no bowel movement in 3 days, no urination in 24 hours, no back/neck pain
Plan of Action: N/A
Doctor: Do you have any known allergies to medications?  
Patient: No.

Clinical note:
Symptoms: N/A
Diagnosis: N/A
History of Patient: N/A
Plan of Action: N/A