HPI: Patient presents for follow up.
His blood pressure today in clinic was 120/76. 

His hemoglobin A1c was 6.1 in 07/2023. His blood sugar ranges in the 100-120s in the morning, 140s in the afternoon. Denies any polyuria, polydipsia or polyphagia.

Hyperlipidemia:  His rosuvastatin was decreased from 40 mg to 20 mg in 06/2023 due to his complaints of generalized aches and pain and I thought it was due to the increased dose of his statin; it turns out it is more likely due to a combination of rheumatologic and orthopedic factors.  I advised him to go back on the 40 mg of the rosuvastatin from today.  I do not think his aches and pains have anything to do with the statin.  His lipid panel done in 06/2023, TC 116, triglycerides 113, HDL 38 and LDL was 55.

His breathing has remained stable, he does not need to use his rescue inhaler. 

Left hand pain and swelling; he followed with rheumatology in 08/25/2023 and given a diagnosis of possibly polymyalgia rheumatica versus rheumatoid arthritis. Ordered blood work through their office and started on prednisone 5 mg 1 bid. He will be following up with them again in 3 weeks’ time. His hand swelling has improved from earlier. 

Denies sleep issues, denies chest pain, palpitations, shortness of breath, abdominal pain, bowel or bladder complaints. 
PE: Left hand is almost completely resolved. Declined a foot examination

A and P:
Name: Horst

CC:

HPI: The patient presents for routine follow up.

Hypertension: He does not monitor his blood pressures at home. His BP today was 124/80. 

Type 2 diabetes mellitus: His hemoglobin A1c was 7.2 in 06/2023; blood sugar at home ranges in the 150s-200s; reports that eating processed chicken generally tends to increase his blood sugar levels. 
He is due on his eye examination, patient advised to follow up at least once a year due to his history of diabetes. 

History of malignant neoplasm of prostate, s/p TURP. His PSA in 03/2023 was 1.0. Followed with urologist, Dr. Beasley who has left our Hamilton office and he does not want to follow him to Syracuse. 

He has lost 10 pounds since 03/2023, current weight of 203 pounds, unintentional weight loss reports no changes in his diet or activity levels but thinks could be due to the hot weather. 

Denies sleep issues, denies chest pain, palpitations, shortness of breath, abdominal pain, bowel or bladder complaints. 

PE: Thick onychomycosis to his toenails mostly in the great toenails.
A and P:
Name: Joseph

CC:

HPI: The patient presents for follow up.
He has received 2 of his J and J COVID 19 vaccines. Advised to receive the new COVID 19 booster. 
He was also advised to receive the influenza vaccine end of September or beginning of October.

Hypertension: He brought in his blood pressure readings from home and they ranges in the 110-120/60-70s; his blood pressure today was 116/64. 

Hyperlipidemia: Lipid panel done in 03/2023 showed a total cholesterol of 214, triglycerides 111, HDL 43 and LDL was 149. 

Type 2 diabetes mellitus: His hemoglobin A1c was 6.1 in 03/2023. He does not monitor his blood sugars at home. Denies any polyuria, polydipsia or polyphagia. Reports nocturia but this is nothing new for him; advised limiting fluid intake after dinnertime.
He had eye examination within the last 2 months with Dr. Briglin. 

He reports tinnitus in his ears; takes ginko biloba supplements with limited benefit.

His current weight is 308 pounds unchanged since 03/2023. 

Denies sleep issues, denies chest pain, palpitations, shortness of breath, abdominal pain, bowel or bladder complaints. 
PE: Thick yellowing toenails, obese. right eye inverts which is chronic for him

A and P:
Name: Judson

CC:

HPI: The patient presents for followup.
The patient is status post excision of a submuscular lipoma from the right thigh area performed by Dr. Ernits on 07/10/2023. 

He had a recent episode of UTI infection end of August; he noticed cloudy urine; and difficulty with catheterization; urinalysis showed burning, urgency and cloud urine. Followed with urology and was given a 10-day supply of antibiotic and reports his urine cleared up on the third day on the antibiotic. He is trying to remain well hydrated. He also had an episode of UTI beginning of August for which he was treated with Augmentin. The patient self-catheterizes 3 times a day due to his history of urinary retention and hence prone to UTIs. 

History of fecal incontinence continues to have the bowel accidents especially early morning. Takes a fiber supplement occasionally, taking it daily makes his bowel movements worse. Advised taking a probiotic daily, he eats a banana daily and other fruits, salads to bulk up is stool. He cancelled his appointment with Syracuse GI on 05/19/2023 due to problems with parking at the spot.

Hypertension:  His blood pressure today in clinic was 122/58.

Hyperlipidemia: He had lipid panel done in 10/2022 showed a total cholesterol of 170, triglycerides 107, HDL 74 and LDL was 75. 

Denies any shortness of breath but occasionally will find it hard to take a deep breath in. Denies chest pain, palpitations, shortness of breath, abdominal pain 


PE: Elongated right pupil. Dentures. 2-3/6 systolic murmur. Walks slowly with a walker. 
correct the errors, moderately elaborate, keep it professional and also segregate CC, HPI, ROS, PE, and plan