make recommendations to strength the short term disability claims 1000 fold Richard A. and Susan F. Smith
Campus Center
75 Mt. Auburn Street
CambridgeMA02138
GREENWOOD, NICOLE Acct #: 21685011 DOB: 8/29/1991 Age: 33 yrs Sex: Female
11/18/2024 12:00 PM with LONDON, DYANNE PHD for BH TELEMEDICINE THERAPY
Encounter #: A6362948‐67
PCP Name: SIRCAR, MONICA MD
Type of Visit: MH Visit
This visit was conducted: by video and audio
At the beginning of this interaction, I determined that this patient was appropriate for telemedicine.
Patient's physical location ﴾U.S. state or territory, or country if outside US﴿: MAPatient is at: home
Clinician's physical location ﴾U.S. state﴿: MA Clinician is at: home
Consent: I introduced and identified myself and received verbal consent from the patient to proceed with this
video and/or telephone visit.
I provided my physical location and verified the patient's name, date of birth and physical location.
Clinic Notes
Next: conversation about marriage, did she get MIT job, issues with Max
Pt described her feelings about trying to get MIT job, all the references, last meeting today via zoom. Has
decided they will not be moving to NC until the situation with max is settled. she wants to have full
custody with Sean of him and Max is doing poorly at school, mother is neglectful;, she doesn't work, Max
has severe asthma, poor eating habits, etc. They will be renting their home in Hingham and live between
the cape and NC if that happens. She is putting on hold the IVF treatments until March and trying naturally
to have a baby. Lots of things in the air
Mental Status Exam: unchanged since last visit
Parasuicidal Behavior
none/not applicable
Diagnosis
Disruptive Mood Dysregulation Disorder ﴾F34.81﴿
Treatment review/Progress towards goals ﴾developed and discussed with patient﴿
to continue to assess and monitor symptoms, continue with Dr Nadal, take meds as prescribed,
acupuncture, CBT and MI modalities
Current Plan
Unchanged
BHM‐20 Survey reviewed by clinician:: Survey not completed by patient
Spent 53 minutes in Psychotherapy only
Harvard UHS Page 1 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Disposition
RETURN VISIT
E/M Coding
VIDEO/PHONE INDIV. PSYCHOTHERAPY 53 MINS OR MORE 90837
Signed by Dyanne London, PhD. on 11/21/2024 10:45:39 AM GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 2 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Richard A. and Susan F. Smith
Campus Center
75 Mt. Auburn Street
CambridgeMA02138
GREENWOOD, NICOLE Acct #: 21685011 DOB: 8/29/1991 Age: 33 yrs Sex: Female
11/12/2024 4:00 PM with LONDON, DYANNE PHD for BH TELEMEDICINE THERAPY
Encounter #: A6362946‐41
PCP Name: SIRCAR, MONICA MD
Type of Visit: MH Visit
This visit was conducted: by video and audio
Patient's physical location ﴾U.S. state or territory, or country if outside US﴿: MAPatient is at: home
Clinician's physical location ﴾U.S. state﴿: MA Clinician is at: home
Consent: I introduced and identified myself and received verbal consent from the patient to proceed with this
video and/or telephone visit.
I provided my physical location and verified the patient's name, date of birth and physical location.
Clinic Notes
Next: did she get the job, resources from pediatrician re: autism and behavior management techniques
for Max
Pt described her waiting to hear about MIT job and is very hopeful she'll get it, she has also applied for
anther admin type job, Spoke a lot of the side effects of the Risperdal and her weight gain. Wants to be a
good parent to Max, talked about wanting to eventually get full support of him since bio mother seems to
neglect him, Pt wants to get her body back in shape and her hormones and sleeping and she and Sean
would like to renew efforts to get pregnant soon.
Mental Status Exam: unchanged since last visit
Parasuicidal Behavior
none/not applicable
Diagnosis
Disruptive Mood Dysregulation Disorder ﴾F34.81﴿
Treatment review/Progress towards goals ﴾developed and discussed with patient﴿
to continue to assess and monitor symptoms, continue with Dr Nadal, take meds as prescribed,
acupuncture, CBT and MI modalities
Current Plan
Unchanged
BHM‐20 Survey reviewed by clinician:: Survey not completed by patient
Spent 53 minutes in Psychotherapy only
Disposition
RETURN VISIT
Harvard UHS Page 1 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
E/M Coding
VIDEO/PHONE INDIV. PSYCHOTHERAPY 53 MINS OR MORE 90837
Signed by Dyanne London, PhD. on 11/16/2024 4:15:11 PM GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 2 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Richard A. and Susan F. Smith
Campus Center
75 Mt. Auburn Street
CambridgeMA02138
GREENWOOD, NICOLE Acct #: 21685011 DOB: 8/29/1991 Age: 33 yrs Sex: Female
11/12/2024 2:00 PM with NADAL‐VICENS, MIREYA MD for BH TELEMEDICINE MEDS
Encounter #: A6299195‐69
PCP Name: SIRCAR, MONICA MD
Type of Visit: Medication Visit
This visit was conducted: by video and audio
At the beginning of this interaction, I determined that this patient was appropriate for telemedicine.
Patient's physical location ﴾U.S. state or territory, or country if outside US﴿: MAPatient is at: home
Clinician's physical location ﴾U.S. state﴿: MA Clinician is at: work
Clinic Notes
_Meds:
Is doing better mood‐wise since starting the risperdal but has been both gaining weight and is causing
hormonal changes ﴾likely increasing her prolactin﴿ which is delaying her menses to the point that it is
worsening her PMDD. Will save risperdal to use prn for hypomania but not sustainable as a daily med
given both of the above. She does not want to go back to the seroquel given how it did not help with
mood compared with risperdal. Will do trial of abilify 5mg instead. Feels the unasom is still helpful for
sleep and still able to sleep 8‐10hrs most nights. Has gained considerable wt, currently at 250# ﴾5'5"﴿.
_Therapy:
Has increased her daily exercise ﴾walking, hitting goal of 2miles per day﴿ as her mood has started to lift.
Vitals
Height=5 ft 5 in; Weight=250 lbs; BMI=41.6;
Vitals Comment: measured at home
11/12/2024 2:21 PM by NADAL‐VICENS, MIREYA MD
Reviewed Patient Problem List/History
Displayed items reviewed by NADAL‐VICENS, MIREYA on 11/12/2024 2:13:37 PM
Problem List
Mood Disorder NOS; R/O Bipolar II ‐ Diagnosed at age 21. Sxs suggest possible hypomania prior to that but
then started on Lithium/Lamictal and no subsequent sxs. Given unclear quality of sxs and no further episodes BPII
can't be definitively ruled in ﴾nor ruled out unfortunately﴿.
OSA ﴾obstructive sleep apnea﴿
GERD ﴾gastroesophageal reflux disease﴿
Environmental allergies
Asthma ‐ exercise‐ and cold‐induced
Surgery/Procedure
History of Nissen fundoplication
Harvard UHS Page 1 of 4 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Social History
Developmental/Social Hx: ‐ Executive assistant HBS; prev worked in corporate ﴾Moderna, other﴿ and higher
education for 2yrs in VT Original from Seattle, currently living in Hingham, MA Male partner: was a therapist for
awhile, has 13yo son from prev relationship stays w/them on weekends Hx crew ﴾often up at 4:30am for this﴿
Attended UG college early at 17yo Hx studied abroad ~20yo for 2 yrs in Dominican Republic
Staff in accounting & management at Business School
Reviewed Medications
Reviewed by MIREYA NADAL‐VICENS, MD on 11/12/2024 2:13 PM
Albuterol Sulfate HFA 108 ﴾90 Base﴿ MCG/ACT Inhalation AEROSOL SOLUTION; PRN
Benadryl Allergy 25 MG CAPS; 1 CAPSULE ﴾25 MG﴿ ORALLY DAILY AT BEDTIME
LaMICtal XR 250 MG TABLET EXTENDED RELEASE 24 HOUR; 1 TABLET ﴾250 MG﴿ ORALLY DAILY
Melatonin; 5MG PO @ HS
Montelukast Sodium 10 MG TABS; 1 TABLET ﴾10 MG﴿ ORALLY DAILY
Prenatal Multivitamin [Free Text]
QUEtiapine Fumarate 25 MG TABS; 1 TABLET ﴾25 MG﴿ ORALLY DAILY QHS
RisperDAL 1 MG TABS; 1 MG ORALLY DAILY
Reviewed Allergies
Reviewed by MIREYA NADAL‐VICENS, MD on 11/12/2024 2:13 PM
DOXYCYCLINE ﴾Hives﴿
REGLAN ﴾NMS‐ neuroleptic malignant syndrome﴿
Mental Status Exam: changes/updates
slightly more hopeful, but still largely stressed, some oversleeping and dragging but less so than last appt,
GAF =
Parasuicidal Behavior
none/not applicable
Additional Behavior: Suicide plan in 2010 in Bellevue, WA with psych hosp'zn; intrusive SI thoughts Jun'24
Diagnosis
Bipolar II Disorder ﴾F31.81﴿
GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 2 of 4 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Treatment review/Progress towards goals ﴾developed and discussed with patient﴿
_1. BPAD‐II ﴾h/o hosp'zn﴿ ‐ worsening in Jun'24 when off lithium, on lamictal XR 250mg, not sleeping.
Restart seroquel 50mg with permission to inc up to 150mg due to sleeping down to < 2hrs/night. Jun'24
50mg seroquel not sufficient to keep her asleep but 100mg oversedating, will use 50mg and add back
unasom. Jul'24 dec seroquel 50‐>25mg and possibly taper off. Sept'24 restart seroquel but at 12.5mg
dose for worsening of depression. Oct'24 trial of risperdal for hypomania at 1mg dose ‐ helped
significantly for mood but caused wt gain and disruption of menses. Nov'24 trial of abilify 5mg instead.
_2. ? ADHD ‐ currently no ability to concentrate or focus but compounded by lack of sleep. Pre‐existing
suggestion of ADHD but will need to assess once more stablilzed.
_3. Workplace stress ‐ new manager started at time she had to come off lithium due to trying to get
pregnant. Inability to focus and concentrate affected. Received verbal warning at work Jun'24.
_4. Attempting to get pregnat with miscarriage Feb'24
_5. Medical leave from work ‐ Recommended she go out on leave 6/17/24 and start Arbour PHP, restart
therapy with Dyanne and become my patient. STD is approved thru 9/30/24 and I am recommending STD
leave be extended through 10/31/24. STD not approved after 9/30/24 and switched to FMLA, approved
through 11/4/24. Requesting extension through 1/17/25.
_6. RTC in 2‐4wks, continue biweekly therapy with Dyanne London
Current Plan
Changes
switch risperdal to prn for hypomania; start trial of abilify 5mg; using unasom for sleep rather than
seroquel
Orders
MEDICATION ORDERS
LaMICtal XR 250 MG TABLET EXTENDED RELEASE 24 HOUR ; 1 TABLET ﴾250 MG﴿ ORALLY DAILY; QTY 90 TABLET; 1
REFILLS ﴾Renew﴿ Rx Issued via Electronic (Network) CVS/pharmacy #1189 405 LINCOLN ST. , HINGHAM, MA 02043
(ph:7817491163)
Comment to Pharmacy: Allergy List: Doxycycline, and Reglan
Ordered by: NADAL‐VICENS, MIREYA MD, 75 MOUNT AUBURN STREET, 6TH FLOOR, CAMBRIDGE, MA 02138 ﴾ph:
6174952323﴿
ARIPiprazole 5 MG TABS ; 1 TABLET ﴾5 MG﴿ ORALLY DAILY; QTY 90 TABLET; 1 REFILLS ﴾New﴿ Rx Issued via Electronic
(Network) CVS/pharmacy #1189 405 LINCOLN ST. , HINGHAM, MA 02043 (ph:7817491163)
Comment to Pharmacy: Allergy List: Doxycycline, and Reglan
Ordered by: NADAL‐VICENS, MIREYA MD, 75 MOUNT AUBURN STREET, 6TH FLOOR, CAMBRIDGE, MA 02138 ﴾ph:
6174952323﴿
BHM‐20 Survey reviewed by clinician:: Survey not completed by patient
Spent 38 minutes in Psychotherapy only
Disposition
RETURN VISIT
E/M Coding
VIDEO ESTAB ‐ MOD COMPLEXITY 99214
VIDEO/PHONE INDIV PSYCHOTHERAPY W/MED38‐52MIN﴾ALSO CODE E&M﴿ 90836
GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 3 of 4 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Signed by Mireya Nadal‐Vicens, MD on 11/12/2024 3:58:44 PM GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 4 of 4 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Richard A. and Susan F. Smith
Campus Center
75 Mt. Auburn Street
CambridgeMA02138
GREENWOOD, NICOLE Acct #: 21685011 DOB: 8/29/1991 Age: 33 yrs Sex: Female
10/28/2024 12:00 PM with LONDON, DYANNE PHD for BH TELEMEDICINE THERAPY
Encounter #: A6335400‐90
PCP Name: SIRCAR, MONICA MD
Type of Visit: MH Visit
This visit was conducted: by video and audio
At the beginning of this interaction, I determined that this patient was appropriate for telemedicine.
Patient's physical location ﴾U.S. state or territory, or country if outside US﴿: MAPatient is at: home
Clinician's physical location ﴾U.S. state﴿: MA Clinician is at: home
Consent: I introduced and identified myself and received verbal consent from the patient to proceed with this
video and/or telephone visit.
I provided my physical location and verified the patient's name, date of birth and physical location.
Clinic Notes
Next: how is she feeling, PHP? journaling?
Pt described feeling better since the change in medication. Said she is feeling mot energy, and motivated.
has not heard back from any jobs and is feeling bad about that. Said Sean is dong a lot of over time and
making a lot of money before his contract ends the end of the year. Pt has been journaling and wants to
resume about her feelings and thoughts for the day. She denied any SI but did say if she feels funny and
weird, she will call to go back to the PHP. Talked a lot of making plans to resume trying to get pregnant
before the end of the year
Mental Status Exam: unchanged since last visit
Parasuicidal Behavior
none/not applicable
Diagnosis
Disruptive Mood Dysregulation Disorder ﴾F34.81﴿
Treatment review/Progress towards goals ﴾developed and discussed with patient﴿
to continue to assess and monitor symptoms, continue with Dr Nadal, take meds as prescribed,
acupuncture, CBT and MI modalities
Current Plan
Unchanged
BHM‐20 Survey reviewed by clinician:: Survey not completed by patient
Spent 53 minutes in Psychotherapy only
Disposition
RETURN VISIT
Harvard UHS Page 1 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
E/M Coding
VIDEO/PHONE INDIV. PSYCHOTHERAPY 53 MINS OR MORE 90837
Signed by Dyanne London, PhD. on 10/31/2024 10:26:24 AM GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 2 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Richard A. and Susan F. Smith
Campus Center
75 Mt. Auburn Street
CambridgeMA02138
GREENWOOD, NICOLE Acct #: 21685011 DOB: 8/29/1991 Age: 33 yrs Sex: Female
10/21/2024 4:40 PM with NADAL‐VICENS, MIREYA MD for BH TELEMEDICINE MEDS
Encounter #: A6362942‐89
PCP Name: SIRCAR, MONICA MD
Type of Visit: Medication Visit
This visit was conducted: by video and audio
At the beginning of this interaction, I determined that this patient was appropriate for telemedicine.
Patient's physical location ﴾U.S. state or territory, or country if outside US﴿: MAPatient is at: home
Clinician's physical location ﴾U.S. state﴿: MA Clinician is at: home
Clinic Notes
_Meds:
Has had more increased stress and feels has had some hypomanic episodes ﴾noticed by both her mother
and her boyfriend﴿ with rapid speech, ideaphoria, increased energy and not always making sense.
Historically it would happen later in the evenings ﴾furthest away from her medication doses﴿. Would
happen after having delayed sleep, so since then, has increased her dose of seroquel 25‐>50mg. Even on
the 50mg dose was having delayed sleep onset, not falling asleep until 2‐3am. However, at the 50mg is
quite groggy and having difficulty with focus. Has also been comfort‐eating since the seroquel increase.
Given the sedation from seroquel, will switch to risperdal 1mg ﴾more potency relative to hypnotic effect﴿.
_Therapy:
Has been struggling emotionally as it has been hard for her to exercise and take care of herself. She is
trying to find a new job as the thought of going back to her current job is traumatic and triggering for her
to the point that her husband is really worried about her depression and whether returning to her old job
would induce feelings of suicidality again. Discussed that she will need to either return to work or find a
new job relatively soon but given the worsening of her bipolar, will request an extension of FMLA through
1/17/25.
Reviewed Patient Problem List/History
Displayed items reviewed by NADAL‐VICENS, MIREYA on 10/21/2024 4:56:30 PM
Problem List
Mood Disorder NOS; R/O Bipolar II ‐ Diagnosed at age 21. Sxs suggest possible hypomania prior to that but
then started on Lithium/Lamictal and no subsequent sxs. Given unclear quality of sxs and no further episodes BPII
can't be definitively ruled in ﴾nor ruled out unfortunately﴿.
OSA ﴾obstructive sleep apnea﴿
GERD ﴾gastroesophageal reflux disease﴿
Environmental allergies
Asthma ‐ exercise‐ and cold‐induced
Surgery/Procedure
History of Nissen fundoplication
Harvard UHS Page 1 of 3 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Social History
Developmental/Social Hx: ‐ Executive assistant HBS; prev worked in corporate ﴾Moderna, other﴿ and higher
education for 2yrs in VT Original from Seattle, currently living in Hingham, MA Male partner: was a therapist for
awhile, has 13yo son from prev relationship stays w/them on weekends Hx crew ﴾often up at 4:30am for this﴿
Attended UG college early at 17yo Hx studied abroad ~20yo for 2 yrs in Dominican Republic
Staff in accounting & management at Business School
Reviewed Medications
Reviewed by MIREYA NADAL‐VICENS, MD on 10/21/2024 4:56 PM
Albuterol Sulfate HFA 108 ﴾90 Base﴿ MCG/ACT Inhalation AEROSOL SOLUTION; PRN
Benadryl Allergy 25 MG CAPS; 1 CAPSULE ﴾25 MG﴿ ORALLY DAILY AT BEDTIME
LaMICtal XR 250 MG TABLET EXTENDED RELEASE 24 HOUR; 1 TABLET ﴾250 MG﴿ ORALLY DAILY
Melatonin; 5MG PO @ HS
Montelukast Sodium 10 MG TABS; 1 TABLET ﴾10 MG﴿ ORALLY DAILY
Prenatal Multivitamin [Free Text]
QUEtiapine Fumarate 25 MG TABS; 1 TABLET ﴾25 MG﴿ ORALLY DAILY QHS
Reviewed Allergies
Reviewed by MIREYA NADAL‐VICENS, MD on 10/21/2024 4:56 PM
DOXYCYCLINE ﴾Hives﴿
REGLAN ﴾NMS‐ neuroleptic malignant syndrome﴿
Mental Status Exam: changes/updates
stressed, overwhelmed
Parasuicidal Behavior
none/not applicable
Additional Behavior: Suicide plan in 2010 in Bellevue, WA with psych hosp'zn; intrusive SI thoughts Jun'24
Diagnosis
Bipolar II Disorder ﴾F31.81﴿
Treatment review/Progress towards goals ﴾developed and discussed with patient﴿
_1. BPAD‐II ﴾h/o hosp'zn﴿ ‐ worsening in Jun'24 when off lithium, on lamictal XR 250mg, not sleeping.
Restart seroquel 50mg with permission to inc up to 150mg due to sleeping down to < 2hrs/night. Jun'24
50mg seroquel not sufficient to keep her asleep but 100mg oversedating, will use 50mg and add back
unasom. Jul'24 dec seroquel 50‐>25mg and possibly taper off. Sept'24 restart seroquel but at 12.5mg
dose for worsening of depression.
_2. ? ADHD ‐ currently no ability to concentrate or focus but compounded by lack of sleep. Pre‐existing
suggestion of ADHD but will need to assess once more stablilzed.
_3. Workplace stress ‐ new manager started at time she had to come off lithium due to trying to get
pregnant. Inability to focus and concentrate affected. Received verbal warning at work Jun'24.
_4. Attempting to get pregnat with miscarriage Feb'24
_5. Medical leave from work ‐ Recommended she go out on leave 6/17/24 and start Arbour PHP, restart
therapy with Dyanne and become my patient. STD is approved thru 9/30/24 and I am recommending STD
leave be extended through 10/31/24. STD not approved after 9/30/24 and switched to FMLA, approved
through 11/4/24. Requesting extension through 1/17/25.
_6. RTC in 2‐4wks, continue biweekly therapy with Dyanne London
GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 2 of 3 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Current Plan
Changes
seroquel inc'd 25‐>50mg
Orders
MEDICATION ORDERS
RisperDAL 1 MG TABS ; 1 MG ORALLY DAILY; QTY 60 TABLET; 0 REFILLS ﴾New﴿ Rx Issued via Electronic (Network)
CVS/pharmacy #1189 405 LINCOLN ST. , HINGHAM, MA 02043 (ph:7817491163)
Comment to Pharmacy: Allergy List: Doxycycline, and Reglan
Ordered by: NADAL‐VICENS, MIREYA MD, 75 MOUNT AUBURN STREET, 6TH FLOOR, CAMBRIDGE, MA 02138 ﴾ph:
6174952323﴿
BHM‐20 Survey reviewed by clinician:: Survey not completed by patient
Spent 38 minutes in Psychotherapy only
Disposition
RETURN VISIT
E/M Coding
VIDEO ESTAB ‐ MOD COMPLEXITY 99214
VIDEO/PHONE INDIV PSYCHOTHERAPY W/MED38‐52MIN﴾ALSO CODE E&M﴿ 90836
Signed by Mireya Nadal‐Vicens, MD on 11/1/2024 7:26:07 PM GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 3 of 3 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Richard A. and Susan F. Smith
Campus Center
75 Mt. Auburn Street
CambridgeMA02138
GREENWOOD, NICOLE Acct #: 21685011 DOB: 8/29/1991 Age: 33 yrs Sex: Female
10/21/2024 10:00 AM with LONDON, DYANNE PHD for BH TELEMEDICINE THERAPY
Encounter #: A6335398‐86
PCP Name: SIRCAR, MONICA MD
Type of Visit: MH Visit
This visit was conducted: by video and audio
At the beginning of this interaction, I determined that this patient was appropriate for telemedicine.
Patient's physical location ﴾U.S. state or territory, or country if outside US﴿: MAPatient is at: home
Clinician's physical location ﴾U.S. state﴿: MA Clinician is at: home
Consent: I introduced and identified myself and received verbal consent from the patient to proceed with this
video and/or telephone visit.
I provided my physical location and verified the patient's name, date of birth and physical location.
Clinic Notes
Next: any med changes, job
Pt described feeling panicky past few days, especially over the week‐end. Said she would talk very quickly,
became unorganized, couldn't focus on all the tasks she had to do.
Did go to the regatta and met up with mom to cheer her fiend on and went to Beverly to see another
friend. Anxious about having the Lincoln work completed and hoping it gets done soon. Concerned about
bfr's son who has missed 7 days of school so far, Sean is working very hard and making lots of money but
hos contract ends in Jan. She will continue to look for jobs. Said she has also been feeling less sexual, too
tired and poor sleep
Mental Status Exam: unchanged since last visit
Parasuicidal Behavior
none/not applicable
Diagnosis
Disruptive Mood Dysregulation Disorder ﴾F34.81﴿
Treatment review/Progress towards goals ﴾developed and discussed with patient﴿
to continue to assess and monitor symptoms, continue with Dr Nadal, take meds as prescribed,
acupuncture, CBT and MI modalities
Current Plan
Unchanged
BHM‐20 Survey reviewed by clinician:: Survey not completed by patient
Spent 53 minutes in Psychotherapy only
Harvard UHS Page 1 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Disposition
RETURN VISIT
E/M Coding
VIDEO/PHONE INDIV. PSYCHOTHERAPY 53 MINS OR MORE 90837
Signed by Dyanne London, PhD. on 10/23/2024 1:02:09 PM GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 2 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Richard A. and Susan F. Smith
Campus Center
75 Mt. Auburn Street
CambridgeMA02138
GREENWOOD, NICOLE Acct #: 21685011 DOB: 8/29/1991 Age: 33 yrs Sex: Female
10/15/2024 10:00 AM with LONDON, DYANNE PHD for BH TELEMEDICINE THERAPY
Encounter #: A6335396‐60
PCP Name: SIRCAR, MONICA MD
Type of Visit: MH Visit
This visit was conducted: by video and audio
At the beginning of this interaction, I determined that this patient was appropriate for telemedicine.
Patient's physical location ﴾U.S. state or territory, or country if outside US﴿: MAPatient is at: home
Clinician's physical location ﴾U.S. state﴿: MA Clinician is at: home
Consent: I introduced and identified myself and received verbal consent from the patient to proceed with this
video and/or telephone visit.
I provided my physical location and verified the patient's name, date of birth and physical location.
Clinic Notes
Next: did she get job, issues re: Lincoln resolved
Pt described being extremely anxious and stressed over not hearing back from her psychiatrist about
paperwork needed back to Lincoln. In addition, she was not feeling well and not hearing back from some
jobs. Discussed focusing on one thing at a time, she was glad she continues to pursues jobs her recruiter
sends her and she has a second interview later today. Is planning to continue in therapy with me in my
private practice if she no longer can be at HUHS and will need to discuss with Dr Nadal re: meds. She
seemed hopeful and positive
Mental Status Exam: unchanged since last visit
Parasuicidal Behavior
none/not applicable
Diagnosis
Disruptive Mood Dysregulation Disorder ﴾F34.81﴿
Treatment review/Progress towards goals ﴾developed and discussed with patient﴿
to continue to assess and monitor symptoms, continue with Dr Nadal, take meds as prescribed,
acupuncture, CBT and MI modalities
Current Plan
Unchanged
BHM‐20 Survey reviewed by clinician:: Survey not completed by patient
Spent 53 minutes in Psychotherapy only
Disposition
RETURN VISIT
Harvard UHS Page 1 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
E/M Coding
VIDEO/PHONE INDIV. PSYCHOTHERAPY 53 MINS OR MORE 90837
Signed by Dyanne London, PhD. on 10/17/2024 9:11:22 AM GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 2 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Richard A. and Susan F. Smith
Campus Center
75 Mt. Auburn Street
CambridgeMA02138
GREENWOOD, NICOLE Acct #: 21685011 DOB: 8/29/1991 Age: 33 yrs Sex: Female
10/8/2024 8:00 AM with LONDON, DYANNE PHD for BH TELEMEDICINE THERAPY
Encounter #: A6335397‐73
PCP Name: SIRCAR, MONICA MD
Type of Visit: MH Visit
This visit was conducted: by video and audio
At the beginning of this interaction, I determined that this patient was appropriate for telemedicine.
Patient's physical location ﴾U.S. state or territory, or country if outside US﴿: MAPatient is at: home
Clinician's physical location ﴾U.S. state﴿: MA Clinician is at: home
Consent: I introduced and identified myself and received verbal consent from the patient to proceed with this
video and/or telephone visit.
I provided my physical location and verified the patient's name, date of birth and physical location.
Clinic Notes
Next: Lincoln stuff all in, any job info
Pt described feeling very low, unmotivated, has been sick, anxious about making sure all info is in to
Lincoln, Talked about not ready to go back to work, if she had to do part time of 20 hours, while
continuing to look for other possibilities, give notice. She and her supervisor, upper level folks do not get
along. will ask dr N to increase her meds to 50 from 25.
Planning on resuming ivf sometime perhaps in December but starting the process of ordering meds in
November,
Mental Status Exam: unchanged since last visit
Parasuicidal Behavior
none/not applicable
Diagnosis
Disruptive Mood Dysregulation Disorder ﴾F34.81﴿
Treatment review/Progress towards goals ﴾developed and discussed with patient﴿
to continue to assess and monitor symptoms, continue with Dr Nadal, take meds as prescribed,
acupuncture, CBT and MI modalities
Current Plan
Unchanged
BHM‐20 Survey reviewed by clinician:: Survey not completed by patient
Spent 53 minutes in Psychotherapy only
Harvard UHS Page 1 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN
Disposition
RETURN VISIT
E/M Coding
VIDEO/PHONE INDIV. PSYCHOTHERAPY 53 MINS OR MORE 90837
Signed by Dyanne London, PhD. on 10/10/2024 9:16:59 AM GREENWOOD, NICOLE Pt#: 21685011 DOB: 8/29/1991 Sex: F Age: 33 yrs Harvard UHS Page 2 of 2 Printed 11/21/2024 by SANDERSON, RICHARD ADMIN