Age: 51.0
Sex: F
Vaccine: COVID19
Symptoms: Blood urine absent, Bradycardia, Bundle branch block right, Carbon dioxide normal, Cardiac murmur
Clinical narrative: Possible TIA, received TPA-April 2022; episode of flushing, vomiting, and near syncope March 2022; Admitted to hospital May 2022, new heart murmur July 2022. DO Physician Specialty:  Cardiology Progress Notes    Signed Encounter Date:  7/19/2022      Expand AllCollapse All        Hide copied text  Hover for details  .  Subjective:   Patient ID: Patient is an 52 y.o. female.   Chief Complaint:  Chief Complaint Patient presents with ? Consultation     Heart murmur.      HPI    NP referral for near syncope. Recently hosp for ? TIA. Having vague symptoms since taking Covid booster in Jan. Had symptomatic bradycardia in ICU. On BB for tachycardia. Dx with new "mumur" echo normal.       Past Medical History Past Medical History: Diagnosis Date ? Asthma   ? Diabetes mellitus   ? High cholesterol   ? Seasonal allergies       Past Surgical History Past Surgical History: Procedure Laterality Date ? HX CESAREAN SECTION       1995 ? HX CHOLECYSTECTOMY       feb 2008 ? HX EGJ N/A 10/8/2021   EGD /C BIOPSY performed by MD  ? HX ESOPHAGEAL MOTILITY/MANOMETRY   11/18/2021   HIGH RESOLUTION ESOPHAGEAL MOTILITY performed by MD ? HX HYSTERECTOMY     ? HX OTHER SURGICAL HISTORY       spur in nasal cavity ? HX TONSILLECTOMY     ? PR BIOPSY OF BREAST, INCISIONAL       lt bx benign     Family History Family History Problem Relation Name Age of Onset ? Diabetes Father     ? Cancer Father     ? Heart Disease Maternal Grandmother     ? Cancer Maternal Grandfather     ? Cancer Paternal Grandfather         Social History     Socioeconomic History ? Marital status: Divorced     Spouse name: Not on file ? Number of children: Not on file ? Years of education: Not on file ? Highest education level: Not on file Occupational History ? Not on file Tobacco Use ? Smoking status: Never Smoker ? Smokeless tobacco: Never Used Vaping Use ? Vaping Use: Never used Substance and Sexual Activity ? Alcohol use: Yes     Alcohol/week: 0.0 standard drinks     Comment: rarely ? Drug use: No ? Sexual activity: Not Currently Other Topics Concern ? Not on file Social History Narrative ? Not on file    Social Determinants of Health    Financial Resource Strain: Not on file Food Insecurity: Not on file Transportation Needs: Not on file Physical Activity: Not on file Stress: Not on file Social Connections: Not on file Intimate Partner Violence: Not on file Housing Stability: Not on file     Current Medications Current Outpatient Medications Medication Sig Dispense Refill ? ubrogepant (UBRELVY) 100 mg tablet Take 1 Tablet by mouth As directed. Take 1 tab with migraine.  Can repeat in 2hrs if needed.  No more than 2/24hrs. 16 Tablet 3 ? propranoloL (INDERAL) 10 mg tablet Take 0.5 Tabs by mouth Once Daily. 90 Tablet 3 ? buPROPion (WELLBUTRIN XL) 300 mg XL tablet Take 1 Tablet by mouth Once Daily. Not dose change, discontinue the evening dose of wellbutrin 90 Tablet 0 ? aspirin (ASPIRIN) 81 mg DR tablet Take 1 Tablet by mouth Once Daily. Indications: CVA 90 Tablet 3 ? esomeprazole (NEXIUM) 20 mg DR capsule Take 20 mg by mouth Once Daily.     ? ergocalciferol (VITAMIN D2) 50,000 unit CAPSULE Take 1 Capsule by mouth Every week. 12 Capsule 3 ? cyanocobalamin (VITAMIN B12) 1,000 mcg/mL injection Administer 1 mL subcutaneously As directed. Give 1 ml SQ daily for 7 days, then 1 ml SQ weekly for 4 weeks, then 1 ml SQ every other week for 4 weeks, then 1 ml SQ monthly x 12 months 30 mL 1 ? Insulin Needles, Disposable, 31 gauge x 3/16" Ndle 1 Each As directed. 50 Each 3 ? dapagliflozin (FARXIGA) 10 mg tablet Take 1 Tablet by mouth Once Daily. 90 Tablet 3 ? levothyroxine (SYNTHROID) 88 mcg tablet Take 1 Tablet by mouth Once Daily. 90 Tablet 3 ? pravastatin (PRAVACHOL) 10 mg tablet Take 1 Tablet by mouth At bedtime. Take with Co Q 10 90 Tablet 3 ? albuterol (VENTOLIN HFA) 90 mcg/Actuation inhaler Take 2 Puffs by inhalation Every 4 hours as needed. 1 Each 2 ? ondansetron (ZOFRAN ODT) 4 mg disintegrating tablet Take 1 Tablet by mouth EVERY 6 TO 8 HOURS PRN. (Patient taking differently: Take 4 mg by mouth EVERY 6 TO 8 HOURS PRN. As needed) 10 Tablet 0 ? meclizine (ANTIVERT) 25 mg tablet Take 1 Tablet by mouth Three times a day as needed. 270 Tablet 1 ? ibuprofen (MOTRIN) 800 mg tablet Take 1 Tab by mouth EVERY 6 TO 8 HOURS PRN for Pain. 60 Tab 0 ? brompheniramine-pseudoephedrine-DM (BROMFED DM) 2-30-10 mg/5 mL Take 5 mL by mouth Every 4 hours as needed (cough/congestion). 118 mL 0 ? EPINEPHrine (EPIPEN) 0.3 mg/0.3 mL AtIn Administer 1 Each subcutaneously As directed as needed. 1 Each 1 ? cetirizine (ZYRTEC) 10 mg tablet Take 10 mg by mouth Daily.     ? Coenzyme Q10 (CO Q-10) 100 mg Cap Take 1 Capsule by mouth Daily. 90 Capsule 0    No current facility-administered medications for this visit.     Allergies Allergen Reactions ? Imitrex [Sumatriptan] Anaphylaxis ? Celebrex [Celecoxib] Hives ? Codeine Hives ? Reglan [Metoclopramide Hcl] Other (See Comments)     "makes me feel weird"     Review of Systems  Constitutional: Positive for fatigue. Negative for appetite change, chills, diaphoresis and fever.  HENT: Negative for ear pain, hearing loss and sinus pressure.   Eyes: Negative for visual disturbance.  Respiratory: Negative for cough, choking, chest tightness, shortness of breath, wheezing and stridor.   Cardiovascular: Negative for chest pain, palpitations and leg swelling.  Gastrointestinal: Negative.   Musculoskeletal: Negative.   Skin: Negative.   Neurological: Positive for syncope and weakness. Negative for dizziness and headaches.  Psychiatric/Behavioral: Negative.        Objective: BP 114/82  | Pulse 87  | Ht 5' 7" (170.2 cm)  | Wt 80.7 kg (178 lb)  | SpO2 96%  | BMI 27.88 kg/m²    Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: She is well-developed.  HENT:     Head: Normocephalic and atraumatic.     Mouth/Throat:     Pharynx: No oropharyngeal exudate.  Eyes:     Conjunctiva/sclera: Conjunctivae normal.     Pupils: Pupils are equal, round, and reactive to light.  Neck:     Thyroid: No thyromegaly.     Vascular: No JVD.     Trachea: No tracheal deviation.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds. No murmur heard.   No friction rub. No gallop.  Pulmonary:     Effort: Pulmonary effort is normal.     Breath sounds: Normal breath sounds.  Abdominal:     General: Bowel sounds are normal.     Palpations: Abdomen is soft. There is no mass.     Tenderness: There is no abdominal tenderness. There is no guarding or rebound.  Musculoskeletal:     Cervical back: Normal range of motion and neck supple.  Skin:    General: Skin is warm and dry.     Findings: No rash.  Neurological:     Mental Status: She is alert.  Psychiatric:        Behavior: Behavior normal.        EKG: SR RBBB      Assessment/Plan:    1. Tachycardia  12 Lead EKG Same Visit 2. Mixed hyperlipidemia    3. Statin intolerance    4. Bradycardia    5. Syncope, unspecified syncope type        Check 2 week EM Check Tilt table- ? Post covid autonomic dysfunction   Cont BB  DO Physician Specialty:  Emergency Medicine ED Provider Notes    Signed Date of Service:  07/16/21 0415             Hide copied text  Hover for details  Patient (F) - 51 y.o. Note Creation:7/16/2021 Encounter Date:7/16/2021      History    Chief Complaint Patient presents with ? Abdominal Pain     Patient is a 51 y.o. female with no pertinent medical histroy who presents to the emergency department for the evaluation of sharp abdominal pain that began approximately 1 day ago. Pt states that she was at work when symptoms began. She complains of associated nausea. She deneis any fever, chills, vomiting, shortness of breath, light-headedness, or HA. She denies any other pertinent symptoms or concerns. She denies any other aggravating or alleviating factors. She denies any other pertinent past medical history.     The history is provided by the patient and medical records. No language interpreter was used.       Past Medical History: Diagnosis Date ? Asthma   ? Seasonal allergies        Past Surgical History: Procedure Laterality Date ? HX CESAREAN SECTION       1995 ? HX CHOLECYSTECTOMY       feb 2008 ? HX HYSTERECTOMY     ? HX OTHER SURGICAL HISTORY       spur in nasal cavity ? HX TONSILLECTOMY     ? PR BIOPSY OF BREAST, INCISIONAL       lt bx benign      Family History Problem Relation Age of Onset ? Diabetes Father   ? Cancer Father   ? Heart Disease Maternal Grandmother   ? Cancer Maternal Grandfather   ? Cancer Paternal Grandfather        Social History    Tobacco Use ? Smoking status: Never Smoker ? Smokeless tobacco: Never Used Substance Use Topics ? Alcohol use: Yes     Alcohol/week: 0.0 standard drinks     Comment: rarely ? Drug use: No     Patient is not a tobacco user.   No LMP recorded. Patient has had a hysterectomy.    Allergies Allergen Reactions ? Imitrex [Sumatriptan] Anaphylaxis ? Celebrex [Celecoxib] Hives ? Codeine Hives ? Reglan [Metoclopramide Hcl] Other (See Comments)     "makes me feel weird"      Current Discharge Medication List    Medication list as of: 7/16/2021  7:56 AM    CONTINUE these medications which have NOT CHANGED    Medication AM Noon PM Bedtime;    propranoloL (INDERAL) 10 mg tablet [   ] [   ] [   ] [   ]     Take 1 Tablet by mouth Daily., Disp-90 Tablet, R-1, Normal             pravastatin (PRAVACHOL) 10 mg tablet [   ] [   ] [   ] [   ]     Take 1 Tablet by mouth At bedtime. Take with Co Q 10, Disp-90 Tablet, R-0, Normal             Coenzyme Q10 (CO Q-10) 100 mg Cap [   ] [   ] [   ] [   ]     Take 1 Capsule by mouth Daily., Disp-90 Capsule, R-0, Normal             levothyroxine (SYNTHROID) 88 mcg tablet [   ] [   ] [   ] [   ]     Take 1 Tablet by mouth Daily., Disp-90 Tablet, R-1, Normal             metFORMIN (GLUCOPHAGE-XR) 500 mg XR tablet [   ] [   ] [   ] [   ]     Take 4 Tabs by mouth Daily., Disp-360 Tablet, R-3, Normal             dicyclomine (BENTYL) 10 mg capsule [   ] [   ] [   ] [   ]     Take 1 Capsule by mouth Three times a day., Disp-270 Capsule, R-3, Normal             meclizine (ANTIVERT) 25 mg tablet [   ] [   ] [   ] [   ]     Take 1 Tablet by mouth Three times a day as needed., Disp-270 Tablet, R-1, Normal             !! ondansetron HCL (ZOFRAN) 4 mg tablet [   ] [   ] [   ] [   ]     Take 1 Tablet by mouth Twice a day as needed for Nausea., Disp-30 Tablet, R-1, Normal             Rizatriptan (MAXALT-MLT) 5 mg TbDL [   ] [   ] [   ] [   ]     Take 5 mg by mouth As needed. The patient states she has had maxalt before and she did not have any allergic reaction., Disp-27 Tab, R-1, Normal             ibuprofen (MOTRIN) 800 mg tablet [   ] [   ] [   ] [   ]     Take 1 Tab by mouth EVERY 6 TO 8 HOURS PRN for Pain., Disp-60 Tab, R-0, Normal             ipratropium (ATROVENT) 0.06 % nasal spray [   ] [   ] [   ] [   ]     Spray 2 Sprays in nose Every 12 hours as needed., Disp-1 Bottle, R-0, Normal             brompheniramine-pseudoephedrine-DM (BROMFED DM) 2-30-10 mg/5 mL [   ] [   ] [   ] [   ]     Take 5 mL by mouth Every 4 hours as needed (cough/congestion)., Disp-118 mL, R-0, Normal             !! albuterol (VENTOLIN HFA) 90 mcg/Actuation inhaler [   ] [   ] [   ] [   ]     Take 2 Puffs by inhalation Every 4 hours as needed., Disp-1 Inhaler, R-0, Normal             mupirocin calcium (BACTROBAN) 2 % CREAM [   ] [   ] [   ] [   ]     by Topical route Twice a day., Disp-30 g,R-0, Normal             ezetimibe (ZETIA) 10 mg tablet [   ] [   ] [   ] [   ]     Take 1 Tab by mouth Daily., Disp-90 Tab,R-1, Normal             !! albuterol (VENTOLIN HFA) 90 mcg/Actuation inhaler [   ] [   ] [   ] [   ]     Take 2 Puffs by inhalation Every 6 hours as needed., Disp-3 Each,R-0, Normal             EPINEPHrine (EPIPEN) 0.3 mg/0.3 mL AtIn [   ] [   ] [   ] [   ]     Administer 1 Each subcutaneously As directed as needed., Disp-1 Each, R-1, Normal             !! ondansetron HCL (ZOFRAN) 4 mg tablet [   ] [   ] [   ] [   ]     Take 1 Tab by mouth Three times a day as needed for Nausea., Disp-10 Tab, R-1, Normal             cetirizine (ZYRTEC) 10 mg tablet [   ] [   ] [   ] [   ]                   triamcinolone (NASACORT) 55 mcg [   ] [   ] [   ] [   ]                   OMEPRAZOLE (PRILOSEC PO) [   ] [   ] [   ] [   ]                    !!  Potential duplicate medications found. Please discuss with provider.            Review of Systems   Review of Systems  Constitutional: Negative for chills and fever.  HENT: Negative for facial swelling.   Eyes: Negative for visual disturbance.  Respiratory: Negative for cough and shortness of breath.   Cardiovascular: Negative for chest pain.  Gastrointestinal: Positive for abdominal pain and nausea. Negative for vomiting.  Endocrine: Negative for cold intolerance and heat intolerance.  Genitourinary: Negative for dysuria.  Musculoskeletal: Negative for arthralgias.  Skin: Negative for rash.  Allergic/Immunologic: Negative for immunocompromised state.  Neurological: Negative for dizziness, weakness, light-headedness and headaches.  Hematological: Does not bruise/bleed easily.  Psychiatric/Behavioral: Negative for suicidal ideas.       Physical Exam    ED Triage Vitals [07/16/21 0337] BP BP Manual or Automatic? Patient Position BP Location Heart Rate (Monitor) 130/84 Automatic Sitting Right Arm --   Pulse Pulse Source Respirations Temp Temp Source 84 -- 20 98.5 °F (36.9 °C) Oral   SpO2 SPO2 Location O2 Delivery O2 Device O2 Flow Rate (l/min) 99 % -- Room air -- --   FIO2 (%) Pain Intensity 1 Exacerbated By Relieved By Quality -- 6 -- -- --   Duration         --             Physical Exam Vitals and nursing note reviewed.  Constitutional:      General: She is not in acute distress.    Appearance: She is well-developed.  HENT:     Head: Normocephalic and atraumatic.  Eyes:     General:        Right eye: No discharge.        Left eye: No discharge.     Pupils: Pupils are equal, round, and reactive to light.  Cardiovascular:     Rate and Rhythm: Normal rate and regular rhythm.     Heart sounds: Normal heart sounds.  Pulmonary:     Effort: Pulmonary effort is normal. No respiratory distress.     Breath sounds: Normal breath sounds.  Abdominal:     General: There is no distension.     Palpations: Abdomen is soft.     Tenderness: There is generalized abdominal tenderness.  Musculoskeletal:        General: No deformity.     Cervical back: Normal range of motion and neck supple.  Skin:    General: Skin is warm and dry.     Findings: No rash.  Neurological:     Mental Status: She is alert and oriented to person, place, and time.        MDM   Treatment: Procedures    Medications NS (sodium chloride 0.9%) IV bolus (0 mL Intravenous Stopped 7/16/21 0619) ondansetron hcl (PF) (ZOFRAN) injection 4 mg (4 mg Intravenous Given 7/16/21 0401) ketorolac (TORADOL) injection 15 mg (15 mg Intravenous Given 7/16/21 0402) iopamidol 76% (ISOVUE-370) 76 % injection 75 mL (75 mL Intravenous Given 7/16/21 0443) ketorolac (TORADOL) injection 15 mg (15 mg Intravenous Given 7/16/21 0801) dicyclomine (BENTYL) injection 20 mg (20 mg Intramuscular Given 7/16/21 0803)      Results for orders placed or performed during the hospital encounter of 07/16/21 CBC Result Value Ref Range   WBC 9.6 4.5 - 11.0 10*3/uL   RBC 4.32 4.00 - 5.20 10*6/uL   HGB 12.7 12.0 - 16.0 g/dL   HCT 36.1 33.0 - 51.0 %   MCV 83.6 80.0 - 100.0 fL   MCHC 35.1 32.0 - 36.0 g/dL   MCH 29.4 26.0 - 34.0 pg   RDW 14.2 (H) 11.5 - 13.1 %   MPV 8.1 6.5 - 10.0 fL   Platelet Cnt 240 150 - 450 10*3/uL   Differential Type Auto     Neutrophils 57.4 35 - 66 %   Lymphocytes 29.3 24.0 - 44.0 %   Monocytes 10.7 2 - 13 %   Eosinophils 2.3 0.3 - 5.0 %   Basophils 0.3 0.0 - 1.0 %   Neutrophils Abs 5.5 1.5 - 8.5 10*3/uL   Lymphocytes Abs 2.8 1.1 - 5.0 10*3/uL   Monocytes Abs 1.0 0.0 - 1.4 10*3/uL   Eosinophils Abs 0.2 0.0 - 0.5 10*3/uL   Basophils Abs 0.0 0.0 - 0.1 10*3/uL Comprehensive Metabolic Panel Result Value Ref Range   SODIUM 137 135 - 145 mmol/L   POTASSIUM 3.8 3.6 - 5.0 mmol/L   CHLORIDE 104 101 - 111 mmol/L   CO2 25 21 - 31 mmol/L   ANION GAP 8     GLUCOSE 143 (H) 70 - 110 mg/dL   CREATININE 0.7 0.4 - 1.0 mg/dL   BUN 12 6 - 20 mg/dL   CALCIUM 9.0 8.5 - 10.5 mg/dL   PROTEIN TOTAL 6.3 (L) 6.7 - 8.2 g/dL   Albumin 4.0 3.2 - 5.0 g/dL   T BILIRUBIN 0.6 0.2 - 1.0 mg/dL   ALP 88 42 - 121 [iU]/L   AST 11 10 - 42 [iU]/L   ALT (SGPT) 10 10 - 60 [iU]/L   OSMOLALITY 276 266 - 309   A/G Ratio 1.7     B/C 17 10 - 20   ESTIMATED GFR 88 mL/min Lactic Acid, Venous Result Value Ref Range   LACTIC ACID 1.2 0.5 - 1.9 mmol/L Lipase Result Value Ref Range   LIPASE 15 11 - 82 U/L Magnesium Result Value Ref Range   MAGNESIUM 1.7 1.7 - 2.8 mg/dL UA for Infection (Reflex Culture)   Specimen: Urine, Clean Catch Result Value Ref Range   UR GLUCOSE Normal NEGATIVE mg/dL   UR BILIRUBIN Negative NEGATIVE mg/dL   UR KETONE Negative NEGATIVE mg/dL   UR SP GRAVITY 1.013 1.005 - 1.030   UR BLOOD Trace (A) NEGATIVE mg/dL   UR PH 5.5 5.0 - 9.0   UR PROTEIN Negative NEGATIVE mg/dL   UR UROBILINOGEN Normal <2.0   UR NITRITE Negative NEGATIVE mg/dL   UR LEUKOCYTE Moderate (A) NEGATIVE   UR COLOR Light-Yellow YELLOW   UR CLARITY Clear CLEAR   UR WBC 21-50 (A) 1 - 3 [HPF]   UR RBC 1-3 1 - 3 [HPF]   UR SQUAMOUS EPI 1-3 3 - 5 [HPF]   UR NON-SQUAMOUS EPI 1 NONE SEEN [HPF]   UR MUCOUS Rare NONE SEEN [HPF]   UR BACTERIA None Seen NONE SEEN [HPF]      Results         CT Abdomen & Pelvis-IV ONLY (Final result)  Result time 07/16/21 07:47:46     Final result             Impression:    IMPRESSION:  1. Mild acute sigmoid diverticulitis. Please see details above. No free air. No  associated abscess formation.  2. Status post cholecystectomy.  3. Status post hysterectomy.  THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD on 07/16/2021 07:47  AM        Narrative:    PROCEDURE INFORMATION:  Exam: CT Abdomen And Pelvis With Contrast  Exam date and time: 7/16/2021 4:44 AM  Age: 51 years old  Clinical indication: Abdominal pain; Generalized; Prior surgery; Surgery date:  6+ months; Surgery type: Surg hyst csection chole. HX breast cancer. Abd pain.  Nausea. R/O diverticulitis. 75 cc's isovue 370 inj @ 2ml/sec 18g right arm. CT  room 2.   TECHNIQUE:  Imaging protocol: Computed tomography of the abdomen and pelvis with contrast.  Radiation optimization: All CT scans at this facility use at least one of these  dose optimization techniques: automated exposure control; mA and/or kV  adjustment per patient size (includes targeted exams where dose is matched to  clinical indication); or iterative reconstruction.  Contrast material: ISOVUE; Contrast volume: 75 ml; Contrast route: INTRAVENOUS  (IV).   Other technique: At the time of dictation 389 images were present.  COMPARISON:  No relevant prior studies available.  FINDINGS:  Lungs: Visualized lung segments are clear.  Pleural spaces: No pleural effusion.  Heart: No cardiomegaly. No pericardial effusion.  Liver: No hepatomegaly. No focal parenchymal abnormality.  Gallbladder and bile ducts: Status post cholecystectomy. No intra or  extrahepatic biliary ductal dilatation.  Pancreas: No pancreatic ductal dilatation. No peripancreatic fat stranding or  fluid collection. No focal parenchymal abnormality.  Spleen: No splenomegaly. No focal parenchymal abnormality.  Adrenal glands: No adrenal masses.  Kidneys and ureters: The kidneys enhance symmetrically. No focal parenchymal  abnormality. No renal stones. No hydronephrosis. No perinephric fluid  collection.  Stomach and bowel: The stomach is collapsed precluding its evaluation. No small  bowel obstruction. Moderate amount of stool in the right and transverse  segments of the colon. Diverticula scattered throughout the colon, more  numerous at the level of the sigmoid colon. Haziness/stranding of the fat  surrounding a large 1.5 x 1.1 cm sigmoid diverticulum in the pelvis on the left  (series 2, image 69). No associated fluid collection or abscess formation.  Appendix: No CT findings to suggest acute appendicitis.  Intraperitoneal space: No free air. No ascites. No fluid collection or abscess  formation.  Vasculature: No abdominal aortic aneurysm. The hepatic veins, portal vein,  splenic vein and superior mesenteric vein are well opacified. Right pelvic  phlebolith.  Lymph nodes: No pathologic lymphadenopathy by radiologic size criteria  Urinary bladder: The urinary bladder is almost completely collapsed limiting  its evaluation. However, no gross abnormality is identified.  Reproductive: Status post hysterectomy.  Bones/joints: No suspicious osseous lesions  Soft tissues: 1.5 cm fat containing umbilical hernia. No associated acute  inflammatory changes. Otherwise, the soft tissue structures of the wall of the  abdomen are unremarkable. The soft tissue structures of the wall of the  visualized lower chest and pelvis are unremarkable. No thickening of the  prevertebral soft tissues. The paraspinal musculature is unremarkable.               Preliminary result             Impression:    This exam has been sent to vRad for reading.  The final report is not yet available.                 Plan:   ED RECHECK: Discharge: The pt is awake, alert and well appearing at time of reevaluation. I spoke with the patient about her ED work up, diagnosis and any further treatment. I discussed the importance of following up with her PCP. I instructed her to return to the Emergency Room for new or worsening symptoms. All of the pt's questions were answered. The patient verbalized understanding. The patient is stable at time of discharge.   MDM Number of Diagnoses or Management Options   Amount and/or Complexity of Data Reviewed Clinical lab tests: ordered and reviewed Tests in the radiology section: ordered and reviewed Decide to obtain previous medical records or to obtain history from someone other than the patient: yes Obtain history from someone other than the patient: yes Review and summarize past medical records: yes Independent visualization of images, tracings, or specimens: yes   Risk of Complications, Morbidity, and/or Mortality Presenting problems: moderate Diagnostic procedures: moderate Management options: moderate  Patient Progress Patient progress: stable     Progress Note:    ED Course as of Jul 16 1907 Fri Jul 16, 2021 0645 ESTIMATED GFR: 88    ED Course User Index DO      ED Prescriptions    Medication Sig Dispense Start Date End Date Auth. Provider   ondansetron (ZOFRAN ODT) 4 mg disintegrating tablet Take 1 Tablet by mouth EVERY 6 TO 8 HOURS PRN. 10 Tablet 7/16/2021   DO   ketorolac (TORADOL) 10 mg tablet Take 1 Tablet by mouth Every 8 hours as needed. 9 Tablet 7/16/2021   DO   amoxicillin-pot clavulanate (AUGMENTIN) 875-125 mg per tablet Take 1 Tablet by mouth Twice a day for 10 days. 20 Tablet 7/16/2021 7/26/2021 NP   ondansetron HCL (ZOFRAN) 4 mg tablet Take 1 Tablet by mouth Twice a day as needed for Nausea for up to 7 days. 14 Tablet 7/16/2021 7/23/2021 NP         Final diagnoses: Lower abdominal pain Nausea Diverticulitis      ED Disposition    ED Disposition Condition Comment   Discharge After Treatment Stable