Dialogue:
Doctor: Good afternoon, sir. My chart here says that you are a fifty one year old white male, is that correct?
Patient: Good afternoon, doctor. Yes, all of that is correct. 
Doctor: Great, thank you. Please, walk me through the history of your symptoms, when did everything begin. 
Patient: Well, I was diagnosed with P T L D towards the end of two thousand seven. 
Doctor: What symptoms were you experiencing? 
Patient: I had swollen lymph nodes, stomach pain, I was losing a lot of weight, and I wasn't really eating. 
Doctor: How have you been treated for this?
Patient: Well, I didn't go to the doctor right away, but eventually I went to the hospital, and they did a biopsy of my groin lymph nodes, and they found large scale lymphoma. 
Doctor: Who's care were you under in the hospital? 
Patient: Um, it was the renal transplant services. Oh yeah, they talked about my case at the hematopathology conference. 
Doctor: That's interesting. After you were diagnosed, what treatments were you given?
Patient: Um, I started chemo with, um, I have it written down, cyclophosphamide, daunorubicin, vincristine, and prednisone. 
Doctor: Did you have any complications with chemo? 
Patient: Um, yeah, I had sepsis during my first cycle, they said that I had it even with growth factor support. I was also disoriented. 
Doctor: How many cycles of chemo have you completed? 
Patient: I've done five to date. 
Doctor: Did you have your P E T Scan after your first three cycles? 
Patient: No, I wasn't feeling well at all, so I didn't go. 
Doctor: Has your chemotherapy been interrupted for any other reason? 
Patient: Yeah, I had an infection related to the skin cancer, and a chest infection, sir. 
Doctor: Did you have surgery for the skin cancer? 
Patient: Yes, I did. 
Doctor: Okay, and you're here for your sixth round of chemo, correct? 
Patient: Yes, that's correct. 
Doctor: How are you feeling today?
Patient: Overall, I feel pretty well. 
Doctor: Are you having any cold or flu like symptoms today? 
Patient: No. 
Doctor: Any shortness of breath, or chest pain?
Patient: No, doctor. 
Doctor: Finally, your E C O G score is one according to the nurse, is that correct? 
Patient: Yes, doctor. That's correct.

Clinical note section (GENHX):
A 51-year-old white male diagnosed with PTLD in latter half of 2007.  He presented with symptoms of increasing adenopathy, abdominal pain, weight loss, and anorexia.  He did not seek medical attention immediately.  He was finally hospitalized by the renal transplant service and underwent a lymph node biopsy in the groin, which showed diagnosis of large cell lymphoma.  He was discussed at the hematopathology conference.  Chemotherapy with rituximab plus cyclophosphamide, daunorubicin, vincristine, and prednisone was started.  First cycle of chemotherapy was complicated by sepsis despite growth factor support.  He also appeared to have become disoriented either secondary to sepsis or steroid therapy. The patient has received 5 cycles of chemotherapy to date.  He did not keep his appointment for a PET scan after 3 cycles because he was not feeling well.  His therapy has been interrupted for infection related to squamous cell cancer, skin surgery as well as complaints of chest infection. The patient is here for the sixth and final cycle of chemotherapy.  He states he feels well.  He denies any nausea, vomiting, cough, shortness of breath, chest pain or fatigue.  He denies any tingling or numbness in his fingers.  Review of systems is otherwise entirely negative. Performance status on the ECOG scale is 1.