galgantar/MTS-Dialog-cleaned huggingface dataset:
Clinical note section (FAM/SOCHX): At home lives mom, dad, a 2-1/2-year-old brother, and a 5-1/2-year-old maternal stepbrother.  Both brothers at home are sick with cold symptoms including diarrhea and vomiting.  The brother (2-1/2-year-old) was seen in the ER tonight with this patient and discharged home with an albuterol prescription.  A nephew of the mom with an ear infection.  Mom also states that she herself was sick with the flu soon after delivery.  There has been recent travel exposure to dad's family over the Christmas holidays.  At this time, there is also exposure to indoor cats and dogs.  This patient also has positive smoking exposure coming from mom.

Dialogue:
Guest_family: My two and half year old son and five and half year old stepson are sick at home, they got a cold, diarrhea and are vomiting. 
Doctor: So, they saw a doctor?
Guest_family: Yes, the little one was taken up to E R and they gave him an inhaler of albuterol.
Guest_family_2: Is he getting sick because of me? I was sick with flu soon after delivery. 
Guest_family: Nephew is sick too.
Doctor: Did you travel anywhere recently?
Guest_family: Around Christmas time we visited dad's family. They had indoor cats and dogs. 
Doctor: Anyone smokes at home?
Guest_family_2: Yes, I do smoke.
Clinical note section (ALLERGY): None by history.

Dialogue:
Doctor: Do you have any known history of allergies?
Patient: No, I don't have any allergies.
Clinical note section (ASSESSMENT): Urinary tract infection, the patient was started on Macrodantin 100 mg orally every six hours for urinary tract infection secondary to Enterococcus species.

Dialogue:
Doctor: Are you taking Macrodantin?
Patient: Yes, I am.
Doctor: For your urine infection, right?
Patient: Yes.
Doctor: One hundred M G?
Patient: I think so.
Doctor: Okay so you had U T I because of the bacteria named Enterococcus.
Patient: Yes, and I am taking the medicine religiously every six hours.
Doctor: Great!
Clinical note section (PASTMEDICALHX): Huntington disease, symptoms of dementia and hypertension.  She has an upcoming appointment with the Neurologist.  Currently, does have a primary care physician and _______ having an outpatient psychiatrist, Dr. X, and her current Neurologist, Dr. Y.

Dialogue:
Doctor: I have your referral here, from your primary physician? She said that you have a history of Huntington disease and that you have been experiencing some memory loss and confusion. 
Patient: Yes. That's right! I also have high blood pressure. 
Doctor: Are you on medication for your high blood pressure? 
Patient: Yes, I am. 
Doctor: Can you tell me more about the memory problems you have been experiencing? 
Patient: My memory has been getting worse. I can never find anything, or people keep moving my things. 
Guest_family: She is not recognizing us more and more these days. And it takes her longer to realize what is going on. I made an appointment with the Neurologist for next week. 
Doctor: Who is her Neurologist? 
Guest_family: Doctor Townsend. 
Doctor: Are you seeing any other specialists for your condition?  
Patient: Yes, I see Doctor Smith. 
Doctor: What kind of doctor is Doctor Smith? 
Patient: She is a psychiatrist. I have been seeing her for a long time. 
Doctor: Oh okay. So, she is not a psychiatrist at our facility? 
Patient: No.
Clinical note section (PASTMEDICALHX): Recent history of pneumonia, urosepsis, dementia, amputation, osteoporosis, and hypothyroidism.

Dialogue:
Guest_family: She recently had pneumonia and urinary tract infection which caused urosepsis. 
Doctor: Oh, okay and she also had amputation of her left toes?
Guest_family: Yes three of them due to gangrene.
Doctor: Oh, I see.
Patient: She is my nurse, she stays with me.
Doctor: That is good, at least she remembers you. 
Guest_family: She does have her days when she does not recognize anyone including me.
Doctor: How long has she been suffering from dementia? 
Guest_family: For some time now, I don't know exactly.
Doctor: Okay, any other medical condition?
Guest_family: Yes, she has a history of hypothyroidism and osteoporosis. 
Doctor: Hm, alright let me make a note of that.
Clinical note section (ASSESSMENT): 1.  Hydrocarbon aspiration. 2.  Bilateral pneumonia with pneumonitis secondary to aspiration. 3.  Asplenic patient.

Dialogue:
Doctor: My diagnosis for you is aspiration pneumonia.
Patient: What kind of aspiration?
Doctor: Hydrocarbon.
Patient: Okay.
Doctor: And it is in both lungs that is causing infection. 
Patient: Also I don't have a spleen. Please add that to the notes.
Doctor: And you don't have a spleen.
Patient: Yes.
Clinical note section (ASSESSMENT): Viral gastroenteritis.

Dialogue:
Doctor: I belive you caught a virus.  You have the stomach flu.
Clinical note section (PASTMEDICALHX): Positive for morbid obesity, chronic lymphedema of the lower extremities, at least for the last three years, spastic colon, knee arthritis, recurrent cellulitis of the lower extremities.  She has had a hysterectomy and a cholecystectomy in the remote past.

Dialogue:
Doctor: I'd like to go over your medical history with you.
Patient: Okay, what would you like to know?  
Doctor: Let's start with your surgical history. 
Patient: I had my gallbladder removed along with my uterus several years ago. 
Doctor: Any complications with those surgeries? 
Patient: No. I recovered sooner than I anticipated. 
Doctor: That's always nice. 
Patient: I've been told many times in the past that I'm morbidly obese. It's never great to hear, but I'm trying my best given my current situation. I've had lymphedema in my legs for the last three years. I also suffer from arthritis. 
Doctor: Where's your arthritis the worst? 
Patient: Probably my knees. Oh, and I've been hospitalized in the past for recurring cellulitis in my legs. 
Doctor: When were you last hospitalized for cellulitis? 
Patient: Back in May. 
Doctor: And I remember reading in your chart that you were recently diagnosed with a spastic colon. 
Patient: Yes, that's correct.
Clinical note section (FAM/SOCHX): Ms. A completed high school degree.  She reported that she primarily obtained B's and C's in school.  She received some tutoring for algebra in middle school, but denied ever having been held back a grade failing any classes or having any problems with attention or hyperactivity. She currently works for the Social Security Administration in data processing.  she has returned to full-time work, but continues to perform only light duties due to her physical condition.  She is now living on her own.  She has never driven.  She reported that she continues to perform ADLs independently such as cooking and cleaning.  She lost her husband in 2005 and has three adult daughters.  She previously reported some concerns that her children wanted her to move into assisted living, but she did not discuss that during this current evaluation.  She also reported number of other family members who had recently passed away.  She has returned to activities she enjoys such as quire, knitting, and cooking and plans to go on a cruise to the Bahamas at the end of October.

Dialogue:
Doctor: Hi there! How are you today, Miss A? 
Patient: I am doing well. 
Doctor: Do you still live on your own? 
Patient: Yes, I do. My husband passed away in two thousand and five. I have been on my own ever since and I am doing fine.  
Doctor: I remembered you telling me that your three grown daughters wanted you to move into an assisted living facility. 
Patient: I think they are just scared for me to be alone, but I am doing just fine. I have had a bunch of other family members that have recently passed away. I think that made them nervus. 
Doctor: Are you still working? 
Patient: Yes, I am. I just returned to full time again, but they put me on light duty until I am fully healed. 
Doctor: What is it that you do for work? 
Patient: I work for Social Security Administration in data processing. All I have is a high school education. I am the kind of person that must stay busy. They give me lots of cool tasks to do.
Doctor: Did you have difficulties in school? 
Patient: No. I primarily got B's and C's in school.  I received some tutoring for algebra in middle school, but I was never held back a grade failing any classes.
Doctor: Did you ever have any problems with attention or hyperactivity?
Patient: No. 
Doctor: Do you drive a car? 
Patient: No. I have never driven before. 
Doctor: Are you able to perform your daily living activities such as getting dressed, cooking and cleaning independently?
Patient: Yes. I still do all that and more. 
Doctor: Have you been able to continue the other activities that you enjoy?
Patient: Yes! I am in the choir at church.  I am back to my knitting and cooking too. At the end of October I am going on a cruise to the Bahamas with a group of ladies from my church. 
Doctor: Excellent!
Patient: So many of my family members have passed away that I have realized I need to live my life to the fullest.
Clinical note section (FAM/SOCHX): The patient admits to heavy alcohol drinking in the past, quit several years ago.  He is also a former cigarette smoker, quit several years ago.

Dialogue:
Doctor: I will ask some questions related to your social history. 
Patient: Okay.
Doctor: Do you drink?
Patient: I use to drink a lot, but when my drinking habit started affecting my family, I knew I need to be sober. I quit it and it was like a decade ago. 
Doctor: Nice, what about smoking?
Patient: Same story, I use to smoke one pack of cigarettes everyday but quit it many years ago. 
Doctor: Wow man! You are an inspiration. I would love to see this level of commitment in all of my patients. If only that was possible.
Clinical note section (EXAM): MSK: The patient is ambulatory with normal and symmetric gait.  There is adequate range of motion without significant pain or deformity.

Dialogue:
Doctor: Are you able to move?
Patient: Yes, I can.
Doctor: Great I can see you are walking well.
Patient: But there is pain.
Doctor: It is quite normal with your situation.
Clinical note section (ALLERGY): None known.

Dialogue:
Doctor: Any known allergies? 
Patient: Um none that I can think of.
Clinical note section (GENHX): Hypertension treated with Cozaar 100 mg daily and Norvasc 10 mg daily.  Esophageal reflux treated with Nexium 40 mg daily.  Allergic rhinitis treated with Allegra 180 mg daily.  Sleep disturbances, depression and anxiety treated with Paxil 25 mg daily, Advair 10 mg nightly and Ativan 1 mg nightly.  Glaucoma treated with Xalatan drops.  History of chronic bronchitis with no smoking history for which he uses p.r.n. Flovent and Serevent.

Dialogue:
Guest_clinician: What medications is he on?  
Doctor: He's currently taking Nexium forty M G daily for esophageal reflux, Cozaar one hundred M G and Norvasc ten M G daily for hypertension, Allegra one eighty daily for allergic rhinitis, and Flovent and Serevent as needed for recurring bronchitis. 
Guest_clinician: Is he a smoker? 
Doctor: No.  
Guest_clinician: How often does he get bronchitis? 
Doctor: It looks like he last had it a year ago. 
Guest_clinician: I see. 
Doctor: He's also on Xalatan drops for glaucoma and Ativan one M G, Advair ten M G, and Paxil twenty five M G nightly for anxiety, depression, and sleep disturbances. 
Guest_clinician: Okay. I think I got it all down.
Clinical note section (CC): Blood-borne pathogen exposure.

Dialogue:
Doctor: Please don't be scared. We will evaluate you for possible infection in blood due to accidental exposure.
Patient: I am nervous.
Doctor: Oh.
Patient: Yeah.
Doctor: Please don't be. We are all with you.
Clinical note section (PASTSURGICAL): Appendectomy when she was 9 years old.

Dialogue:
Doctor: Have you ever had any surgeries? 
Patient: I had my appendix removed when I was nine years old.
Clinical note section (GENHX): The patient was recently hospitalized for CHF exacerbation and was discharged with increased medications.  However, he did not fill his prescriptions and came back with persistent shortness of breath on exertion and on rest.  He has history of orthopnea and PND.  He has gained a few pounds of weight but denied to have any palpitation, presyncope, or syncope.

Dialogue:
Doctor: Hi there, I am looking at your report and you were recently admitted to the hospital due to worsening of your condition of congestive heart failure.
Patient: Yeah, I was. 
Doctor: And then you were discharged but they increased your medications, right?
Patient: Yeah, they did increase my medicines.
Doctor: So, did you refill your medication? 
Patient: Oh, um, no I did not.
Doctor: But why?
Patient: Oh, I forgot.
Doctor: Hm! 
Patient: But now I am feeling shortness of breath and difficulty breathing and it's persistent.
Doctor: Okay, do you feel it now? 
Patient: Yes, at first it was mostly when I was climbing stairs but now even while I am resting, I have difficulty breathing.
Doctor: Any nausea vomiting?
Patient: No, not really.
Doctor: How is your diet? Did you gain or lose any weight?
Patient: I did gain few pounds but not so much. 
Doctor: Any palpitations?
Patient: No.
Doctor: Okay, did you fall unconscious or felt like you might fall unconscious?
Patient: No, nothing of that sort.
Doctor: You do have a history of difficulty breathing when you lay down right? 
Patient: Yes, I do and I have history of shortness of breath when I sleep.
Doctor: But no palpitation?
Patient: No.
Clinical note section (CC): Cut on foot.

Dialogue:
Doctor: What brings you in today? 
Patient: I was at the beach walking along the rocks. My foot slipped and I cut my foot on the barnacles.
Clinical note section (PASTMEDICALHX): Significant for history of seizure disorder, migraine headaches, coronary artery disease, CHF, apparently coronary stenting done, mitral valve prolapse, supraventricular tachycardia, pacemaker placement, colon cancer, and breast cancer.  None of the details of these are available.

Dialogue:
Doctor: How are your seizures?
Patient: Not good.
Doctor: Okay, let me review your file here. You got some serious heart problems along with colon and breast cancer.
Patient: Yes, that's about right.
Doctor: Can you tell me more about the heart issues?
Patient: Yeah. I had coronary artery disease, heart failure, mitral valve prolapse, and a very fast heart beat that is not normal.
Doctor: It says here you have been dealing with migraines too. How long have you been dealing with that?
Patient: All of my life. 
Doctor: When you did you get your stent placed in and your pacemaker?
Patient: Maybe fifteen years ago. 
Doctor: Okay. I need to know more details, do we have them somewhere?
Guest_clinician: Yes, I do have them over here.
Doctor: Thanks.
Clinical note section (FAM/SOCHX): The patient is accompanied with his wife.

Dialogue:
Doctor: Hi, how are you? 
Patient: Doing pretty well.  
Doctor: Is this your wife? I don't think we've met. 
Patient: Yes, let me introduce you. Doctor X, this is my wife ABC. 
Guest_family: Hi, Doctor X, it's nice to meet you. 
Doctor: You as well.
Clinical note section (FAM/SOCHX): The patient is a Mazatlan, Mexico resident, visiting her son here.

Dialogue:
Doctor: It's nice to finally meet your mom. 
Guest_family: I know, right? I talk about her a lot, so I'm glad that she's able to meet you. 
Doctor: Me too. She's visiting from Mexico, correct? 
Guest_family: Yep. She speaks very little English, but I can translate for her.  
Doctor: Which part of Mexico, if you don't mind me asking? 
Guest_family: Mazatlan, Mexico.
Clinical note section (LABS): Pulmonary function studies reportedly show a mild restrictive ventilatory defect without obstruction.  Diffusing capacity is well preserved. An overnight sleep study was performed on this patient at the end of 02/07.  At that time, she reported that her sleep was better in the laboratories compared to home.  She slept for a total sleep time of 398 minutes out of 432 minutes in bed (sleep proficiency 92 percent).  She fell asleep in the middle of latency of less than 1 minute.  She woke up after sleep onset of 34 minutes.  She had stage I sleep that was some elevated at 28 percent of total sleep time, and stage I sleep is predominantly evident in the lateral portion of the night.  The remainders were stage II at 69 percent, stage III and IV at 3 percent of total sleep time. The patient had no REM sleep. The patient had no periodic limb movements during sleep. The patient had no significant sleep-disordered breathing during non-REM sleep with less than one episode per hour.  Oxyhemoglobin saturation remained in the low to mid 90s throughout the night. Intermittent inspiratory flow limitation compatible with snoring was observed during non-REM sleep.

Dialogue:
Doctor: Hi there! Let's go over your sleep study that we did.
Patient: Sure, it was a good experience for me.
Doctor: Yes, I love to sleep too. So, your lung function studies showed a mild ventilatory defect but there was no obstruction.  Your lung capacity is good.
Patient: Okay that's good to know.
Doctor: Um, then, when we did, I think we did overnight sleep study on at the end of February sometime around seventh?  
Patient: Yes, that is correct date.
Doctor: Okay, okay.
Patient: At that time, I slept better in the lab as compared to home.  I slept for a total sleep time of three ninety eight minutes out of four thirty two minutes in bed.  I was asleep in one minute and got up leaving only thirty four minutes.
Doctor: Okay that a good thorough information. Looks like your sleep proficiency is ninety two percent. 
Patient: Yes, here is the complete report on all the stages of sleep.
Doctor: Okay let me check. You had stage one sleep that was some elevated at twenty eight some percent of total sleep time, and stage one sleep is predominantly evident in the lateral portion of the night.  The remainders were stage two at sixty nine percent, stage three and four at three percent of total sleep time. 
Patient: Yeah.
Doctor: You had no R E M sleep.
Patient: Yeah.
Doctor: And no periodic limb movements during sleep. 
Patient: Yeah.
Doctor: As well as you had no significant sleep disordered breathing during non R E M sleep with less than one episode per hour.
Patient: Yeah.
Doctor: Your oxyhemoglobin saturation remained in the low to mid ninety throughout the night. Intermittent inspiratory flow limitation compatible with snoring was observed during non R E M sleep. 
Patient: Okay.
Clinical note section (CC): "I can't walk as far as I used to."

Dialogue:
Doctor: Hi there, so tell me what's going on?
Patient: I have realized lately, I can't walk as much and as far I used to before.
Clinical note section (CC): Altered mental status.

Dialogue:
Doctor: What is going on? Is he okay?
Guest_family: No, I don't think he is okay.
Doctor: What do you mean?
Patient: He is speaking gibberish. 
Doctor: You mean he is talking without making any sense?
Patient: Yes exactly.
Clinical note section (FAM/SOCHX): The patient is retired.  She is married with three grown children.  Has a high school level education.  She does not smoke, drink or utilize illicit substances.

Dialogue:
Patient: Yeah, that's fine. 
Doctor: What's the highest level of education you've received?
Patient: Just a high school diploma. 
Doctor: Are you currently employed. 
Patient: Nope. I'm retired and relaxing at home. 
Doctor: Are you currently married?
Patient: Yeah, I have a husband.
Doctor: Do you have any children? 
Patient: Three kids, but they're all gown up. Less stress on me now. 
Doctor: Do you smoke or drink?
Patient: I have never been interested.
Doctor: So I am assuming no hard drugs?
Patient: Nope.
Clinical note section (ASSESSMENT): A 10-day-old neonate with: 1.  Seizure-like activity. 2.  Physiologic jaundice of the newborn.

Dialogue:
Doctor: Hi mom, this is Doctor Jay. He is a pediatric specialist, and he will take a look at the baby. 
Guest_clinician: Hi there, how are you?
Guest_family: I am a little scared!
Guest_clinician: Don't worry, we will take care of her. How old is she?
Guest_family: She is ten days old. 
Guest_clinician: And what did you notice? 
Guest_family: Well, I noticed these unusual jerky movement in her hand and leg. Like they suddenly start shaking.
Guest_clinician: Kind of seizure like?
Guest_family: Yeah.
Guest_clinician: Anything else going on with baby?
Guest_family: Hm, she was detected with infant jaundice when she was born. 
Doctor: Yeah, baby had physiological jaundice. 
Guest_clinician: Okay.
Clinical note section (FAM/SOCHX): He is single.  He has 2 children.  He drinks 4-8 beers per night and smokes half a pack per day for 30 years.  He was born in Salt Lake City.  He works in an electronic assembly for Harmony Music.  He has no history of hepatitis or blood transfusions.

Dialogue:
Doctor: Are you single? 
Patient: Yes, I'm a single father of two. 
Doctor: Do you drink or smoke? 
Patient: I've smoked half a pack a day for the last thirty years. I drink about four to eight beers a night. 
Doctor: Where do you work? 
Patient: I work in an electronic assembly for Harmony Music. 
Doctor: Is that nearby? 
Patient: Yeah. I used to work at a similar type of place before I moved here. 
Doctor: Where are you originally from? 
Patient: Salt Lake City. Born and raised. 
Doctor: Great.  
Patient: I miss it quite a bit actually. 
Doctor: I can imagine. It's home for you. I have two more questions before we wrap up here. Have you ever had hepatitis or needed a blood transfusion for any reason?
Clinical note section (ALLERGY): None.

Dialogue:
Doctor: Do you have any known allergies to medications? 
Patient: No.
Clinical note section (GENHX): The patient is a 2-year-old little girl who comes in with concerns about stuffiness, congestion and nasal drainage.  She does take Zyrtec on a fairly regular basis.  Mom is having some allergy trouble herself right now.  She does not know her colors.  She knows some of her shapes.  She speaks in sentences.  She is not showing much interest in the potty.  She is in the 80th percentile for height and weight, and still over 95th percentile for head circumference.  Mom has no other concerns.

Dialogue:
Doctor: Hi there, I am Doctor Green.
Guest_family: Hello Doctor, she is Emma and I am her mom, Diana. 
Doctor: Nice to meet you. Hi Emma, how are you?
Patient: Hi.
Guest_family: She speaks in full sentences, maybe just a little shy now.
Doctor: No problem, how old is she?
Guest_family: She is two years old. 
Doctor: Okay. So, what is going on with her?
Guest_family: Well, she is having some congestion and stuffiness and she also has a runny nose. 
Doctor: Okay, are you giving her any medicine? 
Guest_family: I gave her over the counter antiallergic.
Doctor: Do you know the name?
Guest_family: Yeah, its Zyrtec. I use it often. 
Doctor: Okay. Is anybody else sick in the house?
Guest_family: Actually, I am having some allergies myself right now. 
Doctor: Okay. Do you have any other concerns? 
Guest_family: Not really, but I wanted to talk about her growth. 
Doctor: Well, as per the growth chart she is doing fantastic. Her growth curve for both height and weight is at eighty percen-
Guest_family: Percentage?
Doctor: Eighty percentile. And her head percentile is still at ninety five.
Guest_family: Okay.
Doctor: Is she potty trained or did you start training her?
Guest_family: I tried couple of times, but she is showing no interest. 
Doctor: Give it time. Does she identify shapes and colors?
Guest_family: She knows some shapes, but still struggles with colors. 
Doctor: Okay. Any other concerns other than the congestion?
Guest_family: No, no other concerns.
Doctor: Alright then nice meeting you, bye Emma.
Patient: Bye.
Clinical note section (DIAGNOSIS): Intractable migraine with aura.

Dialogue:
Doctor: Do you have a history of classic migraines? 
Patient: Sadly, I do.  
Doctor: I'm sorry to hear that. Let me go ahead and place these orders for you and we'll hopefully get you feeling better soon. 
Patient: Thank you. I appreciate it. And can you keep the lights off when you leave? 
Doctor: Of course.
Clinical note section (CC): Found down.

Dialogue:
Guest_family: Is he okay? 
Guest_family: What happened? 
Doctor: We're running some tests on him, but it appears that he was found face down by his bed. We're thinking he may have tumbled off the side of his bed while asleep. 
Doctor: Does he have a history of falls? 
Guest_family: He's fallen once or twice before, but I wasn't with him when those happened either.
Clinical note section (GENHX): This 3-year-old male is brought by his mother with concerns about his eating.  He has become a very particular eater, and not eating very much in general.  However, her primary concern was he was vomiting sometimes after particular foods.  They had noted that when he would eat raw carrots, within 5 to 10 minutes he would complain that his stomach hurt and then vomit.  After this occurred several times, they stopped giving him carrots.  Last week, he ate some celery and the same thing happened.  They had not given him any of that since.  He eats other foods without any apparent pain or vomiting.  Bowel movements are normal.  He does have a history of reactive airway disease, intermittently.  He is not diagnosed with intrinsic asthma at this time and takes no medication regularly.

Dialogue:
Doctor: Good afternoon, young man. Is this your mother with you today? 
Patient: Yes, that's my mommy. 
Doctor: Can you tell me more about your son, ma'am? 
Guest_family: Well, he's three now, and he's become a really picky eater. 
Doctor: Is he eating in general? 
Guest_family: Well, no, not really. My real concern today is that he vomits sometimes after eating particular foods. 
Doctor: Which foods? 
Guest_family: Well, after eating raw carrots, like five to ten minutes after, he'll complain his stomach hurts and then vomit. 
Doctor: I assume you've stopped giving him carrots, then?
Guest_family: Yes, but last week after he ate celery the same thing happened. 
Doctor: Are there any other foods?
Guest_family: No, not that he's tried yet. 
Doctor: So, there's no pain or vomiting with other foods that you can notice? 
Guest_family: No, doctor. 
Doctor: Is he going to the bathroom regularly? 
Guest_family: Yes, no problems there. 
Doctor: Does he have any other major conditions?
Guest_family: Um, reactive airway disease, it happens sometimes. 
Doctor: Does he have asthma? 
Guest_family: No, he does not.
Clinical note section (CC): Blood in toilet.

Dialogue:
Doctor: Hi there, so tell me what is going on with you?
Patient: I went to use the toilet in the morning and saw blood. Not sure if it was from urine or stool.
Doctor: Oh, okay.
Clinical note section (GENHX): The patient was seen today by me at Nursing Home for her multiple medical problems.  The nurses report that she has been confused at times, having incontinent stool in the sink one time but generally she does not do that poorly.  She does have trouble walking which she attributes to weak legs.  She fell a couple of months ago.  Her eating has been fair.  She has been losing weight a little bit.  She denies diarrhea.  She does complain of feeling listless and unambitious and would like to try some Ensure.

Dialogue:
Doctor: Hi there! How are you today? 
Patient: Hello! I am hanging in there. 
Doctor: Do you remember me from our last visit? 
Patient: Yes! You are the doctor that comes to see me here. It is nice of you to come and see me here. 
Doctor: How do you like it here at the Nursing Home? 
Patient: I wish I didn't have to be here, but they are all very nice to me here. 
Doctor: That is good to hear. The nurses have been a bit concerned about you and have noticed some changes that they would like me to address. 
Patient: I fell. I lost my balance. 
Doctor: Do you remember when that was? 
Patient: When what was? 
Doctor: The fall. 
Patient: No. Not long ago. 
Guest_clinician: It was about a month ago that she fell. 
Doctor: The nurses tell me that you have had a trouble walking. Can you tell me what you have noticed? 
Patient: When I try to get up and walk around my legs are weak. I have never had problems with walking before. 
Doctor: Has the weakness in your legs been something that has been getting worse over time? 
Patient: No. It just was like that when I woke up one morning. 
Doctor: Your nurse tells me that you had and accident trying to get to the bathroom in time the other day. Does this happen to you often? 
Patient: No. I don't remember having any accidents. 
Doctor: The nurse said you went number two in the sink. 
Patient: Oh dear. I did that? I am so sorry dear. I don't remember that. 
Guest_clinician: It's okay ma'am. We are just concurred about you. She has never had any bathroom issues in the past. 
Doctor: Have you been eating well? 
Patient: I eat three times a day. 
Doctor: How much is left on your plate after each meal? 
Patient: I eat about half of what they give me. 
Doctor: That's not bad. 
Guest_clinician: She has lost a little weight. 
Patient: I have? 
Guest_clinician: Just a few pounds. 
Doctor: Have you experienced any diarrhea or loose stool? 
Patient: No. 
Doctor: How has your energy level been? Do you join in on any of the activities that they have going on here? 
Patient: No. I don't ever feel like doing things. I don't have any energy anymore. I wonder if I could try those drinks. What are they called? 
Guest_clinician: Ensure? 
Patient: Yes!
Clinical note section (FAM/SOCHX): As previously documented.

Dialogue:
Doctor: Any changes to your family history since your last visit? 
Patient: No, no changes.
Clinical note section (MEDICATIONS): Ibuprofen.

Dialogue:
Doctor: Are you taking any medications currently?
Patient: Um just Ibuprofen for my pain.
Clinical note section (ROS): The patient currently is agitated.  Rapidly moving his upper extremities.  No other history regarding his systems could be elicited from the patient.

Dialogue:
Doctor: Oh my God, you look so agitated. 
Patient: Um, can you help!
Doctor: Calm down sir and stop moving your hands, you might get hurt. 
Patient: Huh, I don't care I am just so frustrated. 
Doctor: Oh, what happened?
Patient: I don't want to talk about it.
Doctor: Do you have any fever or headache or anything?
Patient: I don't know. Can you not ask me so many questions?
Doctor: Sir you need to relax, or I might not be able to treat you.
Patient: I don't want any treatment.
Doctor: Relax.
Guest_clinician: Hey, what happened?
Doctor: This guy is really agitated, and I am not able to get any history regarding his condition. I don't know what to do.
Guest_clinician: Well, I think he needs to get admitted to a hospital or send him to emergency. You cannot deal with him here.
Doctor: Yeah, you are right. Sir, you need to go a hospital or to E R. Do you want me to call an ambulance?
Guest_clinician: Sir, you need to tell us, or we will call an ambulance for you.
Patient: Um.
Doctor: I am going to ask nurse to call an ambulance.
Clinical note section (PASTMEDICALHX): The patient delivered at term.  Birth weight was 6 pounds 1 ounce.  Postnatal complications:  Neonatal Jaundice.  The patient remained in the hospital for 3 days.  The in utero ultrasounds were reported to be normal.

Dialogue:
Guest_clinician: Is she full term? 
Doctor: Yes, she was delivered at term. Six pounds and one ounce. 
Guest_clinician: How's her bilirubin? I see here that she was hospitalized for three days due to neonatal jaundice. 
Doctor: Correct.  
Guest_clinician: Did the mom have an in utero ultrasound prior? 
Doctor: Yes, it was normal.
Clinical note section (ROS): Negative fever, negative fussiness, tracks with her eyes, some sneezing and hiccups.  This patient has developed some upper airway congestion in the past day.  She has not had any vomiting or diarrhea.  Per mom, she does not spit up, and mom is also unable to notice any relationship between these movements and feeds.  This patient has not had any rashes.  Mom was notified by the nurses at birth that her temperature may be low of approximately 97.5 degrees Fahrenheit.  Otherwise, the above history of present illness and other review of systems negative.

Dialogue:
Doctor: Hello there, how are you?
Guest_family: I am little scared. 
Doctor: I understand, so how old is she? 
Guest_family: She is ten days old today. 
Doctor: And just wanted to confirm the ethnicity is Caucasian, right?
Guest_family: Yes. 
Doctor: Okay, so tell me what's going on with her?
Guest_family: I was feeding her and then I suddenly noticed this unusual jerky movement in both her arms and legs. 
Guest_family: It lasted about a minute. 
Doctor: When did you first notice it? 
Guest_family: The first day when I was feeding her. She was barely a day old.
Doctor: Okay, and how many times till now?
Guest_family: About six times. 
Doctor: Did you notice any interrupted breathing or bluish color around her mouth? 
Guest_family: No.
Doctor: While the episode occurs do you notice any color changes in the baby? 
Guest_family: No.
Doctor: Did you happened to notice any arching of the back or eyes rolling back?
Guest_family: No, it usually happens while she is sleeping, so I didn't notice her eye movements. But I am able to wake her up and stop the hand and leg movements. 
Doctor: Okay. Otherwise, is she feeding well and is active? 
Guest_family: Yes, absolutely! Although she falls asleep a lot during breast feeding but other than that everything is fine.
Doctor: And how often are you feeding her and for how long? 
Guest_family: I breast feed her every two to three hours for about fifteen to twenty minutes. 
Doctor: Okay, and how many dirty diapers? 
Guest_family: Well, her pee diapers have increased up to eight and I would say about six to seven poopy diapers a day.
Doctor: And did you notice the color of her poop? 
Guest_family: Yeah, it's like dirty yellowish color. 
Doctor: Okay.
Clinical note section (PLAN): Similac 4 ounces every 2 to 3 hours.

Dialogue:
Doctor: So I'd like you to supplement with formula to help with her weight gain. 
Guest_family: Is there a particular baby formula you'd recommend? 
Doctor: We have samples of Similac that I can give you before you head out. 
Guest_family: Thank you. 
Doctor: I'd like you to give her four ounces of formula every two to three hours. 
Guest_family: And what if she doesn't take the bottle? 
Doctor: Then you can call me and we can evaluate from there. It might take a minute or two, but she should warm up to it quite quickly.
Clinical note section (PASTMEDICALHX): He has had documented cervical spondylosis, apparently with an evaluation over 15 years ago.

Dialogue:
Doctor: Hello, sir. How are you doing today?
Patient: I need help. My neck is killing me. I can't sleep at night. 
Doctor: I see. Has it hurt before?
Patient: A long time ago. I don't know how it came back. I gave my report to the nurse.
Guest_clinician: Hello, Doctor. Here is his report. It documents any previous medical findings. 
Doctor: Thank you, Nurse. Let me take a look.
Patient: Hurry. My neck is hurting so much. I can't take it anymore. 
Doctor: It looks like you had cervical spondylosis. You were evaluated fifteen years ago for it, correct? 
Patient: Cervical what? Can you dumb it down for me? I remember getting checked for something fifteen years ago, but I forgot what it was. 
Doctor: It's like a degenerative disease that softens the tissue between the vertebras in your neck. 
Patient: Is that why my neck is hurting? Can you fix it?
Doctor: I'll see what I can do. We'll have to do some tests first.
Clinical note section (FAM/SOCHX): Denied tobacco or illicit drug use. Rarely consumes ETOH. Married with 2 teenage children.

Dialogue:
Doctor: Are you married? 
Patient: Yes, happily! I have two teenage kids.
Doctor: Nice. 
Doctor: Do you drink?
Patient: Very rarely. 
Doctor: Okay, how bout smoke or any funny drugs? 
Patient: No.
Doctor: Okay.
Clinical note section (ROS): The patient is unable answer review of systems.

Dialogue:
Doctor: Ma'am, can you tell me how long have you been having this pain? 
Patient: Um, can you?
Guest_family: Oh, she doesn't remember anything doctor. I tried asking her, but she could not answer.
Clinical note section (FAM/SOCHX): Not available at this current time.

Dialogue:
Doctor: Oh, what about patient's family history?
Guest_clinician: At this point of time, we don't have it. 
Doctor: Um okay.
Clinical note section (FAM/SOCHX): Father died of mesothelioma.  Mother gastric problems.

Dialogue:
Doctor: Can you tell me about your family history?
Patient: Well, my dad died of mesothelioma some time back. 
Doctor: I'm so sorry to hear that. 
Patient: It is okay, I manage. 
Doctor: That's good. What about your mother? Did she have any conditions that you know of?
Patient: I know she had some stomach problems too.
Clinical note section (FAM/SOCHX): She works running a day care at home.  She has three children.  She is married.  She does not smoke, use alcohol or illicit drugs.

Dialogue:
Doctor: Do you smoke? 
Patient: No. 
Doctor: Do you drink alcohol or do any recreational drugs? 
Patient: No, I don't. 
Doctor: Are you married? 
Patient: Yes, I am married. 
Doctor: Do you two have children?  
Patient: Yes, we have three kids. 
Doctor: What do you do for work? 
Patient: I run a day care out of my house. 
Doctor: Excellent. So, you are busy? 
Patient: Yes, I am.  It is a lot of work running a day care. 
Doctor: I bet it is.
Clinical note section (FAM/SOCHX): Retired small engine mechanic who worked in a poorly ventilated shop. Married with 13 children. No history of ETOH, Tobacco or illicit drug use. Father had tremors following a stroke. Brother died of brain aneurysm. No history of depression, suicide, or Huntington's disease in family.

Dialogue:
Doctor: I am Doctor Frank. It is nice to meet you. 
Patient: Hi Doctor Frank. It is nice to meet you as well. 
Doctor: I would like to start with a little background information. 
Patient: Okay. 
Doctor: Are you working currently? 
Patient: I am retired. 
Doctor: What kind of work did you used to do? 
Patient: I was an engine mechanic. I worked in the same shop, little shop, for many years. I was the oldest guy there before I retired. 
Doctor: How was the ventilation in shop that you worked in? 
Patient: Not great. I always had the doors open to try to get some air flow in there, but it didn't help very much. 
Doctor: Are you married? 
Patient: Yes, I am. We have thirteen children together. 
Doctor: Oh wow. 
Patient: Yeah! That is most people's reaction to how many children we have. 
Doctor: It used to be very normal to have that many children. Now people only have two or three children at most. 
Patient: Right! 
Doctor: Do you currently or have you had a history of drinking alcohol? 
Patient: No, I don't drink. 
Doctor: Any use of recreational drugs? 
Patient: Nope. 
Doctor: Do you or have you ever used any tobacco products.
Patient: No. 
Doctor: Okay. Great. What is your family medical history? 
Patient: Well, my brother had a brain aneurysm and he died. 
Doctor: I am so sorry. Was he older than you or younger? 
Patient: He was my older brother. My father had a stroke. He was left with tremors after his stroke. 
Doctor: Okay. That is very common for people to have tremors following a significant stroke. 
Patient: Yeah. The doctors said that he was lucky to have had only tremors after the stroke that he experienced. 
Doctor: That is fortunate. Do you have any family history of Huntington's disease?
Patient: No. Not that I can recall. 
Doctor: What about depression or suicide in the family? 
Patient: Nope.
Clinical note section (PLAN): Discharge to home.

Dialogue:
Doctor: So, you were recently discharged from the hospital for home?
Patient: Yes, three days back. 
Doctor: Okay.
Clinical note section (EXAM): BACK: Nontender on midline.  Full range of motion with flexion, extension and sidebending.

Dialogue:
Doctor: Any pain in the back?
Patient: No.
Doctor: Can you stretch it completely?
Patient: Yes.
Doctor: No pain or tenderness in the center of the back or anywhere else? 
Patient: No. 
Doctor: Can you bend sideways for me? 
Patient: Sure. 
Doctor: No pain?
Patient: No pain.
Doctor: Any difficulty bending forward or backward?
Patient: No.
Doctor: So full range of motion. 
Patient: Yes.
Clinical note section (ROS): Because of the patient's inability to communicate, is not obtainable, but apparently, she has urine incontinence and also stool incontinence, and is wheelchair bound.

Dialogue:
Doctor: How has she been doing since her last admission? 
Guest_family: Not great. She still can't seem to hold her urine or bowels. For this reason, we've been using a diaper and changing it at least three times a day. 
Doctor: How does she communicate her needs to you? 
Guest_family: She'll usually point to things or wave her hands when she needs something. 
Doctor: I see. Does she have a visiting nurse or anyone who checks her vitals weekly? 
Guest_family: We have a nurse who comes in three times a week to help take care of her. 
Doctor: When did she first become wheelchair bound? 
Guest_family: About two years ago. 
Doctor: How often does she get turned over in bed to prevent bed sores? 
Guest_family: We try to adjust her once every hour or so. It's harder on the days where we don't have an extra set of hands.
Clinical note section (EXAM): SKIN: Inspection of the skin and subcutaneous tissues appeared to be normal.  The skin was pink, warm and dry to touch.

Dialogue:
Doctor: When we did the surgery there were no complications with the patient. 
Guest_clinician: How did her skin look?
Doctor: Her skin was normal. It was pink, warm, and dry to the touch. Her subcutaneous tissue was also in normal condition.
Clinical note section (PASTSURGICAL): 1.  Small bowel resections. 2.  Appendectomy. 3.  A vasectomy.

Dialogue:
Doctor: And what about surgeries? Have you had any in the past?
Patient: Well, a part of my intestine was removed due to some obstruction.
Doctor: Ah, I see. Big or small?
Patient: Small intestine.
Doctor: Okay anything else? 
Patient: Yeah, my appendix was removed and--and then I had a vasectomy.
Doctor: Okay.
Patient: That's it, I think.
Clinical note section (FAM/SOCHX): Father died of an MI at age 67 with COPD and was a heavy smoker.  His mother is 88, living and well, status post lung cancer resection.  Two brothers, living and well.  One sister died at age 20 months of pneumonia.

Dialogue:
Doctor: How old was your dad when he passed away from a heart attack? 
Patient: Sixty seven.  
Doctor: Did he have a history of any medical problems? 
Patient: Yeah, he had C O P D and smoked a ton.  
Doctor: And how about your mom? How is she doing? 
Patient: She's not bad. Turned eighty eight last week. She's recovering from lung cancer. Two years ago, she had a piece of her lung taken out. 
Doctor: I'm glad to hear that she's in recovery and staying healthy. Do you have any siblings? 
Patient: I have two brothers that are both younger than me. I also had a sister, but she passed away from pneumonia at only twenty months old. 
Doctor: I'm so sorry to hear that.
Clinical note section (PASTMEDICALHX): Negative.

Dialogue:
Doctor: Any medical concerns or issues in the past?
Patient: No.
Clinical note section (FAM/SOCHX): Mother is 61 years old and brother is 39 years old, both alive and well. Father died at 48 of colon cancer and questionable pancreatic cancer. One paternal uncle died at 32 of colon cancer and bile duct cancer. One paternal uncle had colon cancer in his 40s. Thirty cancers are noted on the fathers side of the family, many are colon; two women had breast cancer. The family was told that there is a genetic syndrome in the family, but no one remembers the name of the syndrome.

Dialogue:
Doctor: How's your family? Are they in good health? 
Patient: My mom just turned sixty one and my brother is thirty nine. I'd say they're both doing good for their age. 
Doctor: Always great to hear. Do you know of any medical problems that run in the family? 
Patient: My dad died of colon cancer at the age of forty eight. I think he may have also had pancreatic cancer, but we're not sure.  
Doctor: I'm so sorry for your loss. Cancer is a horrible disease.  
Patient: It's okay. It's been several years now since we lost him. My uncle on my dad's side also had bile duct cancer and colon cancer. 
Doctor: Is he still with us today? 
Patient: No, sadly. He passed away at thirty two years of age. Another one of my uncles on my dad's side had colon cancer in his forties. It seems to run deep in our family. 
Doctor: Oh my. Is there anyone else in your family who has battled cancer? 
Patient: I'd say about thirty some people on my dad's side had cancer. A lot of them had colon cancer and two girls had breast cancer. Oh and I remember learning from one of our cousins that we have some weird genetic syndrome that runs in the family, but I couldn't give you the name. I don't think any of us have been able to figure out the name. Sucks that we have so many problems. 
Doctor: It's definitely difficult to process, however, it's good that you and your family are aware so that you're able to seek preventative measures and get tested early for these particular cancers. If you recall the name of the genetic syndrome, please feel free to call me back so that I can update your records.  
Patient: Sure thing.
Clinical note section (ALLERGY): No known medicine allergies.

Dialogue:
Doctor: Do you have any allergies to medications? 
Patient: No.
Clinical note section (DISPOSITION): Home.

Dialogue:
Guest_clinician: Were they discharged? 
Doctor: Yep, he was sent home with a taxi voucher.
Clinical note section (ASSESSMENT): ITP, the patient has a normal platelet count.

Dialogue:
Doctor: Your platelet counts are normal, but you do have a disease that is called I T P.
Patient: What does it mean?
Doctor: So idiopathic thrombocytopenic purpura is a disorder of low platelet count. 
Doctor: Do you know what platelets are?
Patient: Oh yeah.
Patient: Okay. Can it be treated?
Clinical note section (GENHX): We had the pleasure of seeing the patient today in our Pediatric Rheumatology Clinic.  He was sent here with a chief complaint of joint pain in several joints for few months.  This is a 7-year-old white male who has no history of systemic disease, who until 2 months ago, was doing well and 2 months ago, he started to complain of pain in his fingers, elbows, and neck.  At this moment, this is better and is almost gone, but for several months, he was having pain to the point that he would cry at some point.  He is not a complainer according to his mom and he is a very active kid.  There is no history of previous illness to this or had gastrointestinal problems.  He has problems with allergies, especially seasonal allergies and he takes Claritin for it.  Other than that, he has not had any other problem.  Denies any swelling except for that doctor mentioned swelling on his elbow.  There is no history of rash, no stomach pain, no diarrhea, no fevers, no weight loss, no ulcers in his mouth except for canker sores.  No lymphadenopathy, no eye problems, and no urinary problems.

Dialogue:
Doctor: Good morning, young man, and can I assume that you're his mother? 
Guest_family: Yes, doctor, good morning, that's correct. 
Doctor: Good, tell me a little more about your son, please. 
Guest_family: Well, he's seven years old now, and he's been healthy all his life. But he recently started having pain in his fingers, elbows, and neck. 
Doctor: What race does your family identify with?
Guest_family: We're white, doctor. 
Doctor: Okay, how long has he had this pain? 
Guest_family: It's been, um, about two months now. 
Doctor: Has the pain improved any since it began?
Patient: Well, it's a little better now. 
Guest_family: Yeah, he says it's almost gone now, but he was at a point where he was in so much pain that he would cry. 
Doctor: Is this behavior unusual for him?
Guest_family: Yes, he's not really a complaining kid. 
Doctor: I see. Was he playing and everything before this pain?
Patient: Yes, I like playing sports with my friends. 
Doctor: Has he had any illnesses, or stomach issues in the past? 
Guest_family: No, nothing major, he just has some allergies. 
Doctor: What kind of allergies? 
Guest_family: He just deals with seasonal allergies.
Doctor: So, does he just take a Claritin for this?
Guest_family: Correct. 
Doctor: Is there any swelling? 
Guest_family: Not really, the other doctor said he saw some though. 
Doctor: Are there any other major medical conditions that you're aware of, anything at all?
Guest_family: No, there's absolutely nothing to report.
Doctor: Has he ever had a rash on the painful area?
Guest_family: No. 
Doctor: Any diarrhea, fevers, weigh loss, or mouth ulcers?
Guest_family: No. Just canker sores, but no to everything else. 
Doctor: Is he going to the bathroom fine? What about visual issues?
Guest_family: No. 
Doctor: Okay. His lymph nodes look fine.