[doctor] hi , anna , how are you ?
[patient] i'm doing okay . how are you ?
[doctor] i'm doing well . uh , so i know the nurse told you a little bit about dax . i'd like to tell dax a little bit about you .
[patient] okay .
[doctor] all right . so , uh , anna is a 26-year-old female with a past medical history , significant for epilepsy , depression , and , uh , peptic ulcer disease , who presents with , uh , some joint pain . so , anna , what's going on with your , uh , what's going on with your joints ?
[patient] so , um , it's my left elbow that's really been bothering me . uh , i sit at my desk a lot for work , and type , and i stay in this motion specifically all day . and then after , um , work , it's really hard for me to , uh , open and , and close my , my elbow here , my left elbow , and it's been just really stiff and , and hurts .
[doctor] okay . have you noticed any swelling there on the-
[patient] yeah , i have .
[doctor] okay , and is it right here on the , on the tip ?
[patient] yep , it is .
[doctor] okay , and are you right or left-handed ?
[patient] i am right-handed .
[doctor] okay , so it's your non-dominant hand ?
[patient] yeah , which is good .
[doctor] yeah .
[patient] so , i can still write , which is great , but typing is , is difficult .
[doctor] okay , and any numbing or tingling in your hands at all ?
[patient] no , i have n't felt numbing or tingling .
[doctor] and any weakness in your arm ?
[patient] a little bit of weakness , uh , but nothing too significant .
[doctor] okay , and ... and how about ..
[doctor] and how about , um , any fever or chills ?
[patient] no fever or chills .
[doctor] okay . all right , well , let's talk a little bit about your epilepsy , okay ?
[patient] okay .
[doctor] um , have you had any recent seizures ?
[patient] uh , no , i have n't . i think my last seizure was a year ago .
[doctor] okay , good .
[patient] yeah .
[doctor] and you're still taking the keppra ?
[patient] yes , i am .
[doctor] okay , great . and then , tell me a little about your depression . how're you doing with that ? i know that you went into therapy last year , and you tried to avoid medication since you're already on the keppra . how's that doing ?
[patient] uh , therapy , therapy's been good . it , it has definitely helped . uh , i still feel a little down , uh , and , and stressed .
[doctor] okay . all right , but no , no feelings of wanting to hurt yourself or somebody else ?
[patient] no , nothing like that .
[doctor] okay . all right . and then , how are you doing with your , with your ulcer ? i know that you , you know , you had so much stress a year ago and , you know , you were having some issues there . we did the endoscopy-
[patient] mm-hmm .
[doctor] . and they showed that . so , how are you doing with that ?
[patient] i'm doing , i'm doing better . i have n't had any , um , issues with that , um , since we did the procedure , and everything's been good .
[doctor] okay , well great . let's go ahead and ... i'm gon na go ahead with , um ... and , you know , i know that the nurse did a review of systems sheet on you when you came in , and i know that you were endorsing that left elbow pain .
[patient] mm-hmm .
[doctor] any other symptoms , you know , chest pain , shortness of breath , abdominal pain , nausea or vomiting ?
[patient] no , nothing like that . i have a little bit of nasal , nasal congestion from allergies , uh , but that's it .
[doctor] okay , so you're endorsing some nasal congestion ?
[patient] yeah .
[doctor] okay . all right , well , let's go ahead to a physical exam , okay ?
[patient] okay .
[doctor] hey , dragon , show me the vital signs . good , here in the office , everything looks great with your vital signs . i think that's great , so i'm just gon na take a listen to your heart and your lungs , and take a look at your elbow and , and we'll go from there , okay ?
[patient] okay .
[doctor] all right , so , so on physical examination of your left elbow , you do have some erythema and edema of your left elbow . does it hurt when i touch ?
[patient] yeah , it does .
[doctor] okay , he ... she has some pain to palpation of the olecranon . of the left olecra- olecranon , and it is warm to palpation . um , can you straighten your elbow for me ?
[patient] yeah , it , it hurts , and it's , uh , it's a bit stiff .
[doctor] okay , so she has pain with flexion and extension of the left elbow . there's a palpable right ... or s- ... palpable left radial pulse . okay , um , so let's go over ... i just wan na take a look at some of your results , okay ?
[patient] okay .
[doctor] hey , dragon , show me the left elbow x-ray . hey , dragon , show me the elbow x-ray . hey , dragon , show me the left arm x-ray . okay , so , in reviewing the results of your left arm x-ray , there's no evidence of any elbow fracture , which is not surprising , okay ?
[doctor] hey , dragon , show me the endoscopy results . hey , dragon , show me the endoscopy . okay , well , your recent endoscopy showed that you ... hey , dragon , show me the endoscope . all right , so here it looks like , you know ... your endoscopy results look like you had an episode of gastritis . that's for your , your peptic ulcer disease , and so everything , you know ... you took your , your protonix , and i think everything resolved at that point , okay .
[patient] okay .
[doctor] so , let's talk a little bit about my assessment and my plan for you . so for your first problem , this left elbow pain , you know , i think you have olecranon bursitis , and we're just gon na , you know , have you , you know , get a little pillow for your elbow there . it's just caused by repetitive trauma .
[patient] mm-hmm .
[doctor] so , maybe you're slamming your elbow down a little bit on the desk , so just get a little rest there-
[patient] yeah .
[doctor] . and we'll give you some melo- meloxicam , 15 mg , once a day . you can ice the area , okay ? um , for your next problem , the epilepsy , sounds like you're doing really well . i would go ahead and continue with the keppra , 500 mg , twice a day . do you need a refill of that ?
[patient] yes , i do .
[doctor] hey , dragon , order a refill of keppra , 500 mg , twice daily . for your third problem , the depression , it sounds like you're doing well with the therapy and , if you want , we can talk about medical treatment options .
[patient] yeah , i think that would be great .
[doctor] okay , well , let's go ahead and we'll start you on some lexapro , 10 mg , once a day , and we'll see how you do on that , okay ?
[patient] okay .
[doctor] all right , and then , for your last problem , the peptic ulcer disease , um , i want you to continue on the protonix , 40 mg , once a day before meals , okay ?
[patient] okay .
[doctor] do you have any questions ?
[patient] no , i do n't .
[doctor] okay . all right . well , the nurse will come in soon and see you , okay , and i'll , i'll see you in a couple of weeks .
[patient] okay .
[doctor] all right , take care . bye .
[patient] bye .
[doctor] hey , dragon , finalize the note .

Medical orders:
description: mg once a day lexapro 10
order_type: medication
reason: depression
description: see you couple of weeks
order_type: followup
description: meloxicam 15 mg once a day
order_type: medication
reason: olecranon bursitis
description: 15 keppra 500 twice a day
order_type: medication
reason: epilepsy