[doctor] judy gomez , mrn 869723 . date of birth , 5 , 7 , 1961 . she's in office today for ongoing management of psoriatic arthritis . hello , judy , how are you doing today ?
[patient] i'm doing good , thank you . how are you ?
[doctor] i'm great , thanks . so how have you been since the last time ? i know the last time we were talking about decreasing your prednisone dose , correct ?
[patient] yes . i'm just on one now and that seems to be enough .
[doctor] aw , that's great to hear .
[patient] yeah , there were a couple days there i took an extra one , just because there was a little extra pain in my feet . and i do have a desk job , so when i have a day off where i'm moving around a lot they do tend to hurt a bit more .
[doctor] okay . how many times did you do that ?
[patient] um , it was n't often , maybe once a week .
[doctor] okay . so it sounds like we're still on track for discontinuing the prednisone . we'll do that today and you can let me know how it goes on your next visit . and how about the methotrexate , do you think that helped with your joint pain ?
[patient] yeah , definitely . because i went to get my covid shots , um , but from the letter i got about it , it said that it could interfere with the vaccine , you know , reduce the efficacy . so i did n't take it on the week that i got the first shot .
[doctor] okay . and what happened ?
[patient] i felt absolutely horrible until i took it again a week later .
[doctor] i'm sorry to hear that . and- and what did you do about the second dose ?
[patient] well , i called into the hotline because i was in so much pain with the first one . and they said , " no , just go ahead and take it , " so i did .
[doctor] okay . that's good then . we do have to keep an eye out on it since it's a high-risk medication . do you have an appointment to get your blood drawn for the next time ?
[patient] no , they did n't give me one .
[doctor] okay . so we can do that for you too . uhm , so what questions do you have for me , judy ?
[patient] well , i just wanted to know why i was getting all these bruises here , so like when i bump myself . i do n't know where they're coming from .
[doctor] okay . that's probably from the prednisone , it can increase bruising .
[patient] okay . i did n't know that . um , i do n't even feel it when it happens , they just show up .
[doctor] yeah . unfortunately that can happen , but we're working on discontinuing that so let's see if the bruises do go away .
[patient] okay . that sounds good , thanks .
[doctor] okay , judy , please , um , sit up here and i'll take a look . shoes and socks off please .
[patient] all right .
[doctor] all right . let me see here . okay . so where is it hurting ? in your joints right here ?
[patient] yeah , a little . also in my feet joints as well .
[doctor] okay . and how about when you bend the knee like this ?
[patient] well , it hurt before we increased the methotrexate , but it's doing pretty good now .
[doctor] okay , good . can you flex your toes please ? good range of motion . also ridges in nails , that's from the psoriasis .
[patient] yeah . they've been like that for a long time now .
[doctor] okay . all right , uhm , ms gomez , it looks like we're moving along with your treatment nicely . we'll stop your prednisone and continue with the methotrexate . make sure to stop by the front desk and make an appointment for the blood work , and i'll see you in three months .
[patient] all right . it sounds good . thank you so much , it was great to see you .
[doctor] it was great seeing you too . thank you .

Medical orders:
description: stop prednisone
order_type: medication
description: blood blood work
order_type: lab
description: see you three months
order_type: followup