[doctor] hi , albert . how are you ?
[patient] hey , good to see you .
[doctor] it's good to see you too . so , i know the nurse told you about dax . i'd like to tell dax a little bit about you .
[patient] sure .
[doctor] so , albert is a 62-year-old male , with a past medical history significant for depression , type 2 diabetes , and kidney transplant , who is here today for emergency room follow-up .
[patient] mm-hmm .
[doctor] so , i got a notification that you were in the emergency room , but , but what were you there for ?
[patient] well , i , uh , i was n't really , uh , staying on top of my , uh , blood sugar readings , and i felt kinda woozy over the weekend . and i was little concerned , and my wife wanted to take me in and just have me checked out .
[doctor] okay . and , and was it , in fact , high ?
[patient] yeah , it was .
[doctor] okay . did you ... were you admitted to the hospital ?
[patient] uh , no .
[doctor] okay . all right . and , uh , are you ... did they see a reason , as to why it was elevated ?
[patient] uh , yeah . my mother was actually in the hospital the last week. she had a bit of a fall and had to do a hip replacement. she's feeling better now but we have been just grabbing meals at the cafeteria or picking up fast food on our way home and i just really was n't monitoring what i was eating .
[doctor] okay . that's sorry to hear . and are you feeling better now ?
[patient] uh , actually , when we got home from the , uh , f- from the visit , i felt a lot better .
[doctor] okay . and since then , have you been following your diet pretty closely ?
[patient] yes .
[doctor] okay . 'cause we do n't wan na end up in the hospitaltoo
[patient] no .
[doctor] all right . um , okay . and , so , before that happened , how are you doing with your diet ?
[patient] uh , during the week , i've been fine , 'cause i've been very busy . on the weekends , doing things . you're seeing people . you're having people over . it's , i- not , not as consistent on the weekend .
[doctor] okay . all right . um , is there a way that you think that that can improve ?
[patient] uh , s- stop eating .
[doctor] okay . all right . well , let's talk about your , your kidney transplant . how are-
[patient] mm-hmm .
[doctor] . you doing ? you're taking immunotherapy meds ?
[patient] yes .
[doctor] okay .
[patient] yeah . i've , i've been pretty diligent about it , following doctor's orders , so it's been , it's been pretty good so far .
[doctor] okay . and , and y- the last time i saw that you saw dr. reyes , was about three weeks ago , and everything seemed to be fine .
[patient] that's correct .
[doctor] your kidney function is good .
[patient] yes .
[doctor] okay . all right . and in terms of your depression , how are you , how are you doing ?
[patient] and it's been about a , a tough , ugh , year-and-a-half or so , but i've been pretty good with it . i , i have my moments , but i- as long as i find some time to relax , at least in the afternoon , then , then it seems to work out okay .
[doctor] okay . so , i know that we've kind of talked about holding off on medical therapy-
[patient] mm-hmm .
[doctor] . 'cause you're on so many other meds .
[patient] mm-hmm .
[doctor] um , is that something that you wan na revisit , or do you wan na look into therapy , or do you think anything's needed right now ?
[patient] uh , i think i probably wan na shy away from any therapy . my , my wife got me into meditation recently and , and , uh , i , i find that relaxing . so , i think i'd like to continue that , at least for a couple more months and see how it goes .
[doctor] okay . all right . that sounds good . all right . well , i know the nurse did a quick review of systems with you , when you-
[patient] mm-hmm .
[doctor] . checked in . do you have any symptoms , any chest pain or shortness of breath ?
[patient] none whatsoever .
[doctor] lightheadedness ? dizziness ?
[patient] no .
[doctor] no ? okay . um , and i just wan na go ahead and do a quick physical exam .
[patient] mm-hmm .
[doctor] hey , dragon . show me the vital signs .
[doctor] so , looking here right now , your vital signs look great . you know , your pulse ox is great . your h- your blood pressure and heart rate are right where they should be .
[patient] mm-hmm .
[doctor] so , i'm gon na just check you out , and i'm gon na let you know what i find . okay ?
[patient] sure .
[doctor] okay . so , on your physical exam , everything looks really good . um , you do n't appear in any distress at this time . i do n't appreciate any carotid bruits . your heart , on your heart exam , i do hear that slight 2/6 systolic ejection murmur , but we heard that in the past .
[patient] mm-hmm .
[doctor] your lungs sound nice and clear , but i notice , you know , 1+ , uh , edema in your lower extremities . okay ?
[patient] mm-hmm .
[doctor] um , so , let's go ahead . i wan na look at some of your results . okay ?
[patient] sure .
[doctor] hey , dragon . show me the glucose .
[doctor] so , right now , your blood sugar is about 162 . have you eaten before you came in here ?
[patient] i did not .
[doctor] okay . all right . um , hey , dragon . show me the diabetes labs .
[doctor] okay . i'm looking at your diabetes labs . you know , your hemoglobin a1c is about 8 , and that's a , that's a little high .
[patient] mm-hmm .
[doctor] so , not only , you know , have your blood sugars , were they high that one day , they were , they've been a little elevated .
[patient] mm-hmm .
[doctor] so , we'll talk about , you know , how to go ahead and , and fix that . okay ?
[doctor] so , let me talk a little bit about my assessment and my plan for you .
[patient] mm-hmm .
[doctor] so , for your first problem , this hyperglycemia , you know , i wan na go ahead and increase your lantus to 20 units at night . okay ? i want you to continue your monitor your blood sugar and let me know how they're running 'cause we might have to adjust that further .
[patient] mm-hmm .
[doctor] okay ? um , and i wan na order another hemoglobin a1c in a couple months . hey , dragon . order a hemoglobin a1c .
[doctor] for your next problem , your depression , i think you're doing a great job with your current strategies with the meditation . we will hold off on medication or therapy at this time , and you know to call me if you need anything , right ?
[patient] mm-hmm .
[doctor] okay . and for your third problem , your kidney transplant , your kidney function looks stable . uh , i'm gon na just have you go back to dr. reyes , to manage all of your immunosuppression medications .
[patient] okay .
[doctor] um , and then , he knows to reach out to me if he needs anything . okay ?
[patient] you got it .
[doctor] all right . well , the nurse will be in soon to check you out . okay ?
[patient] perfect .
[doctor] hey , dragon . finalize the note .

Medical orders:
description: lantus 20 units at night
order_type: medication
reason: hyperglycemia
description: hemoglobin a1c in a couple months
order_type: lab
reason: hyperglycemia