[doctor] hi janet , how are you ?
[patient] good , how are you ?
[doctor] i'm good . uh , are you ready to get started ?
[patient] yes .
[doctor] okay . so , janet is a 33-year-old female , here for some , some joint paint . what , what joint's been bothering you , janet ?
[patient] it's been mostly , um , my knees , actually . i've been doing more stair type workouts , which i thought was , you know , building muscle , uh , on my knees and supposed to help .
[doctor] mm-hmm .
[patient] but in turn it , it really has n't , so my knees have been really bothering me .
[doctor] okay . all right . and is it one knee versus the other ? or both equally ?
[patient] it's both equally .
[doctor] okay . and have you been having any other joint pain like , elbows or shoulder , or anything like that ?
[patient] no , but i , i should mention that like , i had a rotator cuff repair about two years ago .
[doctor] mm-hmm .
[patient] um , but i have n't had any problems since that point .
[doctor] okay , and what shoulder was that ?
[patient] that was my right shoulder .
[doctor] okay , all right . and , um , any pins and needles in your feet at all ? any swelling in your legs ?
[patient] uh , no , nothing like that .
[doctor] okay .
[patient] um , but it would be something though i look out for often , just because i have diabetes .
[doctor] okay , and your blood sugars have been under control ?
[patient] yes , they have been .
[doctor] okay . and have you had any fever or chills ?
[patient] no , nothing like that .
[doctor] okay . any nausea or vomiting , chest pains , shortness of breath ?
[patient] no , but i do have high blood pressure , um , but i , i monitor that and i've been taking medication for that , and that has n't elevated , um , in any way since the joint pain .
[doctor] okay . all right . so , yeah , i see on here that you do take norvasc , five mg a day and you've been taking that every day-
[patient] yes .
[doctor] okay . um , and , um , so let's go ahead and do a quick physical exam on you . so , hey dragon , show me the blood pressure . your blood pressure's actually pretty high today , so you might be a little nervous here , which is not uncommon .
[patient] yeah .
[doctor] um , so , looking at you , your , your neck is nice and soft , there's no enlarged thyroid . your heart has a regular rate and rhythm . your lungs are clear . your abdomen is nice and soft , but looking at your knees , on your left knee you do have a slight erythema and edema . there is a small efusion present over your left knee . um , you have some decrease flexion and extension of your knee , but your strength in your lower extremities is good . uh , so let's go ahead and look at some of your results . i know that we did some x-rays when you came in .
[patient] yeah .
[doctor] hey dragon , show me the left knee x-ray . okay , so looking at this , this is an , this is a normal x-ray of your left knee , so you may just have a little bit of a strain going on in your , in your knees there .
[patient] okay .
[doctor] uh , let's look at some of your labs , 'cause i know that you have the diabetes . hey dragon , show me the labs . so , here your white blood cell count is not elevated , so i'm not concerned about an infection or anything like that . um , hey dragon , show me the diabetes' labs . okay and , and your a1c is a little elevated , but it's not , it's not terrible , so i think for right now we'll just continue you on the current regimen . um , so my plan from you , for you in terms of the joint pain , um , i'd like to go ahead and , you know , we'll just send some autoimmune labs to work , work up your left knee pain and , uh , we'll work for you to do some physical therapy and i'd like to go ahead and give you anti-inflammatory medication to help with the pain . does that sound okay ?
[patient] that sounds great .
[doctor] okay . hey dragon , order meloxicam 15 mg once a day . hey dragon , order a physical therapy referral . hey dragon , order an autoimmune profile . and then from a hypertension standpoint you , because your blood pressure is a little elevated today , i'd like you to continue to monitor it at home and , you know , send me a report in the next couple of weeks sh- , you know , giving me the , the blood pressure reportings . do you have a blood pressure cuff at home ?
[patient] yes , i do .
[doctor] okay . and then , um , we'll go ahead and order a lipid profile for you . hey dragon , order a lipid profile . and then for , from a diabetes standpoint let's go ahead and , uh , continue you on your metformin 500 mg twice a day . okay ?
[patient] okay .
[doctor] do you have any questions ?
[patient] no , that's it .
[doctor] okay . the nurse will be in soon . it was good to see you .
[patient] nice seeing you too .
[doctor] hey dragon , finalize the note .


Medical orders:
description: meloxicam 15 mg once a day
order_type: medication
reason: left knee pain
description: autoimmune profile
order_type: lab
reason: left knee pain
description: lipid profile
order_type: lab
reason: hypertension