[doctor] hi , natalie . how are you ?
[patient] good . how are you ?
[doctor] it's good to see you .
[patient] good to see you , too .
[doctor] i know my nurse has already told you about dax . is it okay if i tell dax a little bit about you ?
[patient] go for it .
[doctor] all right . so , natalie is a 39-year-old female , here today for a check-up for an abnormal lab . she's got a history of high blood pressure , diabetes , and acl repair .
[doctor] so , tell me what's going on .
[patient] so , uh , i got some re- routine blood work done last week and , uh , they said that my blood sugars were , were high , so that i should come in , um , and talk to you and get some more work done and , and , uh , see why that is .
[doctor] okay . well , were you having any symptoms at all or just , we had some blood work done routinely ? uh , any chest pain , shortness of breath ? any nausea , vomiting , or diarrhea ?
[patient] no , no symptoms . uh , so i was a little shocked when i came back high and , and elevated , so hopefully we can figure out what's going on .
[doctor] we've been , kind of , checking on this for a while and you've been on metformin . we actually increased your dose last time-
[patient] yup .
[doctor] so right now you're on 100 , 1,000 milligrams a day , correct ?
[patient] correct . yup .
[doctor] okay . all right . no , uh , no difficulty urinating or burning when you urinate at all ?
[patient] nope .
[doctor] okay . all right . um , hey , dragon , show me the hemoglobin a1c . so in reviewing your , that's the lab that we checked after when i saw before i walked in . it says 8.1 , which is elevated , so i think we need to do a maybe a better job with adjusting your medication .
[doctor] how are you doing with your diet for your diabetes ?
[patient] my diet's been really great lately . i've been avoiding sugars , um , been really watching , uh , my weight and power walking every day , so i was a little surprised when the , the blood work came back that i- i had , um , an elevated , uh , test .
[doctor] okay . and , uh , have you had any , uh , any other , are you checking your blood sugars in the morning or your fasting blood sugars ?
[patient] yes , i am .
[doctor] okay . all right . how are you doing with your high blood pressure ?
[patient] that's been good and stable . um , i've been stable on the medication , been taking that every day . um , and i have a b- a cuff at home to , to measure it myself and that , everything's been normal .
[doctor] okay , great . and how's your knee doing that's the other issue we've been , kind of , following ? you had some surgery done for that ?
[patient] yeah . about five years ago , i had , um , an acl repair on my right knee and everything's been going well so far . i have n't had any , uh , issues with mobility . um , it's been great .
[doctor] and you're pretty physically active and doing exercises ?
[patient] yeah . i've been power walking about , at least 30 minutes every day .
[doctor] okay . great . well , let's review , uh , some of your vital signs . hey , dragon , show me the vitals . all right . blood pressure looks good right now . your oxygen level's great . uh , your temperature's good .
[doctor] so i know you checked in with the review of systems with my assistant before coming in . uh , anything else bothering you today except for the abnormal blood work ? no chest pain ? no shortness of breath ?
[patient] no , nothing like that ?
[doctor] no headaches ? no belly pain ?
[patient] no .
[doctor] good . great . well , let me examine you , okay ?
[patient] okay .
[doctor] alright . just gon na listen to your heart here .
[doctor] no belly pain ?
[patient] nope .
[doctor] okay .
[doctor] so on exam , uh , your hent or your neck exam is fine . your , uh , your eyes look fine . your lungs are clear . i do hear a systolic ejection murmur , about three over six . your belly's nice and soft . no swelling in your legs or extremities right now .
[doctor] so let's talk about some of the issues today . all right . for the first issue , for the diabetes , since your hemoglobin a1c is is elevated , uh , and you're already on 1,000 milligrams of metformin , i think we should add , uh , jardiance , uh , 10 milligrams a day . uh , so that's a new medication . we'll start that . i do want you to , uh follow your diet pretty , uh , aggressively . i wan na see if we can get that hemoglobin a1c down the next time .
[doctor] i'm also gon na add some labs today to see what that , to see a lipid panel and some other blood work . hey , dragon , order a cbc , cmp , and a lipid panel . and i'll go ahead and prescribe the jardiance , 10 milligrams a day . hey , dragon , prescribe , uh , order jardiance , 10 milligrams a day .
[doctor] all right . for the high blood pressure , i think you're doing great . you're on lisinopril for that , so i think that we should continue that . uh , we'll re-check it again next time and you are monitoring that at home , correct ?
[patient] yes , i am .
[doctor] okay , great . and for the knee , i think you're doing great with that . you know , continue with your physical exercise , with your physical therapy , uh , uh , with your normal exercise regimen . uh , if you have any issues with that , certainly give us a call .
[patient] okay .
[doctor] all right . any other questions ?
[patient] no , that's it .
[doctor] okay . hey , dragon , finalize the note .

Medical orders:
description: today blood cbc
order_type: lab
description: today blood cmp
order_type: lab
description: today blood lipid panel
order_type: lab
description: jardiance 10 milligrams a day
order_type: medication
reason: diabetes