[doctor] and why is she here ? annual exam . okay . all right . hi , sarah . how are you ?
[patient] good . how are you ?
[doctor] i'm good . are you ready to get started ?
[patient] yes , i am .
[doctor] okay . so sarah is a 27-year-old female here for her annual visit . so , sarah , how have you been since the last time i saw you ?
[patient] i've been doing better . um , i've been struggling with my depression , um , a bit more just because we've been trapped really inside and remotely over the past year , so i've been struggling , um , off and on with that .
[doctor] okay . uh , and from looking at the notes , it looks like we've had you on , uh , prozac 20 milligrams a day .
[patient] yes .
[doctor] are , are you taking that ?
[patient] i am taking it . i think it's just a lot has been weighing on me lately .
[doctor] okay . um , and do you feel like you need an increase in your dose , or do you ... what are you thinking ? do you think that you just need to deal with some stress or you wan na try a , a different , uh , medication or ...
[patient] i think the , the medication has helped me in the past , and maybe just increasing the dose might help me through this patch .
[doctor] okay . all right . and , and what else has been going on with you ? i know that you've had this chronic back pain that we've been dealing with . how's that , how's that going ?
[patient] uh , i've been managing it . it's still , um , here nor there . just , just keeps , um , it really bothers me when i sit for long periods of time at , at my desk at work . so i have ... it helps when i get up and move , but it gets really stiff and it hurts when i sit down for long periods of time .
[doctor] okay , and do you get any numbing or tingling down your legs or any pain down leg versus the other ?
[patient] a little bit of numbing , but nothing tingling or hurting down my legs .
[doctor] okay , and does the , um , do those symptoms improve when you stand up or change position ?
[patient] yeah , it does .
[doctor] okay . all right . and any weakness in , in your legs ?
[patient] no , no weakness , just , just the weird numbing . like , it's , like , almost like it's falling asleep on me .
[doctor] okay . and are you able to , um , do your activities of daily living ? do you exercise , go to the store , that type of thing ?
[patient] yeah , i am . it bothers me when i'm on my feet for too long and sitting too long , just the extremes of each end .
[doctor] okay . and i know that you've had a coronary artery bypass grafting at the young age of 27 , so how's that going ?
[patient] yeah , i had con- i had a congenital ... you know , i had a congenital artery when i was a baby , so , um , they had to do a cabg on me , um , fairly young in life , but i've been ... my heart's been doing , doing well , and arteries have been looking good .
[doctor] okay . all right , well , let's go ahead and do a quick physical exam . um , so looking at you , you do n't appear in any distress . um , your neck , there's no thyroid enlargement . uh , your heart i hear a three out of six , systolic ejection murmur , uh , that's stable . your lungs otherwise sound clear . your abdomen is soft , and you do have some pain to palpation of your lumbar spine . uh , and you've had decreased flexion of your back . uh , your lower extremity strength is good , and there's no edema . so let's go ahead and look at some of your results . hey , dragon , show me the ecg . okay , so that looks basically unchanged from last year , which is really good . hey , dragon , show me the lumbar spine x-ray . hey , dragon , show me the back x-ray . great . so this looks good . that's also stable from last year . okay . so let's go ahead and , you know , my , my plan for you at this time , you know , from a chronic back pain standpoint , if you need , um , you know , some more physical therapy , and i can refer you to physical therapy to help with those symptoms that are kind of lingering .
[patient] mm-hmm .
[doctor] um , and we can always give you some pain medication if you , if you get some pain periodically with activity . how do you feel about that ? do you need some pain medication ?
[patient] no , i think physical therapy is the right way to , way to start out on this .
[doctor] okay . hey , dragon , order physical therapy referral . and then in terms of your depression , we talked about increasing your prozac , so we'll increase it from 20 milligrams to 40 milligrams . it's just one tablet once a day .
[patient] okay .
[doctor] um , and i'll send those to your pharmacy . does that sound okay ?
[patient] that sounds great .
[doctor] hey , dragon , order prozac , 40 milligrams , once a day . and then in terms of your ... the heart bypass that you've had ... let's go ahead and just order another echocardiogram for you , and i wan na continue you on the aspirin for now , okay ?
[patient] okay .
[doctor] hey , dragon , order an echocardiogram . hey , dragon , order aspirin 81 milligrams daily . okay , so the nurse will come in . she'll help you schedule those things , and we'll go from there , okay ?
[patient] okay .
[doctor] all right , take care .
[patient] thank you .
[doctor] hey , dragon , finalize the note .


Medical orders:
description: echocardiogram
order_type: imaging
reason: coronary artery bypass grafting
description: aspirin 81 milligrams daily
order_type: medication
reason: coronary artery bypass grafting
description: increasing your prozac 40 milligrams one tablet once a day
order_type: medication
reason: depression