[doctor] hi , john , how are you doing ?
[patient] hi , good to see you .
[doctor] good to see you too . so i know the nurse told you about dax , i'd like to tell dax a little about you .
[patient] sure .
[doctor] so john is a 55-year-old male with a past medical history significant for anxiety and epilepsy who presents with an abnormal lab finding . so , john , um , i , uh , was notified by the emergency room that you , um , had a really high blood sugar and you were in there with , uh ... they had to treat you for that , what was going on ?
[patient] yeah , we've been going from place to place for different events and we've had a lot of visitors over the last couple of weeks and i just was n't monitoring my sugar intake and , uh , a little too much stress and strain i think over the last couple of weeks .
[doctor] okay , yeah , i had gone through your hemoglobin a1c's and you know , they were borderline in the past but-
[patient] mm-hmm
[doctor] -i guess , you know , i guess they're high now so how are you feeling since then ?
[patient] so far so good .
[doctor] okay , did they put you on medication ?
[patient] uh , they actually did .
[doctor] okay , all right . i think they have here metformin ?
[patient] yeah , that's- that sounds right .
[doctor] all right , um , and , um , in terms of your anxiety , i'm sure that this did n't help much-
[patient] did n't help , no , not at all .
[doctor] how are you doing with that ?
[patient] um , i had my moments but , um , it ... now that it's almost the weekend , it's- it's been a little bit better . i think things are under control by now .
[patient] okay .
[doctor] okay ? um , how about your epilepsy , any seizures recently ?
[patient] not in a while , it's been actually quite a few months and it was something minor but noth- nothing major ever since .
[doctor] okay . all right , well you know i wanted to just go ahead and do , um , a quick review of the systems , i know you did a cheat with the nurse-
[patient] mm-hmm .
[doctor] any chest pain , shortness of breath , nausea , vomiting , dizzy- dizziness ?
[patient] no , no .
[doctor] okay , any recent fever , chills ?
[patient] no .
[doctor] okay . and all right , let's go ahead do a quick physical exam . hey , dragon , show me the vitals . so looking here at your vital signs today , um , they look really good . so i'm just gon na go ahead and take a listen to your heart and lungs .
[patient] mm-hmm .
[doctor] okay , so on physical examination , you know , everything seems to look really good , um lungs are nice and clear , your heart's at a regular rate and rhythm . you do have some trace pitting edema to your lower extremities so what that means is that it looks like you might be retaining a little bit of fluid-
[patient] mm-hmm .
[doctor] um , did they give you a lot of fluid in the emergency room ?
[patient] they actually did .
[doctor] okay , all right , so it might just be from that . okay , well let's look at some of your results . hey , dragon , show me the glucose . okay , so yeah , you know i know that they just checked your blood sugar now and it was 162 and you know , what ... you know , did you eat before this ?
[patient] uh , probably about two hours ago .
[doctor] okay , all right . hey , dragon , show me the diabetes labs . yeah , so your hemoglobin a1c here is is 8 , you know last time we had seen it , it was about 6 and we had n't put you on medications so , um , i think it's something we'll have to talk about , okay ?
[patient] you got it .
[doctor] um , so let's just talk a little bit about my assessment and my plan for you so for your first problem , this newly diagnosed diabetes . um , you know , i want to continue on the metformin 500 mg twice a day . we'll probably increase that over time .
[patient] mm-hmm .
[doctor] i'm gon na go ahead and order hemoglobin a1c for the future okay ?
[patient] sure .
[doctor] um for your second problem , your anxiety . it sounds like you know you might have , you know , some issues leading into the winter . how do you feel about that ?
[patient] well , i'll try something new just to help . if it helps that'd be great .
[doctor] okay , all right , and so for your last ish issue , your- your epilepsy , you know , i think you saw your neurologist about three months ago , you must be due to see her again some time soon ?
[patient] i am .
[doctor] and we'll just continue you on the keppra , okay ?
[patient] sure .
[doctor] any questions ?
[patient] not at this point , no .
[doctor] okay , um , hey , dragon , finalize the note .

Medical orders:
description: hemoglobin a1c
order_type: lab
reason: diabetes