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GENHX

Symptoms: Weakness in left leg, daytime fatigue, falling asleep at work Diagnosis: Hypertension, asthma, sleep apnea, residual left leg weakness, obesity, hypercholesterolemia History of Patient: Patient reports continued left leg weakness and improvement in motor functioning. She acknowledges falling asleep at work, which she attributes to looking at a computer screen. She experiences snoring and forgetfulness at work, with a supervisor offering her coffee. Patient receives 2-5 hours of sleep per night. Plan of Action: Patient to follow up with Dr. X regarding sleep apnea treatment. Advised on risks of untreated sleep apnea, obesity, and hypercholesterolemia.

<s>[INST] Thank you. [/INST] Welcome to the clinic, Miss A. </s><s>[INST] Okay. I have high blood pressure, asthma and sleep apnea. I had blood clots in my left leg about six months ago. I also have cancer. [/INST] Let's start with your medical history. What medical conditions do you have? </s><s>[INST] I have stomach cancer. They also did a total abdominal hysterectomy. [/INST] What kind of cancer do you have? </s><s>[INST] Yes. I took it for six months. I stopped taking it and then I had the stroke. [/INST] Did they put you on an anticoagulant medication for the blood clotting? </s><s>[INST] Yes. I had a colonic resection to remove benign polyps. I had another benign lump removed from my breast. [/INST] Have you had any other surgeries? </s><s>[INST] I am still having weakness in my left leg. That is why I still have to us my walker, but I have been able to get around easier. [/INST] How are you feeling today? </s><s>[INST] No. I have been falling asleep at work. I think it is from looking at my computer screen all day. My supervisor caught me snoring one day and forgot where I was at. My supervisor offered to give me a coffee. This has happened more than once. [/INST] Have you been experiencing any daytime fatigue? </s><s>[INST] Doctor X did a consult and had me do one of those sleep test about two years ago. I only get sleepy when I look at my computer screen. [/INST] This could be due to your sleep apnea. Who is treating you for your sleep apnea? </s><s>[INST] Yes, but I never used to use it. I had another follow up visit with her and she told me that I need to use it every night. I have been using it every other night. [/INST] Did Doctor X recommend a C P A P machine to use at night? </s><s>[INST] Maybe two to five hours, on a good night. [/INST] How much uninterrupted sleep do you think that you get per night? </s><s>[INST] Okay. I will make a follow up visit with her. [/INST] That is not enough sleep. No wonder you are falling asleep at work. I recommend following up again with Doctor X regarding your sleep apnea. You are at a much higher risk for obesity and high cholesterol if you continue to not address the issues you have been having with the lack of sleep and sleep apnea. </s>

PLAN

Symptoms: N/A Diagnosis: N/A History of Patient: positive lymph nodes, issues with J-tube Plan of Action: follow up with Dr. X for blood work (CBC with diff and CMP), follow up with oncologist Dr. Z for lymph node swellings, follow up with endocrinologist Dr. A for insulin pump adjustments, follow up with gastroenterologist Dr. B for J-tube issues, follow up with Dr. Y if condition changes regarding colon cancer

<s>[INST] Yes, seven days back. I went to get my blood work done and then I followed up with Doctor Y. [/INST] So, you saw Doctor X? </s><s>[INST] I will follow up with my oncologist, Doctor Z, for my swellings. [/INST] Yes, I will look at C B C diff and C M P profile. </s><s>[INST] Okay I will do that. [/INST] Yeah, I couldn't get hold of Doctor Z but here is the phone number. You should book the appointment. </s><s>[INST] And you want me to see my gastro doc too? [/INST] Also, I would like to follow up with your endocrinologist that is Doctor A for adjustments that is needed in your insulin pump. </s><s>[INST] Sure thing. [/INST] Yes, please follow up with Doctor B for issues with your J tube. </s><s>[INST] [/INST] Lastly, I want you to see Doctor Y if your condition changes regarding colon cancer. </s>

CC

Symptoms: altered mental status. Diagnosis: N/A. History of Patient: N/A. Plan of Action: N/A.

<s>[INST] Guest_family: My mom is not well. [/INST] Is everything fine? </s><s>[INST] Guest_family: I don't know but she is not in her correct state of mind. [/INST] When did this start? </s><s>[INST] Guest_family: She is around seventy four years old. [/INST] Okay let's see what we can do, how old is she? </s><s>[INST] Guest_family: Thanks! [/INST] Okay. Don't worry, we will see what we can do. </s><s>[INST] [/INST] Of Course. </s>

CC

Symptoms: anxiety, chest pain Diagnosis: N/A History of Patient: left total hip replacement many years ago, history of hysterectomy, appendectomy at a young age, difficulty controlling alcohol consumption Plan of Action: N/A

<s>[INST] I have a lot of anxiety. [/INST] How are you feeling today? </s><s>[INST] I have a lot of pain in my chest as well. [/INST] Anything else? </s><s>[INST] Yes, I cannot stop myself. I have tried many times but it's hard to control. [/INST] Do you drink? </s>

GENHX

Symptoms: weakness, malaise, dyspnea on exertion, weight loss Diagnosis: N/A History of Patient: Symptoms present for approximately one month, denies fever, chills, sweats, cough, diarrhea; mild anorexia reported Plan of Action: N/A

<s>[INST] No, ma'am. I am forty three and this is the first time I have had a major issue. It's only been this past month where I've felt weaker than usual. I'm much more tired and short of breath whenever I move around. [/INST] Any past medical problems I should know of? </s><s>[INST] Yeah, I actually lost about fifteen pounds in less than two or three months. [/INST] Any recent weight loss? </s><s>[INST] Appetite is pretty fine. No nausea, vomiting, or diarrhea. [/INST] How's your appetite? Any nausea, vomiting, diarrhea? </s><s>[INST] No, ma'am. [/INST] How about fever, chills, sweats, cough? </s><s>[INST] No, ma'am. [/INST] And any chest pain with your shortness of breath? </s>

ROS

Symptoms: N/A. Diagnosis: N/A. History of Patient: Denies any issues from head to toe. Plan of Action: N/A.

<s>[INST] No doctor, everything else is fine. [/INST] Anything else going on from head to toe? </s><s>[INST] Yes I am sure. [/INST] Are you sure? </s>

GENHX

Symptoms: Decreased vision in the right eye, anosmia (loss of sense of smell). Diagnosis: N/A History of Patient: 76-year-old male suddenly became anosmic following shoulder surgery 13 years prior to this presentation. He continues to be anosmic but has also recently noted decreased vision OD. He denies any headaches, weakness, numbness, weight loss, or nasal discharge. Plan of Action: N/A

<s>[INST] Thank you. It's nice to meet you. [/INST] Welcome in, sir. I am Doctor Gray. </s><s>[INST] I had surgery on my shoulder thirteen years ago and after the surgery I lost my sense of smell. I still can't smell. I also can't see very well in my right eye. [/INST] What is your past medical history? </s><s>[INST] I am seventy six. [/INST] How old are you? </s><s>[INST] No. [/INST] Do you get headaches? </s><s>[INST] No. [/INST] Do you have any nasal drainage? </s><s>[INST] No. [/INST] Do you ever experience any weakness or numbness throughout or localized to an area of the body. </s><s>[INST] No. [/INST] Have you had any resent weight loss? </s>

ASSESSMENT

Symptoms: N/A Diagnosis: Chronic atrial fibrillation History of Complaint: Patient restarted on aspirin 81 mg at discharge, instructed to continue with Nexium 40 mg once daily to prevent upper GI bleed. If coffee-ground emesis or melena occurs, aspirin should be discontinued. Plan of Action: N/A

<s>[INST] Should I continue taking Nexium? [/INST] I'm glad to hear that your Afib is under control. I'd like for you to start taking baby aspirin again. </s><s>[INST] Sounds good. [/INST] Yes, I'd like you to also take Nexium forty M G once a day in order to reduce the risk of an upper G I bleed. </s><s>[INST] Okay. [/INST] And I ask that you call me immediately if you notice coffee like grounds in your vomit or bloody stool. </s><s>[INST] [/INST] If you have either of these symptoms, then we'll need to put a stop to aspirin. </s>

FAM/SOCHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: Married for almost twenty two years, working as a delivery truck driver. Smokes two packs of cigarettes per day, drinks two beers daily, denies drug use. Plan of Action: N/A.

<s>[INST] Yes, for almost twenty two years now. [/INST] Are you married? </s><s>[INST] Ah yes, I drive a delivery truck in the town. [/INST] That is amazing! And are you working? </s><s>[INST] Doctor: And how much would you say you smoke per day? [/INST] Okay. So, tell me do you smoke or drink? Yes, I do both. </s><s>[INST] Doctor: Hm, how much do you drink? [/INST] Patient: I smoke about two packs a day. </s><s>[INST] Doctor: And do you do any drugs like coke or anything? [/INST] Patient: I drink three, oh wait, I drink two beers every day. </s><s>[INST] [/INST] Patient: No. </s>

CC

Symptoms: chest pain, fever Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] Oh, I have a chest pain. [/INST] Hey, what's going on with you today? </s><s>[INST] Yes, I did. [/INST] You have fever too? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] No. [/INST] Does anyone in your family have or have history of any colon cancer or unusual polyps? </s><s>[INST] Yes, my father died of a cancer called mesothelioma and my mother died of Hodgkin's Lymphoma. [/INST] Any other family history? </s>

GENHX

Symptoms: leg pain, difficulty falling and staying asleep, lower extremity edema Diagnosis: polyarteritis nodosa, mononeuritis multiplex, severe sleep apnea History of Patient: difficulty initiating and maintaining sleep, overnight sleep study with CPAP and oxygen, review of results from hospital study, use of opioids for pain management, Lasix for lower extremity edema Plan of Action: N/A

<s>[INST] Sure, good afternoon, doctor. I'm sixty one years old. [/INST] Good afternoon, ma'am. Can you confirm your age for me, please? </s><s>[INST] I have some notes here with me, but I have a history of polyarteritis nodosa mononeuritis multiplex. [/INST] Great, what brings you in for a visit today? </s><s>[INST] Um, it's in my legs. [/INST] Is this in your legs, or arms? </s><s>[INST] Yeah, I was involved in an overnight sleep study on C P A P and oxygen. [/INST] I see here that you have sleep apnea too. </s><s>[INST] It was in order to determine why I had difficulty falling asleep and staying asleep. [/INST] Why did they do this? </s><s>[INST] Yeah, I had a review done while I was in the hospital about two weeks ago, I have the results right here. [/INST] Have You had any other treatments? </s><s>[INST] Um, I take pretty substantial doses of opioids in order to control it. [/INST] Thank you, so, how is your leg pain been managed? </s><s>[INST] Yes, I take Lasix for my leg swelling. [/INST] Do you have any swelling? </s><s>[INST] I can fall asleep with it, but I usually rip my mask off because I toss and turn. [/INST] How do you sleep with the C P A P? </s><s>[INST] I'd, um, say it's pretty terrible. [/INST] How would you rate your quality of sleep? </s>

PASTMEDICALHX

Symptoms: N/A Diagnosis: N/A History of Patient: past C. difficile infection Plan of Action: N/A

<s>[INST] No, do you have those in today? [/INST] Have you seen your lab results? </s><s>[INST] Yes, I got it when I worked at a hospital after graduating. [/INST] Yes, I have them right here. They're essentially negative, except it appears that you had C difficile in the past. Do you remember that? </s><s>[INST] [/INST] Yeah, its unfortunately more common there. </s>

CC

Symptoms: Lump on the upper outer quadrant of the left breast. Diagnosis: Suspicious calcifications upper outer quadrant, left breast. History of Patient: N/A. Plan of Action: N/A.

<s>[INST] I feel this lump on the upper side of my breast. [/INST] Hi, what brings you here today? </s><s>[INST] No, only on the left side. [/INST] Both sides? </s><s>[INST] Only on the outer side. [/INST] Do you feel it deep inside or on the outer side? </s>

ASSESSMENT

Symptoms: N/A Diagnosis: hay fever History of Patient: Otherwise healthy 2-year-old young lady Plan of Action: N/A

<s>[INST] Doctor: Well, I think she has hay fever. Otherwise she looks like a healthy two year old. [/INST] Guest_family: What do you think doctor, what does she have? </s><s>[INST] [/INST] Guest_family: Hm, okay. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: bilateral knee degenerative arthritis History of Patient: Patient is a 79-year-old female with disabling bilateral knee degenerative arthritis unresponsive to conservative measures. Agreed to proceed with surgery. Plan of Action: Knee replacement surgery discussed and agreed upon. Risks, complications, anticipated benefits, and postoperative course were discussed with patient.

<s>[INST] Yeah. I smoke about a pack a day. [/INST] Do you smoke? </s><s>[INST] Eh not really. [/INST] Do you have any plans of quitting? </s><s>[INST] Okay. I'll see what I can do. [/INST] As your doctor, I'd advise that you consider nicotine patches and find ways to break your smoking habit. </s><s>[INST] Socially. [/INST] Do you drink? </s><s>[INST] No, but I have two littles ones. [/INST] Are you married? </s><s>[INST] I have a four year old and a six year old. [/INST] Aw, how old are they? </s><s>[INST] They really do, especially the four year old. As for hobbies, I like fixing up computers. I also like fishing, hiking, and camping with the family. [/INST] That's great. I'm sure they keep you busy. Any hobbies? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] Nothing that I know of. [/INST] What is your family medical history? </s>

ALLERGY

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: Allergic to IV contrast.

<s>[INST] I am allergic to IV contrast. [/INST] Do you have any allergies? </s><s>[INST] Yes. [/INST] Are you sure? </s>

PASTMEDICALHX

Symptoms: N/A Diagnosis: anxiety, depression History of Patient: N/A Plan of Action: N/A

<s>[INST] Guest_family: Oh, dad did you also talk about your depression? [/INST] Alright we already spoke about your past medical history, anything else you might want to add? </s><s>[INST] Yeah we didn't, it slipped out of my mind. [/INST] Depression? I don't think we spoke about that. </s><s>[INST] Doctor: Okay, let me make a note of it. [/INST] Guest_family: My father has a history of depression and anxiety. </s>

ALLERGY

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] Doctor: Like any medications? [/INST] Are you allergic to anything? </s><s>[INST] Doctor: Perfect! [/INST] Patient: No, I am not allergic to anything. </s><s>[INST] [/INST] Patient: Hm. </s>

PASTSURGICAL

Symptoms: N/A Diagnosis: N/A History of Patient: Lumpectomy on the left breast, breast augmentation surgery, cholecystectomy, cardiac ablation x3, left knee surgery, removal of half of the pancreas Plan of Action: N/A

<s>[INST] Yes, they removed lump from my left breast. [/INST] You had a surgery on your breasts? </s><s>[INST] I do not have a gall bladder, then I had a breast augmentation, I have had heart surgeries three times and they have removed half of my pancreas. [/INST] Okay, and what other surgeries have you had? </s><s>[INST] And knee surgery too, on the left side. [/INST] Okay. </s><s>[INST] Cardiac ablation. [/INST] Okay. What type of heart surgery did you have? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A .

<s>[INST] Guest_family: To be honest, I'm not sure. Possibly? I'd have to check and get back to you. [/INST] Any family history of disease? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] What, like arthritis? [/INST] Do you have any orthopedic conditions that run in your family that I should know about? </s><s>[INST] No, not that I know of. [/INST] Yeah, does anything like that sound familiar? </s>

GENHX

Symptoms: pain in my tummy. Diagnosis: left patellar chondromalacia. History of Patient: started suddenly around noon, since the fall of two thousand seven, seen another orthopedist in November of two thousand seven, MRI done, referral for P T. Plan of Action: N/A

<s>[INST] Thank you. [/INST] Welcome to the clinic., ma'am </s><s>[INST] I have been struggling with pain and stiffness in my right neck and shoulder. [/INST] What brings you into see me? </s><s>[INST] Maybe for about four months. [/INST] How long has this been going on for? </s><s>[INST] It has been getting worse. The pain is worse at night. It wakes me up at night. I haven't had a good night sleep in four months. [/INST] In these past four months have your symptoms becomes worse or has it improved at all? </s><s>[INST] Yes! About two weeks after the pain started, I was having some numbness and painful cramping in these two fingers here. [/INST] Have you experienced any pain or numbness in your arm, wrist, or hand? </s><s>[INST] Yes. [/INST] The right hand and the first and second finger? </s><s>[INST] I am forty six. [/INST] How old are you? </s><s>[INST] Right. It was a throbbing pain in my hand. [/INST] Are you left or right handed? </s><s>[INST] I few times I had some numbness in both of my legs. It started with a pinching from my tailbone area. [/INST] Have you had any other pain anywhere else in your body? </s><s>[INST] No. I don't know where this pain came from. Oh, every once and a while I have this electric shock like sensation shooting down my spine when move my neck certain way. [/INST] Did you experience any trauma neck, head or back? </s><s>[INST] No. [/INST] Any pain or symptoms in your left arm or shoulder? </s><s>[INST] No. [/INST] Have you had any visual changes or disturbances? </s><s>[INST] No. [/INST] Any difficulties with your bowels or your bladder? </s><s>[INST] I have been taking Naprosyn. [/INST] Have you been taking any thing for the pain? </s><s>[INST] Only a little bit. [/INST] Has the Naprosyn help relieve your pain? </s><s>[INST] [/INST] Okay. </s>

PASTMEDICALHX

Symptoms: Difficulty breathing, cough with phlegm. Diagnosis: N/A. History of Patient: Previous visit in July 2007 for asthma Symptoms, history of pneumonia. Plan of Action: N/A.

<s>[INST] My asthma was acting up, and it felt like I couldn't breathe. [/INST] Hello, sir. I see your last visit was on July two thousand and seven. What was the reason for that visit? </s><s>[INST] Not that I know of, but I know I always get this really bad cough where I cough up some nasty phlegm. [/INST] Do you have a history of asthma? </s><s>[INST] [/INST] I see. I'm looking at your report and it says you have a history of pneumonia. </s>

GENHX

Symptoms: back pain Diagnosis: N/A History of Patient: fell on steps three nights ago while bringing in groceries, landed on right hip and hit low back on railing Plan of Action: doctor wants to get imaging done

<s>[INST] Hi! I am okay other then this back pain. [/INST] Hi, how are you? </s><s>[INST] Three nights ago, I fell on my steps bringing in the groceries from the car. [/INST] I am so sorry. Tell me about your back. </s><s>[INST] I fell and landed on my right hip. I hit my low back on the railing. [/INST] How did you land when you fell? </s><s>[INST] Okay. [/INST] I would like to get some imaging done today. </s>

CC

Symptoms: Diarrhea, vomiting, abdominal pain Diagnosis: N/A History of Complaint: N/A Plan of Action: N/A

<s>[INST] Yeah. I have had diarrhea and pain in my stomach. [/INST] It seems like you are not feeling very well today? </s><s>[INST] Yes. I threw up this morning. [/INST] Have you experienced any vomiting? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Complaint: No significant family history of disease according to doctor's records Plan of Action: N/A

<s>[INST] Doctor: None according to my records. [/INST] Guest_clinician: Any significant family history of disease? </s>

FAM/SOCHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: N/A. Plan of Action: N/A.

<s>[INST] No one. [/INST] Anybody sick in family? </s><s>[INST] No, everyone is healthy. [/INST] How about any illnesses that run in your family? </s>

GYNHX

Symptoms: Missing periods, no bleeding Diagnosis: N/A History of Complaint: Has both ovaries, uterus, and cervix, not on hormonal therapy, first time bringing up issue to doctor Plan of Action: N/A

<s>[INST] I have been missing a lot of periods and I am not sexually active. I do not bleed. Is something wrong with me? [/INST] Hello, miss. What brings you into the practice today? </s><s>[INST] I have everything still. I have both ovaries, I have a uterus, and I have a cervix still. [/INST] What is your history with your reproductive parts? Have you had any surgeries? </s><s>[INST] I am not taking anything. This is the first time I have brought this up to the doctor. [/INST] Are you on any type of hormonal therapies? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: The patient was from Brazil. He moved to the United States one year ago. He denied any history of tobacco, alcohol, or illicit drug use. He was married and monogamous. He worked as an engineer/manager, and stated that his job was "very stressful". He had recently been admitted to an MBA program. The patient denied recent travel or exposures of any kind. Plan of Action: N/A

<s>[INST] I am good, Doctor. [/INST] Hi, how are you? </s><s>[INST] Yes, about one year back. I was an engineer manager back there, but my job was so stressful that when I got admitted in the M B A program here in the states, I took it. [/INST] So, I see you recently moved to U S A from Brazil, right? </s><s>[INST] Yeah. [/INST] Wow, that's quite a move! </s><s>[INST] I am a one women man. I married my childhood sweetheart. [/INST] How about your family; wife or girlfriend? </s><s>[INST] No, I haven't traveled anywhere not even within the country. [/INST] Nice. Did you travel outside the country recently or have risk of any kind of exposure? </s><s>[INST] No, I don't. [/INST] Okay. Tell me something, do you smoke or drink? </s><s>[INST] No, never. [/INST] And have you in the past used any recreational or illegal drugs? </s><s>[INST] [/INST] Okay, good. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: Strong family history of heart disease, carcinoma, hypertension, and food allergies. Plan of Action: N/A

<s>[INST] Of course. [/INST] Hello. Before we begin your visit, I noticed some information missing. Could I verify the information with you? </s><s>[INST] Oh, yeah. A lot of my family have heart problems and cancer. [/INST] Does your family have a history of any health related problems? </s><s>[INST] I'm not completely sure, but my wife may know. She's here with me right now. [/INST] I see. Do you know what kind of cancer? </s><s>[INST] Guest_family. Hello. I'm his wife. [/INST] Great. I'll bring her in. </s><s>[INST] Guest_family: I do. I believe it's carcinoma. [/INST] Do you know what type of cancer runs in his family? </s><s>[INST] High blood pressure and food allergies run in my family too. [/INST] Thank you. Sir, are there any other health related problems I should be aware of? </s>

ALLERGY

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] What do you mean? [/INST] Any allergies? </s><s>[INST] No no, oh no. [/INST] Are you allergic to anything? </s>

PASTMEDICALHX

Symptoms: N/A. Diagnosis: GERD (acid reflux), hypertension, arthritis, Parkinson's disease, TIA (mini stroke), chronic atrial fibrillation. History of Patient: Diagnosed with GERD and hypertension 20 years ago, also diagnosed with arthritis and Parkinson's disease, experienced a mini stroke (TIA), currently on Coumadin for chronic atrial fibrillation for three years. Plan Of Action: N/A.

<s>[INST] Yes. [/INST] So, I see you were diagnosed with an acid reflux problem and high blood pressure twenty years back? </s><s>[INST] Yes, both. [/INST] And then you also have arthritis and Parkinson's. </s><s>[INST] Yes, mini stroke! [/INST] Also, you had a brain stroke? </s><s>[INST] Okay. [/INST] Ah, yes. We also call it as T I A. </s><s>[INST] Just Coumadin, for my chronic A Fib. I have been on it three years. [/INST] And currently are you on any medications? </s><s>[INST] Yes. [/INST] Yeah, atrial fibrillation. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: His father died of coronary artery disease. Plan of Action: N/A

<s>[INST] Well, yeah. Actually, my dad passed away due heart disease. [/INST] Has anyone in your family had a history of heart disease or issues? </s><s>[INST] Yeah, it is called co- [/INST] Oh, I am sorry to hear that. Do you know what kind of heart problem he had? </s><s>[INST] Yes, exactly! [/INST] Oh, coronary heart disease? </s><s>[INST] [/INST] I see. </s>

ASSESSMENT

Symptoms: Short-term memory loss (probable situational), anxiety Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] Yeah, I do have anxiety issues. [/INST] So, what I feel is you might have short term memory loss due to high stress, but I also feel it's probably due to your current situation. The other impression I have is that you have anxiety issues and again it's stress related. </s>

GENHX

Symptoms: Pain from hernia, lower leg pain, nausea, vomiting, questionable blood in stool Diagnosis: N/A History of Complaint: 53-year-old man presenting with multiple complaints including pain from hernia, some question of blood in stool, nausea, vomiting, left lower extremity pain. Left lower extremity pain has improved considerably, with past significant paresthesias now improved. History of multiple medical problems including atrial fibrillation, on subtherapeutic Coumadin, multiple CVAs in the past, peripheral vascular disease, congestive heart failure, multiple previous ischemia of large bowel. Plan of Action: N/A

<s>[INST] Guest_family: He is fifty three! [/INST] Hi sir, let me start by getting your age. </s><s>[INST] Guest_family: He is complaining of so many things but- [/INST] So, tell me what's going on? </s><s>[INST] Guest_family: He has so many issues going on with him, that is why I got him to emergency. [/INST] Patient: But I have a lot of pain from my hernia. That's the number one complaint, but I am also having pain in my lower legs. </s><s>[INST] Doctor: Don't worry, let me take a look. So, any nausea and or vomiting? [/INST] Patient: My wife freaks out easily. </s><s>[INST] Doctor: Oh, but you are not sure? [/INST] Patient: Yes both. And I am not sure, but I think I noticed some blood in my stool. </s><s>[INST] Doctor: I see. And on the scale of one to ten, ten being severe, how will you rate your lower extremity pain? [/INST] Patient: It is questionable! </s><s>[INST] Doctor: Hm. [/INST] Patient: Actually, my leg pain has improved considerably. I did have more significant tingling and numbness in the past but now it has improved a great deal. </s><s>[INST] Doctor: Oh, that's great, thank you for getting these, let me go through them quickly. So, I see you have a history of multiple- [/INST] Guest_family: He has so many medical issues. Here, I have gotten his reports. You can look at them Doctor. </s><s>[INST] Doctor: Yeah, also called as C V A. Peripheral vascular disease. Oh, and heart failure too. [/INST] Guest_family: Strokes? </s><s>[INST] Yeah. [/INST] Guest_family: Yes. </s><s>[INST] Well, yeah. [/INST] And you also have a history of multiple bowel ischemia. </s><s>[INST] Guest_family: He is taking Coumadin for his atrial fibrillation. Also, they mentioned it's not optimal for his condition but- [/INST] There is a reason why your wife is worried. So, are you taking any medicines currently? </s><s>[INST] Yeah, but I am still taking it. [/INST] Oh, I see its subtherapeutic. </s>

GENHX

Symptoms: confusion Diagnosis: N/A History of Patient: confusion, difficulty recalling medical history Plan of Action: nurse to call Doctor X to obtain patient's medical history

<s>[INST] Hi. [/INST] Hi there! I am Doctor Kirkland. </s><s>[INST] I feel weird. Like I feel confused. I don't know how I got here. [/INST] How are you feeling? </s><s>[INST] No. [/INST] That's okay. Do you remember what happened to you before you came here? </s><s>[INST] Um. [/INST] Can you tell me about your past medical history? </s><s>[INST] I can't think of what it is called. It's something to do with my brain. [/INST] Take your time. </s><s>[INST] My doctor knows what it is. [/INST] Okay. </s><s>[INST] Doctor Frank. [/INST] What is the name of your doctor? </s><s>[INST] Yes, that is his name. I don't know if that is across the street or not. [/INST] Doctor X? Across the street? </s><s>[INST] Okay. [/INST] I will have your nurse give him a call and get some background information from him. </s><s>[INST] Guest_clinician: Yes, of course. [/INST] Can you please give Doctor X a call and get mister Jones' medical history? </s><s>[INST] [/INST] Thank you. </s>

GENHX

Symptoms: bunion pain Diagnosis: N/A History of Patient: 39-year-old female presenting with bunion for several months, progressively worsening pain, attempted conservative treatment with wider shoe gear without long-term relief, desires surgical treatment Plan of Action: N/A

<s>[INST] I'm thirty nine, doctor. [/INST] Welcome to A B C D General Hospital. Before we get started, ma'am, how old are you? </s><s>[INST] I've had this bunion for a good few months now. [/INST] Great, and what seems to be the problem today? </s><s>[INST] Absolutely, I can't take it anymore. [/INST] Is the pain getting worse? </s><s>[INST] I got some wider shoes, and it's done absolutely nothing. [/INST] How have you managed this bunion so far? </s><s>[INST] Is there surgery or something we can do? I can't take the pain. [/INST] I see. </s>

CC

Symptoms: Severe bruising Diagnosis: Probable Coumadin hypersensitivity History of Patient: Taking Coumadin for three months, concerns about dosage Plan of Action: Testing for hypersensitivity to Coumadin, dosage adjustment pending test results

<s>[INST] I have been having some severe bruising. I have been taking Coumadin for three months now. Am I taking to much Coumadin? [/INST] What brings you back into the clinic today? </s><s>[INST] Okay. [/INST] You are taking a normal start dose. Some people do not metabolize the medication as well as others. I would like to get you tested for hypersensitivity. After we get the test results back, we will be able to adjust your dosage accordingly. </s>

GENHX

Symptoms: generalized weakness, malaise, worsening orthostatic dizziness, intermittent throbbing holocranial headaches Diagnosis: sinusitis History of Patient: Symptoms present for several months, worsening orthostatic dizziness for two weeks, intermittent headaches for several weeks, weight loss of forty pounds over the past year Plan of Action: N/A

<s>[INST] Doctor: Please represent the patient's case. [/INST] Hello, I want you to meet my assistant. She will be helping me out with your case today. </s><s>[INST] Doctor: You said you are feeling dizziness, so what makes it worse? [/INST] Guest_clinician: Patient is a seventy six year old male. He complains of generalized weakness and malaise for several months. He has a two week history of worsening orthostatic dizziness. He denies any recent symptoms of fever or shortness of breath, cough, vomiting, diarrhea, hemoptysis, melena, hematochezia, bright red blood per rectum, polyuria, night sweats, visual changes, or syncopal episodes. </s><s>[INST] Doctor: Do these headaches change with changing the positions or standing straight? [/INST] Patient: It's bad whenever I try to stand straight. I also have these intermittent headaches where it feels like somebody is hammering inside. </s><s>[INST] Doctor: Does the patient have any known medical history? [/INST] Patient: No. </s><s>[INST] Doctor: So, your headaches-- how long has this been going on? [/INST] Guest_clinician: Yes, he has a history of sinusitis. </s><s>[INST] Doctor: Do you smoke? [/INST] Patient: Many weeks now. </s><s>[INST] Doctor: Has there been any weight loss? [/INST] Patient: I used to smoke a hundred and even more packs per year. Now it's just one to two packs each day. </s><s>[INST] [/INST] Patient: I lost forty pounds. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: mesothelioma History of Patient: Born in Munich, Germany, immigrated to America in 1957, divorced, worked as a secretary and later as a clerical worker at IBM, retired for over 20 years due to mesothelioma complications, denies significant tobacco, alcohol, or illicit drug use, bilingual in German and English, high school education equivalent in Germany, has one son living in Santa Cruz with grandchildren whom she is trying to contact, has one brother and one sister who are healthy but with whom she doesn't communicate much Plan of Action: N/A

<s>[INST] Doctor: Wow, I cannot tell, you speak English so well, no German accent. [/INST] Patient: You know doctor, I was born in Munich, Germany. </s><s>[INST] Doctor: Okay and did you move with your family? [/INST] Patient: Yeah, I always knew how to speak English even before I was a teen. So, when I moved to America I did not have any language problem. </s><s>[INST] I had a high school degree from Germany, and I could speak German and English fluently. [/INST] Patient: No, my family moved to the eastern side of the Germany which was occupied by Russia at that time, but I decided to move to America in nineteen fifty seven. </s><s>[INST] Doctor: Your Mesothelioma? [/INST] Patient: As soon as I landed here in America, I started working. I started as a secretary at a private firm and later did clerical work at I B M. Now I am retired for almost twenty years due to my cancer complications. </s><s>[INST] Doctor: Okay, and who all are there in your family? [/INST] Patient: Yeah. </s><s>[INST] Other than him I have a brother and a sister both are healthy and living their life we don't talk much. [/INST] Patient: Well currently I am alone without any companion. I am divorced. I have a son who lives in Santa Cruz he has grand children, but I have not seen them, I am trying to get in touch with them. I want to see my grandkids. </s><s>[INST] Doctor: And do you drink or smoke? [/INST] Okay. </s><s>[INST] Doctor: Any funny drugs like heroine or coke? [/INST] Patient: Hm, nothing significant. </s><s>[INST] Doctor: Okay. [/INST] Patient: No. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: Noncontributory Plan of Action: N/A

<s>[INST] No. [/INST] Anyone in your family have a history of drug or alcohol abuse? </s><s>[INST] Nope. [/INST] Any other medical conditions that might run in your family? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: drink and smoke Plan of Action: N/A

<s>[INST] Yes, I do take two or four beers in a day. [/INST] Do you drink? </s><s>[INST] Oh yeah, I'm a smoker. I take around one to two packs of cigarettes each day. [/INST] Do you smoke? </s>

GENHX

Symptoms: sore throat, puffy eyes, congestion, low-grade fever, feeling run down, tiredness, hoarse voice Diagnosis: N/A History of Patient: sore throat starting last night, eyes very puffy, congestion started suddenly yesterday, low-grade fever, feeling very tired and run down, hoarse voice, no coughing, no shortness of breath, vomiting, diarrhea, or abdominal pain Plan of Action: N/A

<s>[INST] Guest_family: Yeah, he started having a sore throat last night. And that's why we are here. His eyes have been really puffy. Uh, we gave him some Benadryl. [/INST] Hello. You must be his mom. </s><s>[INST] I had a stuffy nose and it was hard to breathe. [/INST] Hm. </s><s>[INST] Guest_family: It started yesterday. All of a sudden, he started complaining saying, “Mama my nose is not working,” and yeah, I noticed he was breathing from his mouth. [/INST] When did it all start? </s><s>[INST] Guest_family: Yeah, he had some low grade fever. He looked very tired and when I asked him he said that, “I feel like I cannot stand. I have no energy. I want to just lie down.” [/INST] Any fever or any other symptoms? </s><s>[INST] Guest_family: He's eating and drinking normally. [/INST] I can notice that his voice is a little bit hoarse. How's he eating and drinking? </s><s>[INST] No. [/INST] Any shortness of breath or pain in your stomach? </s><s>[INST] No. [/INST] Any diarrhea or vomiting? </s>

ASSESSMENT

Symptoms: Right shoulder pain, most likely secondary to muscular strain Diagnosis: very mild evidence of impingement History of Patient: N/A Plan of Action: Further evaluation and treatment will be done.

<s>[INST] Yeah. [/INST] I think you have a muscular strain. </s><s>[INST] Oh really! [/INST] So right side shoulder strain and maybe a little bit of nerve compression. </s><s>[INST] Okay. [/INST] Maybe. I will do further evaluation and treatment. </s>

PROCEDURES

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] Okay. [/INST] I don't think we need to do any major procedure right now. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: He lives in a senior citizens building with daily nursing aids. He previously was a security guard, but is currently on disability. Plan of Action: N/A

<s>[INST] Oh, it's a senior citizen house. They have many nursing aids there. [/INST] Looks like the nurse came in and asked you everything. Ah, she has everything documented here, but I will ask one more time. So, tell me, where do you live? </s><s>[INST] No. [/INST] Do you smoke? </s><s>[INST] Ah, right now I can't because of this disability, but I used to work as the security guard. [/INST] Do you work? </s>

PASTSURGICAL

Symptoms: N/A. Diagnosis: N/A. History of Patient: Patient underwent knee surgery on the right knee. Plan of Action: Further assessment of knee function and pain management for the right knee.

<s>[INST] Yes, I had knee surgery. [/INST] Have you had any surgeries in the past? </s><s>[INST] Right. [/INST] Which knee? </s>

PASTSURGICAL

Symptoms: N/A Diagnosis: N/A History of Complaint: Unknown Plan of Action: N/A

<s>[INST] Guest_family: I couldn't tell ya even if I wanted to. I have no clue, sorry. [/INST] Has she had any surgeries in the past? </s><s>[INST] Guest_family: I can't think of anyone off the top of my head. Maybe her daughter? But she's outta town right now. [/INST] Is there someone we could call who might know? </s>

MEDICATIONS

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: Occasional acetaminophen for pain management

<s>[INST] Yeah, occasionally. [/INST] Are you taking any medications for your pain? </s><s>[INST] Just a regular pain medicine. [/INST] Which one? </s>

GENHX

Symptoms: Ear pain, headache, difficulty hearing, left-sided sinus pressure, tooth pain on left side, left-sided jaw pain Diagnosis: N/A History of Complaint: Symptoms started approximately three weeks ago, difficulty hearing has improved, chronic left-sided headache, history of atopic dermatitis, sinusitis Plan of Action: Refill prescription for Cutivate cream, further evaluation and treatment for ear pain and headache

<s>[INST] I am good doctor, thank you for asking. [/INST] How are you Miss G? </s><s>[INST] I have this ear pain and headache for some time. It's better than before but I still want to get it checked. [/INST] So, tell me what is going on? </s><s>[INST] Um, almost three weeks ago. I am having difficulty hearing. I also feel this pressure on the left side of my sinus causing tooth pain. I went to my dentist yesterday, but my teeth are fine. [/INST] Okay, when exactly did it start? </s><s>[INST] No, just ear pain and this jaw pain on the left side. [/INST] Okay, do you have headache now? </s><s>[INST] No, but I have a sinus problem and I suffer from chronic left sided headache. [/INST] Any fever, cough, sore throat, or any cold like symptoms? </s><s>[INST] Oh, I am forty nine. [/INST] How old are you? </s><s>[INST] No, currently I am just using Cutivate for my eczema. It has helped me a lot, I do need a refill for it. [/INST] Hm, so are you taking any medications for your pain? </s><s>[INST] [/INST] Okay I will send a prescription for it to your pharmacy. </s>

ALLERGY

Symptoms: N/A. Diagnosis: N/A. History of Patient: No allergies Plan of Action: N/A.

<s>[INST] No. [/INST] Are you allergic to anything? </s>

MEDICATIONS

Symptoms: N/A Diagnosis: N/A History of Complaint: Treatment with Accutane for acne for about three months Plan of Action: N/A

<s>[INST] The dermatologist started me on Accutane. [/INST] How've you been treating your acne? </s><s>[INST] About three months now. [/INST] How long have you been on Accutane? </s><s>[INST] Yeah, kinda. [/INST] Have you noticed any improvements since starting it? </s>

PASTMEDICALHX

Symptoms: N/A Diagnosis: N/A History of Patient: mastectomy, chest tube placement, chronic atrial fibrillation Plan of Action: N/A

<s>[INST] Um, yeah, I had a mastectomy, and chest tube placement. [/INST] Do you have a history of any health conditions that I should be aware of, ma'am? </s><s>[INST] Yeah, I have chronic A F I B. [/INST] Oh, wow. Do you have any chronic conditions? </s>

GENHX

Symptoms: N/A Diagnosis: N/A History of Patient: Quit smoking in 1996. He occasionally drinks alcoholic beverages. Plan of Action: N/A

<s>[INST] I am doing well, thanks. Just trying to come to you more regularly to make sure my lungs and heart are okay. [/INST] Hello, sir. How are you doing? </s><s>[INST] Yes, I quit in nineteen ninety six. I come yearly to the doctor's office to make sure that the damage I did to my lungs is monitored. [/INST] That's great. The previous notes said that you quit smoking. Are you still off? </s><s>[INST] Yeah. I smoked for a long time and I know it was bad for me. It was just the norm back in the day. [/INST] You have a great attitude. I appreciate when patient's take their health into their own hands. We can only do so much, but it is up to the patient to bring themselves in. </s><s>[INST] I do. Only occasionally. [/INST] Do you drink at all? </s>

FAM/SOCHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: Family history of cancer and heart disease, specifics unknown. Plan of Action: N/A.

<s>[INST] Well, yes, but I can't remember who had what kind. [/INST] So, do you have any family history of cancer? </s><s>[INST] That too, there's some history of heart disease, but I can't remember who. [/INST] Still, that's helpful, thank you. What about heart disease? </s>

DISPOSITION

Symptoms: N/A. Diagnosis: N/A. History of Patient: N/A. Plan of Action: Patient discharged home with a prescription for Zithromax. Scheduled for reevaluation in the office within a week.

<s>[INST] Doctor: He's doing much better. He'll be going home today with a prescription for Zithromax. [/INST] Guest_family: How's my husband doing? Sorry, I had to take a call outside. </s><s>[INST] Doctor: However, I'd like to still see him in the office next week for a reevaluation. [/INST] Guest_family: I'm glad he's able go home and get some rest. </s><s>[INST] Doctor: Yes, the front desk will be able to help you with that. [/INST] Guest_family: Great. Can we make the appointment right now? </s>

GENHX

Symptoms: shoulder pain Diagnosis: re-tear of rotator cuff History of Patient: 62-year-old female with previous rotator cuff repair, continued shoulder pain, repeat MRI confirmed re-tear of rotator cuff, patient wishes to proceed with repair after discussion of risks and benefits Plan of Action: Surgery discussed and agreed upon to repair re-tear of rotator cuff, risks including infection addressed with assurance of antibiotic use, patient consented to surgery

<s>[INST] Good afternoon, doctor. [/INST] Good afternoon, ma'am. </s><s>[INST] Oh doctor, you flatter me. I'm sixty two years old. [/INST] Remind me, how young are you? </s><s>[INST] Yes, that's correct. [/INST] Great, and you've had a rotator cuff repair before, correct? </s><s>[INST] I'm still having a lot of pain in this shoulder. [/INST] Good, well, what seems to be the problem today? </s><s>[INST] Yes, I had an M R I not too long ago, can you take a look? I have it right here. [/INST] Oh no, have you had any recent imaging done on this shoulder? </s><s>[INST] Oh no, can we do another surgery to repair it again? [/INST] Thank you, yes, um, this M R I shows that you've torn that rotator cuff again. </s><s>[INST] What's the risk of infection of the surgery? [/INST] Yes, we'll have to. </s><s>[INST] Will I be asleep again? [/INST] Its less than one percent. We'll use antibiotics to control for infection the entire time. </s><s>[INST] Great, yes, I'd like to go forward with the surgery. I need to get back to playing tennis. [/INST] Yes, you won't feel a thing. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: Mother died at age 42 of unknown type cancer. Father died at age 62 of unknown type cancer. Patient has 4 sisters, 1 brother, and 2 half-brothers. One of the half-brothers has asthma. Plan of Action: N/A

<s>[INST] Doctor: Does anyone in your family had any medical issues? [/INST] Let's talk a little bit about your family, okay? </s><s>[INST] Doctor: Which cancer? How old were they? [/INST] Patient: Yeah, my parents died of cancer. </s><s>[INST] Doctor: Who else is there in the family? [/INST] Patient: I don't know which cancer they had, but my mother was forty two and dad was sixty two. </s><s>[INST] [/INST] Patient: Oh, I have a big family. I have four sisters, one brother and two half brothers. One of my half brother's has asthma. </s>

GENHX

Symptoms: discomfort in both hands (left worse than right), dry cough, subjective fever Diagnosis: systemic lupus erythematosus History of Patient: bilateral hand discomfort, previous visit on October 30, 2007, trial of Elavil for ulnar or radial neuropathy, prescription for Zostrix cream Plan of Action: routine follow-up evaluation

<s>[INST] Sure, I'm fifty six years old. [/INST] Good afternoon, ma'am. Before we begin, can you confirm your age for me, please? </s><s>[INST] Well, I have a history of systemic lupus erythematosus. [/INST] Great, thank you. What seems to be the problem today? </s><s>[INST] Um, I went to a rheumatologist about four months ago, I had discomfort in both of my hands. [/INST] How have you been treated for this in the past? </s><s>[INST] My left was worse than my right at that time. [/INST] Which hand was worse? </s><s>[INST] Um, I came in on October thirtieth two thousand seven. I was having the same problem. [/INST] Have you seen anyone else for this? </s><s>[INST] They have me a trial of Elavil because they thought it was, um, ulnar or radial neuropathy. [/INST] What did they do for you at that time? </s><s>[INST] Yeah, they gave me a prescription for Zostrix but I couldn't fill it because of my insurance. [/INST] Did they give you any topical creams? </s><s>[INST] Yeah, especially here, at the base of my left hand, like around my wrist. [/INST] I see, have your symptoms gotten worse since they began? </s><s>[INST] Right here, doctor. [/INST] Which fingers do you feel it in? If any? </s><s>[INST] Um, actually yeah, I've been having some respiratory problems for the last three days or so. [/INST] Okay, these are your second, third, and fourth fingers. Do you have any other symptoms of note? </s><s>[INST] Um, I've had a dry cough and I feel like I've had a fever but I haven't taken my temperature. [/INST] What symptoms have you been experiencing? </s><s>[INST] No, not that I can remember. [/INST] Have you had any night sweats or chills? </s><s>[INST] No. [/INST] Have you had any chest pain or discomfort? </s><s>[INST] Thankfully, no. [/INST] What about shortness of breath, or G I problems? </s>

MEDICATIONS

Symptoms: N/A. Diagnosis: N/A. History of Patient: N/A. Plan of Action: N/A.

<s>[INST] Okay. [/INST] I am looking at the list of your medication. </s><s>[INST] I think that is correct. [/INST] All I can see is Risperdal and Invega. </s><s>[INST] Yes, I take some multivitamins, but do I need to mention it? [/INST] Are you not taking anything else? </s><s>[INST] Okay. [/INST] Yes, you should. We need to know everything. </s>

GENHX

Symptoms: back and buttock pain Diagnosis: L5 compression fracture with sclerosis, incomplete healing History of Patient: 86-year-old female with history of back and buttock pain, conservative treatment unsuccessful, CT scan shows incomplete healing of L5 compression fracture Plan of Action: bilateral L5 kyphoplasty scheduled, patient denies bowel or bladder incontinence, wears back brace and corset, no weakness reported

<s>[INST] I'm eighty six years old. [/INST] How old are you? </s><s>[INST] I identify as a female. [/INST] What gender do you identify with? </s><s>[INST] Its been a while, now. I know I have a fracture in my lower back. [/INST] How long have you had this back and buttock pain? </s><s>[INST] Another doctor called this conservative treatment. I've been resting a lot, and using antiinflammatories. [/INST] How have you been managing this? </s><s>[INST] Its been several months at this point, and honestly no, there's been no improvement. I'm still in a lot of pain. [/INST] Has there been any improvement? </s><s>[INST] What can we do about this? I'm in so much pain. [/INST] This C T Scan you had recently shows sclerosis, with some healing of a L five compression fracture, but if you look here, the healing is not complete. </s><s>[INST] What's that? [/INST] I believe you'd be a candidate for a bilateral L five kyphoplasty. </s><s>[INST] Oh, wow, that's good to hear. What are the risks of infection? [/INST] It's a small procedure on that L five vertebra. Its minimally invasive, and we can actually do it as an outpatient procedure. </s><s>[INST] How is this possible? [/INST] Very low, historically, they're less than one percent. </s><s>[INST] That's great, will I be under anesthesia? [/INST] We'll use antibiotics in order to control for infection. </s><s>[INST] Great, yes, I'd like to have this done, I can't keep living in this pain. [/INST] Yes, you'll be asleep for the whole thing. </s><s>[INST] Yes, thankfully, I have complete control over everything like that still. [/INST] Awesome, I agree. Do you have control over your bladder and bowel movements? </s><s>[INST] Yes, I usually wear both. [/INST] Do you wear a brace or corset normally? </s><s>[INST] No, I'm still very strong, even at my age. [/INST] Okay, last question, can you notice any weakness in your body? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: She is a nondrinker and nonsmoker and currently lives at the skilled nursing facility. Plan of Action: N/A

<s>[INST] Ah, I now live in an assisted nursing facility. [/INST] So, where do you live? </s><s>[INST] No, neither. [/INST] Okay, and do you drink or smoke? </s>

EDCOURSE

Symptoms: N/A. Diagnosis: N/A. History of Patient: N/A. Plan of Action: N/A.

<s>[INST] No, I feel great. [/INST] Are you feeling any pain? </s><s>[INST] No, it feels like I'm young again. I'm able to do all my activities. [/INST] Is there any other medical issue that we should be worried about? </s>

GENHX

Symptoms: Rounded back posture. Diagnosis: Thoracic kyphosis. History of Patient: Family history of kyphosis, previously seen orthopedist recommended observation, seeking second opinion. Plan of Action: N/A.

<s>[INST] Good morning, doctor. I'm thirteen. [/INST] Good morning, young lady, how old are you? </s><s>[INST] Guest_family: Well, if you look, doctor, her back posture is very rounded. [/INST] Good, and what seems to be the problem today? Mom, can you explain for me? </s><s>[INST] Guest_family: Yes, on my side, my aunt and grandfather had, um, kyphosis. [/INST] I think, it's rounding about the thoracic spine. Is there a family history of this problem? </s><s>[INST] Guest_family: Yes, we saw another orthopedist. [/INST] Yes, that's what this is. This is thoracic kyphosis to be specific. Has she seen another doctor for this? </s><s>[INST] Guest_family: They recommended we come in for further observation, so we're here for a second opinion. [/INST] What did they recommend? </s><s>[INST] No, I don't have any of that. [/INST] Good, is there any back pain, numbness or tingling? </s><s>[INST] No, I'm very strong, especially for my age. [/INST] Is there any weakness, numbness or tingling in your legs and arms, my dear? </s><s>[INST] Yes, doctor, everything is regular there. [/INST] Are you going to the bathroom with no problem? </s>

GENHX

Symptoms: N/A Diagnosis: gestational diabetes during pregnancy History of Patient: 28-year-old female with gestational diabetes during first pregnancy, previously used insulin, seeking dietary consultation for current pregnancy, lacks understanding of ketones, walks her daughter to school and back daily (20 minutes each way), not a big milk drinker Plan of Action: N/A

<s>[INST] I'm twenty eight. [/INST] How old are you? </s><s>[INST] No, this is my second pregnancy. I had gestational diabetes with my first one as well. [/INST] So, you are here for the dietary consultation. Is this your first pregnancy? </s><s>[INST] Yes, I used insulin last time as well. I'm just here to understand if diet can help me with my gestational diabetes. [/INST] Were you taking any insulin at that time? </s><s>[INST] My Gynecologist was saying something about ketones, I don't know what they are. She asked me to talk about them with you. [/INST] Sure. </s><s>[INST] Thank you. [/INST] Sure, I will explain everything to you. We also have a pamphlet to explain it. Here have a look. You can take it with you. </s><s>[INST] I walk everyday with my daughter. I go to drop her to school and then back home. [/INST] Are you exercising? </s><s>[INST] It takes around twenty minutes on one side. So, everyday it is like forty minutes in the morning and same in the evening around four. [/INST] How long is the walk to school? </s><s>[INST] I try to, I know it is a good source of calcium and is very essential especially with my pregnancy, but I am not a big fan of drinking milk. [/INST] Do you drink milk? </s>

GENHX

Symptoms: Burn on the arm from elbow to wrist, mainly on the medial aspect Diagnosis: N/A History of Complaint: Workers' Compensation injury, hot oil splashed onto arm while cooking in coffee shop kitchen Plan of Action: Provide care for burn injury

<s>[INST] Guest_family: I am his friend; I work with him in a coffee shop. He works as a cook there. [/INST] How are you related to the patient? </s><s>[INST] I'm forty one. [/INST] Can you tell me your age? </s><s>[INST] Guest_family: He was cooking, and the hot oil splashed onto his arm. [/INST] Can you tell me what exactly happened? </s><s>[INST] Yes. I don't know how the oil splashed but burned my hand. I tried to let it cool down, but the pain was unbearable. I asked my friend to take me to the emergency department here. [/INST] Did this happen in the coffee shop kitchen? </s><s>[INST] I guess, yeah. [/INST] So, this will be the workers' compensation for injury. </s><s>[INST] OK. [/INST] OK, let me see your hand. </s><s>[INST] Doctor: OK, don't worry. We will take care of you. [/INST] The burn is from the elbow to the wrist. It is mainly on the medial aspect. </s>

ALLERGY

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] No. [/INST] Do you have any known allergies to medications? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: Paternal grandmother has diabetes and hypertension, paternal grandfather had emphysema and was a smoker, no children needing pediatric subspecialist or any childhood deaths less than 1 year of age Plan of Action: N/A

<s>[INST] My dad's mom has diabetes and hypertension and my dad's dad had emphysema and he was a smoker. [/INST] Can you tell me something about your family? Any illnesses in family? </s><s>[INST] Yeah. [/INST] Okay. </s><s>[INST] No, there isn't. [/INST] Is there any history of death of child who was less than a year maybe? </s><s>[INST] No. [/INST] Okay. That's great. No illnesses for small children? </s>

PASTSURGICAL

Symptoms: N/A Diagnosis: N/A History of Patient: Left total hip replacement many years ago, hysterectomy, appendectomy at a young age Plan of Action: N/A

<s>[INST] I had a hip replacement years ago. [/INST] Any past surgeries that I should know of? </s><s>[INST] My left. [/INST] Both hips? </s><s>[INST] Yeah. [/INST] Total? </s><s>[INST] I also had my uterus and appendix removed. I was young when I had my appendix taken out. [/INST] Got it. </s><s>[INST] Wish I did. I'd have to look back at my records and get back to you. I have everything at home. [/INST] Do you happen to remember who did your most recent surgeries? </s><s>[INST] [/INST] That's no problem. I should be able to look it up from my end, too. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: Father had Von Hippel-Lindau Disease (VHL) Plan of Action: N/A

<s>[INST] Yeah, my father had a special kind of tumor, which doctors said is very rare. [/INST] Any medical disorders in the family? </s><s>[INST] I don't remember the exact name of the disease, but it was a big name and it started with something with V. [/INST] Do you know the name of the tumor? </s>

FAM/SOCHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: Father has a history of high blood pressure and experienced two strokes, one at age 45 and another around 2 years ago at age 80. Mother has sugar issues. Plan of Action: N/A.

<s>[INST] My dad has high blood pressure, and he takes medication for it. He is now eighty two years old. He had a stroke around two years ago. This was his second stroke. First one he had when he was forty five. [/INST] Are there any known disease running in your family? </s><s>[INST] My mom is eighty years old. She does have sugar issues. [/INST] What about your mom? How old is she? </s>

PASTSURGICAL

Symptoms: N/A. Diagnosis: N/A. History of Patient: L5-S1 lumbar laminectomy in 1975, exploratory laparotomy in 1967, tonsillectomy and adenoidectomy, and anal fissure surgery in 1975. Plan of Action: N/A.

<s>[INST] Guest_clinician: Go ahead. [/INST] I have their surgical history if you'd like to go over it. </s><s>[INST] Guest_clinician: Okay. [/INST] So they had an exploratory laparotomy in nineteen sixty seven. </s><s>[INST] Guest_clinician: Got it. Any complications that you know of? [/INST] They had a number of surgeries in nineteen seventy five, which include an L five S one lumbar laminectomy, anal fissure surgery, tonsillectomy, and adenoidectomy. </s><s>[INST] [/INST] None were mentioned by the patient or their spouse. </s>

MEDICATIONS

Symptoms: N/A Diagnosis: N/A History of Patient: None Plan of Action: N/A

<s>[INST] Nope. [/INST] Do you take any daily medications or supplements? </s>

PASTSURGICAL

Symptoms: N/A. Diagnosis: N/A. History of Patient: Denies any past surgeries. Plan of Action: N/A.

<s>[INST] No. [/INST] Did you had any surgery in the past? </s>

GENHX

Symptoms: Feeling sick, weakness Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] I feel terrible. Very sick and I can barely move. I feel so weak. [/INST] Hello, sir how are you feeling today? </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Complaint: Family history of heart disease, cerebrovascular disease, diabetes, and hypertension Plan of Action: N/A

<s>[INST] I think I have some sort of condition. [/INST] Hi, there. How are you doing? </s><s>[INST] My body has been feeling weird lately. [/INST] Why do you say that? </s><s>[INST] I know a lot of my family has some sort of heart problem. We have high blood pressure and blood sugar. There's one more thing. It starts with a C. Something to do with the brain. Do you know? [/INST] I see. Is there anything that runs in your family? </s><s>[INST] There you go. How'd you get that so fast? [/INST] Is it cerebrovascular disease? </s><s>[INST] [/INST] I guess I know my stuff. </s>

ROS

Symptoms: Vomiting (occasional), constipation, bloating, feeling not fresh in the morning or throughout the day, twisty pain in stomach. Diagnosis: N/A. History of Patient: Experiencing intermittent constipation for a couple of months, occasional vomiting. No fever, chills, blood in stool, heartburn, or cough with sputum. Plan of Action: Prescribed strong laxative for constipation, no indications of stomach ulcer or gastrointestinal bleeding.

<s>[INST] No. [/INST] Any fever or chills? </s><s>[INST] No. [/INST] Any headache or body pains? </s><s>[INST] I had vomiting a few times. [/INST] Any nausea vomiting? </s><s>[INST] No. [/INST] Did you observe any blood? </s><s>[INST] No, on the contrary I am having constipation every now and then, it's really bothering me now. I feel bloated all the time and don't feel fresh in the morning or throughout the day. [/INST] Okay, any diarrhea? </s><s>[INST] Couple of months now. [/INST] Oh, how long have you had this problem? </s><s>[INST] No. I use suppositories. [/INST] Hm, I see, does it hurt you to pass stool? Did you notice any blood? </s><s>[INST] Okay! [/INST] Oh, that's great. You are doing the right thing. In addition to that I will prescribe you some strong laxative you can drink that in morning it should help. </s><s>[INST] No, not really. I do get this twisty pain in my stomach sometimes which I think is mainly due to my constipation. [/INST] Any complains of heart burn or acidity or stomach pain? </s><s>[INST] No, I feel fine. [/INST] Yeah, you can get that kind of pain with constipation. Any cough or cold like symptoms? Any cough with sputum? </s><s>[INST] [/INST] Okay, basically I don't think you have any stomach ulcer or anything, but we need to treat your constipation because I know it can be really uncomfortable. </s>

GENHX

Symptoms: Mild nausea, pain with deep inspiration, resolving dysphagia. Diagnosis: Non-small cell lung cancer stage IA (treated with CyberKnife therapy). History of Patient: Completed CyberKnife treatment one month ago, experiencing low-level nausea without vomiting, no heartburn, cough, hemoptysis, rash, or palpable rib pain. Plan of Action: N/A.

<s>[INST] I have seen worse days. [/INST] Hello Miss Sherry, how are you doing today? </s><s>[INST] Guest_clinician: Hello. [/INST] Ha, I will take that as a positive answer then. I have my resident here with me, Doctor Helm, she will be representing your case today. </s><s>[INST] Doctor: Doctor Helm. [/INST] Patient: Hello Doctor Helm. </s><s>[INST] Doctor: Thank you Doctor Helm. So, Miss Sherry, how are you doing after the treatment? [/INST] Guest_clinician: The patient is a sixty one year old female. She was diagnosed with non small cell lung cancer stage one A in the upper right lobe. She was treated with CyberKnife and the treatment was completed one month ago. This is her first visit after the CyberKnife treatment. </s><s>[INST] Doctor: How would you define it mild, moderate, or severe? [/INST] Patient: I feel nauseous. </s><s>[INST] Doctor: What about vomiting? [/INST] Patient: I would say mild. </s><s>[INST] Doctor: How is your dysphagia? Are you able to swallow and eat your food and drink now? [/INST] Patient: No, only nausea is there. If I try to take deep breaths, then I still have pain. </s><s>[INST] Doctor: Is there any heartburn or rash? [/INST] Patient: It has been better now. I won't say I am all good but as I said I have seen the worst days. </s><s>[INST] Doctor: Are you coughing up blood, or just cough? [/INST] Patient: No. </s><s>[INST] Doctor: Let me exam for any rib pain, okay? [/INST] Patient: No, none of them. </s><s>[INST] Doctor: Any pain if I touch you here or here? [/INST] Patient: Okay. </s><s>[INST] [/INST] Patient: No. </s>

IMAGING

Symptoms: N/A Diagnosis: The patient's CBC results from before were reviewed. Her CBC performed in the office today showed hemoglobin of 13.7, white count of 13.3, lymphocyte count of 7.6, and platelet count of 26,000. History of Patient: N/A Plan of Action: N/A

<s>[INST] Sure. [/INST] So, we looked at your previous blood work results, now let me see what these reports say from today's C B C exam. </s><s>[INST] Doctor: Okay? [/INST] Okay so your hemoglobin levels look within range, white counts are thirteen point three, then seven point six lymphocytes and twenty six thousand platelets. </s><s>[INST] [/INST] Patient: Okay. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] Yes my father. They did his heart bypass surgery when he was sixty. [/INST] Has anyone in your family had heart diseases? </s><s>[INST] Yes I know what you mean. [/INST] Is he alright now? </s><s>[INST] Doctor: What exactly was the heart disease named? Do you know? [/INST] Patient: Yes by God's grace, both my parents are alive. </s><s>[INST] Doctor: How old is he now? [/INST] Patient: Yeah they said it was something called coronary artery disease and he had many strokes due to that. </s><s>[INST] Doctor: Okay. Do you smoke or drink alcohol? And how much? [/INST] Patient: My father is in his eighties. My mother is eighty years old too and she has dementia. My father has dementia too. </s><s>[INST] [/INST] Patient: No I do not drink or smoke. </s>

CC

Symptoms: Abdominal pain and discomfort for 3 weeks Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] Right above my belly button. It's been bothering me for three weeks now. [/INST] Where's your pain? </s><s>[INST] Um it's pretty constant, but it does seem to get worse at night. [/INST] Does the pain come and go? </s><s>[INST] Eh not really. I can't seem to really get comfortable since it started. [/INST] Do you find that sitting or laying down in certain positions helps the pain? </s><s>[INST] I uh- [/INST] Have you taken any medicine for the pain? </s><s>[INST] Um I took Pepto Bismol a few times, but that didn't do much. [/INST] Yes? </s><s>[INST] Yeah. [/INST] Did they already take you back for your C T scan? </s><s>[INST] [/INST] We should be getting the results of your scan fairly soon then. In the meantime, I'm going to put in some additional orders. </s>

PASTMEDICALHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: N/A. Plan Of Action: N/A.

<s>[INST] Yes, sir. None. [/INST] So just to double check. No past medical history? </s>

MEDICATIONS

Symptoms: N/A. Diagnosis: N/A. History of Patient: N/A. Plan of Action: N/A.

<s>[INST] Yes, and the Wellbutrin is an inhaler. [/INST] Do you take Diovan, estradiol, Norvasc, Wellbutrin? </s><s>[INST] Yes. [/INST] Okay so inhaler SR? </s><s>[INST] Yes. [/INST] Do you take oxygen therapy at home? </s><s>[INST] [/INST] Okay. </s>

PASTMEDICALHX

Symptoms: N/A. Diagnosis: Asthma, nasal inflammation, abnormal growth on neck (per patient's notes). History of Patient: N/A. Plan of Action: N/A.

<s>[INST] Great. I'm just here for my yearly physical. [/INST] Hello. How are you feeling today? </s><s>[INST] Uhm. Let me check my notes on my phone. I knew this question would pop up, but I always forget. Oh, perfect. You can take a look at them. [/INST] Oh, good. I see your past medical history is missing. Do you, by chance, know if you've had any health related problems before? </s><s>[INST] If it's on there, then it's true. I usually don't remember these kinds of things. My wife is usually here with me. She knows all about my health. [/INST] Thank you. I just want to verify the information with you. You had asthma, nasal inflammation, and some abnormal growth on you neck, correct? </s>

FAM/SOCHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: N/A. Plan of Action: N/A.

<s>[INST] No, I have never smoked in my entire life. [/INST] Do you smoke? </s>

FAM/SOCHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: N/A. Plan of Action: N/A.

<s>[INST] No nothing. No major illnesses. [/INST] Do you have major illnesses in the family like diabetes or high B P? </s><s>[INST] Yes. [/INST] Okay. </s>

FAM/SOCHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: Works at a nursing home. Nonsmoker since 1972. Currently attempting weight loss with success on a new diet, having lost several pounds in recent months. Plan of Action: N/A.

<s>[INST] Quit in nineteen seventy two. [/INST] Do you currently smoke? Or did you smoke in the past? </s><s>[INST] Yeah, I work at a nursing home. [/INST] Great to hear. Are you working right now? </s><s>[INST] Yeah, my job is very supportive. I've actually been trying to lose weight. So far, I've lost a good amount since starting a new diet several months back. [/INST] Does your job allow you to take time for yourself? </s>

PASTSURGICAL

Symptoms: N/A Diagnosis: N/A History of Patient: Surgery for melanoma, hysterectomy Plan of Action: N/A

<s>[INST] Yes, I had it for melanoma some time ago. [/INST] Have you ever had surgery, ma'am? </s><s>[INST] Oh, yes, that's true. I had that done too. [/INST] I see here that you had a hysterectomy as well, is that correct? </s>

PLAN

Symptoms: N/A Diagnosis: N/A History of Complaint: N/A Plan of Action: Take medications regularly, PT, OT, and speech therapy evaluation and treatment at Siskin Rehab Hospital, continue Cipro for additional two days for UTI

<s>[INST] No. [/INST] I have sent over your referral for physical therapy, occupational therapy and speech therapy. The patient coordinator at Siskin Rehab Hospital will give you a call within two days to see up your appointments. It is important to take your medications regularly. You need to continue the Cipro for an additional two days only. That will take care of the U T I. Do you have any questions? </s>

FAM/SOCHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: Retired one year prior to assessment due to disability. Formerly employed as an electronic technician for the US Postal Service. Lives with wife and daughter in an apartment. Denied smoking history. Used to drink alcohol rarely but stopped entirely with the onset of Symptoms. Denied history of drug abuse. Denied recent travel history. Plan of Action: N/A.

<s>[INST] No, I am retired now. I used to work for the U S postal service as an electronic technician but took retirement one year earlier due to my disability. [/INST] Are you still working? </s><s>[INST] Well, I stay with my wife and daughter in our apartment. [/INST] Ah okay. And who is in your family? </s><s>[INST] No. [/INST] Okay. Do you smoke? </s><s>[INST] I use to drink occasionally, that too very rare, but after my symptoms stated I stopped completely. [/INST] How about alcohol? </s><s>[INST] Nope. [/INST] Any use of recreational or illegal drugs? </s><s>[INST] No, it's been really long since I traveled anywhere. [/INST] Did you travel anywhere recently? </s>

GENHX

Symptoms: N/A Diagnosis: N/A History of Patient: N/A Plan of Action: N/A

<s>[INST] Good, can't complain. [/INST] How's it going? </s><s>[INST] Yeah, that's not a problem. [/INST] Glad to hear. So today we're going to do a comprehensive eval. It'll be a bit different than our usual visits together. Would you like your mom to step in the room, too? </s><s>[INST] [/INST] Alright. I'll grab her from the waiting room. I'll be right back. </s>

PASTMEDICALHX

Symptoms: N/A Diagnosis: Dementia, asthma, chronic anemia, hypothyroidism, schizophrenia, positive PPD in the past History of Patient: N/A Plan of Action: N/A

<s>[INST] Guest_family: Hi, I am her nurse. [/INST] And you are- </s><s>[INST] Guest_family: I have very limited information, as I very recently started working with her. She does have dementia and that's the main reason why I was hired. Her family wanted someone to look after her twenty four seven. [/INST] So, do you know about her past medical history? </s><s>[INST] Guest_family: But I do have her medical records. You can have a look. [/INST] Oh, I see. </s><s>[INST] Guest_family: Yes. [/INST] Yeah, that will be nice. Let me check her reports quickly. She has a history schizophrenia, chronic anemia and hypothyroidism and she also suffers from asthma. </s><s>[INST] Guest_family: I honestly don't know, but I wasn't told that. [/INST] Oh, I also see here she tested positive for P P D, was she diagnosed with tuberculosis? </s><s>[INST] [/INST] Okay. </s>

FAM/SOCHX

Symptoms: Stable mood, positive response to Wellbutrin. Diagnosis: Depression. History of Patient: Patient reports feeling good with Wellbutrin treatment for depression. Plan of Action: Continue Wellbutrin regimen, advise against alcohol or recreational drug consumption.

<s>[INST] I have been feeling good. The Wellbutrin is working well for me. [/INST] How have you been feeling? Is the Wellbutrin keeping your mood stabilized? </s><s>[INST] I don't drink or do drugs. [/INST] It is important to not consume any alcohol or recreational drugs while taking Wellbutrin. </s>

FAM/SOCHX

Symptoms: N/A Diagnosis: N/A History of Patient: married, works as a secretary in a law firm, no history of tobacco, alcohol, or illicit drug use Plan of Action: N/A

<s>[INST] Yes. [/INST] Are you married? </s><s>[INST] I work as a secretary in a law firm. [/INST] Where do you work? </s><s>[INST] No, none of these. [/INST] Do you smoke or drink? Have you ever tried any illegal drug? </s>

GENHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: Psychotic episodes recurring for about 20 years, responded well to Clozaril and other medications initially, but eventually experienced new psychotic episodes. Plan of Action: N/A.

<s>[INST] It has been around twenty years. [/INST] How long it has been since these psychotic periods are going off and on? </s><s>[INST] Yes. [/INST] So, you were taking Clozaril and some other medications? </s><s>[INST] Yes. It was better for some years. [/INST] Were you feeling better with them, sir? </s><s>[INST] They were at times, but eventually there was a new episode. [/INST] These antipsychotics, they were good on you, right? </s>

FAM/SOCHX

Symptoms: N/A. Diagnosis: N/A. History of Patient: Patient used to smoke but quit approximately 30 years ago. Patient denies current alcohol or drug use, but her son reports a long history of alcohol use and past abuse of prescription medication. Plan Of Action: N/A.

<s>[INST] About thirty years back. [/INST] When did you stop smoking? </s><s>[INST] No never. [/INST] Okay. How about any alcohol or drugs? </s><s>[INST] Doctor: Yes, please tell me son. [/INST] Guest_family: Mom, please let the doctor know about the time when you had it in the past. </s><s>[INST] Okay. Yes, that. [/INST] Guest_family: She used to drink a long time back and used to take a lot of prescription medication. </s><s>[INST] I don't remember maybe more than twenty years. [/INST] Thank you for that information. How long ago? </s>

ALLERGY

Symptoms: N/A. Diagnosis: N/A. History of Patient: Asthma, sinus issues, hives, history of psoriasis. Plan of Action: N/A.

<s>[INST] Oh, I have a list. I have asthma and sinus issues. I also had hives at some point and psoriasis. [/INST] Were there any medical issues in the past? </s><s>[INST] I don't know of any. [/INST] How about allergies? </s>

DISPOSITION

Symptoms: N/A Diagnosis: N/A History of Complaint: N/A Plan of Action: Going home with his son

<s>[INST] I am going home with my son. I will stay with him. [/INST] Who are going to stay with? </s>