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<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 3. Guaifenesin ___ mL PO Q6H:PRN cough 4. Mylanta *NF* 1 tablet Oral daily prn gas 5. Tiotropium Bromide 1 CAP IH DAILY 6. Amlodipine 5 mg PO DAILY 7. Ibuprofen 400 mg PO Q6H:PRN pain 8. MetFORMIN XR (Glucophage XR) 500 mg PO DAILY 9. Lorazepam 1 mg PO Q6H:PRN anxiety 10. OLANZapine 15 mg PO HS 11. TraZODone 50 mg PO HS:PRN insomnia 12. Haloperidol 5 mg PO TID:PRN agitation 13. Haloperidol 5 mg PO TID 14. Docusate Sodium 100 mg PO BID 15. Senna 1 TAB PO BID:PRN constipation 16. Lisinopril 10 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnosis: Lithium toxicity Secondary diagnoses: bipolar disorder, diabetes mellitus Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospitalization at ___. You were admitted for altered mental status and confusion which was due to an increased lithium level. You likely became dehydrated, your kidneys got injured and you developed a high level of the drug in your blood which caused adverse effects. You were given fluids and your level decreased. Your kidneys improved.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Ms. ___, It was a privilege caring for you at ___. Please see below for more information on your hospitalization. WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted to the hospital because you had chest pain. You were found to have had a heart attack. WHAT WAS DONE WHILE YOU WERE IN THE HOSPITAL? - Your heart arteries were examined (cardiac catheterization) which showed a blockage of one of the arteries. This was opened by placing a tube called a stent in the artery. You were given medications to prevent future blockages. - We started you on medications to help your heart - You had a low blood count (anemia) and we did imaging and the GI team looked at your esophagus, stomach and first part of your intestines with EGD. They saw some ulcers and changes in your esophagus but no obvious signs of bleeding. - We gave you blood to maintain your blood counts - You blood counts remained stable and you were ready to go home. WHAT DO YOU NEED TO DO WHEN YOU LEAVE THE HOSPITAL? - Take all of your medications as prescribed (listed below) - It is very important to take your aspirin and clopidogrel (also known as Plavix every day. - These two medications keep the stents in the vessels of the heart open and help reduce your risk of having a future heart attack. - If you stop these medications or miss ___ dose, you risk causing a blood clot forming in your heart stents and having another heart attack - Please do not stop taking either medication without taking to your heart doctor. - You are also on other new medications for your atrial fibrillation including Metoprolol and Digoxin to help control your heart rate. You were also started on Rivaroxaban to help prevent stroke. - Weigh yourself every morning, seek medical attention if your weight goes up more than 3 lbs from your discharge weight of 163.8 lbs. - Seek medical attention if you have new or concerning symptoms or you develop swelling in your legs, chest pain, abdominal distention, or shortness of breath at night. - Follow up with your doctors as listed below It was a pleasure taking part in your care here at ___! We wish you all the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Apixaban 5 mg PO BID RX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 2. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals [Vitamins and Minerals] 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Zinc Sulfate 220 mg PO DAILY Duration: 10 Days RX *zinc sulfate 220 mg (50 mg zinc) 1 capsule(s) by mouth daily Disp #*3 Capsule Refills:*0 4. Metoprolol Succinate XL 25 mg PO DAILY RX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. erenumab-aooe 70 mg/mL subcutaneous Monthly 6. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH QAM 7. HYDROmorphone (Dilaudid) ___ mg PO QID:PRN Pain - Moderate 8. ketamine (bulk) 100 % miscellaneous TID:PRN 9. Lidocaine 5% Ointment 1 Appl TP TID:PRN pain 10. Mirtazapine 45 mg PO QHS 11. Pregabalin 300 mg PO BID 12. Promethazine 12.5 mg PO BID:PRN nausea 13. Sumatriptan Succinate 6 mg SC ONCE:PRN migraine 14. Tizanidine 8 mg PO TID 15. HELD- amLODIPine 7.5 mg PO DAILY This medication was held. Do not restart amLODIPine until you see your primary care doctor 16. HELD- Furosemide 20 mg PO DAILY This medication was held. Do not restart Furosemide until you see your primary care doctor 17. HELD- Lisinopril 40 mg PO DAILY This medication was held. Do not restart Lisinopril until you see your primary care doctor Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS ================== Oral pharyngeal and esophageal dysphasia Acute kidney injury hypotension SECONDARY DIAGNOSIS ===================== Urinary tract infection Chronic regional pain syndrome Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>====================== DISCHARGE INSTRUCTIONS ====================== Dear Ms. ___, It was a privilege caring for you at ___. WHY WAS I IN THE HOSPITAL? - You came to the hospital because you were found to have a low blood pressure by your outpatient providers. WHAT HAPPENED TO ME IN THE HOSPITAL? - Your blood pressure improved after providing you with fluid. This was likely caused by your low food intake from not being able to eat properly. - We placed a tube to provide you extra nutrition with the hopes we may be able to improve your ability to swallow. You were very nausea and uncomfortable with the tube in your nose so you had a tube in your belly placed. - You received teaching on how to use the tube feeds. - Please follow up with your primary care doctor, ___ ___ neurologist, Dr. ___ to determine need for long term need for supplemental feeding. WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL? - Make sure you continue to have bowel movements. Can take senna or miralax if you do not have a bowel movement in 2 days. - Continue to take all your medicines and keep your appointments. We wish you the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Glargine 25 Units Bedtime Regular 7 Units Lunch Regular 7 Units Dinner Regular 7 Units at 0000 Insulin SC Sliding Scale using REG Insulin 2. Aspirin 81 mg PO DAILY 3. Docusate Sodium 100 mg PO DAILY:PRN Constipation - First Line 4. Dronabinol 10 mg PO TID 5. Escitalopram Oxalate 10 mg PO DAILY 6. Famotidine 20 mg PO Q12H 7. Ferrous Sulfate 325 mg PO DAILY 8. Furosemide 20 mg PO DAILY 9. Heparin 5000 UNIT SC BID 10. HYDROmorphone (Dilaudid) ___ mg PO Q6H:PRN Pain - Moderate 11. Levothyroxine Sodium 150 mcg PO DAILY 12. LORazepam 0.5 mg PO Q8H:PRN anxiety 13. melatonin 5 mg oral QHS 14. Mirtazapine 15 mg PO QHS 15. Moexipril 3.75 mg PO DAILY 16. Multivitamins 1 TAB PO DAILY 17. Ondansetron ODT 4 mg PO Q8H:PRN nausea 18. Senna 17.2 mg PO DAILY:PRN constipation 19. TraZODone 25 mg PO QHS:PRN insomnia Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Hyperglycemia Recurrent necrotizing fasciitis Sacral uclers Gastroparesis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>You came in with high blood sugars as you felt your diabetes was not well managed at the facility you were at. We increased your long-acting insulin and your blood sugars improved. We are sending you to a different facility for you to continue getting rehab and the nursing care you need It was a pleasure taking care of you at ___ ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*90 Tablet Refills:*0 2. Atorvastatin 40 mg PO QPM 3. Losartan Potassium 100 mg PO DAILY 4. Omeprazole 40 mg PO DAILY 5. Tamsulosin 0.4 mg PO QHS 6. PNEUMOcoccal 23-valent polysaccharide vaccine 0.5 ml IM NOW X1 Start: ___, First Dose: Next Routine Administration Time 7. Spironolactone 12.5 mg PO DAILY RX *spironolactone 25 mg 0.5 (One half) tablet(s) by mouth daily Disp #*90 Tablet Refills:*0 8. Isosorbide Mononitrate (Extended Release) 90 mg PO DAILY RX *isosorbide mononitrate 30 mg 3 tablet(s) by mouth daily Disp #*90 Tablet Refills:*0 9. HydrALAZINE 25 mg PO TID RX *hydralazine 25 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 10. Carvedilol 3.125 mg PO BID RX *carvedilol 3.125 mg 1 tablet(s) by mouth twice a day Disp #*180 Tablet Refills:*0 11. Torsemide 40 mg PO DAILY RX *torsemide 20 mg 2 tablet(s) by mouth daily Disp #*90 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY ====== Acute on Chronic Systolic CHF Cardiogenic Shock SECONDARY ======== ___ on CKD CAD s/p CABG Renal Mass GERD BPH Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted after you were found to have worsening heart failure. We were nervous that you might have been developing a condition called "cardiogenic shock," where your body has difficulty delivering enough oxygen to the organs in your body. You were therefore briefly on a medication that helps strengthen your heart's pumping abilities. We also started you on a lot of the Lasix via a drip, and you had excellent urine output in response, and your heart failure improved. Please weigh yourself every morning, and call your PCP or cardiologist if your weight goes up more than 3 lbs. Your dry weight is 125.5kg.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Amiodarone 400 mg PO BID 3. Docusate Sodium 100 mg PO BID 4. Metoprolol Tartrate 25 mg PO TID Hold for HR<55 or SBP <90 5. Senna 8.6 mg PO BID:PRN constipation 6. Warfarin 5 mg PO DAILY16 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: 1. bilateral pulmonary emboli 2. subarachnoid hemorrhage 3. left DVT Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the Acute Care Trauma service on ___ after a fall. You were found to have a small subarachnoid hemorrhage, bilateral pulmonary emobli and a left femoral leg blood clot. You underwent IVC placement and were anticoagulated. You were additionally found to be in atrial fibrillation and you were treated with multiple agents- you will be discharged home on metoprolol and amiodarone.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. mercaptopurine 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 2. Fish Oil 300-500 mg Capsule Sig: One (1) Capsule PO once a day. 3. cyanocobalamin (vitamin B-12) 1,000 mcg/mL Solution Sig: One (1) Injection once a month. 4. multivitamin,tx-minerals Tablet Sig: One (1) Tablet PO DAILY (Daily). 5. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 6. fluticasone 50 mcg/actuation Spray, Suspension Sig: Two (2) Spray Nasal DAILY (Daily). 7. enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) syringe Subcutaneous twice a day. Disp:*28 syringe * Refills:*0* 8. metronidazole 500 mg Tablet Sig: One (1) Tablet PO every eight (8) hours for 14 days: do not drink while taking this medication. Disp:*42 Tablet(s)* Refills:*0* 9. Cipro 500 mg Tablet Sig: One (1) Tablet PO twice a day for 14 days. Disp:*28 Tablet(s)* Refills:*0* 10. oxycodone 5 mg Capsule Sig: One (1) Capsule PO every eight (8) hours as needed for pain: do not drive while taking this medication as it can make you tired . Disp:*10 Capsule(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: Primary Diagnosis Abscess Crohns Disease Microscopic hematuria Secondary Diagnosis Nephrolithiasis Urethral strictures. Rosacea. Anxiety depression Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure participating in your care while you were admitted to ___. As you know you were admitted because you were having abdominal pain. You had a MRI which showed a collection of pus called an abscess. A drain was placed to remove the infected fluid. You were started on antibiotics which you will need to continue for at least 14 more days. You will follow-up with Dr. ___ if you need to continue antibiotics for a longer period of time You were given a medication that reverses the effects of your warfarin so that the drain could be placed. You were started on lovenox in place of the warfarin. You will continue on this medication in the place of the warfarin. You should discuss this further with Dr. ___ at your next appointment. You also had small amount of blood in your urine. You will need to follow up with your PCP about this ___ made the following changes to your medications. 1. START ciprofloxacin 500 mg twice a day 2. START flagyl 500 mg every 8 hours 3. START lovenox 80 mg twice a day 4. STOP Warfarin 5. START oxycodone as needed for pain You should continue to take all other medications as instructed. Please call with any questions or concerns.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild/Fever 2. Calcium Carbonate 500 mg PO QID:PRN heartburn 3. Colchicine 0.6 mg PO DAILY 4. Famotidine 20 mg PO BID:PRN heartburn 5. Furosemide 20 mg PO QPM 6. Furosemide 40 mg PO QAM 7. LORazepam 0.25 mg PO BID:PRN anxiety 8. Losartan Potassium 100 mg PO QHS 9. MethylPHENIDATE (Ritalin) 10 mg PO BID 10. Metoprolol Succinate XL 25 mg PO DAILY 11. Spironolactone 25 mg PO DAILY 12. HELD- Apixaban 5 mg PO BID This medication was held. Do not restart Apixaban until the morning of ___ Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: ================== post-polypectomy lower gastrointestinal bleed SECONDARY DIAGNOSES: ==================== atrial fibrillation hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you at the ___ ___. Why did you come to the hospital? -You were having black sticky stools which was concerning for bleeding from your intestines. What did you receive in the hospital? -You underwent a colonoscopy which showed that you had blood clot over the site where they removed a polyp a few weeks ago during a prior colonoscopy. This suggests that you had a recent bleed from this area, though there were no signs of active bleeding seen. You had clips placed over this area to prevent any further bleeding. You were also seen to have an ulcer at another site where you had a polyp remove which is a normal process of healing after a polyp removal; this did not show any signs of bleeding and a clip was placed at that site to prevent any possible future bleeding. -You were monitored for any more signs of bleeding afterwards and we held your blood thinner Eliquis (apixaban) for 48 hours to decrease your risk of rebleeding. -Your blood counts were stable while you were here which was reassuring that you had no more bleeding. -You did not have any bowel movements while here to show that there was no more bleeding but we were reassured by your blood counts. -We felt you were stable after 2 nights of monitoring and discharged you home. What should you do once you leave the hospital? -Please resume your Eliquis on the morning of ___. -Please make sure to get a CT scan of your lungs to work up the lung nodule that we found. -Please monitor your bowel movements at home. It may be normal for you to have a small streaks of black in your first bowel movement from blood that remained in your intestines after the colonoscopy. If you continue to have large black sticky bowel movements or large amounts of blood in your bowel movements - please call your doctor. If you are having any lightheadedness, dizziness, chest pain, trouble breathing or any other symptoms that concern you please go to the nearest emergency room. -Please follow up with your primary care office as scheduled below We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H pain RX *acetaminophen 325 mg ___ tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*0 3. Milk of Magnesia 30 mL PO Q6H:PRN constipation 4. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every three (3) hours Disp #*60 Tablet Refills:*0 5. Polyethylene Glycol 17 g PO DAILY 6. Senna 8.6 mg PO BID:PRN constipation 7. Enoxaparin Sodium 40 mg SC QHS Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 40 mg SC at bedtime Disp #*14 Syringe Refills:*1 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Anterior column acetabular fracture, right side Right open olecranon fracture Left subarachnoid hemorrhage Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted to ___ after a bike accident. Your injuries include a right olecranon fracture, a right acetabular fracture, and a small bleed in your head. You were seen by Neurosurgery who reviewed your imaging. Your repeat head cat scan did not show any progression of the bleeding and your neuro exam has been stable. You do not need to follow-up with Neurosurgery. Orthopedics was consulted and you were taken to the operating room for repair of the olecranon fracture. INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - Touch down weight bearing right lower extremity - non-weight bearing right upper extremity MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take as prescribed. - You are being discharged home with Lovenox. You should give yourself one injection per day until follow up with the orthopedic surgery department outpatient. WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - No dressing is needed if wound continues to be non-draining. - Splint can be worn for comfort as needed. - Do NOT get splint wet DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. CeftriaXONE 2 gm IV Q 12H please continue until ___ for a total of a 2 week course ___ - ___ RX *ceftriaxone 2 gram 2 grams IV every twelve (12) hours Disp #*16 Bag Refills:*0 2. Losartan Potassium 50 mg PO DAILY RX *losartan 50 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID 4. Ascorbic Acid ___ mg PO BID 5. Albuterol Inhaler ___ PUFF IH Q6H:PRN sob 6. Artificial Tears Preserv. Free ___ DROP BOTH EYES HS:PRN dry eyes RX *dextran 70-hypromellose [Artificial Tears] ___ drops in each eye at bedtime Disp #*1 Bottle Refills:*0 7. Calcium Carbonate 500 mg PO QID:PRN heart burn RX *calcium carbonate 200 mg calcium (500 mg) 1 tablet(s) by mouth four times a day Disp #*120 Tablet Refills:*0 8. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours Disp #*40 Tablet Refills:*0 9. Sodium Chloride 0.9% Flush 10 mL IV PRN line flush 10. Reclast *NF* (zoledronic acid-mannitol&water) 5 mg/100 mL Injection q ___ year Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Strep Bovis pneumonia, meningitis and bacteremia hyponatremia hypocalcemia thromobocytopenia Sjogrens sydrome hematuria Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>___ were admitted to ___ with fatigues, myalgias and cough and were found to have pneumonia and likely meningitis with bacteria in your blood. ___ improved with antibitoics. ___ were also found to have a low platelet count, which improved with steroids. ___ will be sent home with IV antibioitcs and will need to complete a 2 week course of IV antibiotics. ___ should follow closely with your outpatient team of doctors. ___ will need an outpt colonoscopy. . ___ underwent a transesophageal echocardiogram, which did not show evidence of infection in your heart valves. . Medications changes-see next page. please take as prescribed / listed. . Please f/u with your doctors as listed below. .</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN pain 2. Ciprofloxacin HCl 500 mg PO Q24H RX *Cipro 500 mg 1 tablet(s) by mouth once a day Disp #*5 Tablet Refills:*0 3. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *Flagyl 500 mg 1 tablet(s) by mouth three times a day Disp #*15 Tablet Refills:*0 4. NIFEdipine *NF* 30 mg Oral daily extended release 5. Pentoxifylline 400 mg PO DAILY extended release 6. Valsartan 80 mg PO BID 7. Allopurinol ___ mg PO EVERY OTHER DAY 8. Atorvastatin 20 mg PO DAILY 9. Glargine 25 Units Bedtime 10. Warfarin 3 mg PO DAILY16 Discharge Disposition: Home Discharge Diagnosis: cholangitis choledocholithiasis esrd protein c deficincy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Please call Dr. ___ ___ if you have any of the following: temperature of 101 or greater, chills, nausea, vomiting, abdominal pain, jaundice or diarrhea. -you need to take antibiotics for 5 days (ciprofloxacin and flagyl) -continue a low fat diet -resume Coumadin -resume your outpatient hemodialysis schedule</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild RX *acetaminophen 500 mg 2 tablet(s) by mouth every eight (8) hours Disp #*50 Tablet Refills:*0 2. Glargine 20 Units Breakfast 3. Allopurinol ___ mg PO DAILY 4. Amitriptyline 10 mg PO QHS 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY 8. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 9. Levothyroxine Sodium 175 mcg PO DAILY 10. Lisinopril 10 mg PO DAILY 11. Metoprolol Succinate XL 100 mg PO DAILY 12. Nephrocaps 1 CAP PO DAILY 13. Omeprazole 20 mg PO DAILY 14. Vitamin D 4000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY Musculoskeletal chest pain SECONDARY: End Stage Renal Disease Diabetes Mellitus Hypothyroidism Depression Hypertension Anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you. Why you were here? -You were in the hospital because of chest pain. We ruled out any dangerous conditions including heart attack, a clot in your lung, and infection. We suspect your chest pain is related to muscle strain What did we do? -We gave you Tylenol and your chest pain improved -You got a lung scan, chest xray, ultrasound, and EKG which were all normal What you should do when you go home? -Continue taking Tylenol to relieve your chest pain. -Take your medications and follow up with your primary care doctor ___ wish you the best, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear. Ms. ___, It was a pleasure taking care of ___ during your stay at ___. WHY WAS I HERE? - ___ were having diarrhea and belly pain WHAT WAS DONE WHILE I WAS IN THE HOSPITAL? - ___ were given IV fluids WHAT SHOULD I DO WHEN I GO HOME? - ___ should drink plenty of fluids - ___ can take the medication ondansetron if ___ feel nauseous. - ___ should eat a bland (BRAT) diet for the next day or two - ___ should go to see your PCP - ___ should get your INR checked early next week and fax it over to your doctor! Be well! -Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Ferrous Sulfate 325 mg PO DAILY 4. Finasteride 5 mg PO DAILY 5. Glargine 20 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 6. Lisinopril 10 mg PO DAILY 7. Omeprazole 20 mg PO DAILY 8. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP BOTH EYES TID 9. PredniSONE 10 mg PO DAILY 10. Rosuvastatin Calcium 10 mg PO DAILY 11. Tamsulosin 0.4 mg PO HS 12. Vancomycin 1500 mg IV Q 12H RX *vancomycin 750 mg 1500 mg iv every twelve (12) hours Disp #*126 Vial Refills:*0 13. Vitamin D 1000 UNIT PO DAILY 14. diclofenac sodium 0.1 % OPHTHALMIC TID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Fever Secondary Staph epidermis bacteremia Diabetes Mellitus Minimal change disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was ___ caring for you here at ___. You came in because of fevers. We repeated tests to check for infection and you did not have a new infection. Your fevers are resolved and you are ready to go home.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Calcium Carbonate 1500 mg PO DAILY 2. CloNIDine 0.1 mg PO QHS 3. Docusate Sodium 100 mg PO BID 4. Multivitamins W/minerals 1 TAB PO DAILY 5. Ramelteon 8 mg PO QHS 6. ClonazePAM 0.125 mg PO QAM 7. DULoxetine 40 mg PO DAILY 8. Levothyroxine Sodium 125 mcg PO DAILY 9. Liothyronine Sodium 5 mcg PO DAILY 10. Sulfameth/Trimethoprim DS 1 TAB PO 3X/WEEK (___) 11. Vitamin D 800 UNIT PO DAILY 12. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 13. AzaTHIOprine 150 mg PO DAILY 14. LamoTRIgine 50 mg PO BID 15. Mirtazapine 45 mg PO QHS 16. Omeprazole 20 mg PO DAILY 17. Polyethylene Glycol 17 g PO DAILY 18. PredniSONE 30 mg PO DAILY 19. Pyridostigmine Bromide 60 mg PO Q8H 20. Senna 17.2 mg PO BID 21. Thiamine 100 mg PO DAILY 22. HELD- Acidophilus (Lactobacillus acidophilus) 1 cap oral BID This medication was held. Do not restart Acidophilus until you see your primary care provider 23. HELD- GuaiFENesin ER 600 mg PO Q12H This medication was held. Do not restart GuaiFENesin ER until you see your primary care provider 24. HELD- Juven (arginine-glutamine-calcium bmb) ___ gram oral BID This medication was held. Do not restart Juven until you see your primary care provider ___: Extended Care Facility: ___ Discharge Diagnosis: PRIMARY ======= Toxic metabolic encephalopathy Delirium SECONDARY ========= Depression with suicidal ideations Normal pressure hydrocephalus status-post VP shunt Subdural hematoma Hypothyroidism Hypertension Benign prostatic hypertrophy Left clavicular fracture Myasthenia ___ GERD Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, WHY YOU WERE ADMITTED ======================= - You had altered mental status and were not behaving like yourself - You had a small brain bleed likely from falling WHAT WE DID FOR YOU IN THE HOSPITAL ==================================== - We made sure you were not having an infection, which you did not - We checked all your electrolytes, vitamin levels, and thyroid levels which were all normal - We made sure your head bleed remained stable with CT scans - We made sure your VP shunt for your normal pressure hydrocephalus was working properly - We changed your medications to make sure they were not affecting your mental status - You had an EEG study done that showed your mental status was most likely affected by something temporary, most likely the mediations you were taking WHAT YOU SHOULD DO WHEN YOU LEAVE ================================= - You should continue to take your medications as prescribed - You should use a cane/walker to get around to make sure you do not fall It was a pleasure taking care of you! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. T.E.D. Anti-Embolism Stocking (comp stocking,knee,regular,sml) 2 stockings miscellaneous DAILY 2. Acetaminophen 1000 mg PO TID 3. ALPRAZolam 0.5 mg PO QHS:PRN insomnia 4. B-12 DOTS (cyanocobalamin (vitamin B-12)) 1000 mcg oral DAILY 5. Calcium Carbonate 600 mg PO BID 6. Clozapine 37.5 mg PO QHS 7. Docusate Sodium 100 mg PO DAILY 8. Escitalopram Oxalate 20 mg PO DAILY 9. Hydrochlorothiazide 25 mg PO DAILY 10. L-Methylfolate (levomefolate calcium) 15 mg oral DAILY 11. Latuda (lurasidone) 80 mg oral QHS 12. Lithium Carbonate CR (Eskalith) 450 mg PO QHS Eskalith CR 13. Omeprazole 20 mg PO BID 14. Rivaroxaban 15 mg PO BID 15. Simvastatin 20 mg PO QPM 16. Vitamin D 800 UNIT PO BID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: ================== Left lower extremity DVT Secondary DIAGNOSES: ==================== Hypertension GERD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you. You were admitted to the ___ because your left leg was swollen, red, and painful despite recently being started on treatment for a clot in that same leg. What did we do for you while you were in the hospital? - We were initially concerned for a complication of a leg clot that causes interruption of the blood flow to the leg. We initially started you on a blood thinner called heparin because we were concerned the Xarelto was not working well for you. You were evaluated by vascular surgery who did not think that this complication was present and who recommended that we continue your Xarelto and make sure that we keep the leg compressed and elevated whenever possible. What should you do after you leave the hospital? You should continue to take your Xarelto twice daily with large meals. You should try to elevate your legs as much as possible and wear your compression stockings. This is the primary treatment for your blood clot. You should follow-up with your primary care physician and vascular surgery within ___ weeks of discharge. We recommend at least ___ year of Xarelto, perhaps even life long therapy. This should be discussed with both your PCP and ___ ___ Expert. Wishing you a speedy recovery, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amitriptyline 100 mg PO HS 2. Aspirin 81 mg PO DAILY 3. Carbamazepine (Extended-Release) 200 mg PO BID 4. Glucagon 1 mg IM ONCE prn:hypoglycemia 5. Glargine 60 Units Bedtime Humalog 10 Units Breakfast Humalog 10 Units Lunch Humalog 10 Units Dinner Insulin SC Sliding Scale using HUM Insulin 6. Metoclopramide 5 mg PO QIDACHS 7. Multivitamins 1 TAB PO DAILY 8. Omeprazole 40 mg PO BID 9. Pregabalin 150 mg PO QID 10. Ranitidine 150 mg PO DAILY 11. Sucralfate 1 gm PO TID 12. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 13. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*30 Capsule Refills:*2 14. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 capsule by mouth twice a day Disp #*30 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: Hyperglycemia Hyponatremia Abdominal Pain Secondary: Diabetes mellitus Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital with nausea and vomiting. Your blood sugars were high since you had not been able to take your insulin. You were treated with intravenous fluids for dehydration. Your blood sugars returned to normal levels once your insulin was restarted. Please take your medications as prescribed and make sure that you are having regular bowel movements. Please follow up with the ___ doctors and your primary care doctors in the next ___ weeks. Take care, ___ medicine team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acyclovir 400 mg PO Q8H RX *acyclovir 400 mg 1 tablet(s) by mouth every eight (8) hours Disp #*90 Tablet Refills:*0 2. Sulfameth/Trimethoprim SS 1 TAB PO DAILY RX *sulfamethoxazole-trimethoprim 400 mg-80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 4. PredniSONE 80 mg PO DAILY RX *prednisone 20 mg 4 tablet(s) by mouth daily Disp #*32 Tablet Refills:*0 5. Amlodipine 10 mg PO DAILY 6. FoLIC Acid 5 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS ================= WARM AUTOIMMUNE HEMOLYTIC ANEMIA CHRONIC LYMPHOCYTIC LEUKEMIA DIARRHEA SECONDARY DIAGNOSIS =================== HYPERTENSION Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ after experiencing diarrhea with resultant chest pain and shortness of breath. You were found to have low red blood cell count, known as anemia. This was likely due to destruction of your red blood cells known as hemolysis. You were transfused red blood cells to increase your blood counts. You also received steroids to help stop the destruction of the red blood cells. You also received a medication called rituximab to help control your low blood cells. These helped stabilize your red blood cell counts. By the time of discharge you did not require a transfusion in 6 days. You were discharged on a medication called prednisone. Please take 80 milligrams of prednisone DAILY. You were also started on a medication called acyclovir and a medication called trimethoprim-sulfamethoxazole to help prevent infections. Your lisinopril and hydrochlorothiazide were STOPPED as your blood pressure was well controlled on your other blood pressure medications. Please discuss this medication change with your oncologist. We would like you to follow up in clinic on ___ at 2PM to get a blood check to see what your blood levels are. Also on imaging of your chest, two nodules were noted in your lung. PLEASE FOLLOW-UP WITH A REPEAT CT SCAN OF YOUR CHEST IN 3 MONTHS. If you have any worsening symptoms including shortness of breath, chest pain, lightheadedness, nausea, vomiting, or diarrhea please seek medical assistance at your nearest Emergency Department. It was a pleasure taking care of you during hospitalization! We wish you all the best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Azithromycin 500 mg PO Q24H RX *azithromycin 500 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 2. HYDROmorphone (Dilaudid) 2 mg PO Q6H:PRN Pain - Severe Duration: 2 Days RX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth every 6 hours as needed for pain Disp #*8 Tablet Refills:*0 3. PredniSONE 50 mg PO DAILY Duration: 1 Day RX *prednisone 50 mg 1 tablet(s) by mouth daily Disp #*1 Tablet Refills:*0 4. Acamprosate 666 mg PO TID 5. Albuterol Inhaler 2 PUFF IH Q4H:PRN dyspnea 6. Erythromycin 0.5% Ophth Oint 0.5 in BOTH EYES QID 7. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 8. FoLIC Acid 1 mg PO DAILY 9. Furosemide 40 mg PO DAILY 10. melatonin 3 mg oral QHS 11. Methadone 80 mg PO DAILY 12. Montelukast 10 mg PO DAILY 13. Multivitamins 1 TAB PO DAILY 14. Pantoprazole 40 mg PO Q24H 15. Sertraline 100 mg PO DAILY 16. Spironolactone 50 mg PO DAILY 17. Thiamine 100 mg PO DAILY 18. Tiotropium Bromide 1 CAP IH DAILY 19. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Abdominal pain Alcohol withdrawal Asthma exacerbation Opiate dependence Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You came in with abdominal pain. We think that this pain is either from irritation of your stomach or a very mild pancreatitis. We treated you with pain medications which you did not think helped very much and bowel rest for a day. We also did a CT scan of your abdomen which did not show anything concerning. We also treated you for alcohol withdrawal while you were here and continued you on your methadone. We also treated you for an asthma exacerbation and your breathing was much improved by the time you left.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Atorvastatin 10 mg PO DAILY 3. Losartan Potassium 25 mg PO DAILY 4. Metoprolol Succinate XL 100 mg PO DAILY 5. Omeprazole 20 mg PO DAILY 6. Tiotropium Bromide 1 CAP IH DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Throat pain Hypoxia SECONDARY DIAGNOSIS: Hypertension Hyperlipidemia COPD Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___ ___. As you recall, you were admitted for throat pain. Imaging did not show progression of your previous known dissection. Imaging of your neck did not show anything that may cause throat pain. Please see below for follow up appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 10 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Calcium Carbonate 500 mg PO DAILY 4. Docusate Sodium 100 mg PO BID 5. Enalapril Maleate 20 mg PO BID 6. Hydroxychloroquine Sulfate 200 mg PO DAILY; One tablet daily alternating with 2 tablets daily. 7. NPH 15 Units Breakfast; NPH 5 Units Dinner 8. LeVETiracetam 750 mg PO BID 9. Lidocaine 5% Patch 1 PTCH TD DAILY:PRN pain 10. PredniSONE 5 mg PO DAILY 11. Simvastatin 10 mg PO DAILY 12. Vitamin D 1000 UNIT PO DAILY 13. DimenhyDRINATE 50 mg PO Q8H:PRN nausea 14. Furosemide 20 mg PO 3X/WEEK (___) 15. Doxazosin 2 mg PO HS RX *doxazosin [Cardura] 2 mg 1 tablet(s) by mouth at bedtime Disp #*30 Tablet Refills:*0 16. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Ectopioc atrial bradycardia, due to Beta blocker toxicity Chest pain Coronary artery disease Hypertension Shortness of breath Acute on chronic left ventricular diastolic heart failure Acute kidney injury Gastroesophageal reflux disease Tremor Diabetes mellitus Hypothyroidism Systemic lupus erythematosis Rheumatoid arthritis Seizure disorder Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>You were admitted because of chest pain and a slow heart rate. We made sure you did not have a heart attack. Your slow heart rate was likely due to being started on Propranolol. We observed you off the medication and your heart rate resolved. We have listed "beta blockers" as an allergy. Please discuss possible alternative treatments for your tremor with your Primary care doctor. We made the following changes to your home medication list: -STOP Propranolol -START Omeprazole</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*2 2. Warfarin 5 mg PO DAILY RX *Coumadin 1 mg 5 tablet(s) by mouth once a day Disp #*150 Tablet Refills:*2 Discharge Disposition: Home Discharge Diagnosis: Acute ischemic stroke Vertebral artery dissection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were hospitalized due to symptoms of dizziness and vomiting resulting from an ACUTE ISCHEMIC STROKE, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. We are changing your medications as follows: Start taking warfarin (blood thinner) Start taking atorvastatin (for cholesterol) Please take your other medications as prescribed. Please follow up with Neurology and your primary care physician as listed below. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H 2. Gabapentin 100 mg PO TID RX *gabapentin 100 mg 1 capsule(s) by mouth three times a day Disp #*30 Capsule Refills:*0 3. Omeprazole 20 mg PO DAILY 4. Ondansetron 4 mg PO Q8H:PRN nausea 5. OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - Moderate RX *oxycodone 5 mg 1 tablet(s) by mouth Q6H:PRN Disp #*20 Tablet Refills:*0 6. Polyethylene Glycol 17 g PO DAILY 7. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home Discharge Diagnosis: Post-operative pain, status-post open cholecystectomy Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were recently admitted to ___ ___ pain control and evaluation of your post-operative open cholecyctectomy recovery. We have reviewed your imaging with our surgeons and radiologists several times and believe the fluid collection seen on your outside hospital CT scan is a small fluid collection consistent with normal post-operative changes. At this time, you are ready for discharge and can continue to recover at home. Please follow the instructions below: Please call your doctor or nurse practitioner or return to the Emergency Department for any of the following: *You experience new chest pain, pressure, squeezing or tightness. *New or worsening cough, shortness of breath, or wheeze. *If you are vomiting and cannot keep down fluids or your medications. *You are getting dehydrated due to continued vomiting, diarrhea, or other reasons. Signs of dehydration include dry mouth, rapid heartbeat, or feeling dizzy or faint when standing. *You see blood or dark/black material when you vomit or have a bowel movement. *You experience burning when you urinate, have blood in your urine, or experience a discharge. *Your pain in not improving within ___ hours or is not gone within 24 hours. Call or return immediately if your pain is getting worse or changes location or moving to your chest or back. *You have shaking chills, or fever greater than 101.5 degrees Fahrenheit or 38 degrees Celsius. *Any change in your symptoms, or any new symptoms that concern you. Please resume all regular home medications, unless specifically advised not to take a particular medication. Also, please take any new medications as prescribed. Please get plenty of rest, continue to ambulate several times per day, and drink adequate amounts of fluids. Avoid lifting weights greater than ___ lbs until you follow-up with your surgeon. Avoid driving or operating heavy machinery while taking pain medications. Incision Care: *Please call your doctor or nurse practitioner if you have increased pain, swelling, redness, or drainage from the incision site. *Avoid swimming and baths until your follow-up appointment. *You may shower, and wash surgical incisions with a mild soap and warm water. Gently pat the area dry.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q4H:PRN cough, SOB 2. Amlodipine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth daily Disp #*90 Tablet Refills:*0 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 40 mg PO DAILY 5. Carvedilol 12.5 mg PO BID 6. Ferrous Sulfate 325 mg PO BID 7. HydrALAzine 50 mg PO BID 8. Glargine 25 Units Breakfast Humalog 5 Units Breakfast Humalog 5 Units Lunch Humalog 5 Units Dinner 9. Isoniazid ___ mg PO 3X/WEEK (___) 10. Losartan Potassium 50 mg PO BID RX *losartan 50 mg 1 tablet(s) by mouth twice a day Disp #*90 Tablet Refills:*0 11. Nephrocaps 1 CAP PO DAILY 12. Omeprazole 10 mg PO DAILY 13. Pyridoxine 50 mg PO DAILY 14. sevelamer CARBONATE 800 mg PO TID W/MEALS 15. Vitamin D ___ UNIT PO DAILY 16. Fluticasone Propionate 110mcg 2 PUFF IH BID Please talk to your primary care doctor if this does not help you RX *fluticasone [Flovent HFA] 110 mcg/actuation 2 puff inhaled twice a day Disp #*1 Inhaler Refills:*0 17. Loratadine 10 mg PO EVERY OTHER DAY RX *loratadine 10 mg 1 tablet(s) by mouth 3 times per week Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES: #Chronic cough #Pulmonary edema #End stage renal disease #Hypertensive urgency #Diabetes ___ type 2, poorly controlled #Dyspepsia #SECONDARY DIAGNOSES: #Latent tuberculosis infection #Anemia of chronic kidney disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, you were admitted from the ER for workup of your chronic cough. On arrival you had fluid in your lungs called edema. The fluid in your lungs may cause cough. It seems that you usually have too much fluid in your body, which happens when people require dialysis. Please try sticking to a low salt diet (meaning no fast food, chips, crackers, ___ fries). Feeling better in terms of cough after dialysis may mean that your cough is partially caused by fluid in the lungs. We did not think that you had a bacterial pneumonia requiring antibiotics. The most common causes of cough that does not go away after ___ weeks are not infection. They are usually things like asthma, acid reflux, and allergic post-nasal drip. You were already treated with a stomach acid blocker for reflux in the past few weeks without much help. However, you have not had significant treatment for asthma, so we added an inhaled steroid called fluticasone that you should use daily to prevent any asthma symptoms. If this does not work, you should talk to your primary care doctor (___) about stopping it. Additionally, abdominal fullness and poor appetite you described may be due to diabetes. People with poorly controlled diabetes can develop nerve problems like tingling or numbness in the feet. Occasionally, the nerve problems may affect the stomach and intestines. This can cause food not to move through normally and can make you feel sick or full.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Discharge Instructions Dr. ___ of DBS battery and debridement Activity •You may gradually return to your normal activities, but we recommend you take it easy for the next ___ hours. •Heavy lifting, running, climbing, or other strenuous exercise should be avoided for ten (10) days. •You may take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much too soon. •Do not go swimming or submerge yourself in water for fourteen (14) days after your procedure. •You may use a damp washcloth to remove any dried blood or iodine from your skin but do not get your head wet in the shower until your staples or sutures are removed. •The incision on your chest has absorbable sutures and skin sealant. You may take a shower and get your chest wet after 5 days. Medications •Take any new medications (i.e. pain medications) as directed. •If you were on a medication such as Coumadin (Warfarin), or Plavix (Clopidogrel), or Aspirin, do not take this until cleared by your Neurosurgeon. •Do not take any anti-inflammatory medicines such as Motrin, Aspirin, Advil, or Ibuprofen etc. until follow up. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: •Mild tenderness along the incisions. •Soreness in your arms from the intravenous lines. •Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •Severe Constipation •Blood in your stool or urine •Nausea and/or vomiting •Extreme sleepiness •Severe headaches not relieved by pain relievers •Seizures •Any new problems with your vision or ability to speak •Weakness or changes in sensation in your face, arms, or leg Follow-up Instructions •You will need to follow-up with Dr. ___ in ___ days from your surgery for a wound check and staple/suture removal. Please call ___ to make this appointment.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever 2. Docusate Sodium 100 mg PO BID 3. Nitrofurantoin Monohyd (MacroBID) 100 mg PO ONCE prophylaxis RX *nitrofurantoin monohyd/m-cryst 100 mg ONE capsule(s) by mouth once Disp #*2 Capsule Refills:*0 4. Oxybutynin 5 mg PO TID:PRN bladder spasms 5. Senna 8.6 mg PO ONCE Duration: 1 Dose 6. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Bilateral ureterolithiasis. acute kidney injury (creatinine up to 1.7) Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>-You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month; this may be related to the passage of stone fragments or the indwelling ureteral stent. -The kidney stone may or may not have been removed AND/or there may fragments/others still in the process of passing. -You may experience some pain associated with spasm of your ureter. This is normal from the stent irritation. -Ureteral stents MUST be removed or exchanged and therefore it is IMPERATIVE that you follow-up as directed. -Do not lift anything heavier than a phone book (10 pounds) -You may continue to periodically see small amounts of blood in your urine--this is normal and will gradually improve -Resume your pre-admission/home medications EXCEPT as noted. You should ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor. -___ ingredient of Advil, Motrin, etc.) may be taken even though you may also be taking Tylenol/Acetaminophen. You may alternate these medications for pain control. -Ibuprofen should always be taken with food. Please discontinue taking and notify your doctor should you develop blood in your stool (dark, tarry stools) -You may be given “prescriptions” for a stool softener and/or a gentle laxative. These are over-the-counter medications that may be “health care spending account reimbursable.” -Colace (docusate sodium) may have been prescribed to avoid post-surgical constipation or constipation related to use of narcotic pain medications. Discontinue if loose stool or diarrhea develops. Colace is a stool-softener, NOT a laxative. -Senokot (or any gentle laxative) may have been prescribed to further minimize your risk of constipation. -Do not eat constipating foods for ___ weeks, drink plenty of fluids to keep hydrated -No vigorous physical activity or sports for 4 weeks</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. haloperidol 5 mg Tablet Sig: One half Tablet PO twice a day. Disp:*14 Tablet(s)* Refills:*0* Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: Psychosis, NOS Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Dr. ___, ___ were admitted for a change in your behavior following the recent death of your grandmother and other stressors in your life. ___ were also managed for an increase in your heart rate following administration of medication. Your heart rate normalized during the admission and was not affected by the haldoperidol that ___ were started on during this admission. ___ were also seen by Psychiatry for evaluation of your behaviour change who recommended that ___ start haloperidol 2.5mg twice daily. Collectively, it was felt that ___ are safe to go home with your mother and with close psychiatric follow-up which as been arranged for ___ by Psychiatry. ___ have an appointment at ___ Partial ___ Program- ___., ___ on ___ at 9am. ___. Take all medications as instructed. Please note the following medication changes: 1. *ADDED* haloperidol 2.5mg twice daily. ___ and your mother agree to return to the emergency deparment or call ___ should your symptoms worsen again or should ___ experience any suicidal or homicidal ideation. Your mother is to remain with ___ after discharge from ___ ___ to monitor your symptoms and assist with getting ___ to your appointments. In addition to your psychiatric follow-up, ___ will need to make a follow-up with Neurology to follow-up MRI findings that the Neurologists did not feel needed to be worked-up acutely during your admission. Call the following number to schedule an appointment for within 2 weeks of discharge date with the first available appointment: ___. ___ also have a follow-up appointment with your primary care physician on ___ at 9AM.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild/Fever 2. Dexamethasone 1 mg PO AS DIRECTED Duration: 7 Days 4mg q6hr x 8 doses 3mg q6hr x 8 doses 2mg q6hr x 4 doses 2mg q8hr x 3 doses 1mg q8hr x 3 doses RX *dexamethasone 1 mg as directed by mouth as directed Disp #*73 Tablet Refills:*0 3. Famotidine 20 mg PO BID RX *famotidine 20 mg 1 tablet(s) by mouth twice a day Disp #*20 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Brain stem cavernous malformation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Brain Hemorrhage without Surgery Activity • We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. • You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. • No driving while taking any narcotic or sedating medication. • If you experienced a seizure while admitted, you are NOT allowed to drive by law. • No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications • Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. • You have been prescribed a steroid (dexamethasone) taper. Please take this medication as follows: • 4mg every six (6) hours for two days (8 doses) • 3mg every six (6) hours for two days (8 doses) • 2mg every six (6) hours for one day (4 doses) • 2mg every eight (8) hours for one day (3 doses) • 1mg every eight (8) hours for one day (3 doses) • Then stop. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: • You may have difficulty paying attention, concentrating, and remembering new information. • Emotional and/or behavioral difficulties are common. • Feeling more tired, restlessness, irritability, and mood swings are also common. • Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Headaches: • Headache is one of the most common symptom after a brain bleed. • Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. • Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. • There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: • Severe pain, swelling, redness or drainage from the incision site. • Fever greater than 101.5 degrees Fahrenheit • Nausea and/or vomiting • Extreme sleepiness and not being able to stay awake • Severe headaches not relieved by pain relievers • Seizures • Any new problems with your vision or ability to speak • Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: • Sudden numbness or weakness in the face, arm, or leg • Sudden confusion or trouble speaking or understanding • Sudden trouble walking, dizziness, or loss of balance or coordination • Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen (Liquid) 1000 mg PO Q8H RX *acetaminophen 500 mg/5 mL 10 cc by mouth every eight (8) hours Disp ___ Milliliter Refills:*0 2. Bacitracin Ointment 1 Appl TP BID RX *bacitracin zinc [Antibiotic (bacitracin zinc)] 500 unit/gram apply to suture line under chin twice a day Disp #*1 Tube Refills:*0 3. Bisacodyl 10 mg PO DAILY:PRN constipation RX *bisacodyl [Dulcolax (bisacodyl)] 5 mg 1 tablet(s) by mouth once a day Disp #*20 Tablet Refills:*0 4. Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID RX *chlorhexidine gluconate 0.12 % rinse and spit 15 cc twice a day Disp #*420 Milliliter Refills:*0 5. Docusate Sodium (Liquid) 100 mg PO BID RX *docusate sodium 50 mg/5 mL 10 cc by mouth twice a day Disp ___ Milliliter Refills:*1 6. OxycoDONE Liquid ___ mg PO Q3H:PRN Pain RX *oxycodone 5 mg/5 mL ___ cc by mouth every 3 hours Disp #*360 Milliliter Refills:*0 7. Sarna Lotion 1 Appl TP QID:PRN itching 8. Senna 8.6 mg PO BID:PRN constipation 9. Cephalexin 500 mg PO Q6H RX *cephalexin 250 mg/5 mL 10 cc by mouth every six (6) hours Disp #*240 Milliliter Refills:*0 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: S/p assault Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted to the hospital after you were assaulted in the face. You were taken to the operating room where underwent repair of your jaw. Your vital signs have been stable and you are preparing for discharge with the following instructions: Wound care: Do not disturb or probe the surgical area with any objects. The sutures placed in your mouth are usually the type that self dissolve. If you have any sutures on the skin of your face or neck, your surgeon will remove them on the day of your first follow up appointment. SMOKING is detrimental to healing and will cause complications. Bleeding: Intermittent bleeding or oozing overnight is normal. Placing fresh gauze over the area and biting on the gauze for ___ minutes at a time may control the bleeding. If you had nasal surgery, you may have occasional slow oozing from your nostril for the first ___ days. Bleeding should never be severe. If bleeding persists or is severe or uncontrollable, please call our office immediately. If it is after normal business hours, please come to the emergency room and request that the oral surgery resident on call be paged. ___: Normal healing after oral surgery should be as follows: the first ___ days after surgery, are generally the most uncomfortable and there is usually significant swelling. After the first week, you should be more comfortable. The remainder of your postoperative course should be gradual, steady improvement. If you do not see continued improvement, please call our office. Physical activity: It is recommended that you not perform any strenuous physical activity for a few weeks after surgery. Do not lift any heavy loads and avoid physical sports unless you obtain permission from your surgeon. Swelling & Ice applications: Swelling is often associated with surgery. Swelling can be minimized by using a cold pack, ice bag or a bag of frozen peas wrapped in a towel, with firm application to face and neck areas. This should be applied 20 minutes on and 20 minutes off during the first ___ days after surgery. If you have been given medicine to control the swelling, be sure to take it as directed. Hot applications: Starting on the ___ or ___ day after surgery, you may apply warm compresses to the skin over the areas of swelling (hot water bottle wrapped in a towel, etc), for 20 minutes on and 20 min off to help soothe tender areas and help to decrease swelling and stiffness. Please use caution when applying ice or heat to your face as certain areas may feel numb after surgery and extremes of temperature may cause serious damage. Tooth brushing: Begin your normal oral hygiene the day after surgery. Soreness and swelling may nor permit vigorous brushing, but please make every effort to clean your teeth with the bounds of comfort. Any toothpaste is acceptable. Please remember that your gums may be numb after surgery. To avoid injury to the gums during brushing, use a child size toothbrush and brush in front of a mirror staying only on teeth. Mouth rinses: Keeping your mouth clean after surgery is essential. Use 1 teaspoon of salt dissolved in an 8 ounce glass of warm water and gently rinse with portions of the solution, taking 5 min to use the entire glassful. Repeat as often as you like, but you should do this at least 4 times each day. If your surgeon has prescribed a specific rinse, use as directed. Showering: You may shower ___ days after surgery, but please ask your surgeon about this. If you have any incisions on the skin of your face or body, you should cover them with a water resistant dressing while showering. DO NOT SOAK SURGICAL SITES. This will avoid getting the area excessively wet. As you may physically feel weak after surgery, initially avoid extreme hot or cold showers, as these may cause some patients to pass out. Also it is a good idea to make sure someone is available to assist you in case if you may need help. If you develop the following, please return to the emergency room: *fever *chills *nausea/vomitting *abdominal pain *bleeding from mouth *difficulty breathing</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY RX *aspirin [Adult Low Dose Aspirin] 81 mg 1 tablet,delayed release (___) by mouth Daily Disp #*30 Tablet Refills:*2 2. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN Pain Duration: 5 Days RX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Multiple stab wounds Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, You were admitted to the ___ Surgery service at ___ after sustaining multiple stab wounds - to the right flank, anterior neck and posterior neck. We obtained several imaging scans including CT of your head and neck, as well as CT with contrast to evaluate the vessels in your head and neck. This scan showed a small dissection in your L internal carotid artery. You were also seen by our colleagues in Vascular Surgery who advised a carotid doppler imaging study to further evaluate the dissection. This study was reassuring; however, you should follow-up with Vascular Surgery in ONE (1) month for a repeat study and clinic visit. Please keep in mind the following instructions: 1) Activity: You may resume all previous activities. You should limit your alcohol intake as this appears to be causing damage to your liver, a condition called alcoholic cirrhosis, which is irreversible and can lead to very serious medical problems including esophageal varices, bleeding and infection. 2) Medications: you may continue all previous medications. However, you should check with your doctor before starting any new medications that may interfere with, or worsen your liver function. 3) Pain: we are providing you with oxycodone, an opiate pain medication. Please wait at least four hours between doses, and do not drive while taking this medication. You should avoid overusing Tylenol (>3 grams/day) since this can affect your liver as well. 4) Food: You may resume your previous diet.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Multivitamins W/minerals 1 TAB PO DAILY 2. Polyethylene Glycol 17 g PO DAILY 3. Acetaminophen 650 mg PO Q4H:PRN Pain - Mild 4. Allopurinol ___ mg PO DAILY 5. Aqua Care (urea) 10 % topical TID:PRN 6. Bisacodyl ___ID:PRN Constipation - First Line 7. Calcium Carbonate 500 mg PO Q6H:PRN indigestion 8. Docusate Sodium 100 mg PO BID 9. Doxycycline Hyclate 100 mg PO Q12H 10. Ferrous Sulfate 325 mg PO BID 11. Fluticasone Propionate NASAL 1 SPRY NU DAILY 12. Labetalol 200 mg PO BID 13. Levothyroxine Sodium 25 mcg PO DAILY 14. Pravastatin 40 mg PO QPM 15. Rivaroxaban 15 mg PO DAILY 16. Senna 17.2 mg PO BID 17. Tamsulosin 0.4 mg PO QHS 18. urea 10 % topical TID:PRN Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Acute metabolic Encephalopathy Constipation Acute kidney injury secondary to Dehydration Chronic Systolic CHF Dementia Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You came to the hospital because you were more confused and having trouble walking. You were also nauseated. You were found to be constipated which was likely causing your confusion and your nausea. You felt better after having a bowel movement. You were also found to have impaired kidney function. Dehydration likely caused your constipation and the problem with your kidneys. Your kidneys got better with fluids. You worked with ___ for your walking and they recommended that you go to rehab to get stronger. It was a pleasure participating in your care. We wish you all the best in the future. Sincerely, Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin EC 81 mg PO DAILY RX *aspirin 81 mg 1 tablet,delayed release (___) by mouth daily Disp #*30 Tablet Refills:*0 2. Atorvastatin 80 mg PO DAILY RX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Metoprolol Tartrate 25 mg PO TID RX *metoprolol tartrate 25 mg 1 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0 4. Guaifenesin ___ mL PO Q6H:PRN cough RX *guaifenesin [Adult Tussin Chest Congestion] 100 mg/5 mL ___ liquid(s) by mouth every six (6) hours Disp #*1 Bottle Refills:*0 5. Furosemide 40 mg PO BID Duration: 7 Days RX *furosemide 40 mg 1 tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 6. Potassium Chloride 20 mEq PO Q12H Duration: 7 Days RX *potassium chloride [Klor-Con] 20 mEq 1 packet by mouth twice a day Disp #*14 Packet Refills:*0 7. TraMADOL (Ultram) 50 mg PO Q4H:PRN pain RX *tramadol 50 mg 1 tablet(s) by mouth every four (4) hours Disp #*60 Tablet Refills:*0 8. Ranitidine 150 mg PO BID RX *ranitidine HCl 150 mg 1 capsule(s) by mouth twice a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: - Myocardial infarction, coronary artery disease s/p coronary artery bypass graft x 3 - Mitral valve regurgitation s/p Mitral valve replacement - Acute systolic Congestive heart failure Past medical history: - Obesity - Hypertension - Peripheral arterial disease - COPD Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with oral analgesia Incisions: Sternal - eschar at inferior pole, no drainage or erythema Leg - healing well, no erythema or drainage. Edema: 1+ Followup Instructions: ___ [/INST] </s><s>1. Please shower daily including washing incisions gently with mild soap, no baths or swimming, and look at your incisions 2). Please NO lotions, cream, powder, or ointments to incisions 3). Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart 4). No driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive 5). No lifting more than 10 pounds for 10 weeks Females: Please wear bra to reduce pulling on incision, avoid rubbing on lower edge **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q4H 2. Docusate Sodium 100 mg PO BID 3. OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours Disp #*61 Tablet Refills:*0 4. Aspirin 325 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: Right ankle fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Activity: -Continue to be non weight bearing on your right leg. -Elevate right leg to reduce swelling and pain. -Do not remove splint. Keep splint dry. Other Instructions - Resume your regular diet. - Avoid nicotine products to optimize healing. - Resume your home medications. Take all medications as instructed. - Continue taking the aspirin 325 every day to prevent blood clots. -You have also been given Additional Medications to control your pain. Please allow 72 hours for refill of narcotic prescriptions, so plan ahead. You can either have them mailed to your home or pick them up at the clinic located on ___ 2. We are not allowed to call in narcotic (oxycontin, oxycodone, percocet) prescriptions to the pharmacy. In addition, we are only allowed to write for pain medications for 90 days from the date of surgery. - Narcotic pain medication may cause drowsiness. Do not drink alcohol while taking narcotic medications. Do not operate any motor vehicle or machinery while taking narcotic pain medications. Taking more than recommended may cause serious breathing problems. If you have questions, concerns or experience any of the below danger signs then please call your doctor at ___ or go to your local emergency room.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Doxycycline Hyclate 100 mg PO DAILY Duration: 7 Days End date ___ RX *doxycycline hyclate 100 mg 1 tablet(s) by mouth Daily Disp #*7 Tablet Refills:*0 2. Alendronate Sodium 70 mg PO QWED 3. Aspirin 81 mg PO DAILY 4. Furosemide 10 mg PO DAILY 5. Gabapentin 200 mg PO QHS 6. Glargine 24 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 7. Lactulose 30 mL PO TID 8. Lidocaine 5% Ointment 1 Appl TP QID:PRN pain 9. Multivitamins W/minerals 1 TAB PO DAILY 10. Nadolol 20 mg PO DAILY 11. Omeprazole 20 mg PO DAILY 12. Rifaximin 550 mg PO BID 13. Sertraline 50 mg PO DAILY 14. Spironolactone 25 mg PO DAILY 15. Vitamin D ___ UNIT PO DAILY 16. HELD- Atorvastatin 40 mg PO QPM This medication was held. Do not restart Atorvastatin until you talk to your doctor and your blood enzymes return to normal Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary diagnosis: Rhabdomyolysis Urinary tract infection Toxic metabolic encephalopathy Hepatic encephalopathy Secondary Chronic diastolic heart failure Diabetes mellitus Pyoderma gangrenosusm Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Miss ___, You were admitted due to weakness and leg pains. From your laboratory results, we concluded you had rhabdomyolysis. This also led to a rise in liver enzymes which is usually expected. You were given fluids to help this resolve. We are unclear what led to this happening; we suspect sitting in one place for days could have caused that or the use of atorvastatin. We reviewed the rest of your medications to ensure you're not on any new other medications which could have caused this. We also treated you for a urinary tract infection which was initially treated with ciprofloxacin but your cultures showed an organism called Enterococcus which was resistant to it, so we switched you to Doxycyline 100mg daily for a 7 day course, last dose on ___. Note that we STOPPED your atorvastatin. Please do not take it until you see your doctor. Please ensure close follow up with your doctors after ___. It was a pleasure being part of your care. Sincerely, Your ___ Liver Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325 mg PO DAILY 2. Allopurinol ___ mg PO DAILY 3. Amlodipine 5 mg PO DAILY 4. Atorvastatin 40 mg PO QPM 5. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 6. Metoprolol Succinate XL 25 mg PO DAILY 7. Omeprazole 20 mg PO DAILY 8. Timolol Maleate 0.5% 1 DROP BOTH EYES QAM 9. Torsemide 10 mg PO DAILY 10. Vitamin D ___ UNIT PO DAILY 11. Sodium Bicarbonate 650 mg PO BID RX *sodium bicarbonate 650 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 12. Epoetin ___ ___ units SC Q5 WEEKS 13. GlipiZIDE 10 mg PO BID 14. Potassium Chloride 20 mEq PO DAILY 15. Outpatient Lab Work Please have electrolytes drawn ___ and have then sent to PCP: Dr. ___: ___ Fax: ___ ICD10: CKD N18.5 16. Glargine 19 Units Bedtime Insulin SC Sliding Scale using novolog Insulin Discharge Disposition: Home Discharge Diagnosis: Postmenopausal bleeding Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted for vaginal bleeding and weakness. You had an ultrasound of the uterus which showed thickened endometrium which is abnormal. You should contact gynecology clinic to schedule a biopsy of the endometrium. On admission you felt well and did not have further episodes of heavy bleeding or clots, and your blood counts were stable. You felt at you baseline but were found to have low magnesium and low bicarbonate which were repleted. You should continue the bicarbonate supplement at home and have your labs rechecked on ___.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Ms. ___, It was a pleasure meeting and caring for you during your most recent hospitalization at ___. You were admitted with an episode of unresponsiveness witnessed by your daughter. Once you were admitted, we found that you have a slow heart rate which you told us has been known about for a long time. We asked the cardiologists and the neurologists to evaluate you. The cardiologists did not believe that your slow heart rate was related to your symptoms. Following an extensive evaluation, we felt that your symptoms were probably the result of ongoing confusion known as delirium (a common condition we see in elderly patient's) or possibly due to a condition called ___ Body Dementia. Please continue to follow-up with your outpatient doctors. We wish you a speedy recovery. All the best, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sulfameth/Trimethoprim SS 1 TAB PO BID last day antibiotic: ___. Glargine 10 Units Bedtime Humalog 3 Units Breakfast Humalog 3 Units Lunch Humalog 3 Units Dinner 3. Senna 8.6 mg PO BID:PRN constipation 4. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild 5. Amlodipine 10 mg PO DAILY 6. Aspirin 81 mg PO DAILY 7. Atorvastatin 10 mg PO QPM 8. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 9. Calcium Acetate 667 mg PO TID W/MEALS 10. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID 11. Clonidine Patch 0.3 mg/24 hr 1 PTCH TD QFRI 12. CycloSPORINE (Neoral) MODIFIED 75 mg PO Q12H 13. Entecavir 0.5 mg PO 1X/WEEK (___) 14. FoLIC Acid 1 mg PO 3X/WEEK (___) 15. Isosorbide Dinitrate 40 mg PO TID 16. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS 17. LevETIRAcetam 250 mg PO BID 18. Levothyroxine Sodium 100 mcg PO DAILY 19. Lidocaine 5% Patch 1 PTCH TD QAM 20. Metoprolol Tartrate 50 mg PO Q6H 21. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain 22. Pantoprazole 40 mg PO Q24H 23. Sertraline 25 mg PO DAILY 24. sevelamer CARBONATE 800 mg PO TID W/MEALS please use powder formulation 25. Vitamin D 1200 UNIT PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Toxic metabolic encephalopathy Urinary tract infection Secondary: HBV cirrhosis s/p liver transplant ___ ESRD Hypertension Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your hospitalization at the ___. You were admitted to ___ because you were more confused than usual. This is likely because you had a urinary tract infection. We gave you antibiotics to treat the infection and your mental status improve back to your regular baseline. You also received dialysis for your kidney disease while you were hospitalized. We had a family meeting with your wife and your son, ___, to discuss the next best step with you. The neurology (brain) doctor, explained that your mental status may not get much better than it is now. We recommend that you follow up with a urologist (urinary tract doctor) to evaluate the cause of your frequent urinary tract infections. We also recommend that you talk to your primary care doctor and liver doctor about whether or not you need a feeding tube for nutrition. If you have fevers, chills, worsening confusion, or any symptoms that concern you, please seek medical attention. We wish you the best of luck in your health. Sincerely, Your ___ care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Hydrocortisone Cream 2.5% 1 Appl TP BID PRN pruritis 2. Polyethylene Glycol 17 g PO DAILY:PRN constipation 3. Ranitidine 150 mg PO BID 4. Vitamin D ___ UNIT PO DAILY 5. Azithromycin 250 mg PO Q24H RX *azithromycin 250 mg 1 tablet(s) by mouth daily Disp #*3 Tablet Refills:*0 6. MedroxyPROGESTERone Acetate 10 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Increased oral secretions Endobronchial plugging Tachycardia Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted because you had more oral mucous than you normally do and you were having difficulty with these secretions. Your symptoms may have been due to difficulty swallowing or a pneumonia. We will be sending you home with antibiotics to treat a pneumonia. A scan of your chest revealed that you do have mucous build-up in your lungs. We have arranged for you to receive suctioning at home, which will help with these symptoms. We performed some tests to determine if your symptoms are due to the flu. This test has not yet returned. We will discharge you home with a mask until the tests return. Please wear the mask whenever you are in public until we call you with the results. We were also concerned about your fast heart rate. This may have been, in part, the result of dehydration. However, even though you received a lot of fluids, your heart rate was still quite fast. Sometimes this is due to a clot on your lungs. We performed a scan of your chest which did not reveal a clot, but did reveal a build up of mucous in your lungs. The fast heart rate may be your body's response to this mucous build up. We will manage this with suctioning at home. Please continue to take your antibiotics through ___. Please follow up with the appointments listed below. It was a pleasure to be a part of your care! Happy birthday from your ___ treatment team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Bisacodyl 10 mg PO/PR DAILY:PRN Constipation 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 40 mg SC QPM RX *enoxaparin 40 mg/0.4 mL 1 syringe subcutaneous Nightly Disp #*30 Syringe Refills:*0 5. Nitrofurantoin Monohyd (MacroBID) 100 mg PO Q12H Duration: 5 Days Take for 5 total days (last day ___ RX *nitrofurantoin monohyd/m-cryst 100 mg 1 capsule(s) by mouth Every 12 hours Disp #*6 Capsule Refills:*0 6. OxyCODONE (Immediate Release) 2.5-5 mg PO Q4H:PRN Pain RX *oxycodone 5 mg ___ tablet(s) by mouth Every 4 hours as needed Disp #*15 Tablet Refills:*0 7. Senna 8.6 mg PO BID 8. Aspirin 81 mg PO DAILY 9. Atorvastatin 40 mg PO QPM 10. CARVedilol 6.25 mg PO BID 11. Clopidogrel 75 mg PO DAILY 12. Furosemide 20 mg PO DAILY 13. Losartan Potassium 25 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Left intertrochanteric femur fracture Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Discharge Instructions: INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: -Weightbearing as tolerated left lower extremity MEDICATIONS: 1) Take Tylenol ___ every 6 hours around the clock. This is an over the counter medication. 2) Add oxycodone as needed for increased pain. Aim to wean off this medication in 1 week or sooner. This is an example on how to wean down: then 1 tablet every 4 hours as needed x 1 day, then 1 tablet every 6 hours as needed x 1 day, then 1 tablet every 8 hours as needed x 2 days, then 1 tablet every 12 hours as needed x 1 day, then 1 tablet every before bedtime as needed x 1 day. Then continue with Tylenol for pain. 3) Do not stop the Tylenol until you are off of the narcotic medication. 4) Per state regulations, we are limited in the amount of narcotics we can prescribe. If you require more, you must contact the office to set up an appointment because we cannot refill this type of pain medication over the phone. 5) Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and continue following the bowel regimen as stated on your medication prescription list. These meds (senna, colace, miralax) are over the counter and may be obtained at any pharmacy. 6) Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. 7) Please take all medications as prescribed by your physicians at discharge. 8) Continue all home medications unless specifically instructed to stop by your surgeon. ANTICOAGULATION: - Please take Lovenox daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Incision may be left open to air unless actively draining. If draining, you may apply a gauze dressing secured with paper tape. - Splint must be left on until follow up appointment unless otherwise instructed. - Do NOT get splint wet. DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever ___ 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns FOLLOW UP: Please follow up with your Orthopaedic Surgeon, Dr. ___. You will have follow up with ___, NP in the Orthopaedic Trauma Clinic 14 days post-operation for evaluation. Call ___ to schedule appointment upon discharge. Please follow up with your primary care doctor regarding this admission within ___ weeks and for any new medications/refills. THIS PATIENT IS EXPECTED TO REQUIRE ___ DAYS OF REHAB Physical Therapy: Weightbearing as tolerated left lower extremity No other activity or range of motion restrictions Treatments Frequency: Skin staples or sutures to be removed at 2-week follow-up</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: The Preadmission Medication list is accurate and complete. 1. amLODIPine 10 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Brimonidine Tartrate 0.15% Ophth. 1 DROP LEFT EYE BID 4. Furosemide 20 mg PO DAILY 5. Carvedilol 6.25 mg PO BID 6. Januvia (SITagliptin) 100 mg oral DAILY 7. PreserVision AREDS 2 (vit C,E-Zn-coppr-lutein-zeaxan) 250-200-40-1 mg-unit-mg-mg oral DAILY 8. Losartan Potassium 50 mg PO DAILY 9. Apixaban 2.5mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: right MCA stroke Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were hospitalized due to symptoms of left facial droop and slurred speech resulting from an ACUTE ISCHEMIC STROKE, a condition where a blood vessel providing oxygen and nutrients to the brain is blocked by a clot. The brain is the part of your body that controls and directs all the other parts of your body, so damage to the brain from being deprived of its blood supply can result in a variety of symptoms. Stroke can have many different causes, so we assessed you for medical conditions that might raise your risk of having stroke. In order to prevent future strokes, we plan to modify those risk factors. Your risk factors are: -Hypertension -Hyperlipidemia -Atrial fibrillation -Congestive heart failure -Type 2 Diabetes We are changing your medications as follows: -Apixaban 2.5mg twice daily Please take your other medications as prescribed. Please followup with Neurology and your primary care physician. If you experience any of the symptoms below, please seek emergency medical attention by calling Emergency Medical Services (dialing 911). In particular, since stroke can recur, please pay attention to the sudden onset and persistence of these symptoms: - Sudden partial or complete loss of vision - Sudden loss of the ability to speak words from your mouth - Sudden loss of the ability to understand others speaking to you - Sudden weakness of one side of the body - Sudden drooping of one side of the face - Sudden loss of sensation of one side of the body Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amiodarone 200 mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Lisinopril 20 mg PO DAILY 4. Fish Oil (Omega 3) 1000 mg PO DAILY Discharge Disposition: Home Discharge Diagnosis: TIA Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure to take care of you at ___ ___. You were admitted on ___ with a transient episode of right hand numbness that progressed to problems with your speech. The whole event lasted approximately 1 hour. When you arrived, a Code Stroke was called an you were taken urgently for CT which showed ___ new stroke or problems with your blood vessels to account for your symptoms. We also did an MRI which showed ___ stroke or obvious vascular cause of your symptoms. We checked additional laboratory tests to evaluate for increased lipids or diabetes. You do not have diabetes, but you did have elevated cholesterol. We would like to start you on: fish oil and feel strongly that you should start Pradaxa, which you refused at this time but stated you will discuss with your primary care doctor. An ultrasound of your heart was also done which showed normal function. At this time we think your symptoms of a transient ischemic attack or TIA. This is a brief stroke-like event that resolves and causes ___ permanent deficit. You may be at increased risk for future TIAs or stroke and it is important that you come back to the ED if you have new or persistent symptoms. Please remain on the medications listed below and follow up as we have scheduled. Thank you for allowing us to participate in your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB 2. Polyethylene Glycol 17 g PO DAILY Stop medication if you have loose stools. RX *polyethylene glycol 3350 [Miralax] 17 gram/dose 1 packet(s) by mouth Daily Disp #*30 Packet Refills:*11 3. Psyllium 1 PKT PO DAILY Hold for loose stools. RX *psyllium 1 packet(s) by mouth Daily Disp #*30 Packet Refills:*11 4. Bisacodyl 10 mg PO/PR DAILY constipation Duration: 2 Weeks RX *bisacodyl 5 mg ___ tablet(s) by mouth or rectum Daily Disp #*60 Tablet Refills:*0 5. Lorazepam 0.5 mg PO BID: PRN anxiety Do not take if sedated or driving. RX *lorazepam 0.5 mg 1 tablet by mouth Twice a day Disp #*10 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Constipation Depressed mood Secondary diagnosis: Asthma Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure participating in your care at ___. You were admitted to the hospital with abdominal pain due to severe constipation. You had a CT scan of your abdomen that showed significant stool, but no other concerning process. You were treated with laxatives and your symptoms improved. You should continue to take laxatives at home as needed and make sure to drink plenty of fluid and include fiber in your diet to prevent this constipation from happening again in the future. You spoke with the nutrition team to help with your diet. Please discuss setting up a nutrition follow up appointment with your doctor. You appear to have a lot of stress in your life which may be contributing to your abdominal pain and constipation. You felt much better after talking to a social worker, so we recommend that you see a social worker or other therapist after returning home. Please follow up as scheduled with your new primary care provider and note the changes to your medications on the next page.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take lovenox 40mg daily for 2 weeks WOUND CARE: - No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment or by your rehab facility. - No dressing is needed if wound continues to be non-draining. ACTIVITY AND WEIGHT BEARING: - Out of bed w/ assist - Right lower extremity: Full weight bearing - Left lower extremity: Full weight bearing - Encourage turning, deep breathing and coughing Qhour when awake Physical Therapy: - Activity: Out of bed w/ assist - Right lower extremity: Full weight bearing - Left lower extremity: Full weight bearing - No ROM restrictions - Encourage turning, deep breathing and coughing Qhour when awake. Treatments Frequency: Site: Incision Type: Surgical Dressing: Gauze - dry - Change daily or as needed to keep dry; OK to leave open to air once non-draining.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Senna 8.6 mg PO BID:PRN constipation 2. Acyclovir 400 mg PO Q8H 3. amLODIPine 5 mg PO DAILY 4. Docusate Sodium 200 mg PO BID 5. Entecavir 0.5 mg PO DAILY 6. LORazepam 0.5 mg PO Q6H:PRN Nausea, anxiety 7. Ondansetron 4 mg PO Q8H:PRN Nausea 8. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate 9. Pantoprazole 40 mg PO Q24H 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: ================== #Febrile Neutropenia #DLBCL SECONDARY DIAGNOSIS: ===================== #Chronic HBV infection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, You were admitted due to fever when your blood counts were low. You were placed on IV antibiotics for your fever spikes. No source of infection was found. Your counts recovered and you are feeling better and are ready to be discharged home today. You will follow up in the clinic as stated below. It was a pleasure taking care of you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H 2. Amiodarone 400 mg PO BID Duration: 5 Days then decrease to 400mg daily x 5 days, then decrease to 200mg daily continuous 3. Atorvastatin 80 mg PO DAILY 4. Docusate Sodium 100 mg PO BID 5. GuaiFENesin ER 1200 mg PO Q12H Duration: 4 Days 6. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Moderate RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every four (4) hours Disp #*10 Tablet Refills:*0 7. Metoprolol Tartrate 25 mg PO TID hold if SBP<90 or HR<55 8. Polyethylene Glycol 17 g PO DAILY 9. Potassium Chloride 20 mEq PO DAILY Duration: 7 Days 10. Ramelteon 8 mg PO QHS:PRN sleep Should be given 30 minutes before bedtime 11. Ranitidine 150 mg PO BID 12. Senna 17.2 mg PO DAILY 13. Warfarin 5 mg PO ONCE Duration: 1 Dose please dose daily for INR 2.5-3.5 (Mechanical AVR & MVR/afib/CVA) 14. ___ MD to order daily dose PO DAILY16 please dose daily for INR 2.5-3.5 (Mechanical AVR & MVR/afib/CVA) 15. Aspirin EC 81 mg PO DAILY 16. Furosemide 20 mg PO DAILY Duration: 7 Days 17. HELD- Losartan Potassium 25 mg PO DAILY This medication was held. Do not restart Losartan Potassium until SBP consistently >140 Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: Redosternotomy s/p Mechanical Mitral Valve Replacement RV lead extractions with upgrade to a CRT-D device on ___ postop ischemic stroke with Left weakness Secondary: aortic stenosis s/p prior Mechanical Aortic Valve Replacement and Mitral valve repair with 30mm ___ II ring and LV epicardial lead placement ___ Complete Heart Block-s/p Permanent PaceMaker ___ hypertension hyperlipidemia BPH Shingles Valvular cardiomyopathy mitral regurgitation Atrial fibrillation H. pylori gastritis post-quadruple therapy (___) Discharge Condition: Alert and oriented x3, non-focal Ambulating, gait steady Sternal pain managed with oral analgesics Sternal Incision - healing well, no erythema or drainage Edema-left ___ edema 1+ Followup Instructions: ___ [/INST] </s><s>Please shower daily -wash incisions gently with mild soap, no baths or swimming, look at your incisions daily Please - NO lotion, cream, powder or ointment to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for approximately one month and while taking narcotics Clearance to drive will be discussed at follow up appointment with surgeon No lifting more than 10 pounds for 10 weeks Encourage full shoulder range of motion, unless otherwise specified **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Atorvastatin 80 mg PO DAILY 3. Clopidogrel 75 mg PO DAILY 4. Docusate Sodium 100 mg PO BID 5. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN neuropathy 6. Metolazone 2.5 mg PO DAILY 7. PredniSONE 3 mg PO DAILY 8. Ropinirole 1.5 mg PO QPM 9. Sulfameth/Trimethoprim SS 1 TAB PO DAILY 10. Acetaminophen 650 mg PO Q6H:PRN pain 11. Nitroglycerin SL 0.4 mg SL PRN chest pain 12. Prochlorperazine 10 mg PO Q8H:PRN nausea DO NOT TAKE IF NOT NEEDED. 13. Vitamin D 50,000 UNIT PO 1X/WEEK (MO) 14. Metoprolol Tartrate 25 mg PO BID 15. Mycophenolate Mofetil 500 mg PO BID 16. Epoetin Alfa ___ UNIT SC QMOWEFR 17. Citalopram 20 mg PO DAILY 18. Levofloxacin 750 mg PO Q48H Duration: 2 Days RX *levofloxacin 750 mg one tablet(s) by mouth EVERY 2 DAYS Disp #*2 Tablet Refills:*0 19. Glargine 7 Units Breakfast Glargine 8 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 20. Outpatient Lab Work icd-9 996.81: please draw AM tacrolimus level before 8 am an send to Dr. ___ at ___. 21. Torsemide 100 mg PO BID 22. Tacrolimus 1 mg PO Q12H 23. Outpatient Lab Work Please check hematocrit on ___ and send to Dr. ___ ___ at ___. icd-9 996.81. Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: CHF exacerbation Acute kidney injury Chronic kidney dysfunction Type 1 Diabetes Anemia Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to ___ because of acute kidney dysfunction and anemia (low blood count). You were transfused both at ___, and at ___. Your low blood count was thought to be due to your long term kidney dysfunction. You were started on a new medication to improve your blood counts. We also treated you with IV medication in order to help you lose some of the excess water in your body. You were also seen by a diabetes specialist to help you regulate your blood sugar. It is IMPERATIVE that you quit tobacco. While you were here, some changes were made to your medications, please see the sheet below. Please follow up below.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Metoprolol Tartrate 12.5 mg PO BID hold if SBP < 90 or HR < 60 3. Cyanocobalamin 100 mcg PO DAILY 4. Simvastatin 20 mg PO DAILY 5. MetFORMIN (Glucophage) 500 mg PO BID 6. Tamsulosin 0.4 mg PO HS holf for sbp < 100 7. FoLIC Acid 1 mg PO DAILY 8. Thiamine 100 mg PO DAILY 9. Senna 2 TAB PO BID:PRN constipation 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation 11. Docusate Sodium 200 mg PO BID:PRN constipation Discharge Disposition: Extended Care Facility: ___ ___ Diagnosis: Right upper lobe lung mass Non-ST elevation MI Anemia of Chronic Disease Hypotension secondary to dehydration and poor PO intake Hypercalcemia Hypoglycemia Type-II Diabetes Urinary Retention Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were admitted because of low blood pressure secondary to dehydration, low blood counts, low blood sugars, high calcium levels in your blood, and damage to your heart from a mild heart attack. During your admission, a large mass in the upper aspect of your right lung was found. Initially, this mass thought to be an infection and you were treated with antibiotics; however, these antibiotics were discontinued after further studies suggested it was not an infection. The mass was biopsied, and the results of the biopsy are pending. To correct your low blood counts, you received a blood transfusion. To correct your low blood pressure, dehydration, and high calcium, you received intravenous fluids. To evaluate your heart, you received a heart ultrasound, which suggests that you may have mild heart failure and that one of your heart valves is permitting backflow. To correct your low blood sugar, you received sugar intravenously. During your hospitalization, urinary retention and difficulty urinating was noted. You received a catheter in your bladder to facilitate urine excretion, and were discharged with this catheter.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Amlodipine 5 mg PO BID 2. Aspirin 81 mg PO DAILY 3. Gabapentin 200 mg PO QHS 4. Glargine 40 Units Bedtime Insulin SC Sliding Scale using UNK Insulin 5. Levothyroxine Sodium 75 mcg PO DAILY 6. Mycophenolate Mofetil 500 mg PO TID 7. PredniSONE 5 mg PO DAILY 8. Tacrolimus 1 mg PO Q12H 9. Ciprofloxacin 400 mg IV Q12H 10. Ganciclovir 390 mg IV Q12H 11. MetRONIDAZOLE (FLagyl) 500 mg IV Q8H 12. Pantoprazole 40 mg IV Q12H Discharge Disposition: Extended Care Discharge Diagnosis: Abdominal pain and fever Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure participating in your care at ___ ___. You were admitted with abdominal pain and you had a fever. As you know, given your status, we are concerned that you may have a CMV infection. You received a dose of antiviral medication and then were transferred to the ___ for continued care. You received a study to determine if gastroparesis was contributing to your abdominal pain, and the results are not available. We will send you a letter with the results.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Benzonatate 100 mg PO TID 3. Enoxaparin Sodium 70 mg SC Q12H 4. Magnesium Oxide 400 mg PO TID Duration: 3 Doses 5. Warfarin 5 mg PO DAILY16 6. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Moderate RX *hydromorphone 2 mg ___ tablet(s) by mouth every four (4) hours Disp #*30 Tablet Refills:*0 7. Glargine 20 Units Bedtime Humalog 3 Units Breakfast Humalog 3 Units Lunch Humalog 3 Units Dinner Insulin SC Sliding Scale using HUM Insulin 8. LORazepam 0.5 mg PO Q8H:PRN Anxiety RX *lorazepam 0.5 mg 1 TAB by mouth every eight (8) hours Disp #*30 Tablet Refills:*0 9. Nortriptyline 75 mg PO QHS RX *nortriptyline 75 mg 1 tab by mouth at bedtime Disp #*30 Capsule Refills:*0 10. Acetaminophen-Caff-Butalbital 1 TAB PO BID RX *butalbital-acetaminophen-caff 50 mg-300 mg-40 mg 1 tab by mouth twice a day Disp #*20 Capsule Refills:*0 11. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN Wheezing 12. Albuterol Inhaler ___ PUFF IH Q4H:PRN Wheezing 13. amLODIPine 10 mg PO DAILY 14. Aspirin 81 mg PO DAILY 15. Atorvastatin 80 mg PO QPM 16. Cyclobenzaprine 10 mg PO TID:PRN Muscle spasm 17. diclofenac sodium 1 % TOPICAL Q4H 18. Fenofibrate 145 mg PO DAILY 19. Fentanyl Patch 37 mcg/h TD Q72H RX *fentanyl 37.5 mcg/hour 1 patch q72h Disp #*10 Patch Refills:*0 20. Ferrous Sulfate 325 mg PO DAILY 21. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 22. Gabapentin 300 mg PO QHS 23. guaiFENesin 600 mg oral BID 24. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN shortness of breath 25. melatonin 10 mg oral QHS:PRN Insomia 26. methylcellulose (laxative) 15 mL oral DAILY:PRN Constipation 27. Metoclopramide 10 mg PO QIDACHS 28. Metoprolol Succinate XL 25 mg PO QHS 29. Miconazole 2% Cream 1 Appl TP BID 30. Nitroglycerin SL 0.4 mg SL Q5MIN:PRN Chest pain 31. Omeprazole 40 mg PO BID 32. Ondansetron ODT 4 mg PO BID:PRN Nausea/Vomiting - First Line 33. Pancrelipase 5000 1 CAP PO TID W/MEALS 34. Polyethylene Glycol 17 g PO DAILY:PRN constipation Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Pain after fall Hyponatremia Poorly controlled type 2 diabetes mellitus Tracheobronchomalacia Chronic pain Anxiety SIADH Cavitary lesions ___ lung LV aneurysm LV thrombus Discharge Condition: Ambulating with walker Followup Instructions: ___ [/INST] </s><s>Dear ___ was a pleasure caring for you. You were hospitalized with leg pain after your fall. There is thankfully no fracture and your pain is slowly improving. ___ addition, you were found to have low sodium due to a condition called "SIADH" or syndrome of inappropriate antidiuretic hormone. SIADH is likely caused by your pain and maybe your lung issues. This improved with fluid restriction, and we recommend you continue to limit yourself to 1.5L of free water daily. This will hopefully be temporary, but your doctors ___ when you can stop restricting. We also found that you had lesions ___ your lungs ("cavitary lesions"), the cause of which is not completely clear but which may be from infection of mycobacteria. Tests are pending and you will follow up with the lung doctors here to decide what if any management will be necessary. We also found you had a clot ___ your heart with an aneurysm ___ the heart. For this we started you on a blood thinner. You are currently taking 2 blood thinners (Lovenox injections and warfarin) until the warfarin kicks ___, after which you will stop taking the Lovenox and just take the warfarin. You will be on the warfarin for at least 3 months and will have follow up with your cardiologist to consider what if any further diagnosis/management will be necessary. We found that you had slight widening of some of the biliary tubes around your liver. This is likely not a problem, but at some point ___ the near future you will need to have a test called an "MRCP". We have informed your doctors about this. We have increased some of your pain and anxiety medications, but as we discussed, these increase your risk of fall and other adverse outcomes, so we recommend you work with your doctors to reduce these sedating medications as soon as able.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Levothyroxine Sodium 50 mcg PO DAILY 2. Paroxetine 10 mg PO DAILY 3. Simvastatin 40 mg PO DAILY 4. Warfarin 1 mg PO DAILY16 RX *warfarin 1 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*2 5. Lisinopril 5 mg PO DAILY RX *lisinopril 5 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*2 6. Amiodarone 100 mg PO DAILY RX *amiodarone 100 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*2 Discharge Disposition: Home With Service Facility: ___ ___: PRIMARY DIAGNOSES: Fall Atrial Fibrillation s/p embolic stroke SECONDARY DIAGNOSES: Hypertension Celiac disease Dyslipidemia Hypothyroidism Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Ms. ___, It was a pleasure taking care of you at the ___ ___. You were transferred to our hospital from ___ because you had a fall while on the blood thinner coumadin. ___ did a CT scan of your head and did not see any evidence of bleeding. They transferred you to ___ for a second opinion and any further management that you would require. You had a carotid ultrasound which showed no significant disease. You were seen by the physical therapists in the hospital who determined that you are safe for discharge home with physical therapy. Please take all your medications as prescribed. We changed or stopped the following medications: Metoprolol: Please stop the metorpolol. Amiodarone: Please continue your amiodarone at 100 mg by mouth daily. Coumadin: Your coumadin was decreased to 1 mg by mouth daily. Lisinopril: Please start 1 tablet by mouth daily for blood pressure control. You will need to make a follow up appointment with your primary care physician ___ 7 days after discharge. You have an appointment with your cardiologist as listed below. It is important that you make/keep these appointments as they might want to make medication changes. You will need to have an INR and renal function checked on ___ and have the results sent to Dr. ___ ___. Thank you for allowing us to participate in your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Citalopram 10 mg PO DAILY 3. Simvastatin 20 mg PO QPM 4. Cyanocobalamin 50 mcg PO DAILY 5. Docusate Sodium 100 mg PO BID 6. FoLIC Acid 1 mg PO DAILY OTC Medication - Ask your Pharmacist 7. Multivitamins 1 TAB PO DAILY OTC Medication - Ask your Pharmacist 8. Senna 17.2 mg PO HS OTC Medication - Ask your Pharmacist 9. Thiamine 100 mg PO DAILY OTC Medication - Ask your Pharmacist 10. Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush 11. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg 1 tablet(s) by mouth every six (6) hours Disp #*20 Tablet Refills:*0 12. Acetaminophen 325-650 mg PO Q6H:PRN Pain/Fever Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Traumatic Subarachnoid Hemorrhage Chronic Left Subdural Hematoma Rib fractures Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You suffered a small brain bleed after a fall. This did not require surgery, but you will need follow-up as an outpatient with repeat imaging. Activity - We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. - You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. - No driving while taking any narcotic or sedating medication. - If you experienced a seizure while admitted, you are NOT allowed to drive by law. - No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. - Continue to use your Incentive Spirometer 10x every hour to encourage deep breathing. Medications - You may take your Aspirin 81mg as previously prescribed. Please do NOT take any additional blood thinning medication (Ibuprofen, Plavix, Coumadin) until cleared by your Neurosurgeon. - You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. - You may use Oxycodone for more severe pain as needed. This medication may make you drowsy. Do not drive or drink alcohol while taking this medication. What You ___ Experience: - You may have difficulty paying attention, concentrating, and remembering new information. - Emotional and/or behavioral difficulties are common. - Feeling more tired, restlessness, irritability, and mood swings are also common. - Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Headaches: - Headache is one of the most common symptom after a brain bleed. - Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. - Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. - There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: - Fever greater than 101.5 degrees Fahrenheit - Nausea and/or vomiting - Extreme sleepiness and not being able to stay awake - Severe headaches not relieved by pain relievers - Seizures - Any new problems with your vision or ability to speak - Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: - Sudden numbness or weakness in the face, arm, or leg - Sudden confusion or trouble speaking or understanding - Sudden trouble walking, dizziness, or loss of balance or coordination - Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin EC 81 mg PO DAILY 2. Atorvastatin 20 mg PO QPM 3. Docusate Sodium (Liquid) 100 mg PO BID 4. Senna 8.6 mg PO BID:PRN constipation 5. Furosemide 80 mg PO DAILY RX *furosemide 40 mg 2 tablet(s) by mouth daily Disp #*60 Tablet Refills:*3 6. Warfarin 2.5 mg PO DAILY16 RX *warfarin [Coumadin] 1 mg 3 tablet(s) by mouth daily Disp #*90 Tablet Refills:*3 7. Outpatient Lab Work Please check INR ___ and call ___ ___ at ___ with results. 8. Metoprolol Succinate XL 75 mg PO DAILY RX *metoprolol succinate 25 mg 3 tablet(s) by mouth daily Disp #*90 Tablet Refills:*3 9. Potassium Chloride 10 mEq PO DAILY Duration: 24 Hours RX *potassium chloride 10 mEq 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*3 10. Outpatient Lab Work Please draw chem 10 on ___ and call PCP ___ at ___ with the results. 11. Diltiazem Extended-Release 240 mg PO DAILY RX *diltiazem HCl 240 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*3 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Acute on chronic diastolic congestive heart failure exacerbation Left lower lobe pleural effusion Secondary: Atrial fibrillation Aortic stenosis s/p TAVR Aortic regurgitation Complete heart block s/p pacer Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, You were admitted to the hospital with difficulty breathing due to fluid in your lungs and excess fluid in your legs. We gave you medication to remove this extra fluid. Your breathing and swelling improved as the fluid was removed and you were able to walk comfortably and no longer needing oxygen. Please remember to continue to limit salt and total fluid intake and to measure your weight every day. It was a pleasure taking care of you. Sincerely, Your ___ Cardiology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Simvastatin 20 mg PO QPM 3. Metoprolol Succinate XL 12.5 mg PO DAILY 4. Ropinirole 2 mg PO DAILY 5. Tamsulosin 0.4 mg PO QHS 6. Finasteride 5 mg PO DAILY 7. Citalopram 10 mg PO DAILY 8. Calcitriol 0.25 mcg PO DAILY 9. Levothyroxine Sodium 50 mcg PO EVERY OTHER DAY 10. Lisinopril 10 mg PO DAILY 11. Melatin (melatonin) 3 mg oral QPM Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Partial bowel obstruction vs gastroenteritis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Weigh yourself every morning, call MD if weight goes up more than 3 lbs. You were admitted to the hospital for a partial small bowel obstruction vs gastroenteritis. You were given bowel rest and intravenous fluids. Your symptoms have subsequently resolved after conservative management. You have tolerated a regular diet, are passing gas and your pain is controlled with pain medications by mouth. Furthermore you have not had any diarrhea, bloody bowel movements, and your hematocrit (blood count levels) have been stable. You may return home to finish your recovery. Please monitor your bowel function closely. If you notice that you are passing bright red blood with bowel movements or having loose stool without improvement please call the office or go to the emergency room if the symptoms are severe. If you have any of the following symptoms please call the office for advice or go to the emergency room if severe: increasing abdominal distension, increasing abdominal pain, nausea, vomiting, inability to tolerate food or liquids, prolonged loose stool, or extended constipation. Thank you for allowing us to participate in your care! Our hope is that you will have a quick return to your life and usual activities. Good luck!</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Ibuprofen 600 mg PO Q8H:PRN pain Discharge Disposition: Home Discharge Diagnosis: Chest pain with positive stress test Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, Taking care of you at ___ was our pleasure. You came in because you were having chest pain and had findings on your stress test suggesting that your heart was possibly not getting enough blood flow. Because of your ongoing pain, which worsened over the last two days, decision was made to admit you for a cardiac catheterization. The procedure showed normal coronary arteries and no evidence of blockages. Your chest pain is not related to heart disease. Please follow up with your primary care doctor and continue all medications as before. We wish you all the ___. Sincerely, The ___ medical team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 325 mg PO DAILY 2. Avodart (dutasteride) 0.5 mg oral daily 3. Docusate Sodium 100 mg PO BID 4. Levothyroxine Sodium 175 mcg PO DAILY 5. Metoprolol Succinate XL 12.5 mg PO DAILY 6. Omeprazole 20 mg PO DAILY 7. Senna 17.2 mg PO QHS 8. Tamsulosin 0.4 mg PO DAILY 9. ALPRAZolam 1 mg PO DAILY:PRN anxiety 10. Klor-Con (potassium chloride) ___ meq oral BID 11. Theophylline ER 300 mg PO DAILY 12. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q4H:PRN pain 13. Lisinopril 5 mg PO DAILY 14. Nafcillin 2 g IV Q4H 15. Warfarin 5 mg PO DAILY16 16. NPH 22 Units Breakfast NPH 22 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 17. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain 18. Simvastatin 10 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: MSSA Bacteremia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair, requires TLSO brace when out of bed Followup Instructions: ___ [/INST] </s><s>Dear Mr ___, Thank you for allowing us to participate in your care. You were admitted on ___ with symptoms of low back pain and fevers. Our tests showed bacteria in your blood and we started you on intravenous antibiotics for it. We continued your home medications, and gave you medications for your back pain as well. You responded well to therapy, and we placed a tube in your arm veins through which you will continue to receive antibiotics for 9 more days for a total of 14 days since you started the antibiotics. Our neurosurgery, and infectious disease teams who also saw and evaluated you while you were admitted recommend that you follow up with them after you're discharged at the appointments scheduled below. Discharge instructions - Continue receiving antibiotics through your PICC line till ___ for a total 2 week course till you see the infectious disease team as scheduled below - Please continue your coumadin on discharge and follow up with your regular ___ clinic - Please care for your PICC line as instructed to minimize infections - Your rehab can help remove the staples in your back on ___, ___ - Please remember to wear the TLSO brace whenever you are out of bed till you see the neurosurgery team as scheduled below - You were started on a small dose of metoprolol and statin to help protect your heart. Please follow up with PCP to further discuss these medication changes - Weigh yourself every morning, call MD if weight goes up more than 3 lbs - Please follow up with our infectious disease and neurosurgery teams as scheduled below</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 10 mg PO DAILY 2. Eplerenone ___ mg PO DAILY 3. Escitalopram Oxalate 20 mg PO DAILY 4. HydrALAZINE 25 mg PO TID 5. LamoTRIgine 100 mg PO BID 6. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 7. Modafinil 200 mg PO BID 8. Vitamin D ___ UNIT PO DAILY 9. Atorvastatin 80 mg PO QPM RX *atorvastatin 80 mg 1 tablet(s) by mouth QPM Disp #*30 Tablet Refills:*0 10. Torsemide 20 mg PO DAILY RX *torsemide 20 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 11. ammonium lactate 12 % topical BID 12. Multivitamins 1 TAB PO DAILY 13. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 14. Outpatient Lab Work ICD 10 K74.60 ___ Labs: Please obtain Chem 10, LFTS, ___, PTT, CBC and Fax to: PCP ___ ___ (P ___ Liver Center Dr. ___ ___ (P ___ 15. Outpatient Lab Work ICD 10 K74.60 ___ Labs: Please obtain Chem 10, LFTS, ___, PTT, CBC and Fax to: PCP ___ ___ (P ___ Liver Center Dr. ___ ___ (P ___ Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary Diagnoses ===================== Anemia Variceal Bleeding s/p TIPS NSTEMI Acute on chronic diastolic heart failure HCV Cirrhosis Acute kidney injury Sinus bradycardia Secondary Diagnoses ===================== Hypertension Hyperaldosteronism History of CVA c/b seizures Vitamin D deficiency Prolonged QTc Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you during your stay at ___. You were admitted to the hospital with low blood counts. You were found to have evidence of bleeding from your GI tract which is caused by your cirrhosis. You were treated with a procedure called a TIPS which can help lower the pressure in your liver to help prevent further bleeds. Dilated blood vessels in your GI tracts were also fixed by the interventional radiologists. You were restarted on diuretics (water pills) while you were here in the hospital. You should weigh yourself every morning and call your doctor if your weight goes up by more than 3 lbs. It is very important that you follow up with our primary care doctor, the interventional radiologists, liver doctors and ___ ___ after you leave the hospital. You will need to have labs drawn on ___ and every ___ after. Your updated medication list and appointments are listed below. We wish you the best! - Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Spironolactone 12.5 mg PO DAILY RX *spironolactone 25 mg 0.5 (One half) tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Furosemide 40 mg PO DAILY RX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Lisinopril 10 mg PO DAILY RX *lisinopril 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN shortness of breath 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 80 mg PO QPM 7. Metoprolol Succinate XL 25 mg PO DAILY 8. Warfarin 7.5 mg PO 2X/WEEK (MO,FR) 9. Warfarin 5 mg PO 5X/WEEK (___) Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: ================== - Acute heart failure with reduced ejection fraction - LV thrombus - Cholelithiasis SECONDARY DIAGNOSIS: ==================== - CAD - Tobacco use - COPD - Microcytic anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Ms. ___, WHY WERE YOU ADMITTED TO THE HOSPITAL? - You were admitted to ___ because you were feeling fatigued and short of breath when you laid flat on your back. WHAT WAS DONE FOR YOU IN THE HOSPITAL? - You were treated with a medicine called Lasix, which was given to you through your vein to help remove the extra fluid in your body that was making it hard for you to breath. You were then switched to an oral version of Lasix that you should take every day to prevent more fluid from building up. - You were started on a new medicine called spironolactone that will protect your heart. You will take a 12.5mg tablet of this medicine once a day. Your home lisinopril 5mg daily was increased to 10mg daily. - You were having some abdominal pain, so you had an ultrasound of your stomach that showed you had gallstones. There is nothing to do for this right now. WHAT SHOULD YOU DO WHEN YOU GO HOME? - You should continue taking all your medicines, as prescribed. As we discussed, you should consider taking your Lasix pill in the morning so you won't have to get up several times in the middle of the night to urinate. - You should follow up with your primary care doctor and cardiologist. - You should weigh yourself every morning using the same scale and call your cardiologist if your weight increases by more than 3 lbs. in one day or 5lbs. in two days. Your discharge weight is: 199.96 lb. - You should drink less than 2 liters of fluid per day and avoid eating salty foods, such as deli meats and canned soups. You should consume less than 2 grams of salt per day. - You should stop smoking. This is one of the most important things you can do to protect your heart from further damage. It was a pleasure taking care of you, and we wish you all the best! Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. MetFORMIN (Glucophage) 425 mg PO BID 3. Rivaroxaban 20 mg PO DAILY 4. Simvastatin 20 mg PO DAILY 5. Acetaminophen ___ mg PO Q8H:PRN pain 6. Amlodipine 10 mg PO DAILY 7. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 8. Calcium Carbonate 500 mg PO QID:PRN heart burn 9. Docusate Sodium 100 mg PO BID 10. Polyethylene Glycol 17 g PO DAILY:PRN constipation 11. Senna 1 TAB PO BID:PRN constipation 12. Valsartan 40 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: acalculus cholecystitis Secondary diagnosis: A-fib Diabetes Mellitus 2 Coronary artery disease Constipation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___. You came in with 7 days of constipation, loss of appetite, generalized weakness, cough, and sudden onset of chest pain. While ___ were here, we ran some tests including EKG, Troponins, and chest X-ray in order to investigate cardiac causes of your pain. These tests were all negative. You were found to have some upper right quadrant abdominal pain on exam and some of your liver enzymes associated with gallbladder injury were elevated. We did several studies to investigate this further including an ultrasound and a HIDA scan. The ultrasound showed that the gallbladder was distended, there were gallstones and some biliary sludge present, as well as gallbladder wall thickening. The HIDA scan showed normal empting of the gallbladder. We had the surgical team examine you to determine if emergent surgery was necessary. Because you continued to have an elevated white blood cell count and pain, you were taken to the operating room where you had your gallbladder removed. You are slowly recovering from your surgery and you are preparing for discharge home with the following instructions: Do not drive until you have stopped taking pain medicine and feel you could respond in an emergency. You may climb stairs. You may go outside, but avoid traveling long distances until you see your surgeon at your next visit. Don't lift more than ___ lbs for 6 weeks. (This is about the weight of a briefcase or a bag of groceries.) This applies to lifting children, but they may sit on your lap.) You may start some light exercise when you feel comfortable. You will need to stay out of bathtubs or swimming pools for a time while your incision is healing. Ask your doctor when you can resume tub baths or swimming. Heavy exercise may be started after 6 weeks, but use common sense and go slowly at first. You may resume sexual activity unless your doctor has told you otherwise. HOW YOU MAY FEEL: You may feel weak or "washed out" for 6 weeks. You might want to nap often. Simple tasks may exhaust you. You may have a sore throat because of a tube that was in your throat during surgery. You might have trouble concentrating or difficulty sleeping. You might feel somewhat depressed. You could have a poor appetite for a while. Food may seem unappealing. All of these feelings and reactions are normal and should go away in a short time. If they do not, tell your surgeon. YOUR INCISION: Your incision may be slightly red aroudn the stitches or staples. This is normal. You may gently wash away dried material around your incision. Do not remove steri-strips for 2 weeks. (These are the thin paper strips that might be on your incision.) But if they fall off before that that's okay). It is normal to feel a firm ridge along the incision. This will go away. Avoid direct sun exposure to the incision area. Do not use any ointments on the incision unless you were told otherwise. You may see a small amount of clear or light red fluid staining your dressing r clothes. If the staining is severe, please call your surgeon. You may shower. As noted above, ask your doctor when you may resume tub baths or swimming. Ove the next ___ months, your incision will fade and become less prominent. YOUR BOWELS: Constipation is a common side effect of medicine such as Percocet or codeine. If needed, you may take a stool softener (such as Colace, one capsule) or gentle laxative (such as milk of magnesia, 1 tbs) twice a day. You can get both of these medicines without a prescription. If you go 48 hours without a bowel movement, or have pain moving the bowels, call your surgeon. After some operations, diarrhea can occur. If you get diarrhea, don't take anti-diarrhea medicines. Drink plenty of fluitds and see if it goes away. If it does not go away, or is severe and you feel ill, please call your surgeon. PAIN MANAGEMENT: It is normal to feel some discomfort/pain following abdominal surgery. This pain is often described as "soreness". Your pain should get better day by day. If you find the pain is getting worse instead of better, please contact your surgeon. You will receive a prescription from your surgeon for pain medicine to take by mouth. It is important to take this medicine as directied. Do not take it more frequently than prescribed. Do not take more medicine at one time than prescribed. Your pain medicine will work better if you take it before your pain gets too severe. Talk with your surgeon about how long you will need to take prescription pain medicine. Please don't take any other pain medicine, including non-prescription pain medicine, unless your surgeon has said its okay. IF you are experiencing no pain, it is okay to skip a dose of pain medicine. Remember to use your "cough pillow" for splinting when you cough or when you are doing your deep breathing exercises. If you experience any of the folloiwng, please contact your surgeon: - sharp pain or any severe pain that lasts several hours - pain that is getting worse over time - pain accompanied by fever of more than 101 - a drastic change in nature or quality of your pain MEDICATIONS: Take all the medicines you were on before the operation just as you did before, unless you have been told differently. In some cases you will have a prescription for antibiotics or other medication. If you have any questions about what medicine to take or not to take, please call your surgeon. DANGER SIGNS: Please call your surgeon if you develop: - worsening abdominal pain - sharp or severe pain that lasts several hours - temperature of 101 degrees or higher - severe diarrhea - vomiting - redness around the incision that is spreading - increased swelling around the incision - excessive bruising around the incision - cloudy fluid coming from the wound - bright red blood or foul smelling discharge coming from the wound - an increase in drainage from the wound</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Escitalopram Oxalate 20 mg PO DAILY 2. Fentanyl Patch 50 mcg/h TD Q48H Back pain 3. Lorazepam 0.5 mg PO QHS:PRN Insomnia 4. OxycoDONE (Immediate Release) 15 mg PO Q4H:PRN Pain 5. Venlafaxine XR 75 mg PO DAILY 6. Zolpidem Tartrate 5 mg PO QHS Insomnia 7. Vitamin D 1000 UNIT PO DAILY RX *ergocalciferol (vitamin D2) 2,000 unit ___ tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. Celecoxib 100 mg ORAL DAILY Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: - Syncope - Right inferior orbital fracture - Hypophosphatemia - Hypomagnesemia - Hypovitaminosis D Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___, ___ was a pleasure taking care of you at ___ ___. You were transferred from ___ due to concern for a seizure. While there, bloodwork showed extremely abnormal electrolytes. While at ___, your electrolytes were normal. An MRI of your brain was normal. The EEG of your brain appeared normal and is in final review at the time of discharge. Nevertheless, please follow-up with your PCP to have repeat bloodwork done to ensure your electrolytes remain normal. Also, please make sure to follow-up with a neurologist as outlined below. Because of the concern for seizure, **you cannot drive for six months.** When yawning or opening your mouth wide, you should brace jaw with hands to avoid another jaw dislocation. You should apply an ice pack to your face as needed to decrease swelling. Regards, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB 2. Aspirin 81 mg PO DAILY 3. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 4. FoLIC Acid 1 mg PO DAILY 5. Mirtazapine 7.5 mg PO HS 6. Ocutabs (vitamin A-vitamin C-vit E-min) 1 tab oral daily 7. Omeprazole 20 mg PO DAILY 8. Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q6H:PRN pain 9. Prochlorperazine 10 mg PO Q6H:PRN nausea 10. Tiotropium Bromide 1 CAP IH DAILY 11. Atorvastatin 80 mg PO DAILY RX *atorvastatin 80 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 12. Balanced Nutritional (food supplement, lactose-free) 0 can ORAL TID 13. Cyanocobalamin 1000 mcg IM/SC EVERY 9 WEEKS 14. Furosemide 20 mg PO DAILY:PRN swelling 15. garlic 1,000 mg oral daily 16. Metoprolol Succinate XL 25 mg PO DAILY 17. Nitroglycerin SL 0.4 mg SL PRN chest pain 1 tablet under the tongue every five minutes, Maximum of 3 (three) tablets total, for chest pain RX *nitroglycerin 0.4 mg 1 tablet(s) sublingually as needed for chest pain Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: PRIMARY: non-ST-elevation myocardial infarction, Non-small cell lung cancer SECONDARY: Chronic systolic heart failure, hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure caring for you at ___ ___. You were admitted for chest pain, and you appeared to have had a small heart attack. An echocardiogram revealed that the muscle function of your heart seems to be stable to prior. We recommend medical management for your heart disease, including a baby aspirin, controlling your blood pressure, and other medication changes as noted below. Please be sure to follow up with a cardiologist, as below. Your CT-scan showed relatively stable tumor, and you should discuss the imaging with your oncologists. Weigh yourself every morning, call MD if weight goes up more than 3 lbs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB 2. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 3. Montelukast Sodium 10 mg PO DAILY 4. Omeprazole 40 mg PO DAILY 5. Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB 6. Tiotropium Bromide 1 CAP IH DAILY 7. Nystatin Oral Suspension 5 mL PO QID thrush RX *nystatin 100,000 unit/mL 5 cc by mouth four times a day Disp #*1 Bottle Refills:*0 8. Sulfameth/Trimethoprim SS 1 TAB PO DAILY RX *sulfamethoxazole-trimethoprim 400 mg-80 mg One tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 9. PredniSONE 60 mg PO DAILY RX *prednisone 10 mg One tablet(s) by mouth daily Disp #*80 Tablet Refills:*0 10. Ipratropium Bromide Neb 1 NEB IH Q6H SOB 11. Azathioprine 50 mg PO DAILY RX *azathioprine 50 mg One tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 12. Pulmicort Flexhaler (budesonide) 180 mcg/actuation inhalation BID Discharge Disposition: Home Discharge Diagnosis: 1. asthma exacerbation Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you at ___ ___. You presented to us with shortness of breath and worsening of your asthma. We placed you on antibiotics, scheduled nebulizer treatments, and IV steroid. You are being discharged on prednisone, a new medication called azathioprine as recommended by your pulmonologist, and bactrim. We consulted pulmonology who agreed with our plan and made recommendations. Please follow up with your pulmonology, Dr. ___, as scheduled. We also consulted rheumatology to assess for Churg ___ and they believed that your current presentation is unlikely to be due to this illness since you lack many symptoms suggestive of this disease. Please take your medications as instructed. Please attend all your follow up appointments.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID 2. Enoxaparin Sodium 100 mg SC DAILY Start: Tomorrow - ___, First Dose: First Routine Administration Time 3. Lorazepam 0.5 mg PO BID:PRN nausea/anxiety 4. Multivitamins 1 TAB PO DAILY 5. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours as needed Disp #*60 Tablet Refills:*0 6. Polyethylene Glycol 17 g PO DAILY 7. Senna 8.6 mg PO BID 8. Temazepam 15 mg PO QHS:PRN sleep 9. Triumeq (abacavir-dolutegravir-lamivud) 600-50-300 mg oral DAILY 10. Acetaminophen 650 mg PO Q6H:PRN fever 11. Nystatin Oral Suspension 5 mL PO QID Discharge Disposition: Home Discharge Diagnosis: Pancreatic cancer Fever History of biliary obstruction s/p bile duct stenting and percutaneous cholecystostomy tube now removed History of multi-drug resistant pseudomonas Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr ___ it was a pleasure caring for you during your stay at ___. You were admitted again with fever. Given your history of multiple pseudomonas infections in the recent past and recent removal of the gallbladder tube you were restarted on IV antibioitcs. However you did not have any fevers here in the hospital and there were no signs of infection on blood cultures, liver ultrasound or liver MRI.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Cyanocobalamin 1000 mcg PO DAILY RX *cyanocobalamin (vitamin B-12) 1,000 mcg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Ondansetron 8 mg PO Q8H:PRN nausea RX *ondansetron HCl 8 mg 1 tablet(s) by mouth q8 hours Disp #*42 Tablet Refills:*0 6. OxyCODONE SR (OxyconTIN) 30 mg PO Q12H RX *oxycodone 30 mg 1 tablet(s) by mouth q12 hours Disp #*60 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY:PRN constipation RX *polyethylene glycol 3350 [Miralax] 17 gram 1 powder(s) by mouth daily Disp #*24 Packet Refills:*0 8. Senna 8.6 mg PO BID:PRN constipation RX *sennosides [senna] 8.6 mg 1 tab by mouth twice a day Disp #*60 Tablet Refills:*0 9. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 10 mg 1 tablet(s) by mouth q4 hours Disp #*84 Tablet Refills:*0 10. Hydrochlorothiazide 25 mg PO DAILY RX *hydrochlorothiazide 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 11. Lisinopril 20 mg PO BID RX *lisinopril 20 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: # High grade sarcoma # Anemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted with bleeding from your sarcoma. The bleeding stopped and we started you on your radiation treatment, which you tolerated well. We also started you on new pain medications. You also had a port placed to prepare you to start the chemotherapy, along with radiation, to start next ___. Be sure to return to 11 Reismann to be re-admitted early ___ morning before your radiation session. Sincerely, Your ___ Care team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Multivitamins 1 TAB PO DAILY 2. BuPROPion (Sustained Release) 300 mg PO QAM 3. Complera (emtricitab-rilpivirine-tenofov) 200-25-300 mg Oral QD 4. Acetaminophen 650 mg PO Q6H:PRN pain 5. Famotidine 20 mg PO Q12H RX *famotidine 20 mg 1 tablet(s) by mouth Twice a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary: abdominal pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you here at ___. As you know, you were hospitilized for severe abdominal pain. We are unsure of the cause of your abdominal pain. Obstruction of your gallbladder can sometimes cause the type of pain your were having. However, all of your labs were normal and a HIDA scan, which is an imaging test used to look to see if your gallbladder is obstructed, showed no gallbladder obstruction. We also performed an ultrasound of your gallbladder which was equivocal, but HIDA scan is a much better test to look for obstruction of your gallbladder. It is possible that your abdominal pain is being caused by gastritis (inflammation of the stomach) or peptic ulcer disease. We ordered an H. pylori test, which is currently pending, so you will need to contact the hospital in 48 hours for these results. We started you on famotidine, which is a medication that will block acid secretion in your stomach and may help with your symptoms. You are being discharged because you are clinically stable, but you should follow up with your primary care doctor. You should also follow up in the ___ clinic. The information needed in order to make an appointment is included in this document. Please return to the hospital if you are experiencing any symptoms that are concerning, including worsening or persistent abdominal pain, blood in stool or black stool, fevers, chills, nausea/vomiting, or any other symptoms that concern you.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Atorvastatin 20 mg PO DAILY 2. Atenolol 25 mg PO DAILY 3. Diltiazem 120 mg PO DAILY 4. Multivitamins 1 TAB PO DAILY 5. Omeprazole 40 mg PO BID RX *omeprazole 40 mg 1 capsule,delayed ___ by mouth every 12 hours Disp #*60 Capsule Refills:*1 6. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet,delayed release (___) by mouth Daily Disp #*30 Tablet Refills:*0 7. Acetaminophen 1000 mg PO Q8H:PRN pain RX *acetaminophen 500 mg 2 tablet(s) by mouth every 8 hours as needed for shoulder pain Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Upper gastrointestinal bleed Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>It was a pleasure to participate in your care at ___. You came to the hospital for dark stools and dizziness. We found that your blood counts were low. You were seen by the Gastroenterology Team who elected to do a camera study called an EGD (upper endoscopy). Your study showed old blood in your small bowel but no active bleeding. A repeat EGD should similar results. Your blood counts were monitored after the procedure and remained stable. You developed shoulder pain while in the hospital. We treated your pain with tylenol. Please do NOT take medications like ibuprofen, motrin, or naproxen for your pain, as these medications (NSAIDs) can cause bleeding in your gastrointestinal tract. Please take all medications as prescribed. Please follow up with your primary care physician for further care. You will need to have your blood counts checked soon to make sure that there is no further bleeding. If you get dizzy or lightheaded please call your PCP or go the ED to have your labs rechecked.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg ONE capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 2. Senna 1 TAB PO BID constipation 3. OxycoDONE (Immediate Release) ___ mg PO Q6H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth Q6hrs Disp #*40 Tablet Refills:*0 4. Cephalexin 500 mg PO Q6H Duration: 5 Days RX *cephalexin [Keflex] 500 mg ONE capsule(s) by mouth four times a day Disp #*20 Capsule Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: ___: SEVERE RIGHT HYDRONEPHROSIS PREOPERATIVE DIAGNOSIS: Right multiple ureteral stones and right renal calculus, history possible urosepsis. POSTOPERATIVE DIAGNOSIS: Right multiple ureteral stones and right renal calculus, history possible urosepsis. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent Followup Instructions: ___ [/INST] </s><s>-You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month; this may be related to the passage of stone fragments or the indwelling ureteral stent (if there is one). -The kidney stone may or may not have been removed AND/or there may fragments/others still in the process of passing. -You may experience some pain associated with spasm of your ureter.; This is normal. Take the narcotic pain medication as prescribed if additional pain relief is needed. -Ureteral stents MUST be removed or exchanged and therefore it is IMPERATIVE that you follow-up as directed. -Do not lift anything heavier than a phone book (10 pounds) -You may continue to periodically see small amounts of blood in your urine--this is normal and will gradually improve -Resume all of your pre-admission medications and review your post-operative course with your PCP. -As advised, review your post operative course and medications with your pediatrician and your OB-GYN. Medications that you have been given may be excreted in your breat milk and this can effect your child. -Colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. Discontinue if loose stool or diarrhea develops. Colace is a stool softener, NOT a laxative, and available over the counter. The generic name is DOCUSATE SODIUM. It is recommended that you use this medication. -Do not eat constipating foods for ___ weeks, drink plenty of fluids to keep hydrated -No vigorous physical activity or sports for 4 weeks and while nephrostomy is in place. No sports, water-immersion (pool/tub). NEPHROSTOMY TUBE INSTRUCTIONS FOR CARE---FOR ___ & FAMILY: Please leave RIGHT PCN tube capped. If there is increased RIGHT FLANK/BACK pain, the PCN may be uncapped and put to to external gravity drainage. Please monitor and record urine output from the PCN tube. Catheter flushing for troubleshooting only: If there are excessive blood clots or debris or thick urine within the connecting tubing, this can also be flushed as needed to clear from the stopcock into the drainage bag. Change dressing daily. Gently cleanse around the skin entry site of the catheter with povidone iodine or dilute hydrogen peroxide. Dry and apply sterile gauze dressing. Dressing should be changed daily for the first three days and then Q3days and prn saturation. Catheter security: a) Every shift, check to be sure the catheter, the connecting tubing and the drainage bag are securely attached to the patient and are not kinked. b) If the catheter appears to be pulling, please notify Interventional Radiology. c) If the catheter pulls out, please notify Interventional Radiology with in 8 hours. SAVE THE CATHETER for us to inspect. Do not throw it away. Call Angio for ANY catheter related questions or problems. ___ or Fellow/Resident (pager# ___ IF Catheter is attached to drainage bag for external drainage; please measure and record the net output every shift (or more often if the urine output is high).</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO BID Duration: 7 Days 2. Ondansetron ODT 4 mg PO Q8H:PRN Nausea/Vomiting - First Line 3. glatiramer 20 mg/mL subcutaneous five days a week 4. Spironolactone 50 mg PO DAILY 5. Vitamin D 1000 UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: Colitis Multiple sclerosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospitalization at ___! Why did you come to the hospital? - Because you were having bloody stools What happened while you were in the hospital? - You were diagnosed with colitis of the left side of your colon. You were treated with antibiotics and improved. - You were tested for common bacteria that cause bloody diarrhea, but tests came back negative. What should you do after you leave the hospital? - Please complete a total of 7d of antibiotic therapy (last day ___ - Follow up with Dr. ___ Dr. ___ as scheduled - Please stick to a bland diet until your diarrhea improves. - If you notice any recurrent bleeding, worsening abdominal pain, intolerance of oral intake, please come back to the ED right away. We wish you the best! Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild 2. Ciprofloxacin HCl 500 mg PO Q12H Take through morning of ___ RX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every 12 hours Disp #*8 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Elevated liver enzymes Abdominal pain Dilated common bile duct Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear ___ ___ were admitted for abdominal pain and elevated liver enzymes. ___ underwent ERCP with sphincterotomy. No stones were found but sludge was removed. Your liver enzymes improved after the procedure. Your abdominal pain improved and ___ tolerated food. ___ will need to follow up with your PCP next week to check labs again. Thank ___ for allowing us to participate in your care Your ___ team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Allopurinol ___ mg PO DAILY 2. Aspirin 81 mg PO DAILY 3. Doxazosin 4 mg PO DAILY 4. Metoprolol Succinate XL 50 mg PO DAILY 5. Simvastatin 20 mg PO DAILY 6. Warfarin 2.5 mg PO DAILY16 7. Ferrous Sulfate 325 mg PO DAILY RX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. Desonide 0.05% Cream 1 Appl TP DAILY 9. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO TID:PRN jaw pain Duration: 7 Days before meals as needed, no driving or operating heavy machinery while taking med RX *oxycodone-acetaminophen 5 mg-325 mg ___ tablet(s) by mouth every eight (8) hours Disp #*21 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: chronic iron deficiency anemia, hematuria Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted due to shortness of breath. Lab test revealed that you have iron deficiency anemia. The most common cause of which is blood loss. This is most likely due to chronic urinary blood loss however gastrointestinal blood loss is possible as well. You were transfused red blood cells and your numbers were stable after this. Your primary care doctor may want to do a colonoscopy or a bladder test after discharge. You were also evaluated by physical therapy who recommended rehab, which you did not want to do. You will go home with physical therapy instead. You also had some R jaw pain with chewing, most likely from irritation. There were no signs of infection. You were discharged with some pain medications as needed. Please follow up with your PCP and dentist if the pain persists. Thank you, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Lactulose 30 mL PO TID:PRN confusion RX *lactulose 20 gram/30 mL 30 mL by mouth three times a day Disp #*90 Package Refills:*0 3. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 4. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 5. Rifaximin 550 mg PO BID RX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 6. Thiamine 100 mg PO DAILY RX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary diagnosis: Septic shock Pneumonia Secondary diagnoses: Obstructive sleep apnea Upper GI bleed Macrocytic anemia Alcoholic hepatitis Alcohol use disorder Coagulopathy Cirrhosis Thrombocytopenia Anisocoria Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, Why was I admitted? You were admitted because your blood pressure was low and you were found to have an infection in your lung called pneumonia. We were was also concerned that you had bleeding in your belly. What was done while I was here? You were treated with antibiotics for your pneumonia. We watched your bleeding from your belly very closely and looked down your throat with a camera. You have no active bleeding but are prone to bleeding from your underlying liver disease. Your liver disease is thought to be due to alcohol. You were monitored closely for withdrawal from alcohol and given medication to prevent this. In addition, we discovered that Your oxygen becomes low at night and you are diagnosed with sleep apnea. Therefore, we tried to have you sleep with a CPAP machine. Your oxygen also becomes low when you walk; this is probably due to your resolving pneumonia and your liver disease. What should I do now? You should take your medications as instructed. It is very important that you never drink alcohol again to avoid worsening your liver disease. If you continue to drink alcohol, you will be at very high risk of dying from liver disease or problems caused by liver disease. Make sure you seek support in maintaining sobriety through help from you social workers and doctors. You can try a group like AA if you think it would help you stop drinking. You will be discharged with home oxygen. You can use this when you are walking and your oxygen level becomes low. A nurse ___ come to your home and help to measure your oxygen levels to see how much you need. Because you have sleep apnea, you will need to wear oxygen at night at 4L per minute. You will need to see the sleep medicine doctors after leaving the hospital to get a formal sleep study so that you can obtain a CPAP machine. Once you get a CPAP machine, you must use it every night. You should attend your doctor appointments as below. We wish you the best! -Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg 1 (One) capsule(s) by mouth every four (4) hours Disp #*18 Capsule Refills:*0 2. Allopurinol ___ mg PO DAILY 3. Omeprazole 20 mg PO DAILY 4. PHENObarbital 64.8 mg PO BID Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSES: ================== -Septic Shock -E. Coli Bacteremia -Cholecystitis s/p percutaneous cholecystostomy s/p laparoscopic cholecystectomy SECONDARY DIAGNOSES: ==================== -Chronic Pneumobilia -Herpes re-activation -Gout -GERD -Seizure disorder Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to care for you at the ___ ___. Why did you come to the hospital? - You were brought in to the hospital due to concerns for an abdominal infection. What did you receive in the hospital? - Because of how sick you were and your low blood pressure, we had to admit you to the intensive care unit. There you were found to have cholecystitis, or inflammation of your bladder. On ___, our interventional radiologist placed a tube to help drain your gallbladder. - You then had your gallbladder removed by our surgery team. - In addition, we found an infection in your blood related to your gallbladder, and treated it with antibiotics. - After starting antibiotics, you developed a small herpes outbreak around your lips. We treated this with a anti-viral medication. What should you do once you leave the hospital? - Please continue to take your medications as prescribed. - Please keep all your follow-up appointments We wish you the best! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Sulfameth/Trimethoprim Suspension 20 mL PO BID RX *sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL 20 mls by mouth twice a day Refills:*0 2. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 3. albuterol sulfate 90 mcg/actuation inhalation Q6H:PRN wheezing 4. ALPRAZolam 0.5 mg PO Q6H:PRN anxiaty 5. Atorvastatin 20 mg PO QPM 6. Dexamethasone 8 mg PO DAILY 7. Docusate Sodium 100 mg PO BID 8. Guaifenesin-CODEINE Phosphate 5 mL PO Q6H:PRN cough 9. Mirtazapine 30 mg PO QHS 10. Morphine SR (MS ___ 15 mg PO Q12H 11. Ondansetron 4 mg PO Q8H:PRN nausea 12. OxycoDONE Liquid ___ mg PO Q4H:PRN Pain - Moderate 13. Pantoprazole 40 mg PO Q12H 14. Polyethylene Glycol 17 g PO DAILY:PRN constipation 15. Prochlorperazine 10 mg PO Q6H:PRN nausea 16. TraMADol 50 mg PO Q6H:PRN Pain - Moderate Discharge Disposition: Home Discharge Diagnosis: Wound cellulitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>* You were admitted to the hospital for replacement of your J tube and also for a cellulitis around the tube. You were placed on antibiotics which initially seem to be working. The j tube is not sutured in place but it's taped down securely so that the skin around the tube can heal and you can have it resutured in a day or 2. * You should resume your tube feedings but be very careful not to dislodge the tube. No showers until the tube is sutured in place. For now a sponge bath. * Keep a dry gauze over the insertion site. Dr. ___ see you in clinic tomorrow to look at the site and possibly suture. * Continue the Bactrim for a 10 day course. * If you have any fevers > 101, abd pain, chills or any other symptoms that concern you call Dr. ___ at ___</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever 2. amLODIPine 10 mg PO DAILY RX *amlodipine 10 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Artificial Tears Preserv. Free ___ DROP BOTH EYES Q4H:PRN dry eyes 4. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 5. Bisacodyl 10 mg PR QHS:PRN Constipation - Second Line 6. Captopril 37.5 mg PO TID RX *captopril 25 mg 1.5 tablet(s) by mouth three times a day Disp #*135 Tablet Refills:*0 7. CARVedilol 12.5 mg PO BID RX *carvedilol 12.5 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 8. Chlorthalidone 25 mg PO DAILY RX *chlorthalidone 25 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 9. Docusate Sodium (Liquid) 100 mg PO BID 10. Fondaparinux 7.5 mg SC DAILY RX *fondaparinux 7.5 mg/0.6 mL 1 once a day Disp #*30 Syringe Refills:*0 11. Ipratropium-Albuterol Neb 1 NEB NEB Q4H 12. Metoclopramide 10 mg PO Q6H 13. Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Third Line 14. QUEtiapine Fumarate 12.5 mg PO QHS agitation 15. Senna 8.6 mg PO BID 16. Divalproex (DELayed Release) 500 mg PO BID 17. Gabapentin 800 mg PO TID 18. Lovastatin 40 mg oral DAILY 19. Memantine 10 mg PO DAILY ___ 20. Memantine 5 mg PO DAILY AM 21. Omeprazole 20 mg PO DAILY 22. Warfarin 2 mg PO 5X/WEEK (___) 23. Warfarin 4 mg PO 2X/WEEK (___) Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Abdominal Aortic Aneurysm Rupture Peripheral Vascular Disease Anemia secondary to rupture requiring transfusion Oliguria Pleural effusions with pulmonary edema requiring diuresis Discharge Condition: Mental Status: Confused - sometimes. Level of Consciousness: Lethargic but arousable. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Mr. ___- It was a pleasure taking care of you at ___ ___. You were admitted to the hospital after transfer from an outside institution for ruptured abdominal aortic aneurysm. You underwent emergent repair which required placement of a graft in you aorta. You also required an incision made into your abdomen to release the blood that collected after the rupture. Please follow the recommendations below to ensure a speedy and uneventful recovery. Division of Vascular and Endovascular Surgery Endovascular Abdominal Aortic Aneurysm Repair Discharge Instructions PLEASE NOTE: After endovascular aortic repair (EVAR), it is very important to have regular appointments (every ___ months) for the rest of your life. These appointments will include a CT (“CAT”) scan and/or ultrasound of your graft. If you miss an appointment, please call to reschedule. WHAT TO EXPECT: •Bruising, tenderness, and a sensation of fullness at the groin puncture sites (or incisions) is normal and will go away in one-two weeks CARE OF THE GROIN PUNCTURE SITES: •It is normal to have mild swelling, a small bruise, or small amounts of drainage at the groin puncture sites. In two weeks, you may feel a small, painless, pea sized knot at the puncture sites. This too is normal. Male patients may notice some swelling in the scrotum. The swelling will get better over one-two weeks. •Look at the area daily to see if there are any changes. Be sure to report signs of infection. These include: increasing redness; worsening pain; new or increasing drainage, or drainage that is white, yellow, or green; or fever of 101.5 or more. (If you have taken aspirin, Tylenol, or other fever reducing medicine, wait at least ___ hours after taking it before you check your temperature in order to get an accurate reading.) FOR SUDDEN, SEVERE BLEEDING OR SWELLING (Groin puncture site or incision) •If you have sudden, severe bleeding or swelling at either of the groin puncture sites: -Lie down, keep leg straight and apply (or have someone apply) firm pressure to area for ___ minutes with a gauze pad or clean cloth. -Once bleeding has stopped, call your surgeon to report what happened. -If bleeding does not stop, call ___ for transfer to closest Emergency Room. •You may shower 48 hours after surgery. Let the soapy water run over the puncture sites, then rinse and pat dry. Do not rub these sites and do not apply cream, lotion, ointment or powder. •Wear loose-fitting pants and clothing as this will be less irritating to the groin puncture sites. MEDICATIONS •Take aspirin daily. Aspirin helps prevent blood clots that could form in your repaired artery. •It is very important that you never stop taking aspirin or other blood thinning medicines-even for a short while- unless the surgeon who repaired your aneurysm tells you it is okay to stop. Do not stop taking them, even if another doctor or nurse tells you to, without getting an okay from the surgeon who first prescribed them. •You will be given prescriptions for any new medication started during your hospital stay. •Before you go home, your nurse ___ give you information about new medication and will review all the medications you should take at home. Be sure to ask any questions you may have. If something you normally take or may take is not on the list you receive from the nurse, please ask if it is okay to take it. PAIN MANAGEMENT •Most patients do not have much pain following placement of the stent alone. You had an abdominal incision in addition to this, so recovery may take longer. Your puncture sites may be a little sore. This will improve daily. If it is getting worse, please let us know. •You will be given instructions about taking pain medicine if you need it. ACTIVITY •You must limit activity to protect the puncture sites in your groin. For ONE WEEK: -Do not drive -Do not swim, take a tub bath or go in a Jacuzzi or hot tub -Do not lift, push, pull or carry anything heavier than five pounds -Do not do any exercise or activity that causes you to hold your breath or bear down with your abdominal muscles. -Do not resume sexual activity •Discuss with your surgeon when you may return to other regular activities, including work. If needed, we will give you a letter for your workplace. •It is normal to feel weak and tired. This can last six-eight weeks, but should get better day by day. You may want to have help around the house during this time. ___ push yourself too hard during your recovery. Rest when you feel tired. Gradually return to normal activities over the next month. •We encourage you to walk regularly. Walking, especially outdoors in good weather is the best exercise for circulation. Walk short distances at first, even in the house, then do a little more each day. •It is okay to climb stairs. You may need to climb them slowly and pause after every few steps. BOWEL AND BLADDER FUNCTION •You should be able to pass urine without difficulty. Call you doctor if you have any problems urinating, such as burning, pain, bleeding, going too often, or having trouble urinating or starting the flow of urine. Call if you have a decrease in the amount of urine. •You may experience some constipation after surgery because of pain medicine and changes in activity. Increasing fluids and fiber in your diet and staying active can help. To relief constipation, you may talk a mild laxative. Please take to your pharmacist for advice about what to take. SMOKING •If you smoke, it is very important that you STOP. Research shows smoking makes vascular disease worse. This could increase the chance of a blockage in your new graft. Talk to your primary care physician about ways to quit smoking.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, It was a pleasure to take care of you at ___ ___. You were admitted because you fainted and broke several bones in your spine, which in turn hurt your spinal cord. Orthopedics performed surgery to stop the bones blocking your spinal cord, you were monitored for improvement, and you were discharged to rehab. Best of luck to you in your future health. Please take all medications as prescribed, attend all physician appointments as scheduled, and call a doctor if you have any questions or concerns.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Daptomycin 300 mg IV Q24H urinary tract infection Duration: 7 Days RX *daptomycin 350 mg 300 mg IV q24h Disp #*7 Vial Refills:*0 2. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line flush 3. Piperacillin-Tazobactam 4.5 g IV Q12H RX *piperacillin-tazobactam 4.5 gram 4.5 grams IV every 12 hours Disp #*15 Vial Refills:*0 4. amLODIPine 10 mg PO DAILY 5. Warfarin 5 mg PO DAILY16 6. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 7. Allopurinol ___ mg PO DAILY 8. Cerovite Advanced Formula (multivitamin-iron-folic acid) ___ mg-mcg oral daily 9. Cranberry Concentrate (cranberry conc-ascorbic acid;<br>cranberry extract) 500 mg oral daily 10. Cyanocobalamin 500 mcg PO DAILY 11. Epoetin ___ ___ u SC WEEKLY 12. Finasteride 5 mg PO DAILY 13. FoLIC Acid 1 mg PO DAILY 14. Hydrochlorothiazide 25 mg PO DAILY 15. Levothyroxine Sodium 50 mcg PO DAILY 16. LORazepam 0.5 mg PO Q6H:PRN anxiety 17. Oxybutynin 5 mg PO BID PRN bladder spasms 18. OxyCODONE (Immediate Release) 10 mg PO Q6H:PRN Pain - Moderate 19. OxyCODONE SR (OxyconTIN) 10 mg PO Q12H 20. PredniSONE 2.5 mg PO DAILY 21. Sertraline 150 mg PO DAILY 22. Vitamin D 1000 UNIT PO DAILY 23. HELD- Atorvastatin 20 mg PO QPM This medication was held. Do not restart Atorvastatin until you have completed daptomycin Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Pyelonephritis, Catheter associated UTI Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Out of Bed with assistance to chair or wheelchair. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure to look after you. As you know, you were admitted with flank pain and signs of kidney infection on a CT scan. You were initially placed on intravenous antibiotics; both catheters (foley and nephrostomy tube) were exchanged. Urine cultures grew out a resistant pseudomonas, and for that reason, infectious disease team was consulted and made recommendations regarding changes in the antibiotic. You will be on Daptomycin and Zosyn through ___. Please do not take your atorvastatin until you complete the daptomycin to prevent a possible reaction. Given elevated blood pressures in the hospital, your amlodipine dose was increased to 10mg daily. Please take your medications as prescribed and follow up with your outpatient doctors as below. With best wishes, ___ Medicine</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H 2. Amlodipine 10 mg PO DAILY 3. Aspirin 325 mg PO DAILY 4. Carvedilol 12.5 mg PO BID 5. CloniDINE 0.1 mg PO TID 6. Docusate Sodium 100 mg PO BID 7. FoLIC Acid 1 mg PO DAILY 8. Gabapentin 100 mg PO TID 9. HydrALAzine 50 mg PO TID 10. LeVETiracetam Oral Solution 750 mg PO BID 11. Lisinopril 40 mg PO DAILY 12. Paroxetine 10 mg PO DAILY 13. Prazosin 1 mg PO BID 14. Ranitidine 150 mg PO BID 15. traZODONE 25 mg PO QAM 16. traZODONE 25 mg PO QPM 17. traZODONE 50 mg PO HS 18. Atorvastatin 80 mg PO DAILY RX *atorvastatin 80 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 19. Clopidogrel 75 mg PO DAILY RX *clopidogrel 75 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 20. Glargine 23 Units Bedtime novolog 5 Units Breakfast novolog 5 Units Lunch Insulin SC Sliding Scale using Lispro Insulin 21. Potassium Chloride 10 mEq PO DAILY 22. Loperamide 4 mg PO QID:PRN diarrhea 23. Psyllium 1 PKT PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Primary: Non-ST segment myocardial infarction Secondary: Coronary artery disease Hypertension Diabetes mellitus, type II, with neuropathy Prior cerebrovascular accidents Gastroesophageal reflux disorder Anxiety Depression Seizure disorder Discharge Condition: Mental Status: Confused - always. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to ___ treatment and work-up of your chest pain. While you were here you were found to have elevated cardiac enzymes and changes in your EKG which were concerning for a type of heart attack called Non-ST segment myocardial infarction (NSTEMI). While you were here you underwent a cardiac cath, which showed that you have a blockage in one of your vessels in your heart. You had a stent placed in this vessel to help open it up. Also, while you were here you had an unwitnessed fall. You had a head CT scan which did not show any acute damage to your head from the fall.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 500 mg PO Q6H:PRN pain RX *acetaminophen 500 mg 1 tablet(s) by mouth every six (6) hours Disp #*60 Tablet Refills:*0 2. Docusate Sodium 100 mg PO BID RX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 3. Fentanyl Patch 75 mcg/h TD Q72H RX *fentanyl 75 mcg/hour Apply every 72 hours Disp #*10 Patch Refills:*0 4. HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain RX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every three (3) hours Disp #*90 Tablet Refills:*1 5. Ranitidine 75 mg PO DAILY RX *ranitidine HCl 75 mg 1 tablet(s) by mouth daily Disp #*60 Tablet Refills:*0 6. Senna 8.6 mg PO QHS 7. Amoxicillin 1000 mg PO Q12H Duration: 14 Days RX *amoxicillin 500 mg 2 tablet(s) by mouth every twelve (12) hours Disp #*50 Tablet Refills:*0 8. Clarithromycin 500 mg PO Q12H Duration: 14 Days RX *clarithromycin 500 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*24 Tablet Refills:*0 9. Gabapentin 300 mg PO TID RX *gabapentin 300 mg 1 capsule(s) by mouth three times a day Disp #*90 Capsule Refills:*0 10. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Abdominal pain due to T9 Lesion H.pylori/gastritis Multiple myeloma Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you. You were admitted to ___ ___ for evaluation and treatment of abdominal pain. While you were here, we performed imaging of your abdomen and spine. This showed a lesion in the T9 bone, which is likely the cause of your pain. We treated you with pain medicines that help neurologic pain and also medicines that decrease inflammation in your stomach. You were treated with antibiotics to treat an infection in your stomach. Please continue these medications (Pantoprazole 40mg po 2/day, Clarithromycin 500mg 2/day, Amoxicillin 1 g 2/day) until ___. It is very important that you attend follow-up appointments and that you take your medicines as prescribed. We wish you the best in the future. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Ciprofloxacin HCl 500 mg PO Q12H Duration: 7 Days RX *ciprofloxacin HCl 500 mg ONE tablet(s) by mouth twice a day Disp #*14 Tablet Refills:*0 2. Tamsulosin 0.4 mg PO QHS RX *tamsulosin [Flomax] 0.4 mg ONE capsule(s) by mouth Daily Disp #*30 Capsule Refills:*1 3. OxycoDONE (Immediate Release) ___ mg PO Q6H:PRN pain RX *oxycodone 5 mg ___ tablet(s) by mouth Q6hrs Disp #*30 Tablet Refills:*0 4. Zofran ODT (ondansetron) 4 mg oral Q8hrs prn nausea RX *ondansetron [Zofran ODT] 4 mg ONE tablet(s) by mouth Q8hrs Disp #*21 Tablet Refills:*0 5. Acetaminophen 325-650 mg PO Q6H:PRN Pain 6. Amitriptyline 25 mg PO HS 7. Aspirin 81 mg PO DAILY 8. Atorvastatin 40 mg PO HS 9. Ibuprofen 600 mg PO Q8H:PRN pain RX *ibuprofen 600 mg ONE tablet(s) by mouth Q8hrs Disp #*30 Tablet Refills:*0 10. Docusate Sodium 100 mg PO BID RX *docusate sodium [Colace] 100 mg ONE capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0 11. Lisinopril 5 mg PO DAILY 12. Lorazepam 1 mg PO QHS:PRN insomnia 13. pramipexole 0.25 mg oral QHS 14. Ranitidine 75 mg PO DAILY 15. Gabapentin 300 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: ACUTE KIDNEY INJURY (creatinine to 1.7) Right ureteral stone with obstruction and hydronephrosis. Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>-You can expect to see occasional blood in your urine and to possibly experience some urgency and frequency over the next month; this may be related to the passage of stone fragments or the indwelling ureteral stent. -The kidney stone may or may not have been removed AND/or there may fragments/others still in the process of passing. -You may experience some pain associated with spasm of your ureter.; This is normal. Take the narcotic pain medication as prescribed if additional pain relief is needed. -Ureteral stents MUST be removed or exchanged and therefore it is IMPERATIVE that you follow-up as directed. -Do not lift anything heavier than a phone book (10 pounds) -You may continue to periodically see small amounts of blood in your urine--this is normal and will gradually improve -Resume your pre-admission/home medications EXCEPT as noted. You should ALWAYS call to inform, review and discuss any medication changes and your post-operative course with your primary care doctor. HOLD ASPIRIN and aspirin containing products for one week unless otherwise advised. -IBUPROFEN (the ingredient of Advil, Motrin, etc.) may be taken even though you may also be taking Tylenol/Acetaminophen. You may alternate these medications for pain control. For pain control, try TYLENOL FIRST, then ibuprofen, and then take the narcotic pain medication as prescribed if additional pain relief is needed. -Ibuprofen should always be taken with food. Please discontinue taking and notify your doctor should you develop blood in your stool (dark, tarry stools) -You MAY be discharged home with a medication called PYRIDIUM that will help with the "burning" pain you may experience when voiding. This medication may turn your urine bright orange. -Colace has been prescribed to avoid post surgical constipation and constipation related to narcotic pain medication. Discontinue if loose stool or diarrhea develops. Colace is a stool softener, NOT a laxative, and available over the counter. The generic name is DOCUSATE SODIUM. It is recommended that you use this medication. -Do not eat constipating foods for ___ weeks, drink plenty of fluids to keep hydrated -No vigorous physical activity or sports for 4 weeks and while ___ catheter is in place. IF YOU ARE DISCHARGED HOME WITH A FOLEY CATHETER: -Please refer to the provided nursing instructions and handout on Foley catheter care, waste elimination and leg bag usage. -Your Foley should be secured to the catheter secure on your thigh at ALL times until your follow up with the surgeon. -Follow up in 1 week for wound check and Foley removal. DO NOT have anyone else other than your Surgeon remove your Foley for any reason. -Wear Large Foley bag for majority of time, leg bag is only for short-term when leaving house.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Warfarin 5 mg PO DAILY16 RX *warfarin 5 mg 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 2. amLODIPine 5 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Atorvastatin 40 mg PO QPM 5. Finasteride 5 mg PO DAILY 6. Gabapentin 200 mg PO TID 7. GlipiZIDE XL 10 mg PO DAILY 8. Metoprolol Tartrate 25 mg PO BID 9. Mirtazapine 30 mg PO QHS 10. Nicotine Patch 14 mg TD DAILY 11. Venlafaxine XR 150 mg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Subacute infarcts due to LV thrombus Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, You were admitted to the hospital because there was concern about possible bleeding in your brain from a recent stroke. You had an MRI which showed multiple recent strokes in different areas of the brain. There was some bleeding and tissue injury due to the recent strokes. You got an echocardiogram which showed you still have a very large clot in the heart, which could break off and cause more strokes. You were continued on aspirin but Plavix (clopidogrel) was stopped. You were started on Coumadin (or warfarin) as a blood thinner, which requires regular blood tests to make sure the levels are not too high or too low. You will follow up with your primary doctor (___) to measure your INR levels and adjust your Coumadin dose. We discussed your condition with your neurologist (Dr. ___ and your primary doctor (___). Follow up with your neurologist in the next ___ weeks. The neurology clinic will call you to set up an appointment. Follow up with your primary doctor (___) this ___ ___. Take your medications as prescribed. Thank you for allowing us to participate in your care. Sincerely, Your ___ Neurology Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Amoxicillin-Clavulanic Acid ___ mg PO Q12H last dose ___ RX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*14 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID 4. Omeprazole 20 mg PO DAILY 5. Senna 8.6 mg PO BID:PRN constipation Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: intra-abdominal fluid collection Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>You were readmitted to the hospital on ___ with nausea and vomitting. You were also reported to have an elevated white blood cell count. You underwent a cat scan of the abdomen and you were found to have a fluid collection in the abdominal wall. You were started on intravenous antibiotics. You had the fluid collection drained and no bacteria was reported. Your white blood cell count has normalized and you are preparing for discharge home with the following instructions: Please call your doctor or return to the emergency room if you have any of the following: * You experience new chest pain, pressure, squeezing or tightness. * New or worsening cough or wheezing. * If you are vomiting and cannot keep in fluids or your medications. * You are getting dehydrated due to continued vomiting, diarrhea or other reasons. Signs of dehydration include dry mouth, rapid heartbeat or feeling dizzy or faint when standing. * You see blood or dark/black material when you vomit or have a bowel movement. * You have shaking chills, or a fever greater than 101.5 (F) degrees or 38(C) degrees. * Any serious change in your symptoms, or any new symptoms that concern you. * Please resume all regular home medications and take any new meds as ordered. Activity: No heavy lifting of items ___ pounds for 6 weeks. You may resume moderate exercise at your discretion, no abdominal exercises. Wound Care: You may shower, no tub baths or swimming. If there is clear drainage from your incisions, cover with clean, dry gauze. Your steri-strips will fall off on their own. Please remove any remaining strips ___ days after surgery. Please call the doctor if you have increased pain, swelling, redness, or drainage from the incision site</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) Capsule, Delayed Release(E.C.) PO twice a day. 2. nadolol 40 mg Tablet Sig: One (1) Tablet PO once a day. 3. sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times a day). 4. hydroxyzine HCl 25 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). 5. zinc sulfate 220 mg Capsule Sig: One (1) Capsule PO BID (2 times a day). 6. furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 7. spironolactone 100 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). 8. ondansetron HCl 4 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for nausea. 9. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 hours) as needed for pain. 10. fluticasone 110 mcg/actuation Aerosol Sig: Two (2) Puff Inhalation BID (2 times a day). 11. fluticasone 50 mcg/actuation Spray, Suspension Sig: One (1) Spray Nasal DAILY (Daily). 12. B complex vitamins Capsule Sig: One (1) Cap PO DAILY (Daily). 13. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). 14. azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every 24 hours) for 2 days: Please complete 2 more doses, last dose ___. Discharge Disposition: Home Discharge Diagnosis: PRIMARY: abdominal pain SECONDARY: hepatitis C Cirrhosis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted with abdominal pain. You had a CT scan done, which did not show any abnormalities. There was no evidence of infection. Please make the following changes to your medications: # CONTINUE azithromycin 250 mg daily for 2 more days Continue all other medications as prescribed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>You were admitted with headache which was likely due to tapering steroids too quickly after whole brain radiation. Your symptoms improved with steroids. You also experienced some nausea and abdominal fullness that was in part due to steroids. You were started on some medications to help with these symptoms. This is the steroid taper recommended by radiation oncology: Decadron 4mg bid until ___. Then, Decadron 4mg daily for 3 days, then Decadron 2mg daily for 3 days, then Decadron 1mg daily for three days, then stop.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. insulin syringes (disposable) 1 miscellaneous DAILY RX *insulin syringes (disposable) 1 mL Daily Disp #*1 Package Refills:*0 2. Glargine 20 Units Bedtime Insulin SC Sliding Scale using HUM Insulin RX *insulin glargine [Lantus] 100 unit/mL 20 units Before bed Disp #*1 Vial Refills:*0 3. Metoprolol Succinate XL 100 mg PO DAILY RX *metoprolol succinate 100 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 4. OneTouch SureSoft Lancing Dev (lancets) 1 miscellaneous DAILY RX *lancets [OneTouch Delica Lancets] 30 gauge Daily Disp #*1 Package Refills:*0 5. OneTouch Ultra Test (blood sugar diagnostic) 1 miscellaneous DAILY RX *blood sugar diagnostic [OneTouch Ultra Test] Daily Disp #*100 Strip Refills:*0 6. OneTouch Ultra2 ___ meter) 1 miscellaneous DAILY RX ___ meter [OneTouch Ultra2] Daily Disp #*1 Kit Refills:*0 7. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild 8. Artificial Tears ___ DROP BOTH EYES PRN dry eyes 9. Bisacodyl 10 mg PO DAILY:PRN constipation 10. Enoxaparin Sodium 100 mg SC Q12H Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 100 mg/mL 100 mg twice a day Disp #*60 Syringe Refills:*0 11. ___ Neb 1 NEB NEB Q6H:PRN Shortness of breath 12. LOPERamide 2 mg PO TID:PRN Diarrhea 13. Ondansetron 4 mg PO Q8H:PRN nausea 14. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - Moderate 15. OxyCODONE SR (OxyconTIN) 20 mg PO Q12H 16. Pantoprazole 40 mg PO Q24H 17. Senna 8.6 mg PO BID:PRN constipation 18. Simvastatin 20 mg PO QPM 19. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Pancreatic ___ Tumor ___ infection Diabetes mellitus Pericardial effusion Pleural effusion Atrial fibrillation Pulmonary embolism Discharge Condition: Activity Status: Ambulatory - requires assistance or aid (walker or cane). Level of Consciousness: Alert and interactive. Mental Status: Clear and coherent. Followup Instructions: ___ [/INST] </s><s>Dear ___, You were admitted to the hospital from rehab with confusion. This confusion was due to high levels of carbon dioxide in your blood. You were in the ICU and needed oxygen for a while, but improved by the time you left the hospital. The fluid around your pancreas became infected, and you were treated with strong antibiotics for two weeks. You had an additional drain placed, which helped drain the infected fluid. The will keep these drains until you are seen by the surgeons, flushing them with saline several times a day. You developed fluid around your heart and left lung during this admission. The fluid was drained from both places and did not come back. We did not find that exact cause of this, but it may have been related to the infection in your abdomen. Your diabetes was managed with insulin in the hospital. You are being discharged with diabetes supplies. Please inject 20 units of Lantus every night. Check your blood sugar before you eat/drink each morning and once after you eat/drink in ___. Bring these numbers with you to your PCP and they ___ adjust your insulin. You were started on a different blood thinner, Lovenox, this admission for you ___ and pulmonary embolism. You will inject this medicine twice a day. Surgery ___ with Dr. ___ able to be arranged in the hospital. Please call ___ to set up an appointment time in the next ___ weeks. It was a privilege to care for you in the hospital, and we wish you all the best. Sincerely, Your ___ Health Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Citalopram 40 mg PO DAILY 2. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain 3. PrimiDONE 50 mg PO BID 4. Senna 1 TAB PO BID:PRN constipation 5. Tiotropium Bromide 1 CAP IH DAILY 6. traZODONE 200 mg PO HS:PRN insomina 7. Aspirin 81 mg PO DAILY RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 8. Symbicort *NF* (budesonide-formoterol) 160-4.5 mcg/actuation INHALATION DAILY 9. Simvastatin 10 mg PO DAILY 10. Omeprazole 40 mg PO DAILY 11. Albuterol Inhaler 2 PUFF IH Q6H:PRN shortness of breath 12. Metoprolol Tartrate 25 mg PO BID RX *metoprolol tartrate 25 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Aspiration PNA Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms ___, It was a pleasure taking care of you during your hospitalization at ___. You were admitted because of your shortness of breath and recurrent pneumonia, which we treated with the same antibiotics you had been getting at home. While you were here, the bariatric surgery team was involved and removed fluid from your lap band, which improved your symptoms and will help decrease your risk of other pneumonias. You will remain on a bariatric diet for 3 weeks, when you will follow up with the bariatric team as below. While you were here, we were unable to take you off oxygen without your oxygen levels decreasing. Because of this, we did an ECHO (ultrasound) of your heart which revealed high blood pressure in the arteries in your lungs (pulmonary artery hypertension). You will need to follow up with the lung doctors (___) as below. You then had a right heart catheterization which showed that one of your valves is leaky; you will need to follow up with the heart doctors (___) as below. In terms of your medications: You should CONTINUE taking all your other medications as you had been doing prior to being hospitalized. In terms of your home oxygen, please use your pulse oximeter while you are at home. We would like your pulse oxygen to remain above 92%. While you do not feel short of breath when your oxygen saturation is low, please continue taking your albuterol inhaler as needed and keep your oxygen on.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Albuterol Inhaler ___ PUFF IH Q4H:PRN sob or wheeze 2. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID 3. FoLIC Acid 1 mg PO DAILY RX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 4. Lactulose 30 mL PO DAILY RX *lactulose 20 gram/30 mL 30 ml by mouth daily Disp #*1 Bottle Refills:*0 5. Multivitamins 1 TAB PO DAILY RX *multivitamin 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 6. Thiamine 100 mg PO DAILY RX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Buprenorphine-Naloxone (8mg-2mg) 1 TAB SL BID 8. Cetirizine *NF* 10 mg Oral daily 9. Omeprazole 20 mg PO DAILY RX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 Capsule Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Alcohol withdrawal Pancreatitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Mr. ___, It was a pleasure taking care of you at ___ ___. You were admitted with alcohol intoxication and pancreatitis. We gave you IV fluids, pain medicines, vitamins and medicines to help you detox safely. We slowly advanced your diet and you did well. It is important that you refrain from drinking alcohol to prevent this from happening again.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H 2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 3. Docusate Sodium 100 mg PO BID 4. Enoxaparin Sodium 40 mg SC QPM Start: Today - ___, First Dose: Next Routine Administration Time RX *enoxaparin 40 mg/0.4 mL 0.4 ml QPM Disp #*30 Syringe Refills:*0 5. Omeprazole 40 mg PO DAILY 6. OxyCODONE (Immediate Release) 2.5 mg PO TID:PRN Pain - Moderate RX *oxycodone 5 mg 0.5 - 1 tablet(s) by mouth every four (4) hours Disp #*45 Tablet Refills:*0 7. Polyethylene Glycol 17 g PO DAILY:PRN constipation 8. Senna 8.6 mg PO BID 9. Aspirin 81 mg PO DAILY 10. Atorvastatin 80 mg PO QPM 11. Fluticasone Propionate NASAL 1 SPRY NU DAILY 12. FoLIC Acid 1 mg PO DAILY 13. Furosemide 30 mg PO DAILY 14. Methotrexate 20 mg IM WEEKLY 15. Orencia (abatacept) 125 mg/mL subcutaneous Weekly 16. PredniSONE 5 mg PO DAILY 17. Ramelteon 8 mg PO DAILY:PRN agitation 18. Sertraline 25 mg PO DAILY Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: periprosthetic fracture of L distal femur Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY: - You were in the hospital for orthopedic surgery. It is normal to feel tired or "washed out" after surgery, and this feeling should improve over the first few days to week. - Resume your regular activities as tolerated, but please follow your weight bearing precautions strictly at all times. ACTIVITY AND WEIGHT BEARING: - touch down weight Bearing in left lower extremity MEDICATIONS: - Please take all medications as prescribed by your physicians at discharge. - Continue all home medications unless specifically instructed to stop by your surgeon. - Do not drink alcohol, drive a motor vehicle, or operate machinery while taking narcotic pain relievers. - Narcotic pain relievers can cause constipation, so you should drink eight 8oz glasses of water daily and take a stool softener (colace) to prevent this side effect. ANTICOAGULATION: - Please take Lovenox daily for 4 weeks WOUND CARE: - You may shower. No baths or swimming for at least 4 weeks. - Any stitches or staples that need to be removed will be taken out at your 2-week follow up appointment. - Please remain in your dressing and do not change unless it is visibly soaked or falling off. - Splint must be left on until follow up appointment unless otherwise instructed - Do NOT get splint wet DANGER SIGNS: Please call your PCP or surgeon's office and/or return to the emergency department if you experience any of the following: - Increasing pain that is not controlled with pain medications - Increasing redness, swelling, drainage, or other concerning changes in your incision - Persistent or increasing numbness, tingling, or loss of sensation - Fever > 101.4 - Shaking chills - Chest pain - Shortness of breath - Nausea or vomiting with an inability to keep food, liquid, medications down - Any other medical concerns Physical Therapy: TDWB in LLE ROMAT Treatments Frequency: ___ & Rehab</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Clopidogrel 75 mg PO DAILY 3. Cyanocobalamin 500 mcg PO DAILY 4. Gemfibrozil 600 mg PO BID 5. Multivitamins 1 TAB PO DAILY 6. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 7. Isosorbide Mononitrate (Extended Release) 30 mg PO BID This dose has been decreased. 8. Pantoprazole 40 mg PO Q12H RX *pantoprazole 40 mg 1 tablet,delayed release (___) by mouth twice a day Disp #*60 Tablet Refills:*0 9. Sucralfate 1 gm PO BID RX *sucralfate 1 gram/10 mL 10 mL by mouth twice a day Disp #*60 Unit Refills:*0 10. calcium carbonate-vitamin D3 *NF* 600 mg(1,500mg) -200 unit Oral BID 11. Nadolol 10 mg PO DAILY RX *nadolol 20 mg 0.5 (One half) tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Gastrointestinal bleeding Secondary diagnoses: Cirrhosis, Esophageal Varices Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you at the ___ ___. You were admitted for your dark stools, fatigue, and anemia due to bleeding in your gastrointestinal tract. We followed your blood counts closely and had the liver doctors ___. As you know, you were at increased risk for bleeding because of the aspirin and Plavix you are taking for your recent stent, which you must continue for the time-being (discuss this with your cardiologist). While here, you had a esophagogastroduodenoscopy (EGD) and colonoscopy to identify sources of bleeding, which did not show any area concerning for acute bleeding though there were large esophageal varices (which is a complication of liver disease). In order to keep your blood counts up, we gave you 6 units of blood. Your blood counts were stable the last 2 days of your hospital stay with non-bloody stools, both of which are reassuring that you are no longer bleeding. Unfortunately you will stay at continued risk of bleeding because of the medications you are taking for your stent, and therefore you must remain cautious for any sources of bleeding. With signs of bleeding or increasing weakness, you should seek medical care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Losartan Potassium 25 mg PO DAILY RX *losartan 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Metoprolol Succinate XL 100 mg PO DAILY RX *metoprolol succinate 100 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 3. Albuterol Inhaler ___ PUFF IH Q4H:PRN Shortness of breath or wheeze 4. Allopurinol ___ mg PO DAILY 5. Aspirin 81 mg PO DAILY 6. Atorvastatin 40 mg PO QPM 7. Finasteride 5 mg PO DAILY 8. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain 9. Tamsulosin 0.4 mg PO QHS Discharge Disposition: Home Discharge Diagnosis: Primary --------- - Dyspnea of unknown etiology - SVT with aberrancy Secondary ---------- - Coronary artery disease s/p stent - Recent pneumonia - Hypertension Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure participating in your care here at ___ ___. You were admitted for shortness of breath WHAT HAPPENED WHILE YOU WERE HERE: - Your shortness of breath resolved without intervention. It did not appear that you had residual pneumonia. - You had a run of fast heartbeat on the heart monitor. We did not see any signs of heart attack on your lab test or EKG. - You had episodes of feeling sweaty, so we kept you an additional night to watch you on the heart monitor. - We increased the dose of your metoprolol, to keep the heart rate down. We also decreased your dose of losartan so that your blood pressure doesn't drop when on the higher dose of metoprolol. WHAT YOU SHOULD DO AFTER YOU LEAVE: - Please follow up with your cardiologist, Dr. ___ the next week. - You will need a repeat ultrasound of your heart in about 2 weeks. - You will receive ___ of hearts monitor in the mail to monitor your heart rate. Please follow the instructions that come with the monitor. If you have questions, call Dr. ___ ___ they ___ be able to assist you with questions. We wish you the best. Sincerely, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. amLODIPine 5 mg PO DAILY RX *amlodipine 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 2. Polyethylene Glycol 17 g PO DAILY RX *polyethylene glycol 3350 17 gram/dose 1 g by mouth daily Refills:*0 3. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild 4. Labetalol 100 mg PO BID Hold dose if your systolic blood pressure is less than 120. RX *labetalol 100 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0 5. Atorvastatin 40 mg PO QPM 6. Cyanocobalamin 1000 mcg PO DAILY Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: PRIMARY DIAGNOSIS: ================== Subdural hematoma Hypertension Orthostatic Hypotension SECONDARY DIAGNOSIS: ==================== Hyperlipidemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure to be part of your care. You were admitted to the hospital because you were having headaches, vomiting and erratic blood pressure at home. We were concerned that your recent brain bleeding having worsened. You received repeat head imaging which was evaluated by neurosurgery and they determined that no intervention was necessary. Your blood pressure remained quite variable during this admission. We adjusted your blood pressure medications to try to maintain your systolic blood pressure between 110 and 160. Please check your blood pressure at home and HOLD your labetalol dose if your systolic blood pressure is <120. If your blood pressure is dropping lower than systolic of 100 at home or rising higher than systolic 160 at home then please call your doctor. If you are falling down at home or your systolic blood pressure is greater than 180 please return to the hospital. Additionally, if your headaches worsen or you develop new weakness or changes in sensation, please seek medical attention immediately. Of note, your headaches or feeling of head "pressure" will take over several weeks to resolve. Please take Tylenol for your headache. Occasional doses of ibuprofen (<400mg) are ok, but this should not be taken daily as it has some risk of bleeding. We wish you the best, Your ___ Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Aspirin 81 mg PO DAILY 2. Atorvastatin 20 mg PO DAILY 3. Levothyroxine Sodium 100 mcg PO DAILY 4. Omeprazole 40 mg PO BID 5. ALPRAZolam 0.25 mg PO DAILY:PRN anxiety RX *alprazolam 0.25 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet Refills:*0 6. azelastine 137 mcg nasal BID 7. Calcium Carbonate 500 mg PO DAILY Do not take with levothyroxine pill 8. Vitamin D 200 UNIT PO DAILY 9. Loratadine 10 mg PO DAILY:PRN as needed 10. Furosemide 20 mg PO DAILY 11. Outpatient Lab Work Please draw chem7 panel. Hyponatremia, 276.1 Dr. ___, Phone: ___ Fax: ___ 12. Lisinopril 40 mg PO DAILY 13. Fluticasone Propionate NASAL 1 SPRY NU DAILY RX *fluticasone 50 mcg 1 spray NU Daily Disp #*1 Bottle Refills:*0 14. Outpatient Physical Therapy Cervical ligament sprain, 847.0 Dr. ___, Phone: ___ Fax: ___ 15. Walker Please allow patient to obtain walker for aid with balance. Cervical ligament sprain, 847.0 Dr. ___, Phone: ___ Fax: ___ Discharge Disposition: Home Discharge Diagnosis: Primary diagnoses: Hyponatremia, SIADH Subdural hematoma Post-concussive symptoms Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was pleasure caring for you at ___. You were admitted with low sodium in your blood, probably related to your head injury and the hydrochlorothiazide you were taking. Your levels trended back to normal with fluid restriction, salt tabs, lasix, and stopping of the hydrochlorothiazide. Do not restart taking your hydrocholorothiazide unless a physician tells you to. Your subdural hematoma was found to be shrinking on CT of your head. Your scalp stitches were removed.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: [/INST] </s><s>Dear Mr. ___, You came into the hospital because you were having fevers and chills and feeling very tired. We started you on broad spectrum antibiotics. You had multiple tests to look for infection including chest xray, right foot xray, abdominal CT scan, blood and sputum cultures which showed no evidence of infection. We had the podiatry team come evaluate your right lower extremity wound who felt it was not infected and recommended that you follow-up with your podiatrist when you leave the hospital. Your fever was most likely from a viral illness. You improved and your antibiotics were stopped because we couldn't find any source of infection, after which you continued to feel well. You were evaluated by physical therapy who felt you need physical therapy at home to help improve your transfers and safety at home. Weigh yourself every morning, call MD if weight goes up more than 3 lbs. It was a pleasure taking care of you! Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild 2. Dexamethasone 3 mg PO EVERY 8 HOURS X 2 DOSES Duration: 2 Doses Take at 6pm and 2am on ___, then discontinue RX *dexamethasone 1 mg 3 tablet(s) by mouth Every 8 hours x 2 doses Disp #*6 Tablet Refills:*0 3. Docusate Sodium 100 mg PO BID 4. Ondansetron 4 mg PO Q8H:PRN nausea RX *ondansetron 4 mg 1 tablet(s) by mouth Q8H PRN Disp #*30 Tablet Refills:*0 5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - Moderate RX *oxycodone 5 mg 1 to 2 tablet(s) by mouth Every 4 hours PRN Disp #*30 Tablet Refills:*0 6. Pantoprazole 40 mg PO Q24H RX *pantoprazole 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0 7. Aspirin 325 mg PO DAILY 8. TiCAGRELOR 90 mg PO BID Discharge Disposition: Home Discharge Diagnosis: Headache Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Activity • We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. • You make take leisurely walks and slowly increase your activity at your own pace once you are symptom free at rest. ___ try to do too much all at once. • No driving while taking any narcotic or sedating medication. • If you experienced a seizure while admitted, you are NOT allowed to drive by law. • No contact sports until cleared by your neurosurgeon. You should avoid contact sports for 6 months. Medications • Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. • You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. What You ___ Experience: • You may have difficulty paying attention, concentrating, and remembering new information. • Emotional and/or behavioral difficulties are common. • Feeling more tired, restlessness, irritability, and mood swings are also common. • Constipation is common. Be sure to drink plenty of fluids and eat a high-fiber diet. If you are taking narcotics (prescription pain medications), try an over-the-counter stool softener. Headaches: • Most headaches are not dangerous but you should call your doctor if the headache gets worse, develop arm or leg weakness, increased sleepiness, and/or have nausea or vomiting with a headache. • Mild pain medications may be helpful with these headaches but avoid taking pain medications on a daily basis unless prescribed by your doctor. • There are other things that can be done to help with your headaches: avoid caffeine, get enough sleep, daily exercise, relaxation/ meditation, massage, acupuncture, heat or ice packs. When to Call Your Doctor at ___ for: • Severe nausea and/or vomiting • Extreme sleepiness and not being able to stay awake • Severe headaches not relieved by pain relievers • Seizures • Any new problems with your vision or ability to speak • Weakness or changes in sensation in your face, arms, or leg Call ___ and go to the nearest Emergency Room if you experience any of the following: • Sudden numbness or weakness in the face, arm, or leg • Sudden confusion or trouble speaking or understanding • Sudden trouble walking, dizziness, or loss of balance or coordination • Sudden severe headaches with no known reason</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H 2. Multivitamins W/minerals 1 TAB PO DAILY RX *multivitamin,tx-minerals [Vitamins and Minerals] 1 tablet(s) by mouth once a day Disp #*30 Tablet Refills:*0 3. Tamsulosin 0.4 mg PO DAILY 4. Allopurinol ___ mg PO BID 5. Citalopram 40 mg PO DAILY 6. Ensure (food supplemt, lactose-reduced) 5 bottle oral DAILY 7. Finasteride 5 mg PO DAILY 8. Fluvoxamine Maleate 100 mg PO QAM 9. Fluvoxamine Maleate 200 mg PO HS 10. Gabapentin 300 mg PO BID 11. Gabapentin 600 mg PO QAM 12. ibrutinib 280 mg oral DAILY 13. LOPERamide 1 mg PO BID:PRN loose stools 14. Pravastatin 20 mg PO QPM 15. Zolpidem Tartrate 10 mg PO QHS 16.Outpatient Physical Therapy ICD: ___, I95.1, R26.2 Please provide ___ for gait stability, balance training and humeral fracture 17.Outpatient Occupational Therapy ICD: ___.201A, I95.1, R26.2 Please provide ___ for gait stability, balance training and humeral fracture rehabilitation Discharge Disposition: Home Discharge Diagnosis: PRIMARY Fall Orthostatic hypotension L humerus fracture Urinary retention Hypertension Elevated troponin ___ SECONDARY Chronic lymphocytic leukemia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your hospitalization at ___. You came to the hospital after you had fell and hit your arm. We found that your broke your left shoulder. The orthopedic doctors saw ___ and did not think you need surgery. We found that you were dehydrated, and we gave you fluid to replenish you. We did not give you your Flomax on the first day and then restarted it at a once a day dosing to make sure we prevent any further episodes of dizziness. You were evaluated by physical therapy after your fall, and they felt that over the course of your hospital stay you progressed to where you could go home with physical and occupational therapy services. Please follow up with your primary care doctor who can help ___ on the above issues and continue to work on getting stronger. We wish you the best. Sincerely, Your ___ Care Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 325 mg PO Q6H:PRN TMJ pain 2. Benzonatate 100 mg PO TID:PRN cough 3. Guaifenesin-CODEINE Phosphate ___ mL PO Q6H:PRN cough 4. Multivitamins 1 TAB PO DAILY 5. Omeprazole 20 mg PO BID 6. Ondansetron 4 mg PO Q6H:PRN nausea 7. Phenytoin Sodium Extended 100 mg PO BID 8. QUEtiapine Fumarate 25 mg PO QHS 9. Simvastatin 40 mg PO DAILY 10. Venlafaxine XR 225 mg PO DAILY 11. Caltrate 600 + D (calcium carbonate-vitamin D3) 600 mg(1,500mg) -400 unit Oral daily 12. Meclizine 12.5 mg PO Q8H:PRN dizziness 13. Sodium Chloride Nasal ___ SPRY NU QID:PRN dry nose 14. Docusate Sodium 100 mg PO BID 15. Lorazepam 0.5 mg PO Q4H:PRN prior to CT 16. Aspirin 81 mg PO DAILY 17. Heparin IV Sliding Scale No Initial Bolus Initial Infusion Rate: 700 units/hr Target PTT: 60 - 100 seconds 18. Ipratropium Bromide Neb 1 NEB IH Q6H 19. Metoprolol Succinate XL 50 mg PO DAILY 20. Warfarin 3 mg PO DAILY16 21. Acetaminophen 1000 mg PO Q8H:PRN Pain Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: Primary: lung cancer Secondary: paroxsysmal atrial fibrillation with rapid ventricular rate, anxiety Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure caring for you at ___ ___. You came to the hospital with shortness of breath, fatigue, and dizziness. We were concerned for pneumonia and treated you with IV antibiotics. A CT of your chest showed no sign of pneumonia, so antibiotics were stopped. You had a bronchoscopy to better understand what is causing your symptoms. The results of these tests will be available by next week. This is likely progression of your underlying lung cancer. During your stay you had difficulty with anxiety. We recommend that you use your medications to help control this problem, which can make your breathing harder. Please discuss your anxiety with your therapist. While you were in the hospital, we noticed several short periods of irregular heartbeat called atrial fibrillation. You were previously on a medication called atenolol which we switched to a similar medication metoprolol, which will better help to control your heart rate. This irregular heartbeat can put you at risk of forming blood clots, which increases your risk of stroke. You had a blood clot in your heart in ___ for which you were treated with Lovenox. To avoid forming similar clots, you decided to start taking a blood thinning medication called coumadin (warfarin). This medication requires regular monitoring that can be done by the Rehab facility. Dr ___ ___ help manage this medication after you leave the facility. Thank you for allowing us to participate in your care.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Oxybutynin 5 mg PO TID RX *oxybutynin chloride 5 mg 1 tablet(s) by mouth three times daily Disp #*90 Tablet Refills:*0 2. OxyCODONE (Immediate Release) 5 mg PO Q8H:PRN Pain - Severe RX *oxycodone 5 mg 1 tablet(s) by mouth every 8 hours Disp #*12 Tablet Refills:*0 3. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 3 Days RX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by mouth twice daily Disp #*8 Tablet Refills:*0 4. Albuterol Inhaler 2 PUFF IH Q6H:PRN shortness of breath 5. Budesonide 9 mg PO DAILY 6. butalbital-acetaminophen-caff 50-325-40 mg oral Q6H:PRN headache 7. butalbital-acetaminophen-caff 50-300-40 mg oral Q6H:PRN headache 8. Cholestyramine 4 gm PO DAILY 9. ClonazePAM 0.5 mg PO QHS:PRN anxiety 10. Diazepam 10 mg PO QHS anxiety / insomnia 11. Famotidine 20 mg PO BID 12. Fluticasone Propionate 110mcg 2 PUFF IH BID:PRN nose 13. Guaifenesin-Dextromethorphan 5 mL PO Q6H:PRN cough 14. Hydrocortisone Acetate 10% Foam 1 Appl PR QHS 15. HydrOXYzine 100 mg PO QHS 16. Hyoscyamine 0.125 mg PO TID:PRN spasma 17. LORazepam 0.5 mg PO Q6H:PRN nausea RX *lorazepam 0.5 mg 1 tab by mouth every ___ hours Disp #*10 Tablet Refills:*0 18. Metadate CD (methylphenidate) 20 mg oral QAM 19. Methylphenidate SR 72 mg PO QAM 20. Metoclopramide 5 mg PO Q8H:PRN nausea 21. Multivitamins 1 TAB PO DAILY 22. olopatadine 0.1 % ophthalmic BID 23. Probiotic (B.breve-L.acid-L.rham-S.thermo;<br>L. acidophilus-L. rhamnosus;<br>L.acidophilus-Bif. animalis;<br>L.rhamn ___ acidophilus;<br>lactobacillus comb no.10;<br>lactobacillus combination no.4;<br>lactobacillus combo no.11) 15 billion cell oral DAILY 24. Ursodiol 600 mg PO BID 25. Vitamin D ___ UNIT PO DAILY Discharge Disposition: Home Discharge Diagnosis: PRIMARY DIAGNOSIS: 1. Peritoneal Inclusion Cyst s/p drainage. 2. Cystitis, complicated. SECONDARY DIAGNOSIS: 1. Ulcerative Colitis Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Ms. ___, It was a pleasure taking care of you during your hospital stay at ___. You were admitted to the hospital for abdominal pain after a procedure by our interventional radiologists. While here, you underwent drainage of a peritoneal cyst with some fluid removal and started to have relief of your pain. We continued to monitor you until you were able to eat or drink, and your pain was controlled. In addition, you had urinary retention. You were periodically bladder scanned, and your bladder was drained with a straight catheter. We wrote a prescription catheters for you to be able to self-cath at home. Please return to the hospital if you have worsening abdominal pain, fevers, nausea, vomiting, diarrhea, pain with urination, or blood in your urine. Please continue to follow up with your primary care physician and your your specialists upon discharge from the hospital. Take Care, Your ___ Team.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q8H:PRN pain or fever 2. Artificial Tear Ointment 1 Appl BOTH EYES PRN eye care 3. Docusate Sodium 100 mg PO BID 4. Senna 8.6 mg PO BID 5. amLODIPine 5 mg PO DAILY 6. Cyanocobalamin 1000 mcg PO DAILY 7. Famotidine 20 mg PO BID 8. Finasteride 5 mg PO DAILY 9. Pantoprazole 40 mg PO Q24H 10. QUEtiapine Fumarate 50 mg PO QHS 11. Tamsulosin 0.4 mg PO QHS 12. Vitamin B Complex 1 CAP PO DAILY 13. Warfarin 2.5 mg PO DAILY16 alternate with 5 mg QOD 14.rolling walker Diagnosis: bladder perforation Prognosis: good ___: 13 months Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: 1) Bladder perforation 2) abdominal compartment syndrome 3) Cardiac Arrest: cardiovascular collapse with return of circulation after CODE 4) Acute kidney injury on chronic kidney disease 5) generalized deconditioning 6) thrombosis, deep vein (pre-existing) Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>-Please also reference the instructions provided by nursing on SUPRAPUBIC TUBE (SPT) catheter care, hygiene and waste elimination. -ALWAYS follow-up with your referring provider ___ your PCP to discuss and review your post-operative course and medications. Any NEW medications should also be reviewed with your pharmacist. -Resume your pre-admission medications except as noted on the medication reconciliation -You may take ibuprofen and the prescribed narcotic together for pain control. FIRST, use Tylenol and Ibuprofen. Add the prescribed narcotic (examples: Oxycodone, Dilaudid, Hydromorphone) for break through pain that is >4 on the pain scale. -The maximum dose of Tylenol (ACETAMINOPHEN) is 3- 4 grams (from ALL sources) PER DAY. -Ibuprofen should always be taken with food. If you develop stomach pain or note black stool, stop the Ibuprofen. Ibuprofen works best when taken “around the clock.” -For your safety and the safety of others; PLEASE DO NOT drive, operate dangerous machinery, or consume alcohol while taking narcotic pain medications. -Do NOT drive while Foley catheter is in place. -AVOID lifting/pushing/pulling items heavier than 10 pounds (or 3 kilos; about a gallon of milk) or participate in high intensity physical activity (which includes intercourse) until you are cleared by your Urologist in follow-up. Generally about FOUR weeks. Light household chores are generally “ok”. Do not vacuum. -No DRIVING until you are cleared by your Urologist -Do not drive or drink alcohol while taking narcotics and do not operate dangerous machinery -You may be given “prescriptions” for a stool softener ___ a gentle laxative. These are over-the-counter medications that may be “health care spending account reimbursable.” -Colace (docusate sodium) may have been prescribed to avoid post-surgical constipation or constipation related to use of narcotic pain medications. Discontinue if loose stool or diarrhea develops. Colace is a stool-softener, NOT a laxative. -Senokot (or any gentle laxative) may have been prescribed to further minimize your risk of constipation. -You may shower as usual but do not immerse in bath/pool while foley in place -Your Foley should be secured to the catheter secure on your thigh at ALL times until your follow up with the surgeon. -DO NOT allow anyone that is outside of the urology team remove your Foley for any reason. -Wear Large Foley bag for majority of time; the leg bag is only for short-term when leaving the house, etc. -___ medical attention for fevers (temp>101.5), worsening pain, drainage or excessive bleeding from incision, chest pain or shortness of breath.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q8H:PRN pain 2. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB 3. Felodipine 5 mg PO DAILY 4. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID 5. FoLIC Acid 1 mg PO DAILY 6. Ranitidine 300 mg PO QHS 7. Vitamin D 1000 UNIT PO DAILY 8. Ciprofloxacin HCl 500 mg PO Q12H Duration: 4 Days RX *ciprofloxacin HCl 250 mg 1 tablet(s) by mouth every twelve (12) hours Disp #*7 Tablet Refills:*0 9. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H RX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) hours Disp #*11 Tablet Refills:*0 10. Calcarb 600 With Vitamin D (calcium carbonate-vitamin D3) 600 mg(1,500mg) -200 unit oral BID 11. Infliximab 0 mg IV Q6WEEKS 12. Ondansetron 8 mg PO Q8H:PRN nausea 13. Prochlorperazine 10 mg PO Q8H:PRN nausea Discharge Disposition: Home Discharge Diagnosis: Primary diagnosis: Abdominal pain/diarrhea Secondary diagnosis: ___ disease Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - Independent. Followup Instructions: ___ [/INST] </s><s>Dear Mr. ___, It was a pleasure taking care of you during your stay at ___. You were admitted for abdominal pain and diarrhea. You were found to have a fever and elevation in serum inflammatory markers concerning for infection and/or ___ flare. You were started on antibiotics and your symptoms improved. A colonoscopy showed no sign of active ___. By discharge, you were tolerating a regular diet with improved pain and decreased inflammatory markers. You should continue the antibiotics as prescribed and will be contacted by the ___ department for an outpatient follow-up appointment. Wishing you well, Your ___ Medicine Team</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 1000 mg PO Q6H 2. Amphetamine-Dextroamphetamine 15 mg PO TID 3. ClonazePAM 1 mg PO QID:PRN anxiety 4. OxycoDONE (Immediate Release) 20 mg PO Q4H:PRN pain 5. OxyCODONE SR (OxyconTIN) 40 mg PO Q12H 6. Senna 17.2 mg PO QHS 7. Bisacodyl 10 mg PO/PR DAILY:PRN constipation 8. Diazepam 5 mg PO Q8H:PRN muscle spasm 9. Gabapentin 600 mg PO TID 10. Heparin 5000 UNIT SC TID 11. HydrALAzine 10 mg IV Q6H for SBP > 160 12. Omeprazole 40 mg PO BID 13. Simethicone 40-80 mg PO QID:PRN gas 14. Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush 15. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line flush 16. Vancomycin 1250 mg IV Q 12H 17. Tamsulosin 0.4 mg PO QHS 18. CloniDINE 0.2 mg PO QHS 19. Docusate Sodium 100 mg PO BID Discharge Disposition: Extended Care Facility: ___ Discharge Diagnosis: T12 osteomyelitis Anemia Acute on chronic pain Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (walker or cane). Followup Instructions: ___ [/INST] </s><s>Discharge Instructions Spinal Fusion Surgery •Your dressing may come off on the second day after surgery. •Your incision is closed with staples or sutures. You will need suture/staple removal. •Do not apply any lotions or creams to the site. •Please keep your incision dry until removal of your staples. •Please avoid swimming for two weeks after staple removal. •Call your surgeon if there are any signs of infection like redness, fever, or drainage. Activity •You must wear your brace at all times when out of bed. You may apply your brace sitting at the edge of the bed. You do not need to sleep with it on. •We recommend that you avoid heavy lifting, running, climbing, or other strenuous exercise until your follow-up appointment. •You make take leisurely walks and slowly increase your activity at your own pace. ___ try to do too much all at once. •No driving while taking any narcotic or sedating medication. •No contact sports until cleared by your neurosurgeon. •Do NOT smoke. Smoking can affect your healing and fusion. Medications •Please do NOT take any blood thinning medication (Aspirin, Ibuprofen, Plavix, Coumadin) until cleared by the neurosurgeon. •Do not take any anti-inflammatory medications such as Motrin, Advil, Aspirin, and Ibuprofen etc… until cleared by your neurosurgeon. •You may use Acetaminophen (Tylenol) for minor discomfort if you are not otherwise restricted from taking this medication. •It is important to increase fluid intake while taking pain medications. We also recommend a stool softener like Colace. Pain medications can cause constipation. When to Call Your Doctor at ___ for: •Severe pain, swelling, redness or drainage from the incision site. •Fever greater than 101.5 degrees Fahrenheit •New weakness or changes in sensation in your arms or legs.</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Acetaminophen 650 mg PO Q6H:PRN pain 2. Amiodarone 200 mg PO DAILY 3. Aspirin 81 mg PO DAILY 4. Metoprolol Tartrate 12.5 mg PO BID 5. Tamsulosin 0.4 mg PO HS 6. Rosuvastatin Calcium 10 mg PO DAILY 7. Vitamin D 1000 UNIT PO DAILY 8. HYDROmorphone (Dilaudid) 2 mg PO Q4H:PRN pain 9. Insulin SC Sliding Scale Fingerstick QACHS Insulin SC Sliding Scale using REG Insulin 10. Furosemide 40 mg PO BID Duration: 7 Days 11. Potassium Chloride 20 mEq PO BID Duration: 7 Days 12. Omeprazole 20 mg PO QOD 13. Clopidogrel 75 mg PO DAILY 14. GlyBURIDE 2.5 mg PO BID 15. MetFORMIN (Glucophage) 500 mg PO BID Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: s/p Left thoracentesis ___ s/p Urgent coronary artery bypass graft x3: ___ Left internal mammary artery to left anterior descending artery and saphenous vein graft to distal circumflex and ramus arteries Past Medical History: MI ___, angioplasty 6 months later DMII dyslipidemia Hypertension BPH Past Surgical History: herniorrhaphy Past Cardiac Procedures: angioplasty ___ DES to Cx ___ Discharge Condition: Alert and oriented x3 nonfocal Ambulating with steady gait Incisional pain managed with Incisions: Sternal - healing well, no erythema or drainage Leg Right/Left - healing well, no erythema or drainage. Edema Followup Instructions: ___ [/INST] </s><s>Please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. Look at your incisions daily for redness or drainage Please NO lotions, cream, powder, or ointments to incisions Each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart No driving for one month or while taking narcotics. Driving will be discussed at follow up appointment with surgeon. No lifting more than 10 pounds for 10 weeks **Please call cardiac surgery office with any questions or concerns ___. Answering service will contact on call person during off hours**</s>

<s>[INST] <<SYS>> Act as a health expert <</SYS>> create discharge instructions of the following text: 1. Dapsone 100 mg PO DAILY 2. Aspart 12 Units Breakfast Aspart 12 Units Lunch Aspart 12 Units Dinner Levemir 30 Units Bedtime Insulin SC Sliding Scale using HUM Insulin 3. Gabapentin 400 mg PO TID 4. TraMADol 50 mg PO Q6H:PRN Pain - Moderate 5. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild/Fever Maximum 4 of the 500 mg tablets daily 6. Aspirin 81 mg PO DAILY 7. Benzonatate 100 mg PO BID:PRN cough 8. CefePIME 2 g IV Q12H RX *cefepime 100 gram 2 g IV twice a day Disp #*60 Intravenous Bag Refills:*1 9. Daptomycin 800 mg IV Q24H RX *daptomycin 500 mg 800 mg IV once a day Disp #*30 Intravenous Bag Refills:*1 10. Dronabinol 2.5 mg PO BID 11. Fluconazole 400 mg PO Q24H 12. Levothyroxine Sodium 25 mcg PO DAILY 13. Multivitamins W/minerals 1 TAB PO DAILY 14. Pantoprazole 40 mg PO Q12H 15. PredniSONE 5 mg PO DAILY 16. Psyllium Powder 1 PKT PO BID:PRN constipation 17. Tacrolimus 1 mg PO Q12H 18. Ursodiol 300 mg PO BID 19.Right ___ Brace S74.10XA supply one, wear when out of bed Discharge Disposition: Home With Service Facility: ___ Discharge Diagnosis: Hyperkalemia History of liver transplant DM h/o right iliacus hematoma with right femoral nerve compression Right leg numbness/pain/weakness Neutropenia Discharge Condition: Mental Status: Clear and coherent. Level of Consciousness: Alert and interactive. Activity Status: Ambulatory - requires assistance or aid (___ and ___ brace) Followup Instructions: ___ [/INST] </s><s>Care Group ___ for IV Antibiotics . Please call the transplant clinic at ___ for fever of 101 or greater, chills, nausea, vomiting, diarrhea, constipation, inability to tolerate food, fluids or medications, yellowing of skin or eyes, increased abdominal pain, liver drain and biliary drain sites have redness, drainage or bleeding, dizziness or weakness, decreased urine output or dark, cloudy urine, swelling of abdomen or ankles, weight gain of 3 pounds in a day or any other concerning symptoms. . Bring list of current medications to every clinic visit. . You will need to have labwork drawn on ___ then twice weekly as arranged by the transplant clinic. Usually ___ and ___ . *** On the days you have your labs drawn, do not take your Tacrolimus until your labs are drawn. Bring your Tacrolimus with you so you may take your medication as soon as your labwork has been drawn. . Follow your medication card, keep it updated with any dosage changes, and always bring your card with you to any clinic or hospital visits. . Patient may shower with assist. Do not allow drain bag to hang freely. Keep biliary drain (PTBD)open. Change gauze dressing daily and as needed. Make sure to pin your drain to prevent accidently pulling out . Flush the PTBD drain with 5cc STERILE saline-FORWARD flush ONLY 3 times a day. DO NOT ASPIRATE/PULL back. . Continue IV antibiotics via the PICC line as ordered. No end date is established for the antibiotics. PICC line care per protocol . No tub baths or swimming . Avoid direct sun exposure. Wear protective clothing and a hat, and always wear sunscreen with SPF 30 or higher when you go outdoors. . Report consistently elevated blood sugars or blood pressure values above 160 or less than 110 systolic to the transplant clinic . Do not increase, decrease, stop or start medications without checking with the transplant coordinator at ___.</s>