text:  Percocet 5  325 mg one to two q. four hours p.r.n. Aspirin 325 mg q.d. Colace 100 mg b.i.d. Coumadin 5 mg q.d. Sotalol 180 mg b.i.d. Digoxin 0.125 mg q.d. Diltiazem 60 mg q.i.d. 8. Ambien 5-10 mg q.h.s. p.r.n. DISCHARGE INSTRUCTIONS  The patient should follow-up with his cardiologist in one to two weeks . He will also go home with VNA for INRs twice weekly with the results reported to his PCP or cardiologist for Coumadin adjustment . The patient should follow-up with Dr. Halcomb in six weeks time . Octavia W. Levitre   M.D. 05 -383 Dictated By  James Q. Mitchell   M.D. MEDQUIST36 D  2010-03-28 1015 T  2010-03-28 1046 JOB   41466 Signed electronically by  DR. Janice Carpenter on