text:  Lopressor 25 mg p.o. b.i.d. Lasix 20 mg p.o. q. 12 hours times seven days . 3. Potassium chloride 20 mEq p.o. q. 12 hours times seven days . Colace 100 mg p.o. b.i.d. Metformin 500 mg p.o. b.i.d. Percocet 5  325 one to two tablets p.o. q. four to six hours p.r.n. Celexa 20 mg p.o. q.d. Lipitor 20 mg p.o. q.d. Warfarin 5 mg p.o. q.d. times four days   after which point the patient s dosage schedule is to be coordinated by his PCP   Dr. Jerold Esqueda . DISCHARGE INSTRUCTIONS  The patient is to maintain his incisions clean and dry at all times . The patient may shower but should pat dry incisions afterwards  no bathing or swimming until further notice . The patient may resume a Heart Healthy Diet . The patient had been advised to limit his physical exercise  no heavy exertion . No driving while taking prescription pain medications . The patient is to have his Coumadin managed by his primary care provider   Dr. Jerold Esqueda   for a target INR of 2.5 . The patient is to report to Dr. Jones office on 2010-06-14 for an initial blood draw and subsequent Coumadin titration  Coumadin levels are to be monitored per his PCP David . The patient is to follow-up with Dr. Leanne Larimore in Cardiology within two to three weeks following discharge . The patient is to follow-up with Dr. Brenda Hummer four weeks following discharge . The patient is to call to schedule all appointments . Tracy X. Carmen   M.D. 76-050 Dictated By  Gerald R. Quiroz   M.D. MEDQUIST36 D  2010-06-12 0200 T  2010 -06-12 1421 JOB  47222 Signed electronically by  DR. Tiffany D. Picklesimer on  WED 2010-07-28