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His hematocrit was 44.4 with white blood count of 11.9 and platelet count of 410 . His MCV was 92 MCH 32.1 and MCHE 34.8 . His chest X-ray did not reveal any abnormality . A electrocardiogram showed nonspecific T-wave abnormalities otherwise it was normal .

erm appropriate for gestational age male neonate . Exaggerated physiologic hyperbilirubinemia responsive to phototherapy . Jennifer Martin North Dakota 07287 Dictated By', 'Jean TE Fletcher M.D. MEDQUIST36 D 2018-05-13 130731 T 2018-05-13 142441 Job 75582 Signed electronically by DR. Deloris O. Williams on MON 2018-05-14'

Neurological Alert and oriented times 3 . Moves all extremities and follows commands . Respiratory Clear to auscultation bilaterally . Cardiovascular Regular rate and rhythm S1 and S2 . No murmurs . Sternum is stable incision with staples opened to air clean and dry . Abdomen Soft and nontender nondistended with positive bowel sounds . Extremities Warm and well profuse with 1 to 2 plus edema . Right saphenous vein graft site with Steri-strips open to air clean and dry . The patient s condition at discharge is good .

Breast cancer diagnosed in 2010 Stage I status post left lumpectomy on 2012-05-08 and repeat surgery with sentinel node dissection on 2012-06-05 Invasive mucinous carcinoma with estrogen receptor positivity and HER2 NEU negative . Left chest radiation on Tamoxifen therapy She is followed by Dr. Alonso Naugle . Question of vertebral basilar cerebrovascular accident in 2016-08-17 with associated limb ataxia Magnetic resonance imaging was negative except for some microvascular cerebral white matter changes . Question peripheral vertigo takes Meclizine p.r.n. Hypothyroidism Hypertension . Hypercholesterolemia Glaucoma . Cataract Osteopenia . Left hip arthritis History of urinary tract infections . Anemia with a baseline hematocrit of 31.0 with a TIBC that was low and a high ferritin Echocardiogram in 2016-09-16 with preserved ejection fraction of 60 percent with trivial mitral regurgitation and mild left atrial enlargement . Cardiac stress test in 2016-03-17 that was negative for inducible ischemia

A quantitative V Q scan was also done preoperatively and Pulmonary consult was obtained preoperatively . Pulmonary recommended that he just be started on Albuterol and Atrovent metered dose inhalers 2 puffs q6h prior to surgery . The patient underwent his procedure on 12-4-93 without complications . Findings included thickened pleura with multiple adhesions and an abscess near the margin major fissure . He had a firm nodule in the left lower lobe . The patient was transferred to the Respiratory Intensive Care Unit in stable condition and had an uneventful stay there . He had oxygen saturations of 99 with an Fi02 of 40 and had no complaints . He was transferred to the floor on postoperative day number one and tolerated his PO&aposs well . His left lower lobe micro results revealed alpha hemolytic Streptococcus on culture and he was then switched to penicillin and Gentamicin after being started on triples of Flagyl Ampicillin and Gentamicin . He had low grade temperatures though did not spike a high temperature during his hospital course . His hospital course was otherwise uneventful and the patient was discharged in stable condition on postoperative day afebrile . The chest X-ray on the morning of discharge was unchanged from the previous day with slight increase in left pleural fluid . He had completed six days of penicillin and Gentamicin and was discharged on Ciprofloxacin and Flagyl for the next seven days . He stayed at the local Comfort Inn before his return back to Aujer Cin .

Coronary artery disease status post myocardial infarction in 1990 peptic ulcer disease and hypertension

1 Aspirin 81 mg p.o. q. day . 2 Os-Cal 1250 mg p.o. three times a day . 3 Lasix 40 mg p.o. q.o.d. 4 Plaquenil 200 mg p.o. q. day . 5 Ibuprofen 400 mg p.o. t.i.d. 6 Levoxyl 100 mg p.o. q. day . 7 Arava 20 mg p.o. q. day . 8 Zantac 150 mg p.o. b.i.d. 9 Isosorbide dinitrate unclear dose . 10 Diltiazem 240 mg p.o. q. day . 11 Epogen q. two weeks .

Brother with MI at age 35 Father with MI CABG died at age 60 . Physical Exam Vitals BP 144 90 HR 64 RR 14 General well developed male in no acute distress HEENT oropharynx benign poor dental health Neck supple no JVD Heart regular rate normal s1s2 no murmur Lungs clear bilaterally Abdomen soft nontender normoactive bowel sounds Ext warm no edema no varicosities Pulses 2 distally Neuro nonfocal Pertinent Results 2014 -04-24 0730AM BLOOD Hct 25.9 2014-04-23 0705AM BLOOD WBC 5.9 RBC 2.72 Hgb 8.6 Hct 25.2 MCV 93 MCH 31.5 MCHC 34.0 RDW 13.0 Plt Ct 150 2014-04-23 0705AM BLOOD Plt Ct 150 2014-04-24 0730AM BLOOD UreaN 11 Creat 0.8 K 4.4 2014-04-21 ECHO No spontaneous echo contrast is seen in the body of the left atrium . No mass thrombus is seen in the left atrium or left atrial appendage . No spontaneous echo contrast is seen in the body of the right atrium . A patent foramen ovale secundum ASD is present . A left-to-right shunt across the interatrial septum is seen at rest . A right-to-left shunt across the interatrial septum is seen at rest with injection of agitated saline contrast . The inferior vena cava is dilated >2.5 cm . Left ventricular wall thickness cavity size and systolic function are normal LVEF >55 . Left ventricular wall thicknesses are normal . Regional left ventricular wall motion is normal . Overall left ventricular systolic function is normal LVEF>55 . Right ventricular chamber size and free wall motion are normal . The ascending transverse and descending thoracic aorta are normal in diameter and free of atherosclerotic plaque . The aortic valve leaflets 3 appear structurally normal with good leaflet excursion and no aortic regurgitation . No aortic regurgitation is seen . The mitral valve appears structurally normal with trivial mitral regurgitation . The mitral valve leaflets are structurally normal . There is no pericardial effusion . POST BYPASS Flow across the interatrial septum is no longer visualized with color flow doppler or with injection of agitatated saline at rest or with valsalva . The study is otherwise unchanged from pre-bypass . 2014-04-22 CXR Previous right pneumothorax has resolved except for what is either a small fissural component or a bulla adjacent to the minor fissure . May be a small right pleural effusion . Right apical pleural tube in place . Left lung clear from basal atelectasis . Paratracheal mediastinal hematoma is resolving . Heart size is normal . Tip of the left internal jugular line projects over the SVC . Brief Hospital Course Mr. Freeman was admitted to the Nantucket Cottage Hospital on 2014-04-21 for surgical management of his PFO . He was taken to the operating room where he underwent a mini-thoracotomy with closure of his patent foramen ovale PFO . Postoperatively he was taken to the cardiac surgical intensive care unit for monitoring . Within a few hours he woke neurologically intact and was extubated . Aspirin was resumed. On postoperative day one he was transferred to the cardiac surgical step down unit . He was gently diuresed towards his preoperative weight . The physical therapy service was consulted for assistance with his postoperative strength and mobility . Iron and vitamin C were started for postoperative anemia . Mr. Freeman maintained stable hemodynamics with a normal sinus rhythm throughout his postoperative course . He continued to make steady progress and was discharged home on postoperative day three . He will follow-up with Dr. de la Cisneros Dr. Belt his cardiologist and his primary care physician as an outpatient . Medications on Admission Plavix 75mg daily aspirin 81mg daily Discharge Medications 1. Potassium Chloride 10 mEq Capsule Sustained Release Sig Two 2 Capsule Sustained Release PO Q12H every 12 hours for 5 days . Disp 10 Capsule Sustained Release s Refills 0 2. Docusate Sodium 100 mg Capsule Sig One 1 Capsule PO BID 2 times a day . Disp 60 Capsule s Refills 0 3. Aspirin 81 mg Tablet Delayed Release E.C. Sig One 1 Tablet Delayed Release E.C. PO DAILY Daily . Disp 30 Tablet Delayed Release E.C. s Refills 2 4. Oxycodone-Acetaminophen 5-325 mg Tablet Sig 1-2 Tablets PO every 4-6 hours as needed for pain . Disp 50 Tablet s Refills 0 5. Ferrous Sulfate 325 65 mg Tablet Sig One 1 Tablet PO DAILY Daily Take for one month then stop . Disp 30 Tablet s Refills 0 6. Camphor-Menthol 0.5-0.5 Lotion Sig One 1 Appl Topical TID 3 times a day as needed . Disp qs qs Refills 0 7. Ascorbic Acid 500 mg Tablet Sig One 1 Tablet PO BID 2 times a day Take for one month then stop . Disp 60 Tablet s Refills 0 8. Furosemide 20 mg Tablet Sig One 1 Tablet PO BID 2 times a day for 5 days . Disp 10 Tablet s Refills 0 Discharge Disposition Home with Service Discharge Diagnosis PFO TIA lung nodule followed by Dr. Belt s p fissurectomy skull Fx Discharge Condition Good Discharge Instructions 1 Shower wash incisions with mild soap and water and pat dry . No lotions creams or powders to incisions . Call with fever >101 redness or drainage from incision or weight gain more than 2 pounds in one day or five pounds in one week . 3 No driving while on narcotics . Take lasix twice daily with potassium for five days then stop . Take Vitamin C with iron for one month then stop . Call with any questions or concerns . Followup Instructions Follow up with Dr. Heird in four weeks 671 745 2553 Follow up with Dr. Knowlton in 1-2 weeks 246 828-4417 Follow up with Dr. Eckman in 2-3 weeks 506 946-4576 Call all providers for appointments . CAT SCAN Phone 476 713 6117 Date Time 2014-10-16 915 Edna Arnold MD Phone 300 922-6590 Date Time 2014-10-16 230 Melonson de la Donnelly MD 08-301 Completed by Jeremy N. P. Moschella PA 80-BYE 2014-04-24 1103 Signed electronically by DR. Dorothy au Pratt on FRI 2014-06-06 1027 AM

Aspirin under which she develops worsening of her shortness of breath and asthma flare tetracycline sulfa Demerol . MEDICATIONS Diovan 106 mg q.d. Advair 500 50 two puffs b.i.d. Plavix 75 mg q.d. Crestor 20 mg q.d. Neurontin 300 mg t.i.d. Prilosec 20 mg b.i.d. Vicodin as needed . Trazodone 50 mg q.d. Singulair 10 mg q.d. Flexeril 10 mg t.i.d. 11. Lopressor 75 mg b.i.d. Humibid 3600 b.i.d. Colace 100 mg b.i.d. Zetia 10 mg q.d. Benadryl as needed . Tricor 106 mg q.d. Premarin 0.3 mg q.d. Prozac 40 mg q.d. 19. Omega-3 fatty acids t.i.d. 1. Chest pain The patient ruled out for myocardial infarction . However with her history of disease patient underwent a cardiac catheterization .', 'The patient was found at cardiac catheterization to have mild diffuse instent restenosis in the mid stent otherwise hemodynamically normal and the coronary arteries', 'otherwise were without flow-limiting stenoses . The patient was then continued on her cardiac medications . It was felt that if we attempted aspirin desensitize her while an inpatient', 'then she would benefit from the use of aspirin and Plavix . The patient was sent to the CCU and underwent aspirin desensitization protocol which she tolerated well .', 'She had mild worsening of her asthma attacks which was relieved by Benadryl and occasionally albuterol . The patient found that if she took the aspirin in the evening with her Benadryl', 'that she takes for sleep that the asthma exacerbation did not occur . Aspirin no longer should be considered an allergy for this patient and she is going to take this as an outpatient .', '2. Hyperlipidemia The patient s Lipitor was increased to 80 mg q.d. 3. Back pain This is a chronic issue and was controlled with Flexeril and Vicodin . DISPOSITION To home .

Respiratory On admission the patient had what appeared to be acute respiratory distress syndrome secondary to community acquired pneumonia .', 'She was maintained on a ventilator and ventilated according to ARDSNet protocol . For antibiotic coverage of her pneumonia she was started on Levaquin ceftriaxone and vancomycin .', 'Over the next two days after admission the patient s vent settings were gradually weaned and she was extubated two days after being transferred to this hospital .', 'After extubation the patient was oxygenating well on face mask . She did continue to have a persistent fairly severe cough however her cough was weak due to abdominal muscle pain from repeated coughing .', 'The cough was mostly nonproductive . The patient was breathing comfortably . As there was no identified bacterial pathogen on any cultures', 'the patient was continued on the triple antibiotics for first several days of the hospitalization . She was also on round-the-clock Atrovent and albuterol nebulizers .', 'Once the patient was transferred out of the ICU and after extubation the antibiotics were gradually narrowed . The vancomycin and Levaquin were discontinued after approximately four days in the hospital .', 'The ceftriaxone was discontinued after four days in the hospital and the patient was to continue on Levaquin . The patient had gradual improvement in her oxygenation .', 'Pain control The patient had fairly significant abdominal pain secondary to persistent cough . She was started on a regimen of MS Contin with oxycodone for breakthrough pain .', 'This helped her somewhat though she has continued to have difficulty coughing due to the pain . Tylenol and ibuprofen were also added for better control .', 'Transaminitis The patient was noted to have mild transaminitis on admission . However this was felt to be due to her significant infection .', 'This should continue to be followed as an outpatient to assure that it returns back to normal . Anemia The patient s reticulocyte count showed inadequate production .', 'Iron studies showed a mixed picture with decreased iron and decreased iron to TIBC ratio suggestive of iron-deficiency anemia but also normal to high MCV .', 'B12 was noted to be low and the patient was given an injection of IM B12 while in the hospital .', 'She was also started on iron supplementation . Hypothyroidism The patient was continued on Synthroid for her chronic hypothyroidism .

On admission vital signs Temperature 101.4 blood pressure 101 62 pulse 80 respiratory rate 19 on a ventilator with settings of assist control at 500 12 and a PEEP of 5 . General The patient is intubated and sedated but easily arousable . HEENT Pupils equally round and reactive to light . Sclerae are anicteric . ET tube is in place . Neck Soft and supple . Cardiovascular Normal . Chest Faint scattered wheezes bilaterally . Abdomen Benign . Extremities Warm with good distal pulses . There is no edema . Neurologic Able to follow simple commands .

Albuterol inhaler . Amphotericin B 40 mg. qday . Ceftazidime 1 gram intravenous q 8 . Ciprofloxacin 500 mg. po. q12 . Cisapride 10 mg. po. qid . Dakin &aposs solution 1 4 strength to ulcer of penis . Benadryl 50 mg. intravenous tid prn . capsule 1 po. tid . Lasix prn . Nystatin swish and swallow tid . Percocet po. q4 to 6 prn . Trazodone 50 mg. qhs. multivitamins 1 po. qd .

He is 5 feet 9 inches 225 pounds . He walks with a limp related to his right hip . His right hip is irritable with a 10-degree fixed flexion contracture . He is able to flex his right hip to 100 degrees . He has 10 degrees of internal and external rotation . He has intact distal pulses and 5 5 muscle strength in all major muscle groups . His X-rays show advanced osteoarthritis of his right hip . IMPRESSION AND PLAN This is a 62-year-old male with severe osteoarthritis of the right hip who after discussion including the nature risks benefits and alternative treatment plans signed informed consent for a right total hip replacement .

Coronary artery disease status post MI x2 CABG x2 in 02 89 and 2 21 history of arthritis history of bilateral rotator cuff degeneration and tears history of hypertension history of hyperlipidemia .

1. Respiratory . The Athol Memorial Hospital hospital course was initially consistent with transient tachypnea of the newborn .', 'Chest x-ray revealed mild streakiness of the lung fields . He was initially placed on nasal cannula with subsequent resolution of respiratory distress .', 'Nasal cannula was weaned off on day of life 3 and he initially was maintaining O2 sat above 94 and breathing comfortably .', 'He was subsequently placed back on nasal cannula for mild oxygen desaturation and was requiring 25 c min flow at the time of discharge .', 'No apneic or brady episodes . 2. Cardiovascular . The patient s cardiovascular status has been stable throughout his CMED CSRU stay .', 'No murmur on exam . 3. FEN . The patient had been tolerating oral feeding as of day of life 2 and is currently taking Enfamil 20 p.o. ad lib .', 'He has been weaned off IV fluids and has been maintaining good blood glucose . His birth weight was 3285 gm . His weight is 3015 gm on day of life 5 . 4. GI .', 'The patient s bilirubin level at 24 hours of life was 4.6. No phototherapy was started . 5. ID . The patient was not started on antibiotics given lack of sepsis risk factors .', 'His initial CBC showed no left shift . Blood culture had remained no growth to date . 6. Heme . The patient s initial hematocrit was 35.8 . No transfusion during this admission .

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

Menthol Cetylpyridinium lozenges 1 as needed . Tenofovir 300 mg p.o. q.d. Didanosine 250 mg p.o. q.d. Atazanavir 300 mg p.o. q.d. Ritonavir 100 mg p.o. q.d. Calcium carbonate 500 mg p.o. q.d. Methylprednisolone 4 mg tablets per taper regimen . The patient was to take one 4 mg tablet dinner and at bedtime the day of discharge then the next day take one 4 mg tablet in the morning lunch time and with dinner and then at bedtime then the third day to take 4 mg tablet in the morning lunch and bedtime the fourth day to take one tablet in the morning and dinner and in the last day take one 4 mg tablet in the morning . He was also discharged on Augmentin XR 1000 mg 62.5 mg sustained release 1 tablet q. 12h . for 2 weeks . FOLLOW-UP The patient was to follow up with his PCP A. L. . Taylor in 7 to 10 days and the patient was to call Dr. Thibodeau CMED CSRU doctor to follow up in 2 weeks time . Teddy Stephen Louisiana 32870 Dictated By Judy J Johnston M.D. MEDQUIST36 D 2011-07-12 155531 T 2011-07-13 111452 Job 79962 Signed electronically by DR. Ruth Gibson on MON 2011-07-18 748 AM

He is to follow up with Dr. Rach Breutznedeaisscarvwierst in Clinic.

DISCHARGE DISPOSITION Home .follow up VNA and pediatric primary care physician appointments to be scheduled prior to discharge .

Lopressor 100 mg p.o.b.i.d. Lisinopril 10 mg p.o.q.d. Lipitor 10 mg p.o.q.d. Aspirin 81 mg p.o.q.d. Percocet one to two tablets p.o.q. 3-4 h. p.r.n. pain . Colace 100 mg p.o.b.i.d. DISCHARGE PHYSICAL EXAMINATION The patient had a temperature of 98.4 heart rate 72 blood pressure 154 89 respiratory rate 18 and oxygen saturation 90 in room air . He was alert and oriented . His neck was supple without lymphadenopathy . He had faint bibasilar crackles on lung examination . His heart had a regular rate and rhythm with no murmur rub or gallop . His abdomen was soft nontender and nondistended with a nonerythematous peritoneal dialysis insertion site . Extremities were warm and well perfused . DR . Kemp Julie R. 02 -358 Dictated By Judy Y Carnevale M.D. MEDQUIST36 D 2010-09-18 1942 T 2010-09-22 1110 JOB 34822 Signed electronically by DR. Dalila Talbot on Robert 2010-09-23

As noted . PAST SURGICAL HISTORY Significant for having had a cholecystectomy and hysterectomy tonsillectomy and adenoidectomy and mastoidectomy

Topical Bactroban to be applied three times a day to affected naris prednisone 5 mg p.o. q.a.m. K-Dur 10 mEq x2 p.o. q.d. OxyContin 10 mg p.o. q.12h clindamycin 300 mg p.o. q.i.d. lisinopril 10 mg p.o. q.d. atenolol 25 mg p.o. q.d. trazodone 100 mg p.o. q.h.s. Prilosec 40 mg p.o. q.d clotrimazole 1 cream topical to be applied b.i.d. DISCHARGE FOLLOW-UP The patient was arranged for follow-up appointment with Dr. Scarvzine of rheumatology on 10 11 01 . Also with Dr. Fyfe of ENT scheduled for Halloween . Dr. Twada his primary care physician at the SBH clinic for 10 11 01 and Dr. Fyfechird gastroenterologist on 10 13 01 . COMPLICATIONS There were no complications during the patient &aposs hospitalization and he was discharged in stable condition . Dictated By THRYNE ANA M.D. GN628 Attending DRIS UPHKOTE M.D. IF67 TB150 196806 Batch 48373 Index No. RYZKWV6XG4 D

By systems Respiratory . After receiving brief blow by oxygen in the delivery room the patient had no further episodes of ventilatory assistance required with good respiratory rate consistently . The patient was never placed on caffeine . He is stable in room air at this time . Cardiovascular . No active issues . No history of hypotension . On no medications at this time . Notably with respect to apnea and bradycardia of prematurity the patient has reached 5 days without significant apneic or bradycardic spells as of the time of discharge . Fluids electrolytes and nutrition . The patient reached full volume feeds by day of life 6 and had calories increased to maximum of 26 kilocalories per ounce of Similac special care until 2014-12-03 at which point this was weaned to 24 kilocalories per ounce of straight Similac . This is the baby s discharge feedings and he is p.o. ad lib with a minimum of 130 ml kg day the patient has taken on an average greater than 150 ml kg day ad lib over each of the past 5 days . GI . The patient with peak bilirubin of 6.5 on day of life 3 . No phototherapy was required . Hematology Infectious Disease . The patient s hematocrit at delivery was 48 with a white count of 11.2 and platelets of 301 000 . Initial differential was 35 polys and zero bands not suspicious for infectious condition . The patient was initially treated with 48 hours of ampicillin and gentamicin until blood cultures were negative . The infant has had no antibiotics since that time . Neurology . No issues . Sensory . Hearing screen was performed with automated auditory brainstem responses and was normal on 2014-11-24 . Ophthalmology . The patient did not qualify for routine ophthalmology exams due to his gestational age at birth .

Patient was stable with complete clearance of her mental status advancement of her diet blood pressure and heart rate remained stable and her oxygen saturations were well above 90 during the daytime on 2 liters nasal cannula and at night on the BiPAP settings described above . Physical Therapy consult is pending today . DISCHARGE MEDICATIONS 1. NPH 70 units q.a.m. 50 units q.p.m. Humalog sliding scale . SubQ Heparin 5 000 units t.i.d. Ranitidine 150 mg p.o. b.i.d. Multivitamin x1 . Losartan 25 mg p.o. q.d. Iron supplementation 150 mg p.o. q.d. Levofloxacin day four of 10 to be completed for a full 10-day course 500 mg p.o. q.d. Metoprolol 25 mg p.o. b.i.d. Colace 100 mg p.o. b.i.d. Mark Nibbe M.D. 87 -896 Dictated By Jeffrey N. Elvington M.D. MEDQUIST36 D 2015-10-02 0819 T 2015-10-02 0820 JOB 15790 Signed electronically by DR.

Patient is being sent home on Ecotrin one q.d. Digoxin 0. l25 mg every three days Quinidine 648 mg q.a.m. and 324 mg q.p.m. and q.h.s. Mevacor 20 mg p.o. q.d. Carafate one gram p.o. q.i.d. Colace l00 mg p.o. t.i.d. Lasix 80 mg p.o. q.d. Potassium 20 mEq p.o. q.d. and iron supplements . Patient has follow-up with Dr. Merkel and with his private medical doctor . EV956 4659 RISHAN M. MERKEL M.D. BS9 D 01 02 92 Batch 3669 Report F6644X53 T 01 02 92 Dicatated By RAMA R. KOTEOBE M.D. cc 1.

Aricept 10 mg qd Aspirin 81 mg qd Folic acid Gabapentin 200 mg tid Lopressor 12.5 mg bid Lisinopril 5 mg qd Daptomycin 420 mg IV qd Protonix 40 mg qd Seroquel 50 mg tid Heparin 5000 units SQ tid Colace 100 mg bid Lactulose 15 mg bid Comtan 200 mg qd Mirapex 1.5 mg tid Sinemet 50 200 mg tid Discharge Medications 1. Furosemide 20 mg Tablet Sig One 1 Tablet PO once a day for 2 weeks . Potassium Chloride 20 mEq Packet Sig One 1 Packet PO once a day for 2 weeks . Docusate Sodium 100 mg Capsule Sig One 1 Capsule PO BID 2 times a day . 4. Pantoprazole 40 mg Tablet Delayed Release E.C. Sig One 1 Tablet Delayed Release E.C. PO Q24H every 24 hours . 5. Aspirin 81 mg Tablet Delayed Release E.C. Sig One 1 Tablet Delayed Release E.C. PO DAILY Daily . 6. Magnesium Hydroxide 400 mg 5 mL Suspension Sig Thirty 30 ML PO HS at bedtime as needed for constipation . 7. Entacapone 200 mg Tablet Sig One 1 Tablet PO TID 3 times a day . 8. Pramipexole 0.25 mg Tablet Sig Six 6 Tablet PO TID 3 times a day . 9. Carbidopa Levodopa 50 200 mg Tablet Sustained Release Sig One 1 Tablet PO TID 3 times a day . Quetiapine 25 mg Tablet Sig Two 2 Tablet PO DAILY Daily . Procainamide 250 mg Capsule Sig Three 3 Capsule PO Q6H every 6 hours x 6 weeks . 12. Acetaminophen Codeine 300-30 mg Tablet Sig One 1 Tablet PO Q4H every 4 hours as needed . Warfarin 1 mg Tablet Sig as directed Tablet PO DAILY Daily . Daptomycin 500 mg Recon Soln Sig Four 90y 480 mg Intravenous Q24H every 24 hours thru 05-02 . Discharge Disposition Extended Care Discharge Diagnosis mitral valve endocarditis s p MV replacement HTN s p CVA Spinal stenosis s p Lumbar Laminectomy Parkingson s h o paranoid delusions MGUS vs MM Discharge Condition good Discharge Instructions May take shower . Wash incisions with warm water and gentle soap . Do no take bath or swim . Do not apply lotions creams ointments or powders to incision . Do not drive for 1 month . Do not lift more than 10 pounds for 2 months . Please contact office if you develop a fever more than 101.5 or notice drainage from chest incision . Followup Instructions Dr. Portsche in 4 weeks Dr. Bravo PCP in 1-2 weeks Infectious disease Provider Marsha Harriet MD Phone 574-5036 Date Time 2019-04-29 1000 Jeffrey Everett MD 23-815 Completed by MARK Carolyn NP 80-AUO 2019-03 -26 1033 Signed electronically by DR.

A Neurosurgery consultation was obtained and it was their impression that the patient &aposs paraplegia might possibly represent a cord concussion and recommended treatment with intravenous steroids for 24 hours . The patient &aposs paraplegia resolved by the morning of her second hospital day and she maintained 5 5 motor strength in all groups . A Urology consultation was obtained and it was recommended that an IVP be obtained . This was obtained on the day of discharge however due to residual contrast in the colon from the patient &aposs prior abdominal CT scan the exam was postponed after a scout film was obtained . The patient fell well on the day of discharge . She remained afebrile throughout her hospital course . Additionally on the night before discharge flexion and extension views of the lumbosacral spine were obtained and showed no fracture or instability . DISPOSITION CONDITION ON DISCHARGE Good .

discharge disposition 'To home .'

BY SYSTEM 1. PULMONARY She was treated with albuterol and Atrovent continuous nebulizers and was weaned then to intermittent nebulizer treatments and then to her meter-dosed inhalers taking them q.4h. at the time of discharge . She was continued on salmeterol and Flovent . She was continued on Solu-Medrol 80 mg q.8h. then converted to prednisone at 60 mg p.o. q.d. She was started on Singulair 10 mg p.o. q.d. Serial arterial blood gases were followed after an arterial line was placed . Her PCO2 gradually declined to the 48 range . Despite episodes of somnolence the first night which were presumably due to having spent the entire night in the Emergency Department she never became more hypercarbic and her PCO2 trended to 48 by the time the arterial line was discontinued . On the night of admission and thereafter she was noted to have a very stridorous sounding breathing when the patient was asleep . This would disappear whenever she was awake . Her case was discussed with Ear Nose Throat and the Medical Intensive Care Unit attending . She was given a trial of 80 20 mixed helium oxygen to decrease the stridor but had minimal effect . Ear Nose Throat recommended not considering this an airway problem unless she was stridorous while awake . The patient was to arrange for Pulmonary and Medicine followup through her primary care physician upon discharge as she has not been seen in the Pulmonary Clinic in two years . 2. CARDIOVASCULAR The patient ruled out for myocardial infarction with serial creatine kinases although these did rise to 816 . MB was negative . She was treated with captopril for hypertension and this was switched to Norvasc 7.5 mg p.o. q.d. on discharge . She had an echocardiogram which showed a hyperdynamic left ventricular of normal thickness and size and no significant valvular disease . She apparently did not have a cardiovascular component to her wheezing or shortness of breath however she was to go home on Lasix 20 mg p.o. q.d. to help with lower extremity edema as she experiences discomfort with this and the team felt this may be a limiting factor with her prednisone compliance . 3. ENDOCRINE She was treated with a sliding-scale of regular insulin while she was in house . She was given 500 mg p.o. q.d. of metformin to treat her steroid-induced diabetes on discharge . This should be followed up by her primary care physician . 4. INFECTIOUS DISEASE She was treated briefly with levofloxacin because of the gram-positive cocci in her sputum culture however her symptoms were felt to be consistent with a viral upper respiratory infection and levofloxacin was continued at the time of discharge . MEDICATIONS ON DISCHARGE Lasix 20 mg p.o. q.d. Combivent meter-dosed inhaler 2 puffs q.4h. weaning to albuterol meter-dosed inhaler 2 puffs q.4h. Salmeterol 2 puffs q.12h. Flovent 220 mcg 2 puffs q.12h. Prednisone 40 mg p.o. q.d. with taper . Fentress 60 mg p.o. b.i.d. Singulair 10 mg p.o. q.d. Univasc 7.5 mg p.o. q.d. Metformin 500 mg p.o. q.d. Dyazide was discontinued . DISCHARGE STATUS Discharge services included visiting nursing which was to assess in her inhaler technique monitor her fasting blood sugars as well as her blood pressure monitor her peak flows and assess her mobility and activities of daily living at home . DISCHARGE FOLLOWUP She was also to seek the next available appointment with Dr. Jeanette Barr or to see another resident in the Saint Vincent Hospital Clinic if she cannot get an appointment within one week . CONDITION AT DISCHARGE Condition on discharge was good .. CODE STATUS Full code . DISCHARGE DIAGNOSES Asthma flare . Hypertension . Steroid-induced diabetes . James Z Berg M.D. 19-421 Dictated By Melanie L.W. Palevic M.D. MEDQUIST36 D 2011-06-18 1633 T 2011-06-21 1534 JOB 92012 Signed electronically by DR. Andrea Trotter on

Prozac . Tetracycline for acne .

Large for gestational age . Infant of a diabetic mother . Hypoglycemia . Reviewed By Mary Karina Oregon 30621 Dictated By James H. Acosta M.D. MEDQUIST36 D 2012-10-02 154605 T 2012-10-02 171444 Job 07783 Signed electronically by DR. Richard Stripling on Maxine 2012-10-25

eedings breast milk or Enfamil 24 calories per ounce breast milk mixed with 4 calories per ounce of Enfamil powder', 'minimum of 140 cc per kilogram per day po

Labs on admission from outside hospital CBC notable for a white count of 21.9 with hematocrit of 36.3 and normal platelets . Chem-7 notable for potassium of 3.2 and bicarbonate of 30 . LFTs show an elevated ALT of 52 and AST of 101 with normal alkaline phosphatase and total bilirubin . Latest arterial blood gas with pH of 7.45 pCO2 43 and pO2 155 on 100 percent oxygen via ventilator . RADIOGRAPHIC STUDIES Chest x-ray shows right middle lobe right lower lobe and left lower lobe infiltrates . EKG shows normal sinus rhythm at 70 beats per minute with normal axis and intervals borderline LVH .

Negative for any history of sudden death or coronary artery disease .

Nonischemic dilated cardiomyopathy . MEDICATIONS ON DISCHARGE 1. Digoxin 375 mcg and 250 mcg alternating doses each day . Lisinopril 40 mg p.o. q.d. Toprol XL 75 mg p.o. q.d. Flovent 110 mcg two puffs b.i.d. 5. Albuterol 1-2 puffs q.6h. prn . 6. Coumadin 10 mg p.o. q.h.s. Lasix 40 mg p.o. q.d. Keflex 500 mg x6 doses . FOLLOW-UP INSTRUCTIONS The patient will follow up in EP Clinic on 2012-03-19 . She will also be seen in the Heart Failure Clinic on 2012-03-28 . Patient will also followup with her primary care provider Dr. Sandra Lamar for check of her INR in one week s time . Felix Weiss M.D. 95 -771 Dictated By Randy EB Brooks M.D. MEDQUIST36 D 2012-03-13 1225 T 2012-03-13 1400 JOB 15824 Signed electronically by DR.

After consultation with Cardiology as well as Anesthesia on call that evening it was decided to transfer the patient to the ICU for intensive monitoring . Central IV access was obtained . The patient was carefully diuresed over the next 48 hours . Symptoms of congestive heart failure gradually abated over the next 48 to 72 hours . The patient was given antenatal corticosteroids for fetal lung maturity . A Neonatology consultation was obtained during the course of the hospitalization . After discussion it was decided to attempt to obtain 28 weeks gestation and then deliver electively by cesarean section given the decompensation in the third trimester . The patient underwent primary low transverse cesarean section on 2014-05-19 at approximately 28 weeks gestation . The cesarean section was performed on the West Campus in the Cardiothoracic Surgical Suite . This was performed in this location in case any acute cardiac decompensation occurred during the time of cesarean section . Cardiothoracic Surgery was on standby during the surgery . The patient went to the cardiac Intensive Care Unit on the West Campus postoperatively . She did well during the postoperative period . She required several episodes of diuresis due to increasing shortness of breath on postoperative day 1 and postoperative day 2 due to worsening symptoms of shortness of breath from fluid shifts that normally occur during the postpartum period . The patient was transferred to the West Campus on postoperative day 2 in stable condition . She did well during the remainder of her postoperative course and was continued on her medication regimen that she had been on during the antepartum period . She was discharged to home on postoperative day 4 . She was to followup with Maternal Fetal Medicine in 5 to 7 days . She had followup with her primary cardiologist in Shaugnessy-Kaplan Rehab Hospital scheduled for 1 week postoperatively . Of note the patient also underwent tubal ligation at the time of cesarean section .

Aspirin 325 mg. PO q.d. Lipitor 80 mg. PO q.d. Toprol XL 50 mg. PO q.d. Lasix 80 mg. q.a.m. and 40 mg. q.p.m. Potassium chloride 20 mEq. PO b.i.d. Citracal 1 packet q.d. Imdur 60 mg. PO q.d. Vitamin E 400 international units q.d. Prilosec 20 mg. PO q.d. HISTORY OF PRESENT ILLNESS Breunlinke is a 70-year-old patient of Dr. Brendniungand Asilbekote in California . She is referred for progressive angina . She had rheumatoid fever as a child and a heart murmur noted but no further testing . She has used antibiotic prophylaxis since 1980 . In 1980 she had quadruple coronary artery bypass graft surgery by Dr. Elks at Feargunwake Otacaa Community Hospital and did well until 1988 when she had exertional angina and a positive stress test and found that three or four grafts were occluded . In October 1989 Dr. No re-did her bypass operation . She had a left internal mammary artery graft to the left anterior descending saphenous vein graft to the obtuse marginal 1 and a saphenous vein graft to the obtuse marginal 2 . In 1993 she had a DDD pacemaker for complete heart block . She had exertional angina at that time . In November 1997 she had a small myocardial infarction as was transferred to Ona Hospital where a cardiac catheterization showed a tight left internal mammary artery to left anterior descending stenosis high grade saphenous vein graft to obtuse marginal 1 stenosis and patent obtuse marginal 2 graft . She had normal left ventricular function with apical tip akinesis . Since that time she has continued to have exertional left chest burning radiating to the left neck and arm relieved by nitroglycerin . She was turned down for re-do surgery at that time and did not have a percutaneous transluminal coronary angioplasty . Because these symptoms have been increasing particularly at cardiac rehabilitation she was referred here . In May 1998 she had an exercise tolerance test in which her heart rate went to 112 and her blood pressure fell to 95 systolic . She had diffuse ischemic ST segment changes and increased lung uptake and a reversible anterior and lateral defect . She has had no syncope . Her cardiac risk factors are hypertension and elevated cholesterol . She has a very strong family history of coronary artery disease with a mother sister and brother dying of myocardial infarction . She is a remote cigarette smoker . She also has a history of lactose intolerance peptic ulcer disease with a remote gastrointestinal bleed and multiple ectopic pregnancies and mid term miscarriages . She has had a total abdominal hysterectomy .

Coronary artery disease status post coronary artery bypass grafting times 4 with LIMA to the LAD saphenous vein graft to OM1 saphenous vein graft to OM2 and saphenous vein graft to the diagonal . Hypertension . Hypercholesterolemia . Status post partial thyroidectomy . Status post hernia repair . Status post left knee surgery . Status post tonsil and adenoid surgery . DISCHARGE MEDICATIONS 1. Atorvastatin 10 mg q.d. 2. Plavix 75 mg q.d. times 3 months . Aspirin 325 mg q.d. Lasix 20 mg q.d. times two weeks . Potassium chloride 20 mEq q.d. times two weeks . Metoprolol 12.5 mg b.i.d. Percocet 1 to 2 tabs q. 4 hours p.r.n . The patient is to be discharged home with visiting nurses . He is to have follow up in the wound clinic in two weeks and follow up with Dr. Brewster in two to three weeks and follow up with Dr. Rota in 4 weeks . Herbert Jesus Georgia 01835 Dictated By Scott OK Astarita M.D. MEDQUIST36 D 2016-09-14 125227 T 2016-09-14 132805 Job 15604 Signed electronically by DR. Richard Gomez on FRI 2016-09-16

Dexedrine 5 mg per day and Motrin 600 mg tid .

ON ADMISSION Birth weight was 5235 grams length was 56 cm and head circumference was 37.5 cm . Anterior fontanel open and flat . The palate was intact . Nares were patent . Bilateral breath sounds were clear and equal . No grunting flaring or retracting . No murmurs . A regular rate and rhythm . Pink and well perfused . The abdomen was soft and nondistended . There was no hepatosplenomegaly . There was a 3-vessel cord . The spine was intact . The anus was patent . Normal male genitalia . Tone was appropriate for gestational age . SUMMARY OF HOSPITAL COURSE BY ISSUES-SYSTEM RESPIRATORY The infant has remained on room air throughout his hospitalization with oxygen saturations of greater than 95 percent . Respiratory rates have been 40 s to 60 s. The infant has had two spontaneous desaturations which quickly self-resolved on day of life one . No other issues . No apnea or bradycardia . CARDIOVASCULAR The infant has remained hemodynamically stable with heart rates in the 120 s to 140 s and mean blood pressures of 57 to 60 . FLUIDS ELECTROLYTES AND NUTRITION The infant was admitted to the Neonatal Intensive Care Unit for treatment of hypoglycemia . The infant was started on enteral feedings of Enfamil 20 calories per ounce by mouth ad lib and maintained glucoses in the middle to high 40 s taking by mouth feedings every two to three hours by mouth ad lib . On day of life one the infant had a dextrose stick of 34 . At that time an intravenous of D-10-W was started at 80 cc kilogram per day . On day of life two the infant began to wean off intravenous fluids and this was completed by day of life four . Calories were increased to Similac 24 calories per ounce . Before discharge to the Newborn Nursery the infant was taking Similac 22 calories per ounce by mouth ad lib and maintaining dextrose sticks in the 60 s. Weight on discharge was 5200 grams . GASTROINTESTINAL No issues . HEMATOLOGY No issues . NEUROLOGY Normal neurologic examination . SCREENS A hearing screen was performed with automated auditory brain stem responses and the infant passed on both ears . PSYCHOSOCIAL The parents are involved .

Admission medications . YERTREY TANELI SUMCHIRDKAYSMAVVEINDREPS M.D. DICTATING FOR Electronically Signed ALEN LAA CREDKOTE M.D. 09 30 2003 1334 ALEN LAA CREDKOTE M.D. TR ruw DD 09 11 2003 TD 09 12 2003 223 P 366967 cc

Was discharged on 11 16 2003 in stable condition with the last recorded hematocrit of 31.3 . He was asked to continue on his Nexium iron and vitamin C and was continued on his other home medications .

By systems Respiratory Pocasset was admitted to the newborn intensive care unit with mild respiratory distress . Chest x-ray revealed a left pneumothorax which resolved on its own without intervention . The infant has remained in room air throughout her hospital course with occasional apnea and bradycardia episodes the last being documented on 2020-01-14 . Cardiovascular Attleboro has been stable throughout her newborn intensive care course without issue . Fluids and electrolytes Birth weight was 1515 grams . She was initially started on 80 cc per kilo per day of D10W . Enteral feedings were initiated on day of life 1 . Full enteral feedings were achieved by day of life 7 . The infant had a course of heme positive stools with grossly bloody streaks and mucus felt to be protein allergy . The infant is now receiving breast milk with Nutramigen powder concentrate to 24 calorie . Stools have been negative to trace positive and abdominal exam is reassuring . Discharge weight is 2040 gm the head circumference is 32 cm and the length is 46 cm. . GI Peak bilirubin was on day of life 2 of 4.8 0.3 . Hematology Hematocrit on admission was 41 . The infant did not require any blood transfusions during this hospital course . Infectious disease CBC and blood culture were obtained on admission . White count was 4.8 7 polys zero bands platelet count of 316 000 . ANC at that time was 336 . A 24 hour CBC was obtained . White blood cell count was 5.1 22 polys zero bands with a hematocrit of 39.3 and platelets of 313 000 . The infant received 48 hours of ampicillin and gentamicin which were discontinued with a negative blood culture . Neurology The infant has been appropriate for gestational age . Sensory Audiology hearing screen was performed with automated auditory brainstem responses and the infant passed on both ears .

Aspirin 325 mg po q day . Vasotec 7.5 mg po q day . Humalog insulin sliding scale with meals and at bedtime . Humulin Walters insulin 24 units subcutaneous q A.M. and 8 to 16 in the evening depending upon where his blood sugar has been . Preoperative laboratory values were unremarkable . The patient underwent cardiac catheterization on 2011-10-17 which revealed a 20 left vein osteal lesion as well as 70 LAD lesion and an 80 right coronary . The patient was taken to the operating room on 2011-10-18 where he underwent an aortic valve replacement with 23 mm pericardial valve as well as coronary artery bypass graft times two with a LIMA to the LAD and saphenous vein to the acute marginal . Postoperatively the patient was transported to the cardiac surgery recovery unit on Milrinone Neo-Synephrine and Levophed drip . The patient was weaned from mechanical ventilation and subsequently extubated on the night of surgery . He remained on Levophed Milrinone and Neo-Synephrine drips and was hemodynamically stable . N. Saez clinic consult was obtained due to hyperglycemia and the need for insulin drip in the Intensive Care Unit . On postoperative day the Milrinone was weaned down . The Levophed had been discontinued as the Neo-Synephrine and the patient was beginning to progress hemodynamically . Upon discontinuation of the Milrinone the patient s SV02 had dropped significantly in the low 50 s. The patient had decreased exercise tolerance and therefore was placed back on his milrinone to keep his cardiac index greater than 2.0 . Over the next couple of days it was very slowly decreased as his Ace inhibitors were increased orally . The patient ultimately was weaned off the Milrinone transitioned to Captopril on postoperative day five and remained hemodynamically stable . Once the patient had remained off of inotropics for approximately 24 hours he had been given diuretics and Ace inhibitors and remained hemodynamically stable he was transferred from the Intensive Care Unit to the Telemetry floor on postoperative day six . A physical therapy evaluation was obtained for assistance and mobility . Cardiac rehabilitation was initiated at that time . On 2011-10-24 postoperative day six consultation heart failure cardiology service was obtained . It was their recommendation to continue Ace inhibitors to continue daily weights to switch the patient to a long acting beta-blocker and to enroll the patient in postoperative cardiac rehabilitation as well as to make sure the patient was on statin drugs . These measures were all instituted . The patient continued to progress from cardiac rehabilitation and physical therapy standpoint while on the floor . The patient remained hemodynamically stable over the next few days continued to increase with physical therapy and ambulation . His blood sugars were followed by the Cape Cod Hospital Clinic service and insulin has been adjusted accordingly . Today 2011-10-31 postoperative day 13 the patient remains stable and ready for discharge to home . The patient s condition today is as follows Temperature 96.9 F pulse 84 respiratory rate 18 blood pressure 106 59 . Most recent laboratory values are from 2011-10-25 which revealed a white blood cell count 8.4000 hematocrit 35 platelet count 202 000. Sodium 133 potassium 4.4 chloride 93 CO2 30 BUN 24 creatinine 0.7 glucose 198 . The patient s finger stick blood glucose levels range from 151 to 390 over the past 24 hours and his insulin scale has been adjusted upward to compensate for that . Neurologically the patient is grossly intact . Pulmonary exam he is clear upper lobes diminished bilateral bases left greater than right . Coronary exam is regular rate and rhythm . His abdomen is benign . His sternum is stable. His incision is clean and dry Steri Strips intact . His extremities are warm and well perfused with minimal edema of his left foot as well as his right stump . He is able to apply his prosthesis and ambulate as well .

Procardia sustained release 60 mg. po q.day Digoxin .25 mg. po q.day Lasix 30 mg. interval unspecified Prozac 40 mg. po q.day Lovestatin 20 mg. po bid aspirin q. day and supplemental potassium .

HISTORY OF THE PRESENT ILLNESS The patient is a 63 year-old man with a history of hypertension and prior history of atrial fibrillation secondary to hyperthyroidism who presented to an outside hospital with a history of left-sided chest pain at rest . The patient awoke with chest pressure radiating to the right chest associated with diaphoresis . The patient was found to have a blood pressure of 170 108 with atrial fibrillation and rapid ventricular response to a heart rate of 140s . The patient was rate controlled and transferred to the Stillman Infirmary for emergent cardiac catheterization .

The patient is thus stage IV endometrial and stage III-C ovarian vs metastatic endometrial for line II cycle I chemotherapy IFEX MESNA and VP-16 . The plan was for urinalysis q d . With the history of DVT we plan Coumadin and check her coags . The patient was tachycardiac on admission and it was felt she was dehydrated and or anxious at the time of her initial evaluation . EKG showed sinus tachycardia and incomplete right bundle branch block . When compared with ECG of 11-06-90 there was borderline criteria for anterior MI although the patient denied any chest pain at any point .

Hematocrit was 42 PT was 10 potassium was 3.6 BUN was 29 creatinine was 1.4 blood sugar was 111 . EKG showed atrial fibrillation moderate ventricular response right ventricular hypertrophy right axis deviation .

ON ADMISSION Temperature 98.8 heart rate 68 blood pressure 107 82 and oxygen saturation 99 on room air . CHEST Clear to auscultation . HEART Regular rate and rhythm with no murmurs . ABDOMEN Soft mildly distended and tympanic with midepigastric tenderness to palpation and no rebound . The ostomy was pink with minimal fluid in the ostomy bag . It was guaiac negative . EXTREMITIES No signs of edema and the patient had warm and palpable pulses distally .

Docusate sodium 100 mg p.o. b.i.d. Ursodiol 300 mg p.o. b.i.d. Ascorbic acid 500 mg p.o. q.d. Zinc sulfate 220 mg p.o. q.d. Lansoprazole oral solution 30 mg per gastric tube q.d. Caspofungin acetate 50 mg IV q.d. day 23 of treatment and patient should remain on it indefinitely . Nephrocaps one cap p.o. q.d. If on dialysis please take after dialysis treatment . Metoclopramide 5 mg p.o. b.i.d. take 30 minutes before meals . Fluconazole 200 mg p.o. q.h.d. Patient should remain on this medication . Magnesium sulfate 2 gm in 100 ml of D5W IV as needed for repletion p.r.n. Miconazole powder 2 one application t.p. t.i.d. p.r.n. 12. Acetaminophen 325 mg to 650 mg p.o. q.four to six hours p.r.n. 13. Albuterol one to two puffs inhaled q. six hours p.r.n. 14. Bisacodyl 10 mg per rectum h.s. as needed p.r.n. 15. Hydralazine hydrochloride 10 mg IV q. six hours p.r.n. systolic blood pressure greater than 140 . 16. Vancomycin 1 gm IV as needed for vancomycin level less than 15 . This is day 23 of treatment for an approximate six week course . 17. Ceftazidime 1 gm IV q.h.d. after dialysis . 18. Alteplase for catheter clearance 2 mg IV once times one dose for indwelling PermCath . DISCHARGE DIAGNOSES Status post aortic valve replacement and coronary artery bypass grafting times four . Status post sternal debridement . Status post skin graft to chest incision . Status post open jejunostomy tube placement open left subclavian PermCath placement . Status post DDD pacer placement with external generator . Status post abdominal repair of wound dehiscence of jejunostomy site . Status post percutaneous tracheostomy . Status post acute renal failure . Status post myocardial infarction . Hypertension . Hypercholesterolemia . Asthma . Peptic ulcer disease status post gastrectomy 30 years ago . Colon cancer status post colectomy with XRT four years ago . Peripheral vascular disease with history of bilateral lower extremity claudication . COPD with asbestosis on chest CT scan . The patient is discharged on Thursday 12-31 to a rehabilitation facility on postoperative day 93 in stable condition from the cardiac surgery recovery unit . Perry G. Ozuna M.D. 83 -390 Dictated By Keith E. Shafer M.D. MEDQUIST36 D 2015-12-31 1112 T 2015-12-31 1119 JOB 04648 Signed electronically by DR. Kelsey MOORMAN on FRI 2016-01-08

Synthroid Prilosec 20 mg p.o. Fioricet Celebrex .

He was a well-developed well-nourished man who was breathing comfortably . Temperature was 101.3 . HEENT were normal . Neck was supple . Lungs were clear to percussion and auscultation with a few scattered rales left greater than right . Abdominal examination was normal . Extremities were normal . Neurological examination was nonfocal .

Breast cancer status post lumpectomy Mitral commissurectomy . Atrial fibrillation Peripheral vascular disease . Arterial emboli left femoral artery Congestive heart failure . MEDICATIONS ON TRANSFER Lopressor intravenous q 6 hours . Morphine Sulfate 1 mg intravenous p.r.n. ALLERGIES Penicillin Sulfa and Quinidine .