CHIEF COMPLAINT: lethargy

PRESENT ILLNESS: Ms. [**Known lastname 72502**] is a [**Age over 90 **] yo F/ w/ h/o GERD, venous insufficiency,
HTN, DM and recurrent UTIs who presents from [**Hospital1 1501**] with 2 days of
weakness and lethargy. Patient was also noted to have
bradycardia to upper 40-50s, and there was concern for pacemaker
dysfunction. Of note, the pt had a recent admission from [**2122-3-15**]
to [**2122-3-18**] for fever and AMS and was treated for a UTI.
.
At patient's [**Hospital1 1501**], noted to have R sided crackles, 88% RA,
baseline 93% or greater, pulse- 48-50. The NP had thought pt had
lower limit of pacer of 60 (leading her to question if the pacer
was fuctioning poorly) but pt has had pulses in 50s consistently
in past here. concerned about pacemaker function. Last
telephonic interrogation was reportedly normal on [**2122-3-25**]. NP
also confirmed pt's son and HCP wanted the pt full code
.
In our ED, the pt was oriented x2, pleasant but poor historian.
RA sat 88%. EKG was paced and c/w prior EKGs also paced at 50s.
The pt had a CXR with pleural effusions. CT abdomen was
performed for abd tenderness which showed ?appendicitis. Surgery
was consulted in the ED and thought the pt's suprapubic
tenderness was c/w UTI. Pt also had a pericardial effusion on CT
abd and cards was called but was not impressed. TTE [**4-11**] showed
small pericardial effusion. She was given levofloxacin given
inability to rule out pneumonia hidden by pleural effusions. Pt
was also noted to have a UTI. In the [**Name (NI) **], pt was noted to have
poor UOP from foley while getting 75 D5NS/hr. The pt's HCP was
not contact[**Name (NI) **] while the pt was in the [**Name (NI) **]. On transfer from the
ED, vitals were: T 98.1 P 50 paced BP 129/52 R 17 O2 sat 98% on
2l NC. 2 peripheral IVs were placed in the ED.
.
In the ICU, patient was monitored overnight. Patient was very
stable, remained bradycardic, recent interogation of pacer
showed it was working normally. Patient's abx was changed to
ceftriaxone based on prior sensitivities, urine sensitivities
pending. Patient's course was uneventful and was called out to
the floor.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, headache, cough, shortness of breath,
chest pain, nausea, vomiting, diarrhea, constipation.
.

MEDICAL HISTORY: Past Medical History:
Dizziness
GERD
Venous insufficiency
h/o skin cancer
h/o colon cancer
dyspepsia
HTN
DM
Osteoarthritis
Depression
Hyperlipidemia
Chronic recurrent UTIs

MEDICATION ON ADMISSION: - Glipizide ER 10mg daily
- Fluticasone nasal spray 50mcg each nostril [**Hospital1 **]
- Metformin ER 500mg daily
- Metoprolol 12.5mg [**Hospital1 **]
- Zocor 40mg daily
- Prozac 20mg QHS
- Acetaminophen 1gm [**Hospital1 **]
- Aspirin 81mg daily
- Coumadin 5mg 5 days/wk then 2mg 2 days/wk
- Aricept 5mg daily
- Lasix 40mg [**Hospital1 **]
- Multivitamin with minerals daily
- Senna QHS

ALLERGIES: Benzodiazepines / Nsaids

PHYSICAL EXAM: VS:99.2, 108/60, 70, 27, 99%2LNC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Bilateral rales
CV: Regular rate and rhythm, normal S1 + S2
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: +2 BLE edema

FAMILY HISTORY: Family History: Unknown

SOCIAL HISTORY: Social History:
Lives at nursing home
Nonweight bearing
Incontinent of urine and stool
Urinary tract infection, site not specified,Acute on chronic diastolic heart failure,Unspecified disease of pericardium,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Other specified cardiac dysrhythmias,Esophageal reflux,Venous (peripheral) insufficiency, unspecified,Unspecified essential hypertension,Personal history of malignant neoplasm of large intestine,Personal history of other malignant neoplasm of skin,Other persistent mental disorders due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled
Urin tract infection NOS,Ac on chr diast hrt fail,Pericardial disease NOS,Depressive disorder NEC,Hyperlipidemia NEC/NOS,Status cardiac pacemaker,Cardiac dysrhythmias NEC,Esophageal reflux,Venous insufficiency NOS,Hypertension NOS,Hx of colonic malignancy,Hx-skin malignancy NEC,Mental disor NEC oth dis,DMII wo cmp uncntrld
Admission Date:  [**2122-4-11**]              Discharge Date:   [**2122-4-17**]


Service: MEDICINE

Allergies:
Benzodiazepines / Nsaids

Attending:[**First Name3 (LF) 905**]
Chief Complaint:
lethargy

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Ms. [**Known lastname 72502**] is a [**Age over 90 **] yo F/ w/ h/o GERD, venous insufficiency,
HTN, DM and recurrent UTIs who presents from [**Hospital1 1501**] with 2 days of
weakness and lethargy. Patient was also noted to have
bradycardia to upper 40-50s, and there was concern for pacemaker
dysfunction. Of note, the pt had a recent admission from [**2122-3-15**]
to [**2122-3-18**] for fever and AMS and was treated for a UTI.
.
At patient's [**Hospital1 1501**], noted to have R sided crackles, 88% RA,
baseline 93% or greater, pulse- 48-50. The NP had thought pt had
lower limit of pacer of 60 (leading her to question if the pacer
was fuctioning poorly) but pt has had pulses in 50s consistently
in past here. concerned about pacemaker function. Last
telephonic interrogation was reportedly normal on [**2122-3-25**]. NP
also confirmed pt's son and HCP wanted the pt full code
.
In our ED, the pt was oriented x2, pleasant but poor historian.
RA sat 88%. EKG was paced and c/w prior EKGs also paced at 50s.
The pt had a CXR with pleural effusions. CT abdomen was
performed for abd tenderness which showed ?appendicitis. Surgery
was consulted in the ED and thought the pt's suprapubic
tenderness was c/w UTI. Pt also had a pericardial effusion on CT
abd and cards was called but was not impressed. TTE [**4-11**] showed
small pericardial effusion. She was given levofloxacin given
inability to rule out pneumonia hidden by pleural effusions. Pt
was also noted to have a UTI. In the [**Name (NI) **], pt was noted to have
poor UOP from foley while getting 75 D5NS/hr. The pt's HCP was
not contact[**Name (NI) **] while the pt was in the [**Name (NI) **]. On transfer from the
ED, vitals were: T 98.1 P 50 paced BP 129/52 R 17 O2 sat 98% on
2l NC. 2 peripheral IVs were placed in the ED.
.
In the ICU, patient was monitored overnight. Patient was very
stable, remained bradycardic, recent interogation of pacer
showed it was working normally. Patient's abx was changed to
ceftriaxone based on prior sensitivities, urine sensitivities
pending. Patient's course was uneventful and was called out to
the floor.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, headache, cough, shortness of breath,
chest pain, nausea, vomiting, diarrhea, constipation.
.


Past Medical History:
Past Medical History:
Dizziness
GERD
Venous insufficiency
h/o skin cancer
h/o colon cancer
dyspepsia
HTN
DM
Osteoarthritis
Depression
Hyperlipidemia
Chronic recurrent UTIs

Social History:
Social History:
Lives at nursing home
Nonweight bearing
Incontinent of urine and stool


Family History:
Family History: Unknown


Physical Exam:
VS:99.2, 108/60, 70, 27, 99%2LNC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Bilateral rales
CV: Regular rate and rhythm, normal S1 + S2
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: +2 BLE edema


Pertinent Results:
Labs on Admission:
[**2122-4-10**] 11:55PM BLOOD WBC-14.2* RBC-4.01* Hgb-10.2* Hct-33.5*
MCV-83 MCH-25.5* MCHC-30.5* RDW-14.4 Plt Ct-463*
[**2122-4-10**] 11:55PM BLOOD Neuts-73.1* Lymphs-21.8 Monos-3.7 Eos-1.0
Baso-0.4
[**2122-4-10**] 11:55PM BLOOD PT-26.9* PTT-36.5* INR(PT)-2.6*
[**2122-4-10**] 11:55PM BLOOD Plt Ct-463*
[**2122-4-10**] 11:55PM BLOOD Glucose-151* UreaN-16 Creat-0.8 Na-140
K-4.0 Cl-97 HCO3-36* AnGap-11
[**2122-4-10**] 11:55PM BLOOD proBNP-382
[**2122-4-10**] 11:55PM BLOOD cTropnT-0.01
[**2122-4-11**] 12:13AM BLOOD Lactate-1.3

Urine Studies on Admission:
[**2122-4-11**] 01:03AM URINE Color-Yellow Appear-Hazy Sp [**Last Name (un) **]-1.026
[**2122-4-11**] 01:03AM URINE Blood-MOD Nitrite-NEG Protein-75
Glucose-NEG Ketone-TR Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-MOD
[**2122-4-11**] 01:03AM URINE RBC-[**1-30**]* WBC->50 Bacteri-FEW Yeast-NONE
Epi-1

Labs on Transfer to Floor:
[**2122-4-12**] 05:16AM BLOOD WBC-9.4 RBC-3.95* Hgb-10.1* Hct-32.8*
MCV-83 MCH-25.5* MCHC-30.8* RDW-14.4 Plt Ct-460*
[**2122-4-12**] 05:16AM BLOOD Plt Ct-460*
[**2122-4-12**] 05:16AM BLOOD PT-30.9* PTT-38.8* INR(PT)-3.1*
[**2122-4-12**] 05:16AM BLOOD Glucose-138* UreaN-13 Creat-0.7 Na-141
K-3.7 Cl-98 HCO3-37* AnGap-10
[**2122-4-12**] 05:16AM BLOOD Calcium-8.8 Phos-3.0 Mg-1.8

Labs on Discharge:
[**2122-4-17**] 08:40AM BLOOD WBC-10.7 RBC-3.96* Hgb-10.0* Hct-32.8*
MCV-83 MCH-25.2* MCHC-30.5* RDW-14.5 Plt Ct-603*
[**2122-4-17**] 08:40AM BLOOD PT-25.1* PTT-33.5 INR(PT)-2.4*
[**2122-4-17**] 08:40AM BLOOD Glucose-191* UreaN-17 Creat-0.7 Na-140
K-3.9 Cl-96 HCO3-38* AnGap-10
[**2122-4-17**] 08:40AM BLOOD Calcium-8.8 Phos-2.3* Mg-2.0
[**2122-4-13**] 06:20AM BLOOD calTIBC-267 VitB12-326 Folate-12.0
Ferritn-107 TRF-205 Iron 16

MICRO:
 URINE CULTURE (Final [**2122-4-13**]):
      ESCHERICHIA COLI.    10,000-100,000 ORGANISMS/ML..
                              SENSITIVITIES: MIC expressed in M

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------  =>32 R
AMPICILLIN/SULBACTAM--     8 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CIPROFLOXACIN---------   =>4 R
GENTAMICIN------------   <=1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------  <=16 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----  =>16 R

IMAGING:
CT ABDOMEN W/CONTRAST Study Date of [**2122-4-11**] 2:32 AM
IMPRESSION:
1. No evidence of appendicitis.
2. Small pericardial effusion with enhancing pericardium
suggesting a
potential serosanguineous/exudative nature of the effusion.
Clinical
correlation is recommended.
3. Bilateral renal cysts.

CT CHEST [**2122-4-13**]
IMPRESSION: No evidence of pneumonia. No pulmonary masses.
Bilateral
pleural and pericardial effusion. Extensive coronary and aortic
calcifications. Partly calcified thyroid nodules. Bilateral
renal cysts.

TTE: The left atrium and right atrium are normal in cavity size.
Left ventricular wall thickness, cavity size, and global
systolic function are normal (LVEF>55%). Due to suboptimal
technical quality, a focal wall motion abnormality cannot be
fully excluded. Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets are mildly
thickened (?#). There is no aortic valve stenosis. No aortic
regurgitation is seen. The mitral valve appears structurally
normal with trivial mitral regurgitation. There is moderate
estimated pulmonary artery systolic hypertension. There is a
small circumferential pericardial effusion without evidence of
hemodynamic compromise.
IMPRESSION: Suboptimal image quality. Small circumferential
pericardial effusion. Normal biventricular cavity sizes with
preserved global biventricular systolic function.

Brief Hospital Course:
# UTI:  Pt grew 10-100,000 ecoli from urine and had suprapubic
pain. She was treated c 7d course of ceftriaxone.  Blood
cultures from [**4-10**] were negative. Pt was started on suppressive
abx with bactrim ss daily as her family feels that her frequent
UTIs are interfering with her happiness. BLOOD CULTURES FROM
[**4-13**] WERE PENDING AT THE TIME OF DISCHARGE, BUT NO GROWTH TO
DATE.
.
# pleural effusions/O2 req: Felt to be most likely [**12-30**] CHF,
though diastolic dysfunction is relatively mild. Pt could have
PE which can cause pleural effusions, however, that seems less
likely in setting of therapeutic INR. Pt did have chest CT to
r/o which large tumor or pneumonia, which was negative for both.
Thoracentesis was discussed with family and the risks and
benefits shared with them. Both family ([**Doctor First Name **]) and MDs agreed
that risks outweighed the benefits in this elderly lady in whom
the most likely dx remains CHF. Pt was diuresed with lasix and
4doses of acetazolamide and was breathing comfortable on room
air on discharge.
.
# pericardial effusion: noted incidentally on CT. Further
evaluated with TTE which showed only a small effusion.
.
# Acute on Chronic diastolic heart failure:  Patient felt to be
mildly volume overloaded on admission and throughout her stay.
She was diuresed with lasix 60IV [**Hospital1 **] and acetozolamide added as
her bicarbonate approached 40. Pt was able to breathe
comfortably on RA though she did still have occasional crackles
at the bases of her lungs as well as LE edema on discharge. Her
home lasix regimen was increased from 40BID to 60BID (PO). HER
VOLUME STATUS WILL NEED TO BE MONITORED CAREFULLY ON DISCHARGE
IN SETTING OF HIGHER LASIX DOSE.
.
# low grade fevers/mild leukocytosis: pt had several fevers in
the 100-100.5 range throughout admission, even after initiation
of ceftriaxone for UTI. Pt had BCx, chest xray, chest CT and abd
CT as well as repeat UA/UCx, none of which showed a source of
infection. Pt had been afebrile x48h at the time of discharge
and WBC count was 10. C diff toxin was not sent as pt did not
have diarrhea and WBC count improved without intervention. If pt
develops loose stool at rehab, would consider check diff toxin.
.
# abd pain- Pt had abd pain on admission felt to be most c/w
UTI. She did have CT in ED which did not show e/o diverticulitis
or other acute process. This pain resolved by HD2 c treatment of
UTI.
.
# Bradycardia on admission:  EKG showed paced rhythm, recent PPM
interrogation was normal in [**Hospital1 18**] records. HR increased to
60s-70s throughout most of her admission.
.
# [**Name (NI) 1568**] Initially pt's home glipizide and metformin held and pt
maintained on HISS. Glipizide and metformin restarted on
discharge.
.
# Dementia: Continued aricept
.
# h/o PE- continued coumadin.
.
# thyroid nodule: noted incidentally on ct chest, partially
calcified. Could consider further w/u if seems c/w overall
clinical picture.

Medications on Admission:
- Glipizide ER 10mg daily
- Fluticasone nasal spray 50mcg each nostril [**Hospital1 **]
- Metformin ER 500mg daily
- Metoprolol 12.5mg [**Hospital1 **]
- Zocor 40mg daily
- Prozac 20mg QHS
- Acetaminophen 1gm [**Hospital1 **]
- Aspirin 81mg daily
- Coumadin 5mg 5 days/wk then 2mg 2 days/wk
- Aricept 5mg daily
- Lasix 40mg [**Hospital1 **]
- Multivitamin with minerals daily
- Senna QHS


Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
4. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
5. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

6. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
7. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily). Tablet(s)
8. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1)
Spray Nasal [**Hospital1 **] (2 times a day).
9. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
10. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
11. Glipizide 10 mg Tablet Extended Rel 24 hr Sig: One (1)
Tablet Extended Rel 24 hr PO once a day.
12. Lasix 40 mg Tablet Sig: 1.5 Tablets PO twice a day.
13. Metformin 500 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO once a day.
14. Coumadin 5 mg Tablet Sig: One (1) Tablet PO 5 days per week.

15. Coumadin 2 mg Tablet Sig: One (1) Tablet PO the other 2 days
per week.
16. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1)  Inhalation Q6H (every 6 hours) as
needed for shortness of breath or wheezing.
17. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1)
PO DAILY (Daily) as needed for constipation.
18. Sulfamethoxazole-Trimethoprim 400-80 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily): for suppression, continue indefinitely.



Discharge Disposition:
Extended Care

Facility:
[**Hospital **] [**Hospital **] Nursing Home - [**Location (un) **]

Discharge Diagnosis:
PRIMARY: diastolic dysfunction c acute exacerbation, UTI


Discharge Condition:
Mental Status: Confused - always.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
It was a pleasure taking care of you during your admission at
[**Hospital1 69**]. You were admitted for a
urinary tract infection. You were treated with antibiotics. You
also had some extra fluid in your lungs for which you got some
extra lasix. Initially you needed oxygen but you were able to
breathe ok without the oxygen by the time you were discharged.

We have changed some of your medications during your admission
and we will communicate these to your nursing home. In brief, we
have increased your lasix dose and we have started you on an
antibiotic to take every day to try to prevent urinary tract
infections.

Followup Instructions:
You have the following appointment that we arranged for you for
the lesion on your face:
Department: DERMATOLOGY
When: MONDAY [**2122-6-22**] at 2:15 PM
With: [**Name6 (MD) 6821**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 1971**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**Name6 (MD) 251**] [**Name8 (MD) **] MD [**MD Number(1) 910**]

Completed by:[**2122-4-21**]
{'Urinary tract infection, site not specified,Acute on chronic diastolic heart failure,Unspecified disease of pericardium,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Other specified cardiac dysrhythmias,Esophageal reflux,Venous (peripheral) insufficiency, unspecified,Unspecified essential hypertension,Personal history of malignant neoplasm of large intestine,Personal history of other malignant neoplasm of skin,Other persistent mental disorders due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: lethargy

PRESENT ILLNESS: Ms. [**Known lastname 72502**] is a [**Age over 90 **] yo F/ w/ h/o GERD, venous insufficiency,
HTN, DM and recurrent UTIs who presents from [**Hospital1 1501**] with 2 days of
weakness and lethargy. Patient was also noted to have
bradycardia to upper 40-50s, and there was concern for pacemaker
dysfunction. Of note, the pt had a recent admission from [**2122-3-15**]
to [**2122-3-18**] for fever and AMS and was treated for a UTI.
.
At patient's [**Hospital1 1501**], noted to have R sided crackles, 88% RA,
baseline 93% or greater, pulse- 48-50. The NP had thought pt had
lower limit of pacer of 60 (leading her to question if the pacer
was fuctioning poorly) but pt has had pulses in 50s consistently
in past here. concerned about pacemaker function. Last
telephonic interrogation was reportedly normal on [**2122-3-25**]. NP
also confirmed pt's son and HCP wanted the pt full code
.
In our ED, the pt was oriented x2, pleasant but poor historian.
RA sat 88%. EKG was paced and c/w prior EKGs also paced at 50s.
The pt had a CXR with pleural effusions. CT abdomen was
performed for abd tenderness which showed ?appendicitis. Surgery
was consulted in the ED and thought the pt's suprapubic
tenderness was c/w UTI. Pt also had a pericardial effusion on CT
abd and cards was called but was not impressed. TTE [**4-11**] showed
small pericardial effusion. She was given levofloxacin given
inability to rule out pneumonia hidden by pleural effusions. Pt
was also noted to have a UTI. In the [**Name (NI) **], pt was noted to have
poor UOP from foley while getting 75 D5NS/hr. The pt's HCP was
not contact[**Name (NI) **] while the pt was in the [**Name (NI) **]. On transfer from the
ED, vitals were: T 98.1 P 50 paced BP 129/52 R 17 O2 sat 98% on
2l NC. 2 peripheral IVs were placed in the ED.
.
In the ICU, patient was monitored overnight. Patient was very
stable, remained bradycardic, recent interogation of pacer
showed it was working normally. Patient's abx was changed to
ceftriaxone based on prior sensitivities, urine sensitivities
pending. Patient's course was uneventful and was called out to
the floor.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, headache, cough, shortness of breath,
chest pain, nausea, vomiting, diarrhea, constipation.
.

MEDICAL HISTORY: Past Medical History:
Dizziness
GERD
Venous insufficiency
h/o skin cancer
h/o colon cancer
dyspepsia
HTN
DM
Osteoarthritis
Depression
Hyperlipidemia
Chronic recurrent UTIs

MEDICATION ON ADMISSION: - Glipizide ER 10mg daily
- Fluticasone nasal spray 50mcg each nostril [**Hospital1 **]
- Metformin ER 500mg daily
- Metoprolol 12.5mg [**Hospital1 **]
- Zocor 40mg daily
- Prozac 20mg QHS
- Acetaminophen 1gm [**Hospital1 **]
- Aspirin 81mg daily
- Coumadin 5mg 5 days/wk then 2mg 2 days/wk
- Aricept 5mg daily
- Lasix 40mg [**Hospital1 **]
- Multivitamin with minerals daily
- Senna QHS

ALLERGIES: Benzodiazepines / Nsaids

PHYSICAL EXAM: VS:99.2, 108/60, 70, 27, 99%2LNC
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Bilateral rales
CV: Regular rate and rhythm, normal S1 + S2
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
Ext: +2 BLE edema

FAMILY HISTORY: Family History: Unknown

SOCIAL HISTORY: Social History:
Lives at nursing home
Nonweight bearing
Incontinent of urine and stool 

### Response:
{'Urinary tract infection, site not specified,Acute on chronic diastolic heart failure,Unspecified disease of pericardium,Depressive disorder, not elsewhere classified,Other and unspecified hyperlipidemia,Cardiac pacemaker in situ,Other specified cardiac dysrhythmias,Esophageal reflux,Venous (peripheral) insufficiency, unspecified,Unspecified essential hypertension,Personal history of malignant neoplasm of large intestine,Personal history of other malignant neoplasm of skin,Other persistent mental disorders due to conditions classified elsewhere,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}
