CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: Ms. [**Known lastname 9449**] is an 82 y/o lady with a history of severe aortic
stenosis ([**Location (un) 109**] 0.7, transvalvular peak gradient 77mmHg, mean
54mmHg on echo from [**7-/2121**]), ulcerative colitis, breast cancer
in [**2109**], presented to ED on [**2121-8-20**] with worsening dyspnea, SOB,
dry cough, chills, and a fast heart rate. Over the past 2 weeks
she has been having worsening SOB and orthopnea. She denies
chest pain, syncope, or edema. No sick contacts or recent
hospital admissions.
.
She was diagnosed with moderate AS in [**2118**], she saw her
cardiologist in [**6-/2121**] for occasional shortness of breath with
exertion (ie climbing an incline with groceries). Repeat echo
showed severe AS (valve area 0.7) and mild AR. She had follow up
appt with cardiologist recently where findings from echo were
reviewed. At that appt, she was noted to have frequent PACs and
there was concern that this may be precurser for A fib. He
recommended cardiac surgery evaluation.
.
In the ED, initial vitals were T 101.4, HR 58, 117/54, RR 20,
97%2L
Labs and imaging significant for: WBC 13.4, HCT 34, PLT 580,
lactate 1.0.  She received Levofloxacin 750mg and tylenol
1000mg.  CXR significant for LUL and RLL pneumonia and
hyperexpanded lungs consistent with underlying emphysema.
Vitals on transfer to unit were Temp 36.9 P 134, BP 125/78, RR
29 92% on 3 L
.
REVIEW OF SYSTEMS
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, hemoptysis, black stools
or red stools. All of the other review of systems were negative.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: -Diabetes, +Dyslipidemia, +Hypertension

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientAtriuswebOMR.
1. Losartan Potassium 50 mg PO DAILY
2. Simvastatin 10 mg PO HS
3. Mesalamine 800 mg PO TID
4. Multivitamins 1 TAB PO DAILY
5. Aspirin 81 mg PO DAILY
6. Vitamin B Complex 1 CAP PO DAILY

ALLERGIES: Sulfanilamide / lisinopril / Penicillins

PHYSICAL EXAM: On admission:
VS: Temp 36.9 P 134, BP 125/78, RR 29 92% on 3 L
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother CAD, [**Name2 (NI) 499**] C, PVD.  Father died at 69 of [**Last Name (un) 6722**] cause.
[**Name (NI) **] brother with congenital heart disease.

SOCIAL HISTORY: retired, independent in ADLs, lives with son and daughter in law
in 2 story house
-Tobacco history: former smoker 80 pack years quit 20 years ago
Atrial fibrillation,Pneumonia, organism unspecified,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Acute on chronic diastolic heart failure,Hyposmolality and/or hyponatremia,Intestinal infection due to Clostridium difficile,Aortic valve disorders,Personal history of malignant neoplasm of breast,Other emphysema,Osteoporosis, unspecified,Chronic kidney disease, Stage III (moderate),Personal history of tobacco use,Personal history of other diseases of digestive system,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Examination of participant in clinical trial,Anemia, unspecified
Atrial fibrillation,Pneumonia, organism NOS,Acute respiratry failure,Ac kidny fail, tubr necr,Ac on chr diast hrt fail,Hyposmolality,Int inf clstrdium dfcile,Aortic valve disorder,Hx of breast malignancy,Emphysema NEC,Osteoporosis NOS,Chr kidney dis stage III,History of tobacco use,Prsnl hst ot spf dgst ds,Hy kid NOS w cr kid I-IV,Exam-clincal trial,Anemia NOS
Admission Date:  [**2121-8-20**]              Discharge Date:   [**2121-9-4**]

Date of Birth:  [**2039-8-5**]             Sex:   F

Service: MEDICINE

Allergies:
Sulfanilamide / lisinopril / Penicillins

Attending:[**First Name3 (LF) 2265**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Ms. [**Known lastname 9449**] is an 82 y/o lady with a history of severe aortic
stenosis ([**Location (un) 109**] 0.7, transvalvular peak gradient 77mmHg, mean
54mmHg on echo from [**7-/2121**]), ulcerative colitis, breast cancer
in [**2109**], presented to ED on [**2121-8-20**] with worsening dyspnea, SOB,
dry cough, chills, and a fast heart rate. Over the past 2 weeks
she has been having worsening SOB and orthopnea. She denies
chest pain, syncope, or edema. No sick contacts or recent
hospital admissions.
.
She was diagnosed with moderate AS in [**2118**], she saw her
cardiologist in [**6-/2121**] for occasional shortness of breath with
exertion (ie climbing an incline with groceries). Repeat echo
showed severe AS (valve area 0.7) and mild AR. She had follow up
appt with cardiologist recently where findings from echo were
reviewed. At that appt, she was noted to have frequent PACs and
there was concern that this may be precurser for A fib. He
recommended cardiac surgery evaluation.
.
In the ED, initial vitals were T 101.4, HR 58, 117/54, RR 20,
97%2L
Labs and imaging significant for: WBC 13.4, HCT 34, PLT 580,
lactate 1.0.  She received Levofloxacin 750mg and tylenol
1000mg.  CXR significant for LUL and RLL pneumonia and
hyperexpanded lungs consistent with underlying emphysema.
Vitals on transfer to unit were Temp 36.9 P 134, BP 125/78, RR
29 92% on 3 L
.
REVIEW OF SYSTEMS
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, hemoptysis, black stools
or red stools. All of the other review of systems were negative.

.
Cardiac review of systems is notable for absence of chest pain,
syncope or presyncope.

Past Medical History:
1. CARDIAC RISK FACTORS: -Diabetes, +Dyslipidemia, +Hypertension

2. CARDIAC HISTORY:
Aortic stenosis, [**Location (un) 109**] 0.7, transvalvular peak gradient 77mmHg,
mean 54mmHg on echo from [**7-/2121**]
Mild AR
3. OTHER PAST MEDICAL HISTORY:
CKD stage 3 (cr 1.1-1.4)
Breast CA, in remission
Osteoporosis
Ulcerative colitis

Social History:
retired, independent in ADLs, lives with son and daughter in law
in 2 story house
-Tobacco history: former smoker 80 pack years quit 20 years ago

-ETOH:  4 oz /week
-Illicit drugs:  denies

Family History:
Mother CAD, [**Name2 (NI) 499**] C, PVD.  Father died at 69 of [**Last Name (un) 6722**] cause.
[**Name (NI) **] brother with congenital heart disease.

Physical Exam:
On admission:
VS: Temp 36.9 P 134, BP 125/78, RR 29 92% on 3 L
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 10 cm.
CARDIAC:Irregular rhythm, normal S1, soft S2. Late III/VI
systolic murmur at RUSB radiating to back and carotids. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. Occasional pursed lip
breathing.  Decreased B/S in RLL, Rare expiratory wheeze.  No
crackles.
ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.

EXTREMITIES: No c/c/e.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+

On discharge:
98.2 90/35mmHg P70 RR18  95%RA
GA: A&Ox3, pleasant
HEENT: MMM, EOMI, PERRL
CV: irregular rhythm, 3/6 systolic murmur at RUSB, no rubs or
gallops
Pulm: trace bibasilar crackles, no wheezes or rhonchi
Abd: soft, NTND, no HSM
Ext: no peripheral edema, full pulses throughout
Skin: warm, dry

Pertinent Results:
[**2121-8-20**] 01:30PM   PLT COUNT-580*
[**2121-8-20**] 01:30PM   NEUTS-91.4* LYMPHS-4.8* MONOS-3.3 EOS-0.2
BASOS-0.3
[**2121-8-20**] 01:30PM   WBC-13.5* RBC-3.66* HGB-11.3* HCT-34.1*
MCV-93 MCH-30.8 MCHC-33.1 RDW-13.1
[**2121-8-20**] 01:30PM   TSH-2.9
[**2121-8-20**] 01:30PM   estGFR-Using this
[**2121-8-20**] 01:30PM   GLUCOSE-180* UREA N-25* CREAT-1.2* SODIUM-134
POTASSIUM-5.0 CHLORIDE-98 TOTAL CO2-25 ANION GAP-16
[**2121-8-20**] 02:10PM   LACTATE-1.0
[**2121-8-20**] 02:10PM   TYPE-[**Last Name (un) **] COMMENTS-GREEN TOP
[**2121-8-20**] 02:20PM URINE  HYALINE-1*
[**2121-8-20**] 02:20PM URINE  RBC-1 WBC-15* BACTERIA-FEW YEAST-NONE
EPI-2 TRANS EPI-1
[**2121-8-20**] 02:20PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-MOD
[**2121-8-20**] 02:20PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.010
[**2121-8-20**] 02:20PM URINE  UHOLD-HOLD
[**2121-8-20**] 02:20PM URINE  HOURS-RANDOM
[**2121-8-20**] 02:51PM   PT-11.4 PTT-25.8 INR(PT)-1.1
[**2121-8-20**] 06:12PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2121-8-20**] 06:12PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.003
[**2121-8-20**] 10:10PM   PTT-105.7*
.
EKG:  Afib with RVR HR 150
.
2D-ECHOCARDIOGRAM ([**7-/2121**]):
CONCLUSIONS
1. Frequent atrial premature beats.
2. There is mild concentric left ventricular hypertrophy.
3. Tissue and transmitral Doppler demonstrate pseudonormal
filling (moderate grade II diastolic dysfunction).
4. The left atrial volume is moderately increased.
5. There is severe aortic stenosis present, with a calculated
valve area of 0.7cm2.
6. Compared with the findings of the prior report of [**6-/2121**],
the measured gradients are a little higher, resuling in a
slightly lower calculated aortic valve area.
.
ECHO [**8-22**]:
The left atrium is normal in size. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal/small. Overall left ventricular systolic function is
normal (LVEF 60%). Right ventricular chamber size and free wall
motion are normal. The aortic valve leaflets are moderately
thickened. There is critical aortic valve stenosis (valve area
0.5 cm2) (may represent an entity known as "low flow/low
gradient aortic stenosis with preserved ejection fraction").
Mild to moderate ([**12-9**]+) aortic regurgitation is seen. The mitral
valve leaflets are mildly thickened. There is no mitral valve
prolapse. Mild to moderate ([**12-9**]+) mitral regurgitation is seen.
[Due to acoustic shadowing, the severity of mitral regurgitation
may be significantly UNDERestimated.] The tricuspid valve
leaflets are mildly thickened. The supporting structures of the
tricuspid valve are thickened/fibrotic. There is moderate
pulmonary artery systolic hypertension. Significant pulmonic
regurgitation is seen. There is no pericardial effusion.

Discharge:
[**2121-9-4**] 08:50AM BLOOD WBC-6.5 Hct-30.6*
[**2121-9-4**] 08:50AM BLOOD Glucose-147* UreaN-28* Creat-1.5* Na-134
K-4.7 Cl-99 HCO3-25 AnGap-15

Brief Hospital Course:
82F history of critical aortic stenosis ([**Location (un) 109**] 0.7, transvalvular
peak gradient 77mmHg, mean 54mmHg on echo from [**7-/2121**]), IBD,
breast cancer in remission, presenting with SOB, found to have
new atrial fibrillation with RVR, hypotension, and pneumonia.
.
# Pneumonia: Shortness of breath with decreased O2 sat at 88%,
fever (Tmax of 101.4) and chest x-ray consistent with LUL PNA.
Initially thought to be community-acquired PNA.  However,
patient continued to be hypoxic after treatment with
levofloxacin.  Therefore, pulmonology was consulted, and they
recommended broadening with vancomycin and cefepime, which were
eventually stopped.  On [**8-28**], she completed an 8-day course of
levofloxacin for CAP.  Sputum and blood cultures did not grow
any organisms.
.
# New AFIB with RVR: Etiology was thought to be pneumonia or
valvular (aortic) disease.  Given hypotension, diltiazem and
metoprolol were not in itially considered, and she was started
on amiodarone with an understanding of the thromboemoblic risk
of chemical cardioversion.  Metoprolol was started on [**8-28**] when
BP would tolerate. Her CHADS2 score was 3, and she was started
on heparin drip. In preparation for discharge, pt started on
Lovenox, renally dosed. On discharge, rhythm still in atrial
fibrillation, hemodynamically stable. Pt discharged with
amiodarone, Lovenox 40mg SC daily and stopped aspirin in
preparation for cardiac surgery in near future.
.
# Aortic Stenosis: Critical with valve area of 0.7 cm^2, she has
had gradual onset dypsnea per her outpatient cardiology notes,
which is likely associated with her valvular disease.  Initially
denied angina and syncope/presyncope, but had an episode of
syncope during the hospitalization on [**8-26**]; at that time,
further questioning revealed that patient may have had episodes
of syncope/presyncope at home.  Case was discussed with cardiac
surgery who recommended optimization of pneumonia and atrial
fibrillation treatment prior to surgery.  In preparation for
surgery, she underwent catheterization on [**8-28**], which showed
minimal coronary artery disease.  Aortic valve replacement
surgery scheduling will be discussed at [**9-17**] appt with
Dr. [**Last Name (STitle) **].

# C.diff colitis: The patient developed diarrhea. Stool studies
were sent which showed C. Diff positive. The patient was started
on flagyl 500mg q8h on [**9-2**] for 2 week course. At time of
discharge, diarrhea improved.

# Hyperlipidemia: Simvastatin was continued.
.
# Blood Pressure: Patient has a history of hypertension, but was
hypotensive when she presented, likely due to the atrial
fibrillation with RVR.  Home losartan was held throughout
hospital course as pressures were 90s to low 100s.  Pt
discharged with metoprolol and instructed to no longer take home
Losartan.
.

Transitional Issues:
-Pt is to followup with C-[**Doctor First Name **] on [**9-17**] with Dr [**Last Name (STitle) **]
[**Name (STitle) 30412**] is to followup with PCP Dr [**Last Name (STitle) **] on [**9-8**].
-Pt is to have C.diff stool PCR/toxin rechecked 2 weeks after
finishing 2 wk course of Flagyl
-Spiculated RUL Nodule: Seen on Chest CT.  Should be followed up
with repeat CT.
# CODE:  Full code confirmed
# EMERGENCY CONTACT:  daughter


Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from PatientAtriuswebOMR.
1. Losartan Potassium 50 mg PO DAILY
2. Simvastatin 10 mg PO HS
3. Mesalamine 800 mg PO TID
4. Multivitamins 1 TAB PO DAILY
5. Aspirin 81 mg PO DAILY
6. Vitamin B Complex 1 CAP PO DAILY


Discharge Medications:
1. Mesalamine 800 mg PO TID
2. Multivitamins 1 TAB PO DAILY
3. Simvastatin 10 mg PO HS
4. Vitamin B Complex 1 CAP PO DAILY
5. Enoxaparin Sodium 40 mg SC DAILY
RX *enoxaparin 40 mg/0.4 mL one syringe daily Disp #*10 Syringe
Refills:*2
6. Metoprolol Succinate XL 50 mg PO DAILY
RX *metoprolol succinate 50 mg one tablet(s) by mouth daily Disp
#*30 Tablet Refills:*0
7. MetRONIDAZOLE (FLagyl) 500 mg PO Q8H
RX *metronidazole 500 mg one tablet(s) by mouth three times a
day Disp #*36 Tablet Refills:*0
8. Amiodarone 200 mg PO DAILY
RX *amiodarone 200 mg one tablet(s) by mouth daily Disp #*30
Tablet Refills:*0


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Severe Aortic stenosis
C Difficile colitis
Hypertension
Atrial fibrillation
Acute on Chronic kidney injury
Delerium
Community axquired pneumonia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
Dear Ms. [**Known lastname 9449**],

It was a pleasure taking care of you at [**Hospital1 18**]. You had a
pneumonia and was treated with antibiotics. During this time,
your aortic stenosis was causing you to retain fluid and you
needed diuretics to remove the extra fluid. You will need
surgery to fix the aortic stenosis. We found that the diarrhea
was from an infection called c difficile and you are on a 14 day
course of antibiotics to treat this. Dr. [**Last Name (STitle) **] wants to know
that this infection is cured before he performs surgery so Dr.
[**Last Name (STitle) **] will arrange for another test of your stool to be sent
after the antibiotics are finished.

Your heart developed an irregular rhythm called atrial
fibrillation. This rhythm puts you at increased risk of a stroke
so you are on Lovenox, a blood thinner, to prevent blood clots.
You will need to have your daughter give you the injection of
lovenox every day while you are at home.

You will need to save a stool sample after the flagyl is
finished to see if the C. difficile infection is gone. Dr. [**Last Name (STitle) **]
will help you with this.

You should also stop your aspirin in preparation for your aortic
valve replacement in the near future.

Followup Instructions:
Department: CARDIAC SURGERY
When: WEDNESDAY [**2121-9-17**] at 2:30pm
With: [**Name6 (MD) **] [**Name8 (MD) 6144**], MD [**Telephone/Fax (1) 170**]
Building: LM [**Hospital Unit Name **] [**Location (un) 551**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
.
Name:[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]  [**Name8 (MD) **], MD
When: Monday [**9-8**] st at 12:10
Location: [**Hospital1 641**]
Address: [**Street Address(2) 642**], [**Location (un) **],[**Numeric Identifier 643**]
Phone: [**Telephone/Fax (1) 88505**]


                             [**First Name8 (NamePattern2) **] [**Name8 (MD) 162**] MD [**MD Number(2) 2273**]
{'Atrial fibrillation,Pneumonia, organism unspecified,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Acute on chronic diastolic heart failure,Hyposmolality and/or hyponatremia,Intestinal infection due to Clostridium difficile,Aortic valve disorders,Personal history of malignant neoplasm of breast,Other emphysema,Osteoporosis, unspecified,Chronic kidney disease, Stage III (moderate),Personal history of tobacco use,Personal history of other diseases of digestive system,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Examination of participant in clinical trial,Anemia, unspecified'}


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: Shortness of breath

PRESENT ILLNESS: Ms. [**Known lastname 9449**] is an 82 y/o lady with a history of severe aortic
stenosis ([**Location (un) 109**] 0.7, transvalvular peak gradient 77mmHg, mean
54mmHg on echo from [**7-/2121**]), ulcerative colitis, breast cancer
in [**2109**], presented to ED on [**2121-8-20**] with worsening dyspnea, SOB,
dry cough, chills, and a fast heart rate. Over the past 2 weeks
she has been having worsening SOB and orthopnea. She denies
chest pain, syncope, or edema. No sick contacts or recent
hospital admissions.
.
She was diagnosed with moderate AS in [**2118**], she saw her
cardiologist in [**6-/2121**] for occasional shortness of breath with
exertion (ie climbing an incline with groceries). Repeat echo
showed severe AS (valve area 0.7) and mild AR. She had follow up
appt with cardiologist recently where findings from echo were
reviewed. At that appt, she was noted to have frequent PACs and
there was concern that this may be precurser for A fib. He
recommended cardiac surgery evaluation.
.
In the ED, initial vitals were T 101.4, HR 58, 117/54, RR 20,
97%2L
Labs and imaging significant for: WBC 13.4, HCT 34, PLT 580,
lactate 1.0.  She received Levofloxacin 750mg and tylenol
1000mg.  CXR significant for LUL and RLL pneumonia and
hyperexpanded lungs consistent with underlying emphysema.
Vitals on transfer to unit were Temp 36.9 P 134, BP 125/78, RR
29 92% on 3 L
.
REVIEW OF SYSTEMS
On review of systems, she denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, hemoptysis, black stools
or red stools. All of the other review of systems were negative.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: -Diabetes, +Dyslipidemia, +Hypertension

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientAtriuswebOMR.
1. Losartan Potassium 50 mg PO DAILY
2. Simvastatin 10 mg PO HS
3. Mesalamine 800 mg PO TID
4. Multivitamins 1 TAB PO DAILY
5. Aspirin 81 mg PO DAILY
6. Vitamin B Complex 1 CAP PO DAILY

ALLERGIES: Sulfanilamide / lisinopril / Penicillins

PHYSICAL EXAM: On admission:
VS: Temp 36.9 P 134, BP 125/78, RR 29 92% on 3 L
GENERAL: WDWN in NAD. Oriented x3. Mood, affect appropriate.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother CAD, [**Name2 (NI) 499**] C, PVD.  Father died at 69 of [**Last Name (un) 6722**] cause.
[**Name (NI) **] brother with congenital heart disease.

SOCIAL HISTORY: retired, independent in ADLs, lives with son and daughter in law
in 2 story house
-Tobacco history: former smoker 80 pack years quit 20 years ago 

### Response:
{'Atrial fibrillation,Pneumonia, organism unspecified,Acute respiratory failure,Acute kidney failure with lesion of tubular necrosis,Acute on chronic diastolic heart failure,Hyposmolality and/or hyponatremia,Intestinal infection due to Clostridium difficile,Aortic valve disorders,Personal history of malignant neoplasm of breast,Other emphysema,Osteoporosis, unspecified,Chronic kidney disease, Stage III (moderate),Personal history of tobacco use,Personal history of other diseases of digestive system,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Examination of participant in clinical trial,Anemia, unspecified'}
