CHIEF COMPLAINT: Syncope

PRESENT ILLNESS: Mr [**Known lastname 24110**] is a 76 y/o M with a history of multiple sclerosis,
paroxysmal atrial fibrillation on aspirin and [**Known lastname 4532**],
hypertension, hyperlipidemia, previously diagnosed "vasovagal
syncope," prostate cancer, neurogenic bladder with chronic
suprapubic cath, history of ESBL UTI, chronic constipation, and
left parietal AVM, presenting from home after a syncopal
episode.  Patient apparently woke up this morning feeling
extremely weak and tired.  Per his wife, he was also difficult
to arouse with multiple episodes of somnolence.  EMS was called
in the morning, but patient refused to be taken to the hospital
as he felt well by their arrival.  Patient was then eating a
bowl of fruit this afternoon, and his wife found him slumped in
a chair.  He regained conciousness several minutes later. EMS
was subsequently called again.  Patient has no recollection of
passing out, nor did he feel any prodrome of chest pain, nausea,
diaphoresis, SOB, dizziness.  On EMS arrival, HR 30s BP 70s, and
patient was asymptomatic.
.
On arrival to the ED, HR was in the 30s-40s, BPs labile
80s-120s.  Patient had no symptoms during low BPs. He was given
IV cipro for history of UTI, 2L NS and sent to the unit.  His
Hct was 26 and was guiac negative in the ED.  On transfer to the
unit, patient was afebrile HR 44, 114/49 18 100% on 2L NC.
.
Of note, patient had been admitted in [**Month (only) **] for a similar
episode of unresponsiveness with a negative workup, as well as
prior synopal workups in the past.  He reports that todays
episode was similar in nature in that he did not feel any
prodrome and did not remember passing out.  He also has had
several episodes of diagnosed "vasovagal syncope," prior to
which he sometimes feels weak and nauseous. On review of prior
notes, patient is also chronically bradycardic with HRs in 40s
at [**Month (only) 5348**], with transient episodes of hypotension.  He has a
Holter monitor in our system from [**2141**], which showed no ectopy,
HRs 49-70, with prolonged PR intervals .24.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, bleeding at the time of surgery,
myalgias, joint pains, cough, hemoptysis, black stools or red
stools. Of note, he had a EGD/colonoscopy on [**11-11**] for workup of
Fe deficiency anemia, which showed a non-bleeding adenoma.  He
denies recent fevers, chills or rigors. He denies exertional
buttock or calf pain. His last bowel movement was 1.5 weeks ago,
whichg he states is roughly his [**Month/Year (2) 5348**].  All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG:
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
1. Multiple sclerosis - followed by Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**] at [**Hospital1 2025**].
2. Neurogenic bladder - suprapubic catheter in place; followed
by Dr. [**Last Name (STitle) 9125**].
3. Hypertension
4. Severe constipation - followed by Dr. [**Last Name (STitle) 10689**].
5. Glaucoma
6. Prostate cancer - s/p hormonal therapy and radiation. He has
been pursuing watchful waiting since the Spring [**2149**]. He is
followed at the [**Hospital3 328**] Cancer Institute.
7. Pneumonia
8. Cellulitis
9. Osteoarthritis
10. Hyperlipidemia
11. Depression
12. History of AVM in the left parietal lobe
13. Obstructive sleep apnea utilizing CPAP at night
14. Peripheral neuropathy
15. Thoracic outlet syndrome
16. PE - [**3-21**]
17. Gastroesophageal reflux disease
18. History of MRSA
19. History of left foot fracture
21. Osteopenia
22. Atrial Fibrillation on [**Month/Year (2) **]
22. Shingles - [**2151**]

MEDICATION ON ADMISSION: - Amlodipine 7.5 mg daily
- Baclofen 20 mg qhs
- Brimonidine .1% drops TID
- [**Known lastname **] 75 mg daily
- Darifenacin 7.5 mg daily
- Dorzolamide-timolol 1 drop TID
- Enalapril 20 mg [**Hospital1 **]
- Latanoprost 1 drop qhs
- Macrobid 100 mg daily one out of 3 weeks
- Omeprazole 40 mg [**Hospital1 **]
- Peg-electrolyte solution 420 1 bottle daily
- Simvastatin 10 mg qhs
- Aspirin 325 mg daily
- Calcium 600 mg + D daily
- Cascara
- Colace
- Multivitamin
- Omega-3 fatty acids

ALLERGIES: Morphine / Coumadin

PHYSICAL EXAM: VS: T= 97 BP= 108/57 HR= 44 RR= 12 O2 sat= 100% RA
GENERAL: 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: Per notes, daughter and cousin with MS, mother with AD, father
with leukemia, brother with arrhythmia.

SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Former etoh, sober since [**2123**] via
AA. Quit cigars a few years ago. Retired judge (at age 68 due to
fatigue).
Syncope and collapse,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Multiple sclerosis,Neurogenic bladder NOS,Other constipation,Personal history of malignant neoplasm of prostate,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Syncope and collapse,Urin tract infection NOS,Atrial fibrillation,Hypertension NOS,Hyperlipidemia NEC/NOS,Multiple sclerosis,Neurogenic bladder NOS,Constipation NEC,Hx-prostatic malignancy,DMII wo cmp nt st uncntr
Admission Date:  [**2153-11-18**]              Discharge Date:   [**2153-11-20**]

Date of Birth:  [**2077-7-1**]             Sex:   M

Service: MEDICINE

Allergies:
Morphine / Coumadin

Attending:[**First Name3 (LF) 7881**]
Chief Complaint:
Syncope

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr [**Known lastname 24110**] is a 76 y/o M with a history of multiple sclerosis,
paroxysmal atrial fibrillation on aspirin and [**Known lastname 4532**],
hypertension, hyperlipidemia, previously diagnosed "vasovagal
syncope," prostate cancer, neurogenic bladder with chronic
suprapubic cath, history of ESBL UTI, chronic constipation, and
left parietal AVM, presenting from home after a syncopal
episode.  Patient apparently woke up this morning feeling
extremely weak and tired.  Per his wife, he was also difficult
to arouse with multiple episodes of somnolence.  EMS was called
in the morning, but patient refused to be taken to the hospital
as he felt well by their arrival.  Patient was then eating a
bowl of fruit this afternoon, and his wife found him slumped in
a chair.  He regained conciousness several minutes later. EMS
was subsequently called again.  Patient has no recollection of
passing out, nor did he feel any prodrome of chest pain, nausea,
diaphoresis, SOB, dizziness.  On EMS arrival, HR 30s BP 70s, and
patient was asymptomatic.
.
On arrival to the ED, HR was in the 30s-40s, BPs labile
80s-120s.  Patient had no symptoms during low BPs. He was given
IV cipro for history of UTI, 2L NS and sent to the unit.  His
Hct was 26 and was guiac negative in the ED.  On transfer to the
unit, patient was afebrile HR 44, 114/49 18 100% on 2L NC.
.
Of note, patient had been admitted in [**Month (only) **] for a similar
episode of unresponsiveness with a negative workup, as well as
prior synopal workups in the past.  He reports that todays
episode was similar in nature in that he did not feel any
prodrome and did not remember passing out.  He also has had
several episodes of diagnosed "vasovagal syncope," prior to
which he sometimes feels weak and nauseous. On review of prior
notes, patient is also chronically bradycardic with HRs in 40s
at [**Month (only) 5348**], with transient episodes of hypotension.  He has a
Holter monitor in our system from [**2141**], which showed no ectopy,
HRs 49-70, with prolonged PR intervals .24.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, bleeding at the time of surgery,
myalgias, joint pains, cough, hemoptysis, black stools or red
stools. Of note, he had a EGD/colonoscopy on [**11-11**] for workup of
Fe deficiency anemia, which showed a non-bleeding adenoma.  He
denies recent fevers, chills or rigors. He denies exertional
buttock or calf pain. His last bowel movement was 1.5 weeks ago,
whichg he states is roughly his [**Month/Year (2) 5348**].  All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations.

Past Medical History:
1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG:
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
1. Multiple sclerosis - followed by Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**] at [**Hospital1 2025**].
2. Neurogenic bladder - suprapubic catheter in place; followed
by Dr. [**Last Name (STitle) 9125**].
3. Hypertension
4. Severe constipation - followed by Dr. [**Last Name (STitle) 10689**].
5. Glaucoma
6. Prostate cancer - s/p hormonal therapy and radiation. He has
been pursuing watchful waiting since the Spring [**2149**]. He is
followed at the [**Hospital3 328**] Cancer Institute.
7. Pneumonia
8. Cellulitis
9. Osteoarthritis
10. Hyperlipidemia
11. Depression
12. History of AVM in the left parietal lobe
13. Obstructive sleep apnea utilizing CPAP at night
14. Peripheral neuropathy
15. Thoracic outlet syndrome
16. PE - [**3-21**]
17. Gastroesophageal reflux disease
18. History of MRSA
19. History of left foot fracture
21. Osteopenia
22. Atrial Fibrillation on [**Month/Year (2) **]
22. Shingles - [**2151**]

Social History:
Lives with wife in [**Name (NI) **]. Former etoh, sober since [**2123**] via
AA. Quit cigars a few years ago. Retired judge (at age 68 due to
fatigue).


Family History:
Per notes, daughter and cousin with MS, mother with AD, father
with leukemia, brother with arrhythmia.

Physical Exam:
VS: T= 97 BP= 108/57 HR= 44 RR= 12 O2 sat= 100% RA
GENERAL: 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 6 cm.
CARDIAC: PMI located in 5th intercostal space, midclavicular
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or
S4.
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp
were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Distended, firm.  Hypoactive bowel sounds. Nontender,
no guarding or rebound.
EXTREMITIES: No c/c/e. No femoral bruits.
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+

Pertinent Results:
1. Labs on admission:
[**2153-11-18**] 05:40PM BLOOD WBC-7.8 RBC-3.31* Hgb-8.7* Hct-26.8*
MCV-81*# MCH-26.4* MCHC-32.6 RDW-15.3 Plt Ct-178
[**2153-11-18**] 05:40PM BLOOD PT-14.1* PTT-31.7 INR(PT)-1.2*
[**2153-11-19**] 05:00AM BLOOD Glucose-159* UreaN-16 Creat-0.9 Na-139
K-3.6 Cl-112* HCO3-23 AnGap-8
[**2153-11-19**] 05:00AM BLOOD CK(CPK)-40*
[**2153-11-18**] 05:40PM BLOOD cTropnT-<0.01
[**2153-11-19**] 05:00AM BLOOD CK-MB-3 cTropnT-<0.01
[**2153-11-19**] 05:00AM BLOOD Calcium-8.0* Phos-2.9 Mg-2.0
[**2153-11-18**] 05:54PM BLOOD freeCa-1.08*
.
2. Labs on discharge;
[**2153-11-20**] 05:59AM BLOOD WBC-5.2# RBC-3.80*# Hgb-9.9*# Hct-30.7*#
MCV-81* MCH-26.0* MCHC-32.3 RDW-14.6 Plt Ct-161
[**2153-11-20**] 05:59AM BLOOD Glucose-110* UreaN-17 Creat-0.9 Na-140
K-3.9 Cl-111* HCO3-23 AnGap-10
[**2153-11-20**] 05:59AM BLOOD Calcium-8.6 Phos-3.1 Mg-2.0
.
3. Imaging/diagnostics:
- CXR ([**2153-11-18**]): No acute cardiopulmonary process.
- EKG ([**2153-11-19**]): Sinus bradycardia and A-V conduction delay with
slight shortening of the P-R interval as compared to the
previous tracing of [**2153-11-18**]. The Q-T interval remains prolonged.
No diagnostic interim change.
- Tilt-table test ([**2153-11-20**]): *preliminary finding*: delayed
neurally mediated syncope with orthostatic hypotension, systolic
blood pressure drop from 160s to 60s. Final report to follow.

Brief Hospital Course:
Mr [**Known lastname 24110**] is a 76 y/o M with a history of multiple sclerosis,
paroxysmal atrial fibrillation on aspirin and [**Known lastname 4532**],
hypertension, hyperlipidemia, previously diagnosed "vasovagal
syncope," neurogenic bladder with chronic suprapubic cath,
history of ESBL UTI, chronic constipation, and left parietal
AVM, presenting from home after a syncopal episode.
.
#. Syncope: EKG on admission showed first degree heart block.
Patient did not have any other arrythmia throughout the hospital
course. Symptoms similar to prior vaso-vagal episodes. Tilt
table test was done which showed delayed neurally mediated
syncope with orthostatic hypotension (sBP 160s-->60s). Patient
to follow-up with outpatient cardiologist.
.
#. Atrial Fibrillation: Remained in sinus bradycardia and was
kept on home regimen of aspirin/[**Known lastname 4532**] rather than coumadin in
the context of known AVM.
.
# HTN: Kept on home enalapril. New home [**Known lastname 4085**] amlodipine
was stopped.
.
# HLD: Continue one home simvastatin
.
# Chronic UTI: History of ESBL UTI with suprapubic catheter
site. Urinanalysis on admission was positive and urine culture
grew out E. coli. Speciation at the time of discharge was not
available. Per outpatient urologist, this is consistent with
chronic colonization and will be treated with outpatient
antibiotics regimen by urologist.
.
#. Multiple Sclerosis: Continue baclofen.
.
# Neurogenic bladder: Patient was on oxybutynin while in patient
and discharged with home darifenacin on discharge.
.
#. Constipation: Secondary to neuropathy from MS, chronic
problem. Aggressive bowel regimen administered with effect.
.

Medications on Admission:
- Amlodipine 7.5 mg daily
- Baclofen 20 mg qhs
- Brimonidine .1% drops TID
- [**Known lastname **] 75 mg daily
- Darifenacin 7.5 mg daily
- Dorzolamide-timolol 1 drop TID
- Enalapril 20 mg [**Hospital1 **]
- Latanoprost 1 drop qhs
- Macrobid 100 mg daily one out of 3 weeks
- Omeprazole 40 mg [**Hospital1 **]
- Peg-electrolyte solution 420 1 bottle daily
- Simvastatin 10 mg qhs
- Aspirin 325 mg daily
- Calcium 600 mg + D daily
- Cascara
- Colace
- Multivitamin
- Omega-3 fatty acids

Discharge Medications:
1. brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q8H
(every 8 hours).
2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at
bedtime).
4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO BID (2 times a day).
5. simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
7. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One
(1) Tablet, Chewable PO TID (3 times a day).
8. cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
9. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. enalapril maleate 20 mg Tablet Sig: One (1) Tablet PO once a
day.
11. baclofen 20 mg Tablet Sig: One (1) Tablet PO once a day.
12. darifenacin 7.5 mg Tablet Sustained Release 24 hr Sig: One
(1) Tablet Sustained Release 24 hr PO QHS (once a day (at
bedtime)).
13. carbamide peroxide 6.5 % Drops Sig: 5-10 Drops Otic [**Hospital1 **] (2
times a day) for 4 days.
14. dorzolamide-timolol 2-0.5 % Drops Sig: One (1) Drop
Ophthalmic TID (3 times a day).
15. dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID (3
times a day).
16. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Vasovagal syncope


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid ([**Hospital1 **]
or cane).


Discharge Instructions:
You were seen in the hospital because a syncopal episode.  This
episode was likely secondary due a vasovagal cause. You had a
tilt table test to explore possible causes for your syncopal
episode, which showed a drop in your blood pressure with
tilting.  You will need to follow up with your cardiologist Dr.
[**Last Name (STitle) **] (appointment below) to discuss the final results.
.
We made the following changes to your medications:
STOPPED Amlodipine
.
It was a pleasure taking care of you during your hospital stay.

Followup Instructions:
-You have an appointment scheduled with Dr. [**Last Name (STitle) **]:
Monday [**2153-11-26**] at 11:30 AM

-You should also make a follow up appointment with your PCP [**Last Name (NamePattern4) **].
[**Last Name (STitle) **]



Completed by:[**2153-11-20**]
{'Syncope and collapse,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Multiple sclerosis,Neurogenic bladder NOS,Other constipation,Personal history of malignant neoplasm of prostate,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as 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: Syncope

PRESENT ILLNESS: Mr [**Known lastname 24110**] is a 76 y/o M with a history of multiple sclerosis,
paroxysmal atrial fibrillation on aspirin and [**Known lastname 4532**],
hypertension, hyperlipidemia, previously diagnosed "vasovagal
syncope," prostate cancer, neurogenic bladder with chronic
suprapubic cath, history of ESBL UTI, chronic constipation, and
left parietal AVM, presenting from home after a syncopal
episode.  Patient apparently woke up this morning feeling
extremely weak and tired.  Per his wife, he was also difficult
to arouse with multiple episodes of somnolence.  EMS was called
in the morning, but patient refused to be taken to the hospital
as he felt well by their arrival.  Patient was then eating a
bowl of fruit this afternoon, and his wife found him slumped in
a chair.  He regained conciousness several minutes later. EMS
was subsequently called again.  Patient has no recollection of
passing out, nor did he feel any prodrome of chest pain, nausea,
diaphoresis, SOB, dizziness.  On EMS arrival, HR 30s BP 70s, and
patient was asymptomatic.
.
On arrival to the ED, HR was in the 30s-40s, BPs labile
80s-120s.  Patient had no symptoms during low BPs. He was given
IV cipro for history of UTI, 2L NS and sent to the unit.  His
Hct was 26 and was guiac negative in the ED.  On transfer to the
unit, patient was afebrile HR 44, 114/49 18 100% on 2L NC.
.
Of note, patient had been admitted in [**Month (only) **] for a similar
episode of unresponsiveness with a negative workup, as well as
prior synopal workups in the past.  He reports that todays
episode was similar in nature in that he did not feel any
prodrome and did not remember passing out.  He also has had
several episodes of diagnosed "vasovagal syncope," prior to
which he sometimes feels weak and nauseous. On review of prior
notes, patient is also chronically bradycardic with HRs in 40s
at [**Month (only) 5348**], with transient episodes of hypotension.  He has a
Holter monitor in our system from [**2141**], which showed no ectopy,
HRs 49-70, with prolonged PR intervals .24.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, bleeding at the time of surgery,
myalgias, joint pains, cough, hemoptysis, black stools or red
stools. Of note, he had a EGD/colonoscopy on [**11-11**] for workup of
Fe deficiency anemia, which showed a non-bleeding adenoma.  He
denies recent fevers, chills or rigors. He denies exertional
buttock or calf pain. His last bowel movement was 1.5 weeks ago,
whichg he states is roughly his [**Month/Year (2) 5348**].  All of the other
review of systems were negative.
.
Cardiac review of systems is notable for absence of chest pain,
dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea,
ankle edema, palpitations.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension
2. CARDIAC HISTORY:
-CABG:
-PERCUTANEOUS CORONARY INTERVENTIONS:
-PACING/ICD:
3. OTHER PAST MEDICAL HISTORY:
1. Multiple sclerosis - followed by Dr.[**First Name4 (NamePattern1) 449**] [**Last Name (NamePattern1) 45435**] at [**Hospital1 2025**].
2. Neurogenic bladder - suprapubic catheter in place; followed
by Dr. [**Last Name (STitle) 9125**].
3. Hypertension
4. Severe constipation - followed by Dr. [**Last Name (STitle) 10689**].
5. Glaucoma
6. Prostate cancer - s/p hormonal therapy and radiation. He has
been pursuing watchful waiting since the Spring [**2149**]. He is
followed at the [**Hospital3 328**] Cancer Institute.
7. Pneumonia
8. Cellulitis
9. Osteoarthritis
10. Hyperlipidemia
11. Depression
12. History of AVM in the left parietal lobe
13. Obstructive sleep apnea utilizing CPAP at night
14. Peripheral neuropathy
15. Thoracic outlet syndrome
16. PE - [**3-21**]
17. Gastroesophageal reflux disease
18. History of MRSA
19. History of left foot fracture
21. Osteopenia
22. Atrial Fibrillation on [**Month/Year (2) **]
22. Shingles - [**2151**]

MEDICATION ON ADMISSION: - Amlodipine 7.5 mg daily
- Baclofen 20 mg qhs
- Brimonidine .1% drops TID
- [**Known lastname **] 75 mg daily
- Darifenacin 7.5 mg daily
- Dorzolamide-timolol 1 drop TID
- Enalapril 20 mg [**Hospital1 **]
- Latanoprost 1 drop qhs
- Macrobid 100 mg daily one out of 3 weeks
- Omeprazole 40 mg [**Hospital1 **]
- Peg-electrolyte solution 420 1 bottle daily
- Simvastatin 10 mg qhs
- Aspirin 325 mg daily
- Calcium 600 mg + D daily
- Cascara
- Colace
- Multivitamin
- Omega-3 fatty acids

ALLERGIES: Morphine / Coumadin

PHYSICAL EXAM: VS: T= 97 BP= 108/57 HR= 44 RR= 12 O2 sat= 100% RA
GENERAL: 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: Per notes, daughter and cousin with MS, mother with AD, father
with leukemia, brother with arrhythmia.

SOCIAL HISTORY: Lives with wife in [**Name (NI) **]. Former etoh, sober since [**2123**] via
AA. Quit cigars a few years ago. Retired judge (at age 68 due to
fatigue). 

### Response:
{'Syncope and collapse,Urinary tract infection, site not specified,Atrial fibrillation,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Multiple sclerosis,Neurogenic bladder NOS,Other constipation,Personal history of malignant neoplasm of prostate,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
