CHIEF COMPLAINT: hypoxic respiratory distress

PRESENT ILLNESS: 80 yo W w/ end stage frontotemporal dementia, OSA, HTN,
depression and an unprovoked PE dx in [**2-22**] on coumadin, who
developed hypoxic respiratory distress, diagnosed with new PEs
on CTA and admitted to MICU for monitoring.

MEDICAL HISTORY: -Pulmonary embolism, Dx [**2-/2181**] on coumadin, 84% on RA with
ambulation on d/c.
-Frontal-temporal dementia:  Neurocognitive decline has been
tested at least three times consistent findings with frontal
lobe "dementia."
-Spinal stenosis: arthritis of lumbar spine with sciatica
diagnosed in [**2172**].
-Depression: currently on Fluoxetine
-Mild sleep apnea, although patient refuses to use equipment.
-Hypertension in past: subsequently had "low blood pressure"
treated with Florinef.
-Bilateral cataract surgeries in [**2170**].
-Surgery on both feet foot for bunions. Chronic foot pain.

MEDICATION ON ADMISSION: - Coumadin 4mg daily
- omeprazole 20mg daily
- citalopram 10mg daily
- MVI
- Risperdal 0.25mg 4PM
- Buspar 10mg [**Hospital1 **]
- VPA sprinkles 125mg [**Hospital1 **]
- Docusate 100mg [**Hospital1 **]
- Senna 8.6mg daily
- aPAP prn
- Ca/D 500/200 tid

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
General: Alert, disoriented, inattentive
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no JVD, no LAD
CV: RR, normal S1 + S2, no murmurs, rubs, gallops
Lungs: CTA
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: Awake, alert, inattentive.
EOMI, VFF, Face symmetric, tongue midline.
UEs and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]-resistance.
Toes down.
.
DISCHARGE EXAM
VS -  97.5, BP 119/69 (98/56-135/71) , HR 85, R 20 , O2-sat 95%
4L
GENERAL - well-appearing female in NAD, comfortable, appropriate

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives now in [**First Name4 (NamePattern1) 2299**] [**Last Name (NamePattern1) **].  In the past, lived [**Street Address(1) 18292**]
Senior Living Center (adult [**Doctor Last Name **] day care). Per prior d/c
summary, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], the program director at Bishop St., knows
the patient well (contact #: [**Telephone/Fax (1) 18294**]; [**Telephone/Fax (1) 18295**]).
Divorced, no kids, former violinist.  Hcp/[**Telephone/Fax (1) 18297**] [**First Name4 (NamePattern1) **]
[**Name (NI) 18298**] [**Telephone/Fax (1) 18299**] home, [**Telephone/Fax (1) 18300**] cell
Tobacco - denies, long standing history prior to this.
EtOH - denies
Drug [**Doctor Last Name **] - denies.
Other pulmonary embolism and infarction,Hyperosmolality and/or hypernatremia,Other pulmonary insufficiency, not elsewhere classified,Other chronic pulmonary heart diseases,Urinary tract infection, site not specified,Other frontotemporal dementia,Dementia in conditions classified elsewhere without behavioral disturbance,Other and unspecified Escherichia coli [E. coli],Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Long-term (current) use of anticoagulants,Spinal stenosis, lumbar region, without neurogenic claudication,Personal history of pulmonary embolism,Heart disease, unspecified,Benign essential hypertension
Pulm embol/infarct NEC,Hyperosmolality,Other pulmonary insuff,Chr pulmon heart dis NEC,Urin tract infection NOS,Frontotemp dementia NEC,Dementia w/o behav dist,E.coli infection NEC/NOS,Obstructive sleep apnea,Esophageal reflux,Long-term use anticoagul,Spin sten,lumbr wo claud,Hx pulmonary embolism,Heart disease NOS,Benign hypertension
Admission Date:  [**2181-5-12**]              Discharge Date:   [**2181-5-20**]

Date of Birth:  [**2100-6-30**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**Doctor First Name 2080**]
Chief Complaint:
hypoxic respiratory distress

Major Surgical or Invasive Procedure:
none

History of Present Illness:
80 yo W w/ end stage frontotemporal dementia, OSA, HTN,
depression and an unprovoked PE dx in [**2-22**] on coumadin, who
developed hypoxic respiratory distress, diagnosed with new PEs
on CTA and admitted to MICU for monitoring.

Of note, pt. was admitted to [**Hospital1 18**] [**Date range (1) 2820**] for diagnosis of
submassive PE and dishcarged to [**Hospital1 1501**] on lovenox/coumadin.  While
at [**First Name4 (NamePattern1) 2299**] [**Last Name (NamePattern1) **], has done will until the morning of admission,
when patient was found to be SOB, unable to ambulate and weak
while going to the bathroom.  HR 110s and O2 sats in 70s on RA
and 84-86% on 6L.  Of note last INR was 1.3 on [**5-9**], last dose
of coumadin at 4mg.  INR was 2.4 on [**4-25**], when last checked (on
3mg at that time).  No events noted by [**Hospital1 1501**] and they are unsure
as to why INR may have decreased. No medication changes other
decr. of risperidone dose and having been started on [**4-26**] on
Carnation instant breakfast 120ml daily.

In the ED, initial VS were:  97.7F 123/83 90 20 96% NRB.  She
underwent CTA that showed a new PE in addition to the prior.
ECG was not done. Labs showed 11K, Trop < 0.01, lactate of 1.9.
UA w/ pyuria, bacteriuria, positie nitrates w/ 57 epis.  She
received 650mg of APAP, CFTX 1g, Heprain gtt was started at
1300.  Pt. is DNR/I from prior admission, family was not
contact[**Name (NI) **] at time of admission.
.
On arrival to the MICU, pt. in NAD on 50% face mask. No acute
complaints.  She is unable to provide any reproducible history,
her responses are incongruent.
.
Review of systems: unable to obtain reproducibly.


Past Medical History:
-Pulmonary embolism, Dx [**2-/2181**] on coumadin, 84% on RA with
ambulation on d/c.
-Frontal-temporal dementia:  Neurocognitive decline has been
tested at least three times consistent findings with frontal
lobe "dementia."
-Spinal stenosis: arthritis of lumbar spine with sciatica
diagnosed in [**2172**].
-Depression: currently on Fluoxetine
-Mild sleep apnea, although patient refuses to use equipment.
-Hypertension in past: subsequently had "low blood pressure"
treated with Florinef.
-Bilateral cataract surgeries in [**2170**].
-Surgery on both feet foot for bunions. Chronic foot pain.


Social History:
Lives now in [**First Name4 (NamePattern1) 2299**] [**Last Name (NamePattern1) **].  In the past, lived [**Street Address(1) 18292**]
Senior Living Center (adult [**Doctor Last Name **] day care). Per prior d/c
summary, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], the program director at Bishop St., knows
the patient well (contact #: [**Telephone/Fax (1) 18294**]; [**Telephone/Fax (1) 18295**]).
Divorced, no kids, former violinist.  Hcp/[**Telephone/Fax (1) 18297**] [**First Name4 (NamePattern1) **]
[**Name (NI) 18298**] [**Telephone/Fax (1) 18299**] home, [**Telephone/Fax (1) 18300**] cell
Tobacco - denies, long standing history prior to this.
EtOH - denies
Drug [**Doctor Last Name **] - denies.

Family History:
NC

Physical Exam:
ADMISSION EXAM
General: Alert, disoriented, inattentive
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no JVD, no LAD
CV: RR, normal S1 + S2, no murmurs, rubs, gallops
Lungs: CTA
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: Awake, alert, inattentive.
EOMI, VFF, Face symmetric, tongue midline.
UEs and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]-resistance.
Toes down.
.
DISCHARGE EXAM
VS -  97.5, BP 119/69 (98/56-135/71) , HR 85, R 20 , O2-sat 95%
4L
GENERAL - well-appearing female in NAD, comfortable, appropriate

HEENT - NC/AT,  MMM, OP clear
LUNGS - CTAB on the anterior chest
HEART -  RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND,
EXTREMITIES - WWP,no edema
SKIN - no rashes or lesions
NEURO - awake, A&Ox3, CNs II-XII grossly intact


Pertinent Results:
ADMISSION LABS
[**2181-5-12**] 10:35AM BLOOD WBC-11.1* RBC-4.22# Hgb-12.9 Hct-40.8#
MCV-97 MCH-30.6 MCHC-31.6 RDW-13.7 Plt Ct-419
[**2181-5-12**] 10:35AM BLOOD Neuts-76.1* Lymphs-14.6* Monos-6.7
Eos-0.8 Baso-1.8
[**2181-5-12**] 10:35AM BLOOD PT-15.7* PTT-30.8 INR(PT)-1.5*
[**2181-5-12**] 10:35AM BLOOD Glucose-110* UreaN-15 Creat-0.7 Na-137
K-4.8 Cl-103 HCO3-22 AnGap-17
[**2181-5-12**] 10:35AM BLOOD Calcium-8.8 Phos-4.8* Mg-1.9
[**2181-5-12**] 10:35AM BLOOD cTropnT-<0.01 proBNP-PND
[**2181-5-12**] 10:54AM BLOOD Lactate-1.9
[**2181-5-12**] 11:00AM URINE RBC-0 WBC->182* Bacteri-MANY Yeast-NONE
Epi-57
[**2181-5-12**] 11:00AM URINE Blood-NEG Nitrite-POS Protein-30
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-LG
[**2181-5-12**] 11:00AM URINE Color-Yellow Appear-Cloudy Sp [**Last Name (un) **]-1.017
.
DISCHARGE LABS
[**2181-5-17**] 07:02AM BLOOD WBC-10.0 RBC-3.95* Hgb-11.8* Hct-38.2
MCV-97 MCH-30.0 MCHC-31.0 RDW-14.2 Plt Ct-388
[**2181-5-17**] 07:02AM BLOOD PT-29.3* PTT-34.9 INR(PT)-2.8*
[**2181-5-17**] 07:02AM BLOOD Glucose-129* UreaN-24* Creat-0.8 Na-144
K-4.4 Cl-110* HCO3-23 AnGap-15
[**2181-5-12**] 10:35AM BLOOD cTropnT-<0.01 proBNP-[**Numeric Identifier **]*
[**2181-5-17**] 07:02AM BLOOD Calcium-8.8 Phos-3.9 Mg-2.2
.
MICROBIOLOGY
[**2181-5-12**] 11:31 am URINE      ADDED TO SPECIMEN 67639B.

                            **FINAL REPORT [**2181-5-14**]**

   URINE CULTURE (Final [**2181-5-14**]):
      ESCHERICHIA COLI.    >100,000 ORGANISMS/ML..
         Cefazolin interpretative criteria are based on a dosage
regimen of
         2g every 8h.
         Piperacillin/tazobactam sensitivity testing available
on request.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------     8 S
AMPICILLIN/SULBACTAM--     4 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
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S
.
Blood cultures [**2181-5-12**]- No growth x 2
.
CTA [**2181-5-12**]:
FINDINGS: There are curvilinear filling defects in the main
pulmonary artery extending into the right main pulmonary artery
and left main pulmonary artery. The left upper lobe artery
appears patent but just distal to the bifurcation, there appears
to be additional thrombus completely occluding one arterial
branch. There is a large thrombus within the right main
pulmonary artery extending into the right middle lobe artery and
right lower lobe artery, some of which branches appear to be
patent. There is flattening and perhaps mild bowing of the
interventricular septum and reflux of contrast into the hepatic
veins, as seen previously.

The aorta and branch vessels demonstrate calcifications but are
otherwise
unremarkable. Trace pericardial fluid is within physiologic
range and appears unchanged compared to recent prior exam.
Diffuse patchy ground-glass opacity persists and is nonspecific.
No pleural effusion or pneumothorax is detected. A 1-cm
subcarinal lymph node is again noted. No other lymphadenopathy
is detected.

The visualized portion of the thyroid appears homogeneous.

This study is not optimized for evaluation of subdiaphragmatic
structures.  Small hiatal hernia is again noted. No acute
subdiaphragmatic process is detected. A 12-mm soft tissue
density subcutaneous nodule in the left anterior chest wall is
again noted. No concerning lytic or sclerotic osseous lesions
are detected.

IMPRESSION: Increased clot burden within the central and
bilateral main
pulmonary arteries.
.
Chest Xray [**2181-5-17**]
FINDINGS: As compared to the previous radiograph, there is no
relevant
change. Borderline size of the cardiac silhouette without
evidence of
pulmonary edema. No pleural effusions. No focal parenchymal
opacity
suggesting pneumonia. Normal hilar and mediastinal structures
.
CTA [**2181-5-17**]
 Extensive pulmonary emboli with increased clot burden in the
left
descending and lower lobe pulmonary artery with associated right
heart strain and enlargement of pulmonary artery.
.
TTE [**2181-5-19**]
The left atrium is elongated. Due to suboptimal technical
quality, a focal wall motion abnormality cannot be fully
excluded. Overall left ventricular systolic function is normal
(LVEF>55%). The right ventricular free wall is hypertrophied.
The right ventricular cavity is moderately dilated with mild
global free wall hypokinesis. The aortic valve leaflets (3) are
mildly thickened but aortic stenosis is not present. The mitral
valve leaflets are mildly thickened. Mild (1+) mitral
regurgitation is seen. Moderate [2+] tricuspid regurgitation is
seen. There is severe pulmonary artery systolic hypertension.
There is a trivial/physiologic pericardial effusion.

IMPRESSION: Severe pulmonary hypertension. Dilated and
hypertrophied right ventricle with mild global systolic
dysfunction. Normal global and regional left ventricular
systolic function. Moderate tricuspid regurgitation.

Compared with the prior study (images reviewed) of [**2181-3-1**],
estimated pulmonary pressures have further increased.

Brief Hospital Course:
Primary Reason for Admission
80 yo W w/ end stage frontotemporal dementia, OSA, HTN,
depression and an unprovoked PE dx in [**2-22**] on coumadin, who
developed hypoxic respiratory distress, diagnosed with new PEs
on CTA and admitted to MICU for monitoring.
.
# Hypoxic respiratory distress/ Submassive Acute Pulmonary
Embolism- As above the patient presented in respiratory distress
from her nursing facility.  CTA demonstrated increased clot
burden.  which was felt to be the most likely etiology of her
symptoms. Clot burden was significantly increased and appears to
have saddle configuration.  Etiology of orignal PE in [**2-22**] is
unclear, but this current event is likely due to subtherapeutic
INR in the setting of initiation of a vitamin K containing meal
supplement (carnation instant breakfast).  She was currently
hemodynamically  stable.  Other etiologies such as PNA and
cardiac ischemia were on the differential, but there was
evidence of this clinically and troponins were negative x 2.
During her ICU stay, the patient did not have increasing oxygen
requirements and only required nasal cannula.  She was started
on heparin drip, then Lovenox until her INR could reach
therapeutic levels. Lovenox was discontinued when INR was
therapeutic. Her coumadin dose was decreased from her home dose
of 4 mg daily given antibiotic treatment (see below). She
remained hypoxic and had one acute desaturation to an oxygen
saturation of 82% on 4 L NC.  Repeat CTA was performed and
showed increased clot burden despite therapeutic INR, in
addition to evidence of right heart strain.  She was restarted
on lovenox and coumadin was discontinued. Both pulmonary and
hemetology were consulted and recommended continuation of
lovenox.  Though it was felt presentation may be suggestive of
an underlying malignancy.  In discussion with her HCP the
decision was made to forgo further work-up given her age and
comorbities. The patient remained hemodynamically stable with
was weaned to 4L nasal cannula.  The patient was discharged back
to [**Hospital3 **] after discussing her clinical status with the
[**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] nurse practitioner.
.
# Aspiration risk- There was some some concern for risk of
aspiration raised by nursing. She was evalutated by speech and
swallow who recommended a diet of thin liquids and regular
solids.
.
# UTI- Patient was noted to have a positive UA on admission with
> 182 WBC. Urine culture grew E. coli. She was initally started
on IV ceftriaxone which she received for 3 days. When
sensitivities returned she was transitioned to oral
nitrofurantoin 100 mg twice a day to complete a 7 day course.
The patient was afebrile throughout admission without suprapubic
tenderness on exam.  Blood cultures were drawn on admission and
were pending at the time of discharge.
.
STABLE ISSUES
# Frontotemporal dementia- Patient has end state dementia. She
was A+O x1 throughout this hospitalization which per report is
her baseline. The patient was continued on risperdal, valproic
acid.
.
# HTN: She has a documented history of hypertension but was not
on anti-hypertensives as an outpatient. Patient was normotensive
throughout this hospitalization.
.
# OSA. Has not tolerated CPAP in the past, therefore CPAP was
not done while the patient was in house.
.
# Depression/anxiety- Patient was continued on her home celexa
and buspar.
.
# GERD- Patient was continued on her home PPI
.
TRANSITIONAL ISSUES
- DNR/DNI

Medications on Admission:
- Coumadin 4mg daily
- omeprazole 20mg daily
- citalopram 10mg daily
- MVI
- Risperdal 0.25mg 4PM
- Buspar 10mg [**Hospital1 **]
- VPA sprinkles 125mg [**Hospital1 **]
- Docusate 100mg [**Hospital1 **]
- Senna 8.6mg daily
- aPAP prn
- Ca/D 500/200 tid

Discharge Medications:
1. citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
2. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. risperidone 0.25 mg Tablet Sig: One (1) Tablet PO daily at 4
pm:  .
4. divalproex 125 mg Capsule, Sprinkle Sig: One (1) Capsule,
Sprinkle PO BID (2 times a day).
5. buspirone 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. docusate sodium 50 mg/5 mL Liquid Sig: Ten (10) mL PO BID (2
times a day).
7. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
8. calcium carbonate-vitamin D3 500 mg(1,250mg) -200 unit Tablet
Sig: One (1) Tablet PO three times a day.
9. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO three
times a day as needed for pain/fever: Do not exceed 4 grams in
24 hours .
10. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
11. enoxaparin 80 mg/0.8 mL Syringe Sig: Seventy (70) mg
Subcutaneous Q12H (every 12 hours).


Discharge Disposition:
Extended Care

Facility:
[**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **] - [**Location (un) 538**]

Discharge Diagnosis:
Primary Diagnosis
Acute Pulmonary Embolism

Secondary Diagnosis
Frontotemporal Dementia
Depression
Obstructive sleep apnea


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:

Ms [**Known lastname **],

It was a pleasure participating in your care while you were
admitted to [**Hospital1 69**]. As you know
you were admitted because you were having difficulty breathing.
You had a CT scan which showed the clots in your lungs have
gotten worse. This is most likely because the test we use to
monitor your coumadin level was low.  The clots continued to
worse and we needed to switch you a new blood thinner. You were
also found to have a urinary tract infection for which you were
given antibiotics.

We made the following changes to your medications
1. STOP Coumadin
2. START lovenox 70 mg twice a day


Followup Instructions:
You will be seen by your doctor at the [**First Name4 (NamePattern1) 1188**] [**Last Name (NamePattern1) **]
{'Other pulmonary embolism and infarction,Hyperosmolality and/or hypernatremia,Other pulmonary insufficiency, not elsewhere classified,Other chronic pulmonary heart diseases,Urinary tract infection, site not specified,Other frontotemporal dementia,Dementia in conditions classified elsewhere without behavioral disturbance,Other and unspecified Escherichia coli [E. coli],Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Long-term (current) use of anticoagulants,Spinal stenosis, lumbar region, without neurogenic claudication,Personal history of pulmonary embolism,Heart disease, unspecified,Benign essential hypertension'}


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: hypoxic respiratory distress

PRESENT ILLNESS: 80 yo W w/ end stage frontotemporal dementia, OSA, HTN,
depression and an unprovoked PE dx in [**2-22**] on coumadin, who
developed hypoxic respiratory distress, diagnosed with new PEs
on CTA and admitted to MICU for monitoring.

MEDICAL HISTORY: -Pulmonary embolism, Dx [**2-/2181**] on coumadin, 84% on RA with
ambulation on d/c.
-Frontal-temporal dementia:  Neurocognitive decline has been
tested at least three times consistent findings with frontal
lobe "dementia."
-Spinal stenosis: arthritis of lumbar spine with sciatica
diagnosed in [**2172**].
-Depression: currently on Fluoxetine
-Mild sleep apnea, although patient refuses to use equipment.
-Hypertension in past: subsequently had "low blood pressure"
treated with Florinef.
-Bilateral cataract surgeries in [**2170**].
-Surgery on both feet foot for bunions. Chronic foot pain.

MEDICATION ON ADMISSION: - Coumadin 4mg daily
- omeprazole 20mg daily
- citalopram 10mg daily
- MVI
- Risperdal 0.25mg 4PM
- Buspar 10mg [**Hospital1 **]
- VPA sprinkles 125mg [**Hospital1 **]
- Docusate 100mg [**Hospital1 **]
- Senna 8.6mg daily
- aPAP prn
- Ca/D 500/200 tid

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM
General: Alert, disoriented, inattentive
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, no JVD, no LAD
CV: RR, normal S1 + S2, no murmurs, rubs, gallops
Lungs: CTA
Abdomen: obese, soft, non-tender, non-distended, bowel sounds
present, no organomegaly
GU: foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: Awake, alert, inattentive.
EOMI, VFF, Face symmetric, tongue midline.
UEs and [**Name Prefix (Prefixes) **] [**Last Name (Prefixes) **]-resistance.
Toes down.
.
DISCHARGE EXAM
VS -  97.5, BP 119/69 (98/56-135/71) , HR 85, R 20 , O2-sat 95%
4L
GENERAL - well-appearing female in NAD, comfortable, appropriate

FAMILY HISTORY: NC

SOCIAL HISTORY: Lives now in [**First Name4 (NamePattern1) 2299**] [**Last Name (NamePattern1) **].  In the past, lived [**Street Address(1) 18292**]
Senior Living Center (adult [**Doctor Last Name **] day care). Per prior d/c
summary, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], the program director at Bishop St., knows
the patient well (contact #: [**Telephone/Fax (1) 18294**]; [**Telephone/Fax (1) 18295**]).
Divorced, no kids, former violinist.  Hcp/[**Telephone/Fax (1) 18297**] [**First Name4 (NamePattern1) **]
[**Name (NI) 18298**] [**Telephone/Fax (1) 18299**] home, [**Telephone/Fax (1) 18300**] cell
Tobacco - denies, long standing history prior to this.
EtOH - denies
Drug [**Doctor Last Name **] - denies. 

### Response:
{'Other pulmonary embolism and infarction,Hyperosmolality and/or hypernatremia,Other pulmonary insufficiency, not elsewhere classified,Other chronic pulmonary heart diseases,Urinary tract infection, site not specified,Other frontotemporal dementia,Dementia in conditions classified elsewhere without behavioral disturbance,Other and unspecified Escherichia coli [E. coli],Obstructive sleep apnea (adult)(pediatric),Esophageal reflux,Long-term (current) use of anticoagulants,Spinal stenosis, lumbar region, without neurogenic claudication,Personal history of pulmonary embolism,Heart disease, unspecified,Benign essential hypertension'}
