CHIEF COMPLAINT: Shortness of breath, Fever

PRESENT ILLNESS: Ms. [**Known firstname **] [**Known lastname **] is a 68 year old female with history of DM2,
HTN, hyperlipidemia who presents with productive cough x 2 days
and sudden development of shortness of breath and fever since
evening prior to admission.  She had been in her usual state of
health until 2 days ago when she developed cough.  She was
unable to bring up any sputum with the cough.  She had no other
associated symptoms until yesterday evening at 11PM, while lying
in bed she developed acute onset of shortness of breath, fevers,
chills.  She had associated headache, lightheadedness.  She had
no chest pain, abdominal pain, diarrhea or constipation.
.
On [**7-25**] she was seen in dermatology clinic for abdominal
rash/nonhealing erosion which was biopsied at that time.  Biopsy
revealed trauma/excoriation with bacterial superinfection with
S. aureus.  She was started on topical bactroban and topical
triamcinolone which reportedly helped initially, but worsened
over the past day.  Ms. [**Known lastname **] is also followed in [**Hospital **] clinic for
chronic minocycline suppression for history of recurrent Group B
strep cellulitis/bacteremia.
.
In the ED, T 102.6, Tmax 102.9, BP 154/88, HR 131, RR 16, O2sat
98% on NRB.  EKG with ST at 105, nl axis, nl intervals, ST
depressions V2, TWI III, V1, V2, TWF avF, V3-V4.  Labs were
notable for lactate of 4.6, WBC 16.2, 2% bands.  First set of
cardiac enzymes are negative.  CXR showed LLL PNA.  UA was
negative.  She was given one dose of Levaquin 750mg x1.  She was
given tylenol 500mg x1, Aspirin 325mg x1 and 1L NS.  She has 2
PIV in place.  She was seen by Dr. [**Last Name (STitle) **] of ID in the ED who felt
that abdominal rash was expanding compared to prior.
.
On arrival to the [**Hospital Unit Name 153**] the patient is on NRB.  She notes that
her breathing is much more comfortable than on arrival to the
ED.  She denies chest pain, diaphoresis, abdominal pain,
diarrhea, constipation.  She continues to have cough but is
unable to produce sputum.  She also reports dysuria and urinary
frequency over the past week.  She reports history of food
"going down the wrong pipe" and food getting stuck occasionally.

MEDICAL HISTORY: 1. DM2
2. HTN
3. Dyslipidemia
4. Obesity
5. Panic disorder/Depression
6. Personality disorder, NOS
7. Status post R knee replacement
8. Total abdominal hysterectomy-for Ovarian CA in [**2158**]
9. s/p GI bleed
10. Peptic ulcer disease/GERD
11. Diverticulosis
12. Status post cholecystectomy
[**85**]. Borderline personality
14. B/L Breast reduction c/b L breast cellulitis/abscess
15. UTI completed 7 d course of Cipro [**2178-8-15**]
16. Osteoarthritis
17. OSA on CPAP at home
18. Sinusitis

MEDICATION ON ADMISSION: Medications:  (per list provided from [**Hospital3 **] House)
Albuterol inh 2 puffs q4-6H PRN
Celexa 40mg daily
Lipitor 40mg daily
Lasix 20mg daily
Lisinopril 10mg daily
Lactulose 10g/15mL syrup
Lamictal 200mg daily
Loratadine 10mg daily
Metoprolol 25mg hs
Mirtazapine 7.5mg daily
Minocycline 100mg [**Hospital1 **]
Metformin SR 500mg daily
Nystatin 100,000 unit topical
Prilosec 20mg daily
Seroquel 400mg hs
Temazepam 15mg hs

ALLERGIES: Penicillins / Erythromycin Base / Compazine / Benadryl /
Sulfonamides / Oxycodone

PHYSICAL EXAM: VS: T 97.6, BP 106/57, HR 89, RR 22, O2 sat 100% NRB
GEN: Well appearing elderly, obese female in NAD on NRB.  Not
using accessory muscles, breathing comfortably.  Speaking in
full sentences.
HEENT: AT, NC, poor dentition, PERRLA, EOMI bilaterally, edema
of right eyelid, no conjunctival erythema, anicteric, dry MM
Neck: supple, no LAD, no carotid bruits, JVP difficult to assess

FAMILY HISTORY: non-contributory at present.

SOCIAL HISTORY: Patient lives alone in [**Location (un) **] - in a shelter. She attends a
psych day facility called [**First Name4 (NamePattern1) 1634**] [**Last Name (NamePattern1) **]. Has 1 child but is estranged
from him. Sister [**Name (NI) 12074**] is HCP. [**Name (NI) **] alcohol, tobacco, or drug
use.
Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Cellulitis and abscess of trunk,Sepsis,Hypoxemia,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Benign essential hypertension,Other and unspecified hyperlipidemia,Unspecified sleep apnea,Panic disorder without agoraphobia,Depressive disorder, not elsewhere classified
Septicemia NOS,Food/vomit pneumonitis,Cellulitis of trunk,Sepsis,Hypoxemia,DMII unspf uncntrld,Benign hypertension,Hyperlipidemia NEC/NOS,Sleep apnea NOS,Panic dis w/o agorphobia,Depressive disorder NEC
Admission Date:  [**2180-8-4**]              Discharge Date:   [**2180-8-7**]

Date of Birth:  [**2111-12-2**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins / Erythromycin Base / Compazine / Benadryl /
Sulfonamides / Oxycodone

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
Shortness of breath, Fever

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Ms. [**Known firstname **] [**Known lastname **] is a 68 year old female with history of DM2,
HTN, hyperlipidemia who presents with productive cough x 2 days
and sudden development of shortness of breath and fever since
evening prior to admission.  She had been in her usual state of
health until 2 days ago when she developed cough.  She was
unable to bring up any sputum with the cough.  She had no other
associated symptoms until yesterday evening at 11PM, while lying
in bed she developed acute onset of shortness of breath, fevers,
chills.  She had associated headache, lightheadedness.  She had
no chest pain, abdominal pain, diarrhea or constipation.
.
On [**7-25**] she was seen in dermatology clinic for abdominal
rash/nonhealing erosion which was biopsied at that time.  Biopsy
revealed trauma/excoriation with bacterial superinfection with
S. aureus.  She was started on topical bactroban and topical
triamcinolone which reportedly helped initially, but worsened
over the past day.  Ms. [**Known lastname **] is also followed in [**Hospital **] clinic for
chronic minocycline suppression for history of recurrent Group B
strep cellulitis/bacteremia.
.
In the ED, T 102.6, Tmax 102.9, BP 154/88, HR 131, RR 16, O2sat
98% on NRB.  EKG with ST at 105, nl axis, nl intervals, ST
depressions V2, TWI III, V1, V2, TWF avF, V3-V4.  Labs were
notable for lactate of 4.6, WBC 16.2, 2% bands.  First set of
cardiac enzymes are negative.  CXR showed LLL PNA.  UA was
negative.  She was given one dose of Levaquin 750mg x1.  She was
given tylenol 500mg x1, Aspirin 325mg x1 and 1L NS.  She has 2
PIV in place.  She was seen by Dr. [**Last Name (STitle) **] of ID in the ED who felt
that abdominal rash was expanding compared to prior.
.
On arrival to the [**Hospital Unit Name 153**] the patient is on NRB.  She notes that
her breathing is much more comfortable than on arrival to the
ED.  She denies chest pain, diaphoresis, abdominal pain,
diarrhea, constipation.  She continues to have cough but is
unable to produce sputum.  She also reports dysuria and urinary
frequency over the past week.  She reports history of food
"going down the wrong pipe" and food getting stuck occasionally.


Past Medical History:
1. DM2
2. HTN
3. Dyslipidemia
4. Obesity
5. Panic disorder/Depression
6. Personality disorder, NOS
7. Status post R knee replacement
8. Total abdominal hysterectomy-for Ovarian CA in [**2158**]
9. s/p GI bleed
10. Peptic ulcer disease/GERD
11. Diverticulosis
12. Status post cholecystectomy
[**85**]. Borderline personality
14. B/L Breast reduction c/b L breast cellulitis/abscess
15. UTI completed 7 d course of Cipro [**2178-8-15**]
16. Osteoarthritis
17. OSA on CPAP at home
18. Sinusitis


Social History:
Patient lives alone in [**Location (un) **] - in a shelter. She attends a
psych day facility called [**First Name4 (NamePattern1) 1634**] [**Last Name (NamePattern1) **]. Has 1 child but is estranged
from him. Sister [**Name (NI) 12074**] is HCP. [**Name (NI) **] alcohol, tobacco, or drug
use.


Family History:
non-contributory at present.

Physical Exam:
VS: T 97.6, BP 106/57, HR 89, RR 22, O2 sat 100% NRB
GEN: Well appearing elderly, obese female in NAD on NRB.  Not
using accessory muscles, breathing comfortably.  Speaking in
full sentences.
HEENT: AT, NC, poor dentition, PERRLA, EOMI bilaterally, edema
of right eyelid, no conjunctival erythema, anicteric, dry MM
Neck: supple, no LAD, no carotid bruits, JVP difficult to assess

CV: RRR, nl s1, s2, no m/r/g appreciated.
PULM: Distant breath sounds bilaterally with decreased most
notably at left base. No wheezing on exam.
ABD: Obese, soft, NT, ND, + BS, no HSM.  Rash described below.
EXT: Varicose veins, warm, dry, +2 distal pulses BL, no femoral
bruits, trace edema bilaterally
NEURO: Alert & oriented, CN II-XII grossly intact, 5/5 strength
throughout. No sensory deficits to light touch appreciated.
PSYCH: appropriate affect
Skin: Erythema, warmth on abdomen extending from site of prior
biopsy, no pus able to be expressed from biopsy site.  Sutures
in place.  Area marked.  Erythema and papules also appreciated
in inguinal folds bilaterally.


Pertinent Results:
[**2180-8-4**] 05:15AM   WBC-16.5*# RBC-4.67 HGB-13.1 HCT-41.5 MCV-89
MCH-28.1 MCHC-31.6 RDW-14.3
[**2180-8-4**] 05:15AM   NEUTS-82* BANDS-2 LYMPHS-13* MONOS-3 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2180-8-4**] 05:15AM   HYPOCHROM-1+ ANISOCYT-NORMAL POIKILOCY-NORMAL
MACROCYT-NORMAL MICROCYT-NORMAL POLYCHROM-OCCASIONAL
[**2180-8-4**] 05:15AM   PLT SMR-NORMAL PLT COUNT-196
[**2180-8-4**] 05:15AM   GLUCOSE-207* UREA N-24* CREAT-1.0 SODIUM-140
POTASSIUM-5.0 CHLORIDE-102 TOTAL CO2-26 ANION GAP-17
[**2180-8-4**] 05:20AM   LACTATE-4.6*
[**2180-8-4**] 05:50AM URINE  RBC-0-2 WBC-0-2 BACTERIA-NONE YEAST-NONE
EPI-<1
[**2180-8-4**] 05:50AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-100 KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
.
[**2180-7-24**] 3:12 pm TISSUE     Site: SKIN      Source: Skin biopsy.


   GRAM STAIN (Final [**2180-7-24**]):
      REPORTED BY PHONE TO [**First Name8 (NamePattern2) 6118**] [**Last Name (NamePattern1) 6119**] @ 4PM [**2180-7-24**].
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      2+   (1-5 per 1000X FIELD):   GRAM POSITIVE COCCI.
                                    IN PAIRS.

   TISSUE (Final [**2180-7-27**]):
      STAPH AUREUS COAG +.    SPARSE GROWTH.
         Please contact the Microbiology Laboratory ([**8-/2478**])
immediately if
         sensitivity to clindamycin is required on this
patient's isolate.
         Staphylococcus species may develop resistance during
prolonged
         therapy with quinolones.   Therefore, isolates that are
initially
         susceptible may become resistant within three to four
days after
         initiation of therapy.  Testing of repeat isolates may
be
         warranted.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |
ERYTHROMYCIN----------   =>8 R
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------  0.25 S
OXACILLIN-------------   0.5 S
PENICILLIN G---------- =>0.5 R
TRIMETHOPRIM/SULFA---- <=0.5 S

   ANAEROBIC CULTURE (Final [**2180-7-28**]):    NO ANAEROBES ISOLATED.


   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.

   ACID FAST SMEAR (Final [**2180-7-25**]):
      NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.

   ACID FAST CULTURE (Preliminary):

.
[**7-24**] Skin biopsy: Bacterial (Gram positive cocci in clusters on
Gram stain) colonies are present within the surface of the ulcer
bed.  No fungi are seen in PAS - reacted sections.  No viral
cytopathic changes are seen (multiple levels examined).  The
findings suggest traumatic injury/excoriation with bacterial
superinfection, however a primary impetigo complicated by
excoriation is also within the differential diagnosis


Brief Hospital Course:
# Aspiration Pneumonia:
The patient presented with a 2 day history of cough, shortness
of breath and found to have LLL PNA on CXR.  Tmax 102.9 and WBC
count 16.5 with 2% bands on admission. She was started on
Levofloxacin and flagyl for community acquired aspiration PNA
for planned 10 day course.

# Cellulitis - Trunk:
On [**7-25**] the pt was seen in dermatology clinic for abdominal
rash/ nonhealing erosion which was biopsied at that time. Biopsy
revealed trauma/excoriation with bacterial superinfection with
S. aureus. On admission the pt was found to have a worsening
abdominal cellulitis. Levaquin was started initially given her
multiple antibiotic alleriges however on the evening on
admission she developed worsening of her cellulitis and
vancomycin was started. Her stitches were removed, no purulence
could be expressed for culture. After 3 days of vancomycin,
dramatic improvement, well within ink line. Plan for additional
10 days of IV antibiotics. Midline placed.

# Hypoxia:
Requiring NRB in ED and on arrival to [**Hospital Unit Name 153**].  Found to have PNA
on CXR, known OSA. She was weaned from O2 quickly on arrival to
the ICU and was maintained on CPAP overnight for her OSA. PNA
treated as above.

#Obstructive Sleep Apnea
Maintained on CPAP 10cm with good results

# Tachycardia:
Present on admission to the ED, however resolved upon transfer
to ICU.  EKG with possibly new TWF in lateral leads.  Last
stress test [**2180-1-14**] with no EKG changes or ischemic symptoms
during exercise, normal cardiac perfusion.  No chest pain this
admission. CE negative for ACS.

# Type 2 Diabetes Uncontrolled with Complications
- The patient was maintained on insulin sliding scale and home
dose insulin
- Metformin was held due to lactate

# Benign Hypertension -
- Antihypertensives initially held on admission
Metoprolol restarted at lower dose
- lisinopril and lasix held due to hypotension

# Hyperlipidemia
- Continued statin

# Panic disorder/depression
- Continued outpatient regimen

#COMMUNICATION: patient
- [**Month/Day/Year **] House [**Telephone/Fax (1) 107342**]
- [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]: Nurse [**First Name (Titles) **] [**Last Name (Titles) **] House [**Telephone/Fax (1) 107342**] at work, cell
phone is [**Telephone/Fax (1) 18294**]
- PCP [**Name Initial (PRE) 1266**] [**Telephone/Fax (1) 608**]
- Sister [**Name (NI) 12074**] [**Name (NI) **] [**Telephone/Fax (1) 107343**] (cell)
[**Hospital3 4262**] Group Patient

Medications on Admission:
Medications:  (per list provided from [**Hospital3 **] House)
Albuterol inh 2 puffs q4-6H PRN
Celexa 40mg daily
Lipitor 40mg daily
Lasix 20mg daily
Lisinopril 10mg daily
Lactulose 10g/15mL syrup
Lamictal 200mg daily
Loratadine 10mg daily
Metoprolol 25mg hs
Mirtazapine 7.5mg daily
Minocycline 100mg [**Hospital1 **]
Metformin SR 500mg daily
Nystatin 100,000 unit topical
Prilosec 20mg daily
Seroquel 400mg hs
Temazepam 15mg hs

Discharge Medications:
1. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

2. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1)
gram Intravenous Q 12H (Every 12 Hours) for 10 days.
4. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: One (1) neb Inhalation Q6H (every 6 hours) as
needed.
5. Lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
6. Mirtazapine 15 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).

7. Minocycline 50 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
8. Insulin Regular Human 100 unit/mL Solution Sig: One (1)
sliding scale Injection ASDIR (AS DIRECTED).
9. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
10. Quetiapine 200 mg Tablet Sustained Release 24 hr Sig: Two
(2) Tablet Sustained Release 24 hr PO HS (at bedtime).
11. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
12. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000)
units Injection TID (3 times a day).
13. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) tab PO BID (2
times a day).
14. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical QID
(4 times a day).
15. Levofloxacin 250 mg Tablet Sig: Two (2) Tablet PO once a day
for 5 days.
16. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2
times a day).
17. Temazepam 15 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
18. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
19. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
20. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours) as needed for headache.
21. Heparin, Porcine (PF) 10 unit/mL Syringe Sig: Two (2) ML
Intravenous PRN (as needed) as needed for line flush.
22. Respiratory
CPAP 10cm h20 nightly for obstructive sleep apnea


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 1186**] - [**Location (un) 538**]

Discharge Diagnosis:
Sepsis from Pneumonia (aspiration)
Abdominal wall cellulitis
sleep apnea, obstructive

Discharge Condition:
stable

Discharge Instructions:
You were treated for pneumonia and infection of the abdominal
wall skin.

Followup Instructions:
PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Telephone/Fax (1) 608**]

Provider: [**Name10 (NameIs) 1571**] FUNCTION LAB Phone:[**Telephone/Fax (1) 609**]
Date/Time:[**2180-10-2**] 3:10
Provider: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], [**Name Initial (NameIs) **].D. Phone:[**Telephone/Fax (1) 612**]
Date/Time:[**2180-10-2**] 3:30
Provider: [**Name10 (NameIs) 1570**],INTERPRET W/LAB NO CHECK-IN [**Name10 (NameIs) 1570**] INTEPRETATION
BILLING Date/Time:[**2180-10-2**] 3:30
Provider: [**Name10 (NameIs) 1570**],INTERPRET W/LAB NO CHECK-IN [**Name10 (NameIs) 1570**] INTEPRETATION
BILLING Date/Time:[**2180-10-2**] 3:30
{'Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Cellulitis and abscess of trunk,Sepsis,Hypoxemia,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Benign essential hypertension,Other and unspecified hyperlipidemia,Unspecified sleep apnea,Panic disorder without agoraphobia,Depressive disorder, not elsewhere classified'}


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, Fever

PRESENT ILLNESS: Ms. [**Known firstname **] [**Known lastname **] is a 68 year old female with history of DM2,
HTN, hyperlipidemia who presents with productive cough x 2 days
and sudden development of shortness of breath and fever since
evening prior to admission.  She had been in her usual state of
health until 2 days ago when she developed cough.  She was
unable to bring up any sputum with the cough.  She had no other
associated symptoms until yesterday evening at 11PM, while lying
in bed she developed acute onset of shortness of breath, fevers,
chills.  She had associated headache, lightheadedness.  She had
no chest pain, abdominal pain, diarrhea or constipation.
.
On [**7-25**] she was seen in dermatology clinic for abdominal
rash/nonhealing erosion which was biopsied at that time.  Biopsy
revealed trauma/excoriation with bacterial superinfection with
S. aureus.  She was started on topical bactroban and topical
triamcinolone which reportedly helped initially, but worsened
over the past day.  Ms. [**Known lastname **] is also followed in [**Hospital **] clinic for
chronic minocycline suppression for history of recurrent Group B
strep cellulitis/bacteremia.
.
In the ED, T 102.6, Tmax 102.9, BP 154/88, HR 131, RR 16, O2sat
98% on NRB.  EKG with ST at 105, nl axis, nl intervals, ST
depressions V2, TWI III, V1, V2, TWF avF, V3-V4.  Labs were
notable for lactate of 4.6, WBC 16.2, 2% bands.  First set of
cardiac enzymes are negative.  CXR showed LLL PNA.  UA was
negative.  She was given one dose of Levaquin 750mg x1.  She was
given tylenol 500mg x1, Aspirin 325mg x1 and 1L NS.  She has 2
PIV in place.  She was seen by Dr. [**Last Name (STitle) **] of ID in the ED who felt
that abdominal rash was expanding compared to prior.
.
On arrival to the [**Hospital Unit Name 153**] the patient is on NRB.  She notes that
her breathing is much more comfortable than on arrival to the
ED.  She denies chest pain, diaphoresis, abdominal pain,
diarrhea, constipation.  She continues to have cough but is
unable to produce sputum.  She also reports dysuria and urinary
frequency over the past week.  She reports history of food
"going down the wrong pipe" and food getting stuck occasionally.

MEDICAL HISTORY: 1. DM2
2. HTN
3. Dyslipidemia
4. Obesity
5. Panic disorder/Depression
6. Personality disorder, NOS
7. Status post R knee replacement
8. Total abdominal hysterectomy-for Ovarian CA in [**2158**]
9. s/p GI bleed
10. Peptic ulcer disease/GERD
11. Diverticulosis
12. Status post cholecystectomy
[**85**]. Borderline personality
14. B/L Breast reduction c/b L breast cellulitis/abscess
15. UTI completed 7 d course of Cipro [**2178-8-15**]
16. Osteoarthritis
17. OSA on CPAP at home
18. Sinusitis

MEDICATION ON ADMISSION: Medications:  (per list provided from [**Hospital3 **] House)
Albuterol inh 2 puffs q4-6H PRN
Celexa 40mg daily
Lipitor 40mg daily
Lasix 20mg daily
Lisinopril 10mg daily
Lactulose 10g/15mL syrup
Lamictal 200mg daily
Loratadine 10mg daily
Metoprolol 25mg hs
Mirtazapine 7.5mg daily
Minocycline 100mg [**Hospital1 **]
Metformin SR 500mg daily
Nystatin 100,000 unit topical
Prilosec 20mg daily
Seroquel 400mg hs
Temazepam 15mg hs

ALLERGIES: Penicillins / Erythromycin Base / Compazine / Benadryl /
Sulfonamides / Oxycodone

PHYSICAL EXAM: VS: T 97.6, BP 106/57, HR 89, RR 22, O2 sat 100% NRB
GEN: Well appearing elderly, obese female in NAD on NRB.  Not
using accessory muscles, breathing comfortably.  Speaking in
full sentences.
HEENT: AT, NC, poor dentition, PERRLA, EOMI bilaterally, edema
of right eyelid, no conjunctival erythema, anicteric, dry MM
Neck: supple, no LAD, no carotid bruits, JVP difficult to assess

FAMILY HISTORY: non-contributory at present.

SOCIAL HISTORY: Patient lives alone in [**Location (un) **] - in a shelter. She attends a
psych day facility called [**First Name4 (NamePattern1) 1634**] [**Last Name (NamePattern1) **]. Has 1 child but is estranged
from him. Sister [**Name (NI) 12074**] is HCP. [**Name (NI) **] alcohol, tobacco, or drug
use. 

### Response:
{'Unspecified septicemia,Pneumonitis due to inhalation of food or vomitus,Cellulitis and abscess of trunk,Sepsis,Hypoxemia,Diabetes with unspecified complication, type II or unspecified type, uncontrolled,Benign essential hypertension,Other and unspecified hyperlipidemia,Unspecified sleep apnea,Panic disorder without agoraphobia,Depressive disorder, not elsewhere classified'}
