CHIEF COMPLAINT: chest pressure, STEMI

PRESENT ILLNESS: Mr. [**Known lastname 17988**] is an 87yo male with pmhx of pancreatic cancer s/p
Whipple in [**2105**], htn, hld who is presenting with STEMI, which
resolved with ASA and nitrates. The patient reports that he ate
his dinner this evening without incident and then he did his
physical therapy exercises without discomfort. He subsequently
was watching hockey and at 8:50pm had chest pressure,
diaphoresis and nausea. He took 2 baby aspirin and called 911.
EMS gave him sublingual nitroglycerin and his pain improved. EKG
done at that time showed NSR with STE in I, aVL, V2 and inferior
inversions. Upon presentation to the ED, the patient was chest
pain free and his EKG changes had largely resolved, with largely
resolved STE in I and aVL. 1 mm STD still in inferior lead, STE
in V2 likely posterior ST depression.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes (with peripheral neuropathy),

MEDICATION ON ADMISSION: GABAPENTIN - 100 mg Capsule - 1 (One) Capsule(s) by mouth at
bedtime
INSULIN GLARGINE [LANTUS SOLOSTAR] - 100 unit/mL (3 mL) Insulin
Pen - inject 10  units or as directed subcutaneously once a day
dispense 3 month supply
LEVOTHYROXINE - 100 mcg Tablet - 1 Tablet(s) by mouth once a day
LIPASE-PROTEASE-AMYLASE [CREON] - 60,000 unit-[**Unit Number **],000 unit-[**Unit Number **],000
unit Capsule, Delayed Release(E.C.) - 4 Capsule(s) by mouth
three
times a day
METOCLOPRAMIDE - 5 mg Tablet - 1 Tablet(s) by mouth before meals
OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 (One)
Capsule, Delayed Release(E.C.)(s) by mouth once a day
CHOLECALCIFEROL (VITAMIN D3) -  (OTC) - 1,000 unit Tablet - 1
Tablet(s) by mouth daily
CYANOCOBALAMIN (VITAMIN B-12) -  (Prescribed by Other Provider;
OTC) - 250 mcg Tablet - two Tablet(s) by mouth Daily
DOCUSATE SODIUM -  (Prescribed by Other Provider) - Dosage
uncertain
MAGNESIUM OXIDE - 500 mg Tablet - 2 Tablet(s) by mouth twice
daily
MULTIVITAMIN-MINERALS-LUTEIN [CENTRUM SILVER] -  (Prescribed by
Other Provider) -   Tablet - one Tablet(s) by mouth daily
VITAMIN A-VITAMIN C-VIT E-MIN [OCUVITE] -   Tablet - One
Tablet(s) by mouth Daily0

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Bacitracin

PHYSICAL EXAM: ADMISSION EXAM:
.
VS: T=97.6 BP=180/70 HR=75 RR=12 O2 sat=  97% 2L
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: No history of pancreatic cancer. Father had stroke, MI (60).
Mother
had breast CA in her 70s. One brother had MI (40s) s/p CABG and
lung
cancer. Other brother has DM. Children are all healthy.

SOCIAL HISTORY: Lives with his wife and 2 daughters in [**Name (NI) **]. Has a son in
[**Name (NI) **]. Uses a cane when he goes out of the home. Is
relatively inactive. Denies current or past smoking,
EtOH, drug use. Occupation: merchandise
Acute myocardial infarction of other lateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Unspecified vitamin D deficiency,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Personal history of malignant neoplasm of other gastrointestinal tract,Anemia in chronic kidney disease,Other and unspecified angina pectoris,Other specified diseases of pancreas
AMI lateral NEC, initial,Crnry athrscl natve vssl,Hy kid NOS w cr kid I-IV,Hyperlipidemia NEC/NOS,Chronic kidney dis NOS,Hypothyroidism NOS,Vitamin D deficiency NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Long-term use of insulin,Hx of GI malignancy NEC,Anemia in chr kidney dis,Angina pectoris NEC/NOS,Pancreatic disease NEC
Admission Date:  [**2109-11-25**]              Discharge Date:   [**2109-11-29**]


Service: MEDICINE

Allergies:
Penicillins / Sulfa (Sulfonamide Antibiotics) / Bacitracin

Attending:[**First Name3 (LF) 4327**]
Chief Complaint:
chest pressure, STEMI

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 17988**] is an 87yo male with pmhx of pancreatic cancer s/p
Whipple in [**2105**], htn, hld who is presenting with STEMI, which
resolved with ASA and nitrates. The patient reports that he ate
his dinner this evening without incident and then he did his
physical therapy exercises without discomfort. He subsequently
was watching hockey and at 8:50pm had chest pressure,
diaphoresis and nausea. He took 2 baby aspirin and called 911.
EMS gave him sublingual nitroglycerin and his pain improved. EKG
done at that time showed NSR with STE in I, aVL, V2 and inferior
inversions. Upon presentation to the ED, the patient was chest
pain free and his EKG changes had largely resolved, with largely
resolved STE in I and aVL. 1 mm STD still in inferior lead, STE
in V2 likely posterior ST depression.

The patient reports that at baseline, he is able to run some
errands with his family and requires a cane to ambulate. He is
able to walk up a flight of stairs but does endorse dyspnea with
this exercise. He works with physical therapy and his exercise
tolerance per PT notes is about 6 minutes walk on flat ground.
He does endorse some exertional calf pain. He says that he has
not had any episodes of chest pressure, pain or dyspnea over the
preceeding weeks.
.
On review of systems, he denies any prior history of stroke,
TIA, deep venous thrombosis, pulmonary embolism, bleeding at the
time of surgery, myalgias, joint pains, cough, hemoptysis, black
stools or red stools. He denies recent fevers, chills or rigors.
He denies exertional buttock pain. All of the other review of
systems were negative.
.
Cardiac review of systems is notable for absence of  dyspnea on
exertion, paroxysmal nocturnal dyspnea, orthopnea, ankle edema,
palpitations, syncope or presyncope.
.


Past Medical History:
1. CARDIAC RISK FACTORS: +Diabetes (with peripheral neuropathy),

-Dyslipidemia, +Hypertension
2. CARDIAC HISTORY:  none
- CABG:  none
- PERCUTANEOUS CORONARY INTERVENTIONS:  none
- PACING/ICD:  none
3. OTHER PAST MEDICAL HISTORY:
Pancreatic cancer diagnosed [**7-/2106**] s/p Whipple [**2106-7-20**], no
evidence of recurrence on CT Torso in [**2107-8-9**]
Chronic Kidney Disease with baseline Cr 1.3-1.5
Hypothyroidism
Macular degeneration
Remote hx of one episode of gout
Anemia, with baseline Hct 26-30, on B12
s/p cholecystectomy
s/p appendectomy
h/o squamous cell carcinoma on scalp
Vitamin D Deficiency
Chronic back pain


Social History:
Lives with his wife and 2 daughters in [**Name (NI) **]. Has a son in
[**Name (NI) **]. Uses a cane when he goes out of the home. Is
relatively inactive. Denies current or past smoking,
EtOH, drug use. Occupation: merchandise

Family History:
No history of pancreatic cancer. Father had stroke, MI (60).
Mother
had breast CA in her 70s. One brother had MI (40s) s/p CABG and
lung
cancer. Other brother has DM. Children are all healthy.

Physical Exam:
ADMISSION EXAM:
.
VS: T=97.6 BP=180/70 HR=75 RR=12 O2 sat=  97% 2L
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 [**6-14**] 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: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: Multiple keratotic lesions throughout dermis. 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:
ADMISSION LABS:
.
[**2109-11-25**] 09:25PM BLOOD WBC-5.0 RBC-3.06* Hgb-9.5* Hct-27.6*
MCV-90 MCH-31.1 MCHC-34.6 RDW-14.0 Plt Ct-154
[**2109-11-25**] 09:25PM BLOOD Neuts-57.5 Lymphs-36.6 Monos-3.5 Eos-2.0
Baso-0.4
[**2109-11-25**] 09:25PM BLOOD PT-10.6 PTT-29.6 INR(PT)-1.0
[**2109-11-25**] 09:25PM BLOOD Glucose-247* UreaN-39* Creat-1.5* Na-135
K-5.2* Cl-104 HCO3-23 AnGap-13
[**2109-11-25**] 09:25PM BLOOD Calcium-8.9 Phos-3.8 Mg-1.9
.
PERTINENT LABS AND STUDIES:
[**2109-11-25**] 09:25PM BLOOD cTropnT-0.03*
[**2109-11-26**] 05:07AM BLOOD CK-MB-7 cTropnT-0.41*
[**2109-11-26**] 01:30PM BLOOD CK-MB-8 cTropnT-0.34*
[**2109-11-26**] 05:07AM BLOOD CK(CPK)-92
[**2109-11-26**] 01:30PM BLOOD CK(CPK)-109
.
ECHO [**2109-11-26**] The left atrium is elongated. Left ventricular
wall thickness, cavity size and regional/global systolic
function are normal (LVEF >55%). There is no ventricular septal
defect. Right ventricular chamber size and free wall motion are
normal. The aortic root is mildly dilated at the sinus level.
The aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. Trace aortic regurgitation is seen. The
mitral valve leaflets are moderately thickened. Mild (1+) mitral
regurgitation is seen. The pulmonary artery systolic pressure
could not be determined. There is no pericardial effusion.
.
IMPRESSION: Normal global and regional biventricular systolic
function. Mild mitral regurgitation.


Brief Hospital Course:
87M with HTN, T2DM, pancreatic cancer presenting with STEMI,
medically managed without intervention.
.
ACUTE CARE:
.
# CORONARY ARTERY DISEASE - The patient's chest pain and EKG
changes resolved with Aspirin and nitrates, thus, he was not
taken emergently to the catheterization lab. The following
morning, after discussion with his PCP, [**Name10 (NameIs) **] patient opted for
medical management of his myocardial ischemia. He was initially
started on Plavix load, heparin drip, and nitroglycerin drip. He
will continue on Aspirin, Plavix, Metoprolol, Atorvastatin,
Lisinopril for medical management of ACS, and he will also take
Imdur for treatment of chronic stable angina.
.
# NORMOCYTIC ANEMIA - The patient has a known baseline HCT of
26-30%. His hematocrit dropped to 22% this admission without
obvious bleeding. Hematology recommended a goal hematocrit of
30% in the setting of coronary ischemia. The patient received 1
unit of packed red cells and his hematocrit was subsequently 28%
and remained stable. He will follow-up with his outpatient
Hematologist.
.
CHRONIC CARE:
.
# HYPERTENSION - Not on home regimen but elevated at
presentation to hospital, was treated with Lisinopril and
Metoprolol, as above.
.
# INSULIN-DEPENDENT TYPE 2 DIABETES MELLITUS WITH NEUROPATHY -
HgA1C was 7% in [**9-/2109**], revealing good control of
insulin-dependent diabetes. Maintained on ISS and Lantus while
in house, and we continued his Gabapentin for neuropathy.
.
# PANCREATIC CANCER - The patient is status-post Whipple
procedure and has pancreatic insufficiency. He is considered in
remission although he no longer has surveillance imaging, as he
has opted to not pursue further aggressive management. We
continued Creon, vitamin repletion, metoclopramide and
omeprazole - per his outpatient regimen. His hematologist did
not feel that his hematocrit decline was related to his cancer.
This was discussed with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD.
.
# CKD - The patient's baseline creatinine is 1.5 and this
remained stale at time of presentation.
.
# HYPOTHYROIDISM - We continued his home Synthroid dosing.
.
# VITAMIN D DEFICIENCY - We continued his home vitamin D
supplement.
.
TRANSITION OF CARE ISSUES:
1. No pending radiologic studies, laboratory data or
microbiologic data at the time of discharge.
2. Will follow-up with outpatient Hematologist, Cardiologist and
primary care physician. [**Name10 (NameIs) **] appointments have been scheduled.
3. Will need hematocrit checked as an outpatient, to be followed
by his primary care physician.


Medications on Admission:
GABAPENTIN - 100 mg Capsule - 1 (One) Capsule(s) by mouth at
bedtime
INSULIN GLARGINE [LANTUS SOLOSTAR] - 100 unit/mL (3 mL) Insulin
Pen - inject 10  units or as directed subcutaneously once a day
dispense 3 month supply
LEVOTHYROXINE - 100 mcg Tablet - 1 Tablet(s) by mouth once a day
LIPASE-PROTEASE-AMYLASE [CREON] - 60,000 unit-[**Unit Number **],000 unit-[**Unit Number **],000
unit Capsule, Delayed Release(E.C.) - 4 Capsule(s) by mouth
three
times a day
METOCLOPRAMIDE - 5 mg Tablet - 1 Tablet(s) by mouth before meals
OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 (One)
Capsule, Delayed Release(E.C.)(s) by mouth once a day
CHOLECALCIFEROL (VITAMIN D3) -  (OTC) - 1,000 unit Tablet - 1
Tablet(s) by mouth daily
CYANOCOBALAMIN (VITAMIN B-12) -  (Prescribed by Other Provider;
OTC) - 250 mcg Tablet - two Tablet(s) by mouth Daily
DOCUSATE SODIUM -  (Prescribed by Other Provider) - Dosage
uncertain
MAGNESIUM OXIDE - 500 mg Tablet - 2 Tablet(s) by mouth twice
daily
MULTIVITAMIN-MINERALS-LUTEIN [CENTRUM SILVER] -  (Prescribed by
Other Provider) -   Tablet - one Tablet(s) by mouth daily
VITAMIN A-VITAMIN C-VIT E-MIN [OCUVITE] -   Tablet - One
Tablet(s) by mouth Daily0


Discharge Medications:
1. lipase-protease-amylase 12,000-38,000 -60,000 unit Capsule,
Delayed Release(E.C.) Sig: Three (3) Cap PO TID W/MEALS (3 TIMES
A DAY WITH MEALS).
2. gabapentin 100 mg Capsule Sig: One (1) Capsule PO HS (at
bedtime).
3. insulin glargine 100 unit/mL (3 mL) Insulin Pen Sig: Ten (10)
units Subcutaneous at bedtime.
4. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. metoclopramide 10 mg Tablet Sig: 0.5 Tablet PO before meals.

6. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
7. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
8. Vitamin D-3 1,000 unit Tablet, Chewable Sig: One (1) Tablet,
Chewable PO once a day.
9. cyanocobalamin (vitamin B-12) 250 mcg Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
10. docusate sodium  Oral
11. multivitamin-minerals-lutein     Tablet Sig: One (1) Tablet
PO once a day.
12. Ocuvite     Tablet Sig: One (1) Tablet PO once a day.
13. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
14. metoprolol succinate 25 mg Tablet Extended Release 24 hr
Sig: 1.5 Tablet Extended Release 24 hrs PO once a day.
Disp:*45 Tablet Extended Release 24 hr(s)* Refills:*2*
15. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
16. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
Disp:*30 Tablet Extended Release 24 hr(s)* Refills:*2*
17. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
18. Outpatient Lab Work
Please check CBC and Chem-7 on Tuesday [**12-2**] with
results to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 216**] at Phone: [**Telephone/Fax (1) 250**]
Fax: [**Telephone/Fax (1) 4004**]

19. nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet
Sublingual as directed as needed for chest pain: Take one tablet
5 minutes apart, do not take more than 2 tablets total.
Disp:*25 tablets* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Primary diagnoses:
1. Acute ST-elevation myocardial infarction
2. Acute on chronic normocytic anemia
.
Secondary Diagnoses:
1. Anemia of chronic disease
2. Hypertension
3. Inuslin-dependent diabetes mellitus
4. Pancreatic cancer


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr. [**Known lastname **],
You were admitted because you had a heart attack. As you know,
you opted to medically manage your heart attack and not proceed
with a cardiac catheterization. You did not have further chest
pain and you will continue your new medications at home.

Please note the following changes to your medications:
- START atorvastatin 80mg daily to lower your cholesterol
- START clopidogrel 75mg daily to keep your arteries open
- START metoprolol 37.5mg daily to lower your heart rate
- START lisinopril 5mg daily to lower your blood pressure
- START imdur 30mg daily to prevent chest pain
- START aspirin 325mg daily to prevent another heart attack.
- START nitroglycerin as needed if you have chest pressure at
home. Take one tablet, then wait 5 minutes, you can take up to
one more tablet if you still have chest pressure. Call 911 if
you still have chest pressure after taking nitroglycerin.
Continue to take the remainder of your medications as
prescribed.

Please be sure to follow up with  your physicians.

It was a pleasure taking care of you.

Followup Instructions:
Department: [**Hospital3 249**]
When: MONDAY [**2109-12-16**] at 11:10 AM
With: [**Name6 (MD) **] [**Name8 (MD) **], MD [**Telephone/Fax (1) 250**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
.
Department: HEMATOLOGY/ONCOLOGY
When: MONDAY [**2110-1-20**] at 11:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 593**], MD [**Telephone/Fax (1) 22**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
.
Department: HEMATOLOGY/ONCOLOGY
When: MONDAY [**2110-1-20**] at 11:00 AM
With: DR. [**First Name8 (NamePattern2) 24186**] [**Last Name (NamePattern1) 24187**] [**Telephone/Fax (1) 22**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
.
Department: CARDIAC SERVICES
When: MONDAY [**2109-12-30**] at 9:20 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 62**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Acute myocardial infarction of other lateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Unspecified vitamin D deficiency,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Personal history of malignant neoplasm of other gastrointestinal tract,Anemia in chronic kidney disease,Other and unspecified angina pectoris,Other specified diseases of pancreas'}


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: chest pressure, STEMI

PRESENT ILLNESS: Mr. [**Known lastname 17988**] is an 87yo male with pmhx of pancreatic cancer s/p
Whipple in [**2105**], htn, hld who is presenting with STEMI, which
resolved with ASA and nitrates. The patient reports that he ate
his dinner this evening without incident and then he did his
physical therapy exercises without discomfort. He subsequently
was watching hockey and at 8:50pm had chest pressure,
diaphoresis and nausea. He took 2 baby aspirin and called 911.
EMS gave him sublingual nitroglycerin and his pain improved. EKG
done at that time showed NSR with STE in I, aVL, V2 and inferior
inversions. Upon presentation to the ED, the patient was chest
pain free and his EKG changes had largely resolved, with largely
resolved STE in I and aVL. 1 mm STD still in inferior lead, STE
in V2 likely posterior ST depression.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: +Diabetes (with peripheral neuropathy),

MEDICATION ON ADMISSION: GABAPENTIN - 100 mg Capsule - 1 (One) Capsule(s) by mouth at
bedtime
INSULIN GLARGINE [LANTUS SOLOSTAR] - 100 unit/mL (3 mL) Insulin
Pen - inject 10  units or as directed subcutaneously once a day
dispense 3 month supply
LEVOTHYROXINE - 100 mcg Tablet - 1 Tablet(s) by mouth once a day
LIPASE-PROTEASE-AMYLASE [CREON] - 60,000 unit-[**Unit Number **],000 unit-[**Unit Number **],000
unit Capsule, Delayed Release(E.C.) - 4 Capsule(s) by mouth
three
times a day
METOCLOPRAMIDE - 5 mg Tablet - 1 Tablet(s) by mouth before meals
OMEPRAZOLE - 20 mg Capsule, Delayed Release(E.C.) - 1 (One)
Capsule, Delayed Release(E.C.)(s) by mouth once a day
CHOLECALCIFEROL (VITAMIN D3) -  (OTC) - 1,000 unit Tablet - 1
Tablet(s) by mouth daily
CYANOCOBALAMIN (VITAMIN B-12) -  (Prescribed by Other Provider;
OTC) - 250 mcg Tablet - two Tablet(s) by mouth Daily
DOCUSATE SODIUM -  (Prescribed by Other Provider) - Dosage
uncertain
MAGNESIUM OXIDE - 500 mg Tablet - 2 Tablet(s) by mouth twice
daily
MULTIVITAMIN-MINERALS-LUTEIN [CENTRUM SILVER] -  (Prescribed by
Other Provider) -   Tablet - one Tablet(s) by mouth daily
VITAMIN A-VITAMIN C-VIT E-MIN [OCUVITE] -   Tablet - One
Tablet(s) by mouth Daily0

ALLERGIES: Penicillins / Sulfa (Sulfonamide Antibiotics) / Bacitracin

PHYSICAL EXAM: ADMISSION EXAM:
.
VS: T=97.6 BP=180/70 HR=75 RR=12 O2 sat=  97% 2L
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: No history of pancreatic cancer. Father had stroke, MI (60).
Mother
had breast CA in her 70s. One brother had MI (40s) s/p CABG and
lung
cancer. Other brother has DM. Children are all healthy.

SOCIAL HISTORY: Lives with his wife and 2 daughters in [**Name (NI) **]. Has a son in
[**Name (NI) **]. Uses a cane when he goes out of the home. Is
relatively inactive. Denies current or past smoking,
EtOH, drug use. Occupation: merchandise 

### Response:
{'Acute myocardial infarction of other lateral wall, initial episode of care,Coronary atherosclerosis of native coronary artery,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other and unspecified hyperlipidemia,Chronic kidney disease, unspecified,Unspecified acquired hypothyroidism,Unspecified vitamin D deficiency,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Long-term (current) use of insulin,Personal history of malignant neoplasm of other gastrointestinal tract,Anemia in chronic kidney disease,Other and unspecified angina pectoris,Other specified diseases of pancreas'}
