CHIEF COMPLAINT: Change in mental status.

PRESENT ILLNESS: This is a 50-year-old man
with a history of type 2 diabetes, congestive heart failure,
coronary artery disease, COPD, obstructive sleep apnea,
depression, and with a history of lower extremity cellulitis,
who presented with four days of mental status change and
falls.  Most of the history was obtained from his sister,
[**Name (NI) **] [**Name (NI) **].  The patient also reports one episode of
worsening depression per report from his sister.  The patient
remained in bed most of the time.  The patient had also
recently been on Keflex times seven days for a lower
extremity cellulitis beginning from about [**2114-4-4**],
questionable possible diarrhea while on these antibiotics but
had resolved by the time of admission.  The patient was found
at home by his sister.  [**Name (NI) **] was found to be shaking and had
tremors.  She also noted that he had increased lower
extremity edema as well as erythema on his shins.  She notes
that he had a decreased appetite and decreased urinary output
for these several days.

MEDICAL HISTORY: 1.  Type 2 diabetes:  His hemoglobin A1C from [**2114-4-3**]
was 7.7.
2.  Coronary artery disease:  He had an echocardiogram done
in [**2111-12-2**] notable for left ventricular dilatation,
mildly depressed ejection fraction.
3.  History of COPD.
4.  Asthma.
5.  History of lower extremity cellulitis.
6.  History of falls.
7.  History of chronic renal insufficiency.
8.  History of obstructive sleep apnea on BIPAP.
9.  History of depression.
10. History of peripheral neuropathy.
11. History of hypercholesterolemia.
12. History of obesity.
13. History of foot pain.
14. History of hypertension.
15. History of BPH.
16. History of bladder papilloma.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Notable for diabetes and end-stage renal
disease in his mother who was also on hemodialysis and in his
grandmother notable for the presence of depression.

SOCIAL HISTORY: The patient has been on disability.  He is a
current smoker, smoking a pack per day times the past 35
years.  He does not drink.  He lives alone with the exception
of his dog.  The only social contact is his sister, [**Name (NI) **]
[**Name (NI) 3450**].
Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Cellulitis and abscess of leg, except foot,Mechanical complication due to other implant and internal device, not elsewhere classified,Morbid obesity,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus
Acute respiratry failure,Obs chr bronc w(ac) exac,Acute kidney failure NOS,CHF NOS,Cellulitis of leg,Malfunc oth device/graft,Morbid obesity,Other staphylococcus
Name:  [**Known lastname **], [**Known firstname **]                       Unit No:  [**Numeric Identifier 15143**]

Admission Date:  [**2087-3-31**]     Discharge Date:  [**2087-3-31**]

Date of Birth:                  Sex:  M

Service:

ADDENDUM:  This is an addendum to discharge summary dictated
on the [**2114-5-10**].  Original chief complaint and
history of present illness, as well as presenting history
remain the same.  This summary will include the following:

Additions to the hospital course:

Agitation remained a final issue for this patient where he
experienced episodes of apparent anxiety with some
diaphoresis, apparently with no precipitating events, at
various points throughout the day.  History that was provided
by the patient's sister indicated that he did have such
episodes of anxiety in the past, prior to hospitalization,
where he would suddenly get out of bed, become very agitated
and need to walk around the apartment.

Physical Therapy for his symptoms initially consisted of
intravenous Haldol prn.  These were later transitioned to
fixed doses of 5 mg Haldol given t.i.d. with prn intravenous
Haldol 10 mg per episode given as well as additional sedation
provided with Ativan and fentanyl.

Psychiatry was consulted to evaluate the patient's symptoms.
It was felt that his symptoms were primarily due to
polypharmacy, at which time efforts were made to simplify his
regimen.  His outpatient medication of Effexor was
discontinued.  The prn dose of Haldol was stopped and the
patient is maintained at 5 mg intravenous t.i.d. of Haldol.
The Ativan was discontinued and for any breakthrough anxiety
the patient was written for Fentanyl at doses of 100 mg q. 1
hour prn.

On subsequent day, in discussion with Pharmacy, it was felt
that patient could be transitioned to longer acting or
constant dose of Fentanyl and the patient was started on the
Fentanyl patch at 125 mg per hour.  Patient responded well to
the patch with decreased requirements for Fentanyl.  In
addition, patient was evaluated by Physical Therapy who felt
that given his current level of activity in his bed, that he
be transitioned to a regular hospital bed to improve greater
mobility as well as more accurate evaluation.

Patient has been screened by various Physical [**Hospital **]
rehabilitation centers and tentatively patient will be going
to [**Hospital3 **] most likely on the [**5-15**].
The plan is for the patient to go to rehabilitation to
regain his physical strength as well as to continue possibly
weaning off the vent.

The decision was made not to proceed with percutaneous
endoscopic gastrostomy tube placement given the patient's
comorbidities and to have a Dobbhoff tube
inserted.

DISCHARGE MEDICATIONS:
1.  Pantoprazole 30 mg per Dobbhoff tube q.d.
2.  Acetaminophen elixir 160 mg q. 4-6 hours prn.
3.  Docusate sodium 100 mg b.i.d.
4.  Senna syrup 5 mL twice a day.
5.  Amiodarone 400 mg daily.
6.  Miconazole topical powder applied b.i.d. prn.
7.  Fluconazole cream applied once or twice a day prn.
8.  Atrovent MDI 6 puffs q. 4 hours prn.
9.  Albuterol 90 mcg 4-6 puffs q. 4 hours.
10. Subcutaneous heparin at 5000 units q. 8 hours which can
be discontinued once the patient is ambulatory.
11. Aspirin 325 mg daily.
12. Metoprolol 25 mg twice a day.
13. Captopril 6.25 mg three times a day.
14. Insulin given as NPH 8 units in the morning, 7 units in
the evenings with q.i.d. regular insulin sliding scale.
15. Silver sulfadiazine applied topically twice a day to the
arm.
16. Citalopram 10 mg q.d.
17. Fentanyl patch starting at 125 mg per hour q. 72 hours to
be weaned down every week by 25 mg per hour, so week two will
be 100 mg per hour, week three 75 mg per hour, week four 50
mg per hour, week five 25 mg per hour, then none for week six
on.
18. Haldol 5 mg po t.i.d.
19. Lactulose 30 mL t.i.d.

Additional note:  The patient had been on a ten day course of
intravenous vancomycin for oxacillin resistant staphylococcus
coagulase negative, however, which did not require contact
precautions.  [**Name2 (NI) **] finished this course of antibiotics on
the [**2114-5-14**].

DISCHARGE PLAN:
1.  Eventually, the plan is for the patient to transition
back to a home setting and continue attempts at weaning at
the rehabilitation center.
2.  Further it is recommended by Psychiatry that he be seen
by a psychiatrist and followed at rehabilitation.





This has been noted in the discharge work sheet as well as
the page 1.


                               [**First Name4 (NamePattern1) 963**] [**Last Name (NamePattern1) 964**], M.D.

Dictated By:[**Last Name (NamePattern1) 1124**]

MEDQUIST36

D:  [**2114-5-14**]  02:35
T:  [**2114-5-14**]  14:41
JOB#:  [**Job Number 15144**]


Admission Date:  [**2114-4-18**]       Discharge Date: [**2114-5-10**]

Date of Birth:   [**2063-11-14**]       Sex:  M

Service:  MICU/GREEN [**Hospital Ward Name **]

CHIEF COMPLAINT:  Change in mental status.

HISTORY OF THE PRESENT ILLNESS:  This is a 50-year-old man
with a history of type 2 diabetes, congestive heart failure,
coronary artery disease, COPD, obstructive sleep apnea,
depression, and with a history of lower extremity cellulitis,
who presented with four days of mental status change and
falls.  Most of the history was obtained from his sister,
[**Name (NI) **] [**Name (NI) **].  The patient also reports one episode of
worsening depression per report from his sister.  The patient
remained in bed most of the time.  The patient had also
recently been on Keflex times seven days for a lower
extremity cellulitis beginning from about [**2114-4-4**],
questionable possible diarrhea while on these antibiotics but
had resolved by the time of admission.  The patient was found
at home by his sister.  [**Name (NI) **] was found to be shaking and had
tremors.  She also noted that he had increased lower
extremity edema as well as erythema on his shins.  She notes
that he had a decreased appetite and decreased urinary output
for these several days.

PAST MEDICAL HISTORY:
1.  Type 2 diabetes:  His hemoglobin A1C from [**2114-4-3**]
was 7.7.
2.  Coronary artery disease:  He had an echocardiogram done
in [**2111-12-2**] notable for left ventricular dilatation,
mildly depressed ejection fraction.
3.  History of COPD.
4.  Asthma.
5.  History of lower extremity cellulitis.
6.  History of falls.
7.  History of chronic renal insufficiency.
8.  History of obstructive sleep apnea on BIPAP.
9.  History of depression.
10. History of peripheral neuropathy.
11. History of hypercholesterolemia.
12. History of obesity.
13. History of foot pain.
14. History of hypertension.
15. History of BPH.
16. History of bladder papilloma.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS AT THE TIME OF ADMISSION:
1.  Lasix 80 mg q.d.
2.  Metformin 100 mg twice a day.
3.  Glipizide 10 mg twice a day.
4.  Neurontin 600 mg three times a day.
5.  Motrin 600 mg four times a day.
6.  Celexa 20 mg daily.
7.  Lipitor 60 mg daily.
8.  Lisinopril 20 mg daily.
9.  Protonix 40 mg daily.
10. Atenolol 12.5 mg daily.
11. Serevent MDI.
12. Triamcinolone.
13. Beclomethasone spray.
14. Rhinocort spray.

FAMILY HISTORY:  Notable for diabetes and end-stage renal
disease in his mother who was also on hemodialysis and in his
grandmother notable for the presence of depression.

SOCIAL HISTORY:  The patient has been on disability.  He is a
current smoker, smoking a pack per day times the past 35
years.  He does not drink.  He lives alone with the exception
of his dog.  The only social contact is his sister, [**Name (NI) **]
[**Name (NI) 3450**].

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  Temperature
97.2, blood pressure 190/144, heart rate 99, respirations 18,
saturation 97% on room air, 02 saturations dropped to 88% on
1 liter nasal cannula.  Initial K 6.6, creatinine 7.0,
phosphate 10.3, ammonia 61.  ABGs at that time was 7.22, PC02
67, P02 68.

The EKG at the time was notable for questionable atrial
fibrillation versus multifocal atrial tachycardia.

The patient was given 10 mg of IV diltiazem.  His blood
pressure then dropped to 80s systolic at that point.  He had
a left femoral line placed and received 2 liters of normal
saline as well as an amp of bicarbonate, lactulose, calcium
gluconate, Kayexalate, 10 units of regular insulin, as well
as an amp of D50.

On arrival to the floor, her vital signs were as follows:
Temperature 97.2, blood pressure 115/72, saturating 90% on
BIPAP.  General appearance:  He was confused, occasional
twitching, and an obese man.  HEENT:  Difficult to assess.
Notable for some dry mucous membranes.  The heart sounds were
distant.  The heart examination was notable for decreased
breath sounds bilaterally.  Abdomen was notable for morbid
obesity.  Normal bowel sounds were present.  It was
nontender.  The extremities were notable for erythema but no
warmth with blisters on his anterior shins.  Neurologically,
he was confused with occasional twitches.

LABORATORY DATA:  White cell count 11.1, hematocrit 40.3,
baseline in the upper 30s, platelets 315,000.  His
differential was 80% neutrophils, 9% lymphs, 8% monos.  His
Chem-7 was 134, 6.6, 90, 27, 109, 7, and 140 glucose.  His
calcium was 8.2, magnesium 2.1, phosphorus 10.3.  ALT 27, AST
18, total bilirubin 0.2, amylase 142, ammonia 61 at the time.

The chest x-ray was notable for a limited examination due to
poor penetration and possible right lower lobe pneumonia.

The EKG was notable for a right axis deviation, sinus
tachycardia, 104 beats per minute, T waves flipped in aVL and
V6, poor R wave progression but no ST changes.

HOSPITAL COURSE:  Initially it was felt that the patient's
mental status changes were due to acute renal failure, uremia
with possible COPD narcosis because he is believed to be a
chronic C02 retainer.  The possibility of infection such as
pneumonia could not necessarily be ruled out.

His acute renal failure was believed to be a combination of
dehydration and prerenal state secondary to depression and/or
pneumonia, urinary tract infections, cellulitis.  His hypoxia
was believed to be either pneumonia versus COPD exacerbation,
treated on BIPAP but then due to respiratory failure he was
electively intubated for airway protection.  Blood cultures
were done.  He was empirically started on levofloxacin,
Flagyl, and vancomycin.

During his hospitalization, he had a repeat echocardiogram
which showed LVEF about 30%, right ventricular free wall
motion significantly depressed, and there was some
....................septal motion defect consistent with
ventricular overload.  The patient was also dependent on
pressors believed to be secondary to sepsis.  He was
responsive to boluses as well as stress-dose steroids.  For
his hypokalemia, he was given Kayexalate and urine was
followed.

On [**2114-4-20**], the patient had a hemodialysis catheter
placed after consultation with the Renal Service given that
the patient's renal failure was considered to be a possible
indication for emergent hemodialysis.  However, the patient's
renal failure began to resolve on its own, thus alleviating
the need for hemodialysis.  Urine output was also seen to
improve over the [**Hospital 228**] hospital course.

The patient's nutritional status was maintained on tube
feeds.  The patient gradually became more responsive and
consideration made to wean the patient off the vent.  Of
note, it should be stated that the patient was difficult
peripheral status.  Central line placements all required the
need for guidance by ultrasound Dopplers for proper line
placement.  The patient also had an episode over his hospital
course of pulseless V tach which was preceded by atrial
tachycardia.  The patient coded but responded to one shock of
200 joules and reverted back to sinus rhythm.

The patient was started on an Amiodarone drip and then
switched to initially 400 mg of Amiodarone p.o. b.i.d. and
then eventually transitioned to 400 mg of Amiodarone daily.
His blood sugars were difficult to control, believed to
possibly be due to his body habitus as well as edema, with
the concern that subcutaneous heparin was not being absorbed.
The patient was maintained on an insulin drip.

The patient also developed foot blisters first noted on about
[**2114-4-26**] to [**2114-4-27**].  Podiatry was consulted who
felt that these blisters were secondary to his lower
extremity edema rather than pressure blisters per say and so
recommendations for dressings were placed on the blisters.

Attempts were made to wean the patient off the vent.  The
patient lasted as long as five hours on one attempt but
became increasingly tachycardiac and hypercapnic and so
require reintubation which was done fiberoptically by
Anesthesiology.  At this point, it was decided in
consultation with the patient's sister as well as the patient
to undergo a tracheostomy which was performed as a
cooperative effort between Interventional Pulmonology and
General Surgery.

The tracheostomy tube was placed on [**2114-5-7**].  The
procedure was uneventful with no complications.  At this
point, given the risks of PEG placement, the possibility of
PEG was discussed.  Interventional Radiology was unable to
take the patient as his body weight exceeded the carrying
capacity of their procedures table.  Gastroenterology was
willing to proceed but the patient's proxy was hesitant to
proceed with another operation.  The procedure was deferred.

An attempt was made to have the patient undergo a swallow
evaluation with his tracheostomy tube in place on [**2114-5-10**]; however, the patient was unable to pass the
examination, unable to swallow colored dye which was seen to
be in his trachea.  Given this consideration, the patient and
his sister decided at this point to forgo PEG placement at
this time and consider a Dobbhoff tube.  The plan was for the
patient to undergo Dobbhoff placement and be transitioned to
a rehabilitation facility.

Additional note:  The patient's course has been further
complicated by episodes of anxiety with the patient flailing
about and occasionally pulling out his tubes.  He has
required occasional use of a one-to-one sitter.  Currently,
he is being sedated with a combination of standing as well as
p.r.n. doses of Haldol with Fentanyl and Ativan.  Psychiatry
was consulted to evaluate his anxiety and they concluded that
most likely it is a combination believed to be primarily due
to polypharmacy.

Additional details will be added as an addendum to this
discharge summary.




                    DR.[**First Name (STitle) **],[**First Name3 (LF) **] 12-981

Dictated By:[**Last Name (NamePattern1) 95530**]
MEDQUIST36

D:  [**2114-5-10**]  04:30
T:  [**2114-5-10**]  17:01
JOB#:  [**Job Number 95531**]


Name:  [**Known lastname **], [**Known firstname **]                       Unit No:  [**Numeric Identifier 15143**]

Admission Date:  [**2114-4-18**]     Discharge Date:  04/25/2993

Date of Birth:   [**2063-11-14**]     Sex:  M

Service:  MICU

This is an addendum to an addendum on [**2114-5-14**],
referring to original discharge summary for dates which was
dictated on [**2114-5-10**], for the admission starting from
[**2114-4-18**].  The original discharge dictation as well as
the addendum stand with this addendum as an additional note.

The patient's discharge to rehabilitation was delayed
secondary to agitation which was believed to be a combination
of patient's prehospitalization baseline anxiety as well as
possible withdrawal at patient had been on a fentanyl drip at
rather high doses while he was intubated.  Patient was
gradually weaned off fentanyl and transitioned to a fentanyl
patch 125 mcg per hour and then switched to 100 mcg per hour,
then 75 and then 50 mcg per hour with additional fentanyl
provided on a p.r.n. basis, initially at 100 q.two hours and
then dropped to 50 q.two hours.  In addition, patient was
initially started on a standing dose of Haldol 5 mg p.o.
b.i.d. and then dropped down to 7.5 mg p.o. t.i.d. and this
was eventually discontinued completely at the recommendation
of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] from neurology who reviewed patient's
case to provide a second opinion as per the request of
patient's proxy, his sister.

The patient also experienced an episode of agitation and
during this episode ripped the balloon off his tracheostomy.
This was emergently filled with air via use of an Angiocath
and with a hyperdermic and the free end was clamped shut
until the tracheostomy could be replaced at bedside by CT
surgery.  The replacement procedure proceeded without
complications except for a transient drop in blood pressure
to the mid-80s systolic which recovered with a bolus of
normal saline.  Patient also had completed his course of 10
days of vancomycin and repeat culture while on antibiotics
was negative for further Staphylococcus.

Currently the patient is undergoing a weaning trial status
post tracheostomy replacement with minimal pressure support
and minimum PEEP.  Patient has lasted typically two to three
hours with each of these trials, although has needed to be
put back on resting settings secondary to hypercapnia.
Currently patient is being rescreened for other
rehabilitation placements.  Plan is to discharge patient on
the following medications.

DISCHARGE MEDICATIONS:
1.  Lansoprazole oral solution 30 mg per Dobbhoff tube q.day.
2.  Acetaminophen 325 to 650 mg per Dobbhoff tube q.four to
six hours p.r.n.
3.  Docusate liquid 100 mg per NG b.i.d.
4.  Amiodarone 400 mg per NG once per day to be continued for
a total of three months, at which point serum amiodarone
level should be measured as per cardiology recommendations.
5.  Miconazole powder topically to groin area p.r.n.
6.  Ipratropium bromide six puffs inhaled q.four hours p.r.n.
7.  Albuterol four to six puffs MDI q.four hours p.r.n.
8.  Heparin 5000 units subcu q.eight hours.
9.  Aspirin 325 mg p.o. q.d.
10. Metoprolol 25 mg p.o. b.i.d. with holding parameters of
less than 100 systolic blood pressure, heart rate less than
55.
11. Captopril 6.25 mg p.o. t.i.d., to be held if SBP is less
than 100.
12. Citalopram 10 mg p.o. q.d.
13. Nystatin oral suspension 5 mg p.o. q.i.d. p.r.n. swish
and swallow.
14. Insulin 16 units NPH at breakfast, 15 units NPH at bed
time with additional coverage provided with a regular insulin
sliding scale to be applied q.i.d. with the following notes:
1 unit of insulin starting at 121 to 150 mg/dl finger stick,
2 units 151 to 200, 4 units 201 to 240 mg/dl glucose, 6 units
241 to 280, 8 units 281 to 320 mg/dl, 10 units 321/360, 12
units greater than 361 mg/dl glucose.
15. Diazepam 5 mg p.o. b.i.d.
16. Fentanyl patch 25 mcg per hour.  This should be weaned
off in 72 hours.
17. Haloperidol 5 mg q.six hours p.o. p.r.n. for break
through agitation.
18. Peri-Colace one capsule p.o. b.i.d. p.r.n.
19. Lasix 20 mg p.o. b.i.d.
20. Senna 15 ml liquid p.o. b.i.d. p.r.n.

DISCHARGE INSTRUCTIONS:  The patient should be weighed daily
and an increase of more than 3 pounds per day should be
reason for reassessment of patient's Lasix dose.  In
addition, patient's BUN and creatinine should be checked once
per week to follow if patient's creatinine should rise while
on the diuretic.  At rehab patient should be followed by a
psychiatrist for his depression as well as his anxiety
issues.  As noted in previous discharge summary and addendum,
patient developed bilateral heel blisters believe to be
secondary to his initial lower extremity edema.  Dressings
should be dry gauze dressings to be changed twice per day.
Patient has been cleared by podiatry for weight bearing upon
discharge to rehab.  In addition, in rehab patient should
undergo at least once per day, if not two to three times per
day, weaning trials with minimal pressure support and minimal
PEEP until patient is noted to develop discomfort at which
time he should be put back on his original resting settings.
Long term goal would be for patient to eventually be
independent of the ventilator and to be mobile enough with
physical therapy rehabilitation to return to his home
setting.






                   DR.[**First Name (STitle) 3353**],[**First Name3 (LF) 3354**] 12-981

Dictated By:[**Last Name (NamePattern1) **]

MEDQUIST36

D:  [**2114-5-24**]  12:18
T:  [**2114-5-24**]  12:48
JOB#:  [**Job Number 15145**]
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Cellulitis and abscess of leg, except foot,Mechanical complication due to other implant and internal device, not elsewhere classified,Morbid obesity,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus'}


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: Change in mental status.

PRESENT ILLNESS: This is a 50-year-old man
with a history of type 2 diabetes, congestive heart failure,
coronary artery disease, COPD, obstructive sleep apnea,
depression, and with a history of lower extremity cellulitis,
who presented with four days of mental status change and
falls.  Most of the history was obtained from his sister,
[**Name (NI) **] [**Name (NI) **].  The patient also reports one episode of
worsening depression per report from his sister.  The patient
remained in bed most of the time.  The patient had also
recently been on Keflex times seven days for a lower
extremity cellulitis beginning from about [**2114-4-4**],
questionable possible diarrhea while on these antibiotics but
had resolved by the time of admission.  The patient was found
at home by his sister.  [**Name (NI) **] was found to be shaking and had
tremors.  She also noted that he had increased lower
extremity edema as well as erythema on his shins.  She notes
that he had a decreased appetite and decreased urinary output
for these several days.

MEDICAL HISTORY: 1.  Type 2 diabetes:  His hemoglobin A1C from [**2114-4-3**]
was 7.7.
2.  Coronary artery disease:  He had an echocardiogram done
in [**2111-12-2**] notable for left ventricular dilatation,
mildly depressed ejection fraction.
3.  History of COPD.
4.  Asthma.
5.  History of lower extremity cellulitis.
6.  History of falls.
7.  History of chronic renal insufficiency.
8.  History of obstructive sleep apnea on BIPAP.
9.  History of depression.
10. History of peripheral neuropathy.
11. History of hypercholesterolemia.
12. History of obesity.
13. History of foot pain.
14. History of hypertension.
15. History of BPH.
16. History of bladder papilloma.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Notable for diabetes and end-stage renal
disease in his mother who was also on hemodialysis and in his
grandmother notable for the presence of depression.

SOCIAL HISTORY: The patient has been on disability.  He is a
current smoker, smoking a pack per day times the past 35
years.  He does not drink.  He lives alone with the exception
of his dog.  The only social contact is his sister, [**Name (NI) **]
[**Name (NI) 3450**]. 

### Response:
{'Acute respiratory failure,Obstructive chronic bronchitis with (acute) exacerbation,Acute kidney failure, unspecified,Congestive heart failure, unspecified,Cellulitis and abscess of leg, except foot,Mechanical complication due to other implant and internal device, not elsewhere classified,Morbid obesity,Staphylococcus infection in conditions classified elsewhere and of unspecified site, other staphylococcus'}
