CHIEF COMPLAINT: malaise

PRESENT ILLNESS: 85 yo male w/ h/o Afib, systolic CHF, and recent cholecystitis
treated medically p/w fatigue, poor po intake, and malaise. Upon
questioning he admits to mild ruq pain and chills but no fevers.
He lost ten lbs in the last week due to poor po intake. His son
brought him to the [**Name (NI) **] for evaluation after he had an appointment
at his cardiologist's office.
.
He had been hospitalized through [**2152-12-10**] at an OSH for rx of
cholecytitis afterwhich he developed lower extremity edema and
dyspnea on exertion. He was started on lasix one week ago and
has improved since then. He says that he gets extremely short of
breath after 20 steps. No chest pain.
.
He has had several mechanical falls lately and for this reason,
he is not anticoagulated.

MEDICAL HISTORY: S/P BILATERAL TKR
*S/P ILIAL FRACTURE
ATRIAL FIBRILLATION
AWB DONATION- DEFFERRAL
B12 DEFICIENCY ANEMIA
BLADDER CANCER
CERVICAL SPONDYLOSIS
CHRONIC RENAL FAILURE
GASTROESOPHAGEAL REFLUX
HERNIATED DISC
HYPERCHOLESTEROLEMIA
HYPERTENSION
HYPOTHYROIDISM
MGUS
MITRAL VALVE PROLAPSE
PROCTITIS
PROSTATE CANCER
R SHOULDER DJD
TRANSIENT ISCHEMIC ATTACK
[**2141**] LVEF 25%

MEDICATION ON ADMISSION: tylenol #3 daily prn
furosemide 20mg daily
amlodipine 5mg daily
bupropion 300mg daily
calcitriol .25mcg
domperidone 5mg daily
gabapentin 900mg daily
esmeprasole 40mg daily
eszopiclone (lunesta) 2mg hs
gabapentin 800mg daily
hydralazine 25mg [**Hospital1 **]
levothyroxine 112 mcg daily
metoprolol succinate 50mg [**Hospital1 **]
ranitidine 150mg daily
rosuvastatin 20mg daily
tamsulosin .4mg daily
asa 325
vitamin d
b12 1000mcg daily

ALLERGIES: Codeine / Iodine

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact

FAMILY HISTORY: Mother died of alzheimers dementia
Father died of prostate cancer

SOCIAL HISTORY: lives alone but has daily help; no smoking or etoh
Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Acute on chronic systolic heart failure,Toxic encephalopathy,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Delirium due to conditions classified elsewhere,Other and unspecified Escherichia coli [E. coli],Atrial fibrillation,Chronic kidney disease, Stage III (moderate),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other vitamin B12 deficiency anemia,Monoclonal paraproteinemia,Unspecified acquired hypothyroidism,Adult failure to thrive,Hypotension, unspecified,Mitral valve disorders,Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified vitamin D deficiency,Hypoxemia,Diarrhea,Insomnia, unspecified,Other and unspecified hyperlipidemia,Right bundle branch block,Esophageal reflux,Knee joint replacement,Personal history of malignant neoplasm of prostate,Personal history of malignant neoplasm of bladder,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,History of fall
Cholelith w ac cholecyst,Ac on chr syst hrt fail,Toxic encephalopathy,Urin tract infection NOS,Acute kidney failure NOS,Delirium d/t other cond,E.coli infection NEC/NOS,Atrial fibrillation,Chr kidney dis stage III,Hy kid NOS w cr kid I-IV,B12 defic anemia NEC,Monoclon paraproteinemia,Hypothyroidism NOS,Failure to thrive-adult,Hypotension NOS,Mitral valve disorder,Loc osteoarth NOS-shlder,BPH w/o urinary obs/LUTS,Vitamin D deficiency NOS,Hypoxemia,Diarrhea,Insomnia NOS,Hyperlipidemia NEC/NOS,Rt bundle branch block,Esophageal reflux,Joint replaced knee,Hx-prostatic malignancy,Hx of bladder malignancy,Hx TIA/stroke w/o resid,Personal history of fall
Admission Date:  [**2153-1-5**]              Discharge Date:   [**2153-1-11**]

Date of Birth:  [**2067-1-25**]             Sex:   M

Service: MEDICINE

Allergies:
Codeine / Iodine

Attending:[**First Name3 (LF) 2782**]
Chief Complaint:
malaise


Major Surgical or Invasive Procedure:
Percutaneous Chol.

History of Present Illness:
85 yo male w/ h/o Afib, systolic CHF, and recent cholecystitis
treated medically p/w fatigue, poor po intake, and malaise. Upon
questioning he admits to mild ruq pain and chills but no fevers.
He lost ten lbs in the last week due to poor po intake. His son
brought him to the [**Name (NI) **] for evaluation after he had an appointment
at his cardiologist's office.
.
He had been hospitalized through [**2152-12-10**] at an OSH for rx of
cholecytitis afterwhich he developed lower extremity edema and
dyspnea on exertion. He was started on lasix one week ago and
has improved since then. He says that he gets extremely short of
breath after 20 steps. No chest pain.
.
He has had several mechanical falls lately and for this reason,
he is not anticoagulated.

In the ED, initial VS were: 97.8 48 95/76 18 90%. He was given
1.5L ivf. He was treated with azithromycin 500mg iv once,
ceftriaxone 1g iv once, unasyn 3g iv once. Lactate decreased
from 4.6 to 2.2 with fluids. Troponin stable at .03. Surgical
consultation recommends percutaneous cholecystostomy tubes. CT
head
.
Upon transfer to the micu, 98.0, Pulse: 94, RR: 16, BP: 129/72,
O2Sat: 97%, O2. On arrival to the MICU, he had no acute
complaints.
.
Review of systems:
(+) Per HPI
(-) Denie night sweats, recent wt gain. Denies headache, sinus
tenderness, rhinorrhea or congestion. Denies or wheezing. Denies
chest pain, chest pressure, palpitations, or weakness. Denies
nausea, vomiting, diarrhea, constipation, abdominal pain, or
changes in bowel habits. Denies dysuria, frequency, or urgency.
Denies arthralgias or myalgias. Denies rashes or skin changes.


Past Medical History:
S/P BILATERAL TKR
*S/P ILIAL FRACTURE
ATRIAL FIBRILLATION
AWB DONATION- DEFFERRAL
B12 DEFICIENCY ANEMIA
BLADDER CANCER
CERVICAL SPONDYLOSIS
CHRONIC RENAL FAILURE
GASTROESOPHAGEAL REFLUX
HERNIATED DISC
HYPERCHOLESTEROLEMIA
HYPERTENSION
HYPOTHYROIDISM
MGUS
MITRAL VALVE PROLAPSE
PROCTITIS
PROSTATE CANCER
R SHOULDER DJD
TRANSIENT ISCHEMIC ATTACK
[**2141**] LVEF 25%


Social History:
lives alone but has daily help; no smoking or etoh


Family History:
Mother died of alzheimers dementia
Father died of prostate cancer

Physical Exam:
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact


Pertinent Results:
Admission Labs

[**2153-1-5**] 09:45PM   GLUCOSE-136* UREA N-41* CREAT-1.8* SODIUM-141
POTASSIUM-3.9 CHLORIDE-109* TOTAL CO2-21* ANION GAP-15
[**2153-1-5**] 09:45PM   CALCIUM-8.1* PHOSPHATE-4.3 MAGNESIUM-2.0
[**2153-1-5**] 12:03PM URINE  HOURS-RANDOM UREA N-932 CREAT-99
SODIUM-50 POTASSIUM-68 CHLORIDE-41
[**2153-1-5**] 12:03PM URINE  OSMOLAL-595
[**2153-1-5**] 12:03PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.018
[**2153-1-5**] 04:49AM   GLUCOSE-136* UREA N-45* CREAT-2.1* SODIUM-139
POTASSIUM-4.2 CHLORIDE-105 TOTAL CO2-21* ANION GAP-17
[**2153-1-5**] 04:49AM   ALT(SGPT)-55* AST(SGOT)-55* LD(LDH)-255* ALK
PHOS-128 TOT BILI-0.6
[**2153-1-5**] 04:49AM   CALCIUM-8.2* PHOSPHATE-4.2 MAGNESIUM-2.0
IRON-38*
[**2153-1-5**] 04:49AM   calTIBC-179* VIT B12-740 FOLATE-GREATER TH
FERRITIN-246 TRF-138*
[**2153-1-5**] 04:49AM   WBC-8.6 RBC-3.08* HGB-9.9* HCT-30.7* MCV-100*
MCH-32.2* MCHC-32.4 RDW-17.9*
[**2153-1-5**] 04:49AM   PLT COUNT-239
[**2153-1-5**] 04:49AM   PT-13.4* PTT-20.7* INR(PT)-1.2*
[**2153-1-5**] 01:04AM   LACTATE-2.2*
[**2153-1-5**] 12:55AM   cTropnT-0.03*
[**2153-1-4**] 08:25PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.013
[**2153-1-4**] 08:25PM URINE  RBC-1 WBC-10* BACTERIA-MANY YEAST-NONE
EPI-0
[**2153-1-4**] 08:25PM URINE  MUCOUS-RARE
[**2153-1-4**] 06:25PM   LACTATE-4.6* K+-4.8
[**2153-1-4**] 06:25PM   HGB-11.3* calcHCT-34
[**2153-1-4**] 06:12PM   PT-14.7* PTT-24.4* INR(PT)-1.4*
[**2153-1-4**] 06:12PM   PLT COUNT-267#
[**2153-1-4**] 06:12PM   cTropnT-0.03*
[**2153-1-4**] 06:12PM   LIPASE-33

Brief Hospital Course:
BRIEF HOSPITAL COURSE: This is an 85 year old gentleman with a
history of atrial fibrillation, systolic heart failure and
recent medically treated cholecystitis who presented with
recurrent cholecystitis that was treated with percutaneous
drainage and antibiotics.  His hospital course was complicated
by delirium and mild pulmonary edema.
.
ACTIVE ISSUES:
ACUTE CHOLECYSTITIS: Mr. [**Known lastname 79**] presented with right upper
quadrant pain and nausea and fatigue. Labs significant for
normal LFTs. RUQ ultrasound demonstrate dacute cholecystitis.
Suurgery was consulted and recommended percutaneous drainage of
his gallbladder which was carried out by IR. Initial pus was
drained from the gallbladder which transioned to bilious
drainage on Day # 2 of admission. He was covered with Vancomycin
and Zosyn initially. Culture data from the biliary drain grew
ecoli sensitive to ciprofloxacin. Antibiotic therapy was changed
to ciprofloxacin and metronidazole to include anaerobic coverage
for a total of 14 days.  His biliary drain was kept in place
with plan for discontinuation by general surgery in [**5-25**] weeks.
He was afebrile for the duration of his hospital course.
.
CONGESTIVE HEART FAILURE: On admission he was noted be dyspneic.
An initial chest xray was concerning for right lower lobe
pneumonia that could not be ruled out in the setting of
pulmonary edema. He was initially on vancomycin and zosyn on
admission to the intensive care unit.  While diuresis was
initially held on secondary to concern for acute kidney injury
his pulmonary edema accumulated during his initial hospital
days.  He was given IV lasix 20mg twice and restarted on his
home dose of lasix 20mg daily.  This dose was uptitrated to 40mg
daily which appeared to better control his volume status and
improved his breathing. An echo demonstrated symmetric left
ventricular hypertrophy with cavity dilation and global systolic
dysfunction suggestive of a non-ischemic pattern with EF 25%. A
low dose ace-inhibitor (lisinopril 5mg) was started and he was
continued on an aspirin and beta blocker. He reported no cough
and was afebrile for the duration of hospitalization.  A repeat
chest xray after diuresis revealed no evidence of pneumonia. His
nighttime oxygen saturations were noted to be stably in the low
90s.
.
URINARY TRACT INFECTION: A urine sample from admission was
concerning for infection and culture grew ecoli sensitive to
ciprofloxacin. A repeat UA prior to discharge was clear of
infection.
.
ATRIAL FIBRILLATION: Mr. [**Known lastname 79**] is rate controlled with metoprolol
and anticoagulated with aspirin given fall risk.  He was noted
to have heart rates in the 110s with frequent episodes of non
sustained ventricular tachycardia, therfore his metoprolol was
incrased to 50mg three times a day with improvement in the
frequency of NSVT and heart rates in the 60-70s during the day.
Cardiology was consulted and agreed with management changes.
There was a question of whether he was on domperidone in the
past. It was taken off his medication list.
.
DELIRIUM: Mr. [**Known lastname 79**] was noted to have progressive delirium
throughout his hospitalization which was improving prior to
discharge. No pharmacologic agents were required for management.
He had an attentive family at his bedside at all his times.
Repeat infectious work-up including UA, chest xray and cdiff
toxin were negative for infection. His electrolytes were stable.
 Etiology attributed to age, dementia and hospitalization
including ICU stay.
.
SPEECH AND SWALLOW: While delirius, Mr. [**Known lastname 79**] was noted to have
small aspiration events with eating and drinking. A speech and
swallow evaluation recommended nectar thickened liquids with
suggested re-evaluation when his delirium clears.
.
INACTIVE ISSUES
CHRONIC KIDNEY DISEASE: His renal function ranged between 1.8
and 2.0 throughout his hospitalization which was just above his
baseline.
.
HYPERTENSION:  Well controlled. Furosemide increased to 40mg PO.
 Amlodipine was discontined in favor of lisinopril 5mg.
Hydralazine was held on discharge given normotensive. He should
discuss restarting this medication with his primary care
physician after discharge.
.
HYPOTHYROID: He was continued on levothyroxine.
.
VITAMIN D:  He was continued on vitamin D.
.
DYSLIPIDEMIA: He was continued on crestor 20mg daily.
.
DEPRESSION: He was continued on wellbutrin 300mg daily.
.
BENIGN PROSTATIC HYPERTROPHY: He was continued on flomax.
.
PAIN: Secondary to frequent falls. He was continued on tylenol
and gabapentin.
.
INSOMNIA: Lunesta was held on admission and should be
reconsidered on discharge.
.
GERD: He was continued on ranitidine and nexium.
.
TRANSITIONAL ISSUES:
- Continue ciprofloxacin and metronidazole for 8 additional days
- Primary care follow-up, Electrolytes should be checked within
1 week as she has started lasix and lisinopril.
- Full Code

Medications on Admission:
tylenol #3 daily prn
furosemide 20mg daily
amlodipine 5mg daily
bupropion 300mg daily
calcitriol .25mcg
domperidone 5mg daily
gabapentin 900mg daily
esmeprasole 40mg daily
eszopiclone (lunesta) 2mg hs
gabapentin 800mg daily
hydralazine 25mg [**Hospital1 **]
levothyroxine 112 mcg daily
metoprolol succinate 50mg [**Hospital1 **]
ranitidine 150mg daily
rosuvastatin 20mg daily
tamsulosin .4mg daily
asa 325
vitamin d
b12 1000mcg daily


Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
2. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO once a
day.
4. esomeprazole magnesium 40 mg Capsule, Delayed Release(E.C.)
Sig: One (1) Capsule, Delayed Release(E.C.) PO once a day.
5. eszopiclone 2 mg Tablet Sig: One (1) Tablet PO at bedtime as
needed for insomnia.
6. levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. rosuvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
8. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1)
Capsule, Ext Release 24 hr PO HS (at bedtime).
9. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
10. Vitamin D 2,000 unit Capsule Sig: One (1) Capsule PO once a
day.
11. cyanocobalamin (vitamin B-12) 1,000 mcg Tablet Sig: One (1)
Tablet PO once a day.
12. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 8 days: day 1 = [**1-5**] (total course 14
days).
13. metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H
(every 8 hours) for 8 days: day 1 = [**1-5**] (total 14 days).
14. bupropion HCl 300 mg Tablet Extended Release 24 hr Sig: One
(1) Tablet Extended Release 24 hr PO once a day.
15. gabapentin 800 mg Tablet Sig: One (1) Tablet PO once a day.

16. metoprolol succinate 50 mg Tablet Extended Release 24 hr
Sig: Three (3) Tablet Extended Release 24 hr PO once a day.
17. lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
[**First Name8 (NamePattern2) 1495**] [**Hospital 122**] Rehabilitation Center

Discharge Diagnosis:
Acute cholecystitis
Urinary tract infection
Atrial fibrillation
Decompensated systolic heart failure
Hypertension
Chronic kidney disease


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
It was a pleasure taking care of you. You came with the feeling
of fatigue and fever. The reason was that you had inflammation
of your galbladder and urinary tact infection. The tube was
placed into your gallblader so that the bile can drain. We gave
you antibiotics and you recovered.
.
The tube should stay in your gallbladder. Wou will see the
surgeon on [**1-26**] and they will give you further
instructions.
.
We have done the following changes to your medications:
CONTINUE ciprofloxacin 500 mg tbl. twice a day for 8 more days
CONTINUE metronidazole 500 mg tbl. three times a day for 8 more
days
CHANGE furosemide 20 mg po daily to furosemide 40 mg daily
DISCONTINUE dronedorol
DISCONTINUE amlodipine 5 mg daily
START lisinopril 5 mg daily
DISCONTINUE hydralazine 25 mg twice a day
DISCONTINUE ranitidine 150 mg daily

Followup Instructions:
Department: GENERAL SURGERY/[**Hospital Unit Name 2193**]
When: FRIDAY [**2153-1-26**] at 10:15 AM
With: ACUTE CARE CLINIC [**Telephone/Fax (1) 600**]
Building: LM [**Hospital Ward Name **] Bldg ([**Last Name (NamePattern1) **]) [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
.
Department: WEST [**Hospital 2002**] CLINIC
When: WEDNESDAY [**2153-2-7**] at 11:30 AM
With: [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 720**], M.D. [**Telephone/Fax (1) 721**]
Building: De [**Hospital1 **] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage
.
Department: WEST [**Hospital 2002**] CLINIC
When: WEDNESDAY [**2153-3-28**] at 11:30 AM
With: [**First Name11 (Name Pattern1) 177**] [**Last Name (NamePattern4) 720**], M.D. [**Telephone/Fax (1) 721**]
Building: De [**Hospital1 **] Building ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage
{'Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Acute on chronic systolic heart failure,Toxic encephalopathy,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Delirium due to conditions classified elsewhere,Other and unspecified Escherichia coli [E. coli],Atrial fibrillation,Chronic kidney disease, Stage III (moderate),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other vitamin B12 deficiency anemia,Monoclonal paraproteinemia,Unspecified acquired hypothyroidism,Adult failure to thrive,Hypotension, unspecified,Mitral valve disorders,Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified vitamin D deficiency,Hypoxemia,Diarrhea,Insomnia, unspecified,Other and unspecified hyperlipidemia,Right bundle branch block,Esophageal reflux,Knee joint replacement,Personal history of malignant neoplasm of prostate,Personal history of malignant neoplasm of bladder,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,History of fall'}


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: malaise

PRESENT ILLNESS: 85 yo male w/ h/o Afib, systolic CHF, and recent cholecystitis
treated medically p/w fatigue, poor po intake, and malaise. Upon
questioning he admits to mild ruq pain and chills but no fevers.
He lost ten lbs in the last week due to poor po intake. His son
brought him to the [**Name (NI) **] for evaluation after he had an appointment
at his cardiologist's office.
.
He had been hospitalized through [**2152-12-10**] at an OSH for rx of
cholecytitis afterwhich he developed lower extremity edema and
dyspnea on exertion. He was started on lasix one week ago and
has improved since then. He says that he gets extremely short of
breath after 20 steps. No chest pain.
.
He has had several mechanical falls lately and for this reason,
he is not anticoagulated.

MEDICAL HISTORY: S/P BILATERAL TKR
*S/P ILIAL FRACTURE
ATRIAL FIBRILLATION
AWB DONATION- DEFFERRAL
B12 DEFICIENCY ANEMIA
BLADDER CANCER
CERVICAL SPONDYLOSIS
CHRONIC RENAL FAILURE
GASTROESOPHAGEAL REFLUX
HERNIATED DISC
HYPERCHOLESTEROLEMIA
HYPERTENSION
HYPOTHYROIDISM
MGUS
MITRAL VALVE PROLAPSE
PROCTITIS
PROSTATE CANCER
R SHOULDER DJD
TRANSIENT ISCHEMIC ATTACK
[**2141**] LVEF 25%

MEDICATION ON ADMISSION: tylenol #3 daily prn
furosemide 20mg daily
amlodipine 5mg daily
bupropion 300mg daily
calcitriol .25mcg
domperidone 5mg daily
gabapentin 900mg daily
esmeprasole 40mg daily
eszopiclone (lunesta) 2mg hs
gabapentin 800mg daily
hydralazine 25mg [**Hospital1 **]
levothyroxine 112 mcg daily
metoprolol succinate 50mg [**Hospital1 **]
ranitidine 150mg daily
rosuvastatin 20mg daily
tamsulosin .4mg daily
asa 325
vitamin d
b12 1000mcg daily

ALLERGIES: Codeine / Iodine

PHYSICAL EXAM: General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred, finger-to-nose intact

FAMILY HISTORY: Mother died of alzheimers dementia
Father died of prostate cancer

SOCIAL HISTORY: lives alone but has daily help; no smoking or etoh 

### Response:
{'Calculus of gallbladder with acute cholecystitis, without mention of obstruction,Acute on chronic systolic heart failure,Toxic encephalopathy,Urinary tract infection, site not specified,Acute kidney failure, unspecified,Delirium due to conditions classified elsewhere,Other and unspecified Escherichia coli [E. coli],Atrial fibrillation,Chronic kidney disease, Stage III (moderate),Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Other vitamin B12 deficiency anemia,Monoclonal paraproteinemia,Unspecified acquired hypothyroidism,Adult failure to thrive,Hypotension, unspecified,Mitral valve disorders,Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Unspecified vitamin D deficiency,Hypoxemia,Diarrhea,Insomnia, unspecified,Other and unspecified hyperlipidemia,Right bundle branch block,Esophageal reflux,Knee joint replacement,Personal history of malignant neoplasm of prostate,Personal history of malignant neoplasm of bladder,Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits,History of fall'}
