CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 101054**] is a 57-year-old
type 2 diabetic male with right Charcot hind foot deformity.
The patient recently developed a right lateral foot ulcer
with copious bloody drainage several days prior to admission.

MEDICAL HISTORY: 1.  Type 2 diabetes times 15 years.
 2.  Retinopathy.
 3.  Peripheral neuropathy.
 4.  Nephropathy.
 5.  Chronic renal insufficiency.
 6.  Congestive heart failure.
 7.  Anemia.
 8.  Hepatitis C.
 9.  Hypertension.
10.  History of tuberculosis.
11.  History of abnormal liver function tests.
12.  History of gastrointestinal bleeding.
13.  History of intravenous drug abuse.
14.  Status post left below-knee amputation.

MEDICATION ON ADMISSION: 1.  NPH 38 units subcutaneously q.a.m. and 4 units
subcutaneously q.p.m.
 2.  Regular insulin 5 units subcutaneously q.a.m. and 5
units subcutaneously q.p.m.
 3.  Neurontin 100 mg p.o. twice per day.
 4.  Methadone 100 mg p.o. once per day.
 5.  Diovan 160 mg p.o. once per day.
 6.  Lasix 40 mg p.o. twice per day.
 7.  Zaroxolyn 2.5 mg p.o. once per day.
 8.  Iron 325 mg p.o. twice per day.
 9.  Epogen 10,000 units every Tuesday, Thursday, and
Saturday.
10.  Metoprolol 100 mg p.o. twice per day.

ALLERGIES: REVIEW OF SYSTEMS:  The patient denies chest pain, shortness
of breath, abdominal complaints, and diarrhea.  The patient
complains of positive right foot and ankle pain.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Ulcer of ankle,Acute osteomyelitis, ankle and foot,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other vascular complications of medical care, not elsewhere classified,Congestive heart failure, unspecified,Chronic hepatitis C without mention of hepatic coma,Arthropathy associated with neurological disorders
DMII neuro nt st uncntrl,Ulcer of ankle,Ac osteomyelitis-ankle,Acute kidney failure NOS,Hyp kid NOS w cr kid V,Vasc comp med care NEC,CHF NOS,Chrnc hpt C wo hpat coma,Arthropathy w nerve dis
Admission Date:  [**2183-3-12**]     Discharge Date:  [**2183-4-9**]

Date of Birth:   [**2125-5-16**]     Sex:  M

Service:  Podiatric Surgery

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 101054**] is a 57-year-old
type 2 diabetic male with right Charcot hind foot deformity.
The patient recently developed a right lateral foot ulcer
with copious bloody drainage several days prior to admission.

The foot was in a brace for a recent acute severe Charcot
foot with worsening x-ray changes and significant
malalignment at the ankle, hind foot, and midfoot joints.

The patient was previously admitted to the Medicine Service
under Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] on [**2183-2-14**] through
[**2183-2-17**] for right Charcot foot.  The patient was
followed up by Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] as an outpatient.  The
patient was placed in a AO splint then crow walker by [**First Name5 (NamePattern1) **]
[**Last Name (NamePattern1) 101080**] of [**Location (un) **] Prosthetics for immobilization of the
foot.  The patient was on Levaquin as an outpatient.

PAST MEDICAL HISTORY:
 1.  Type 2 diabetes times 15 years.
 2.  Retinopathy.
 3.  Peripheral neuropathy.
 4.  Nephropathy.
 5.  Chronic renal insufficiency.
 6.  Congestive heart failure.
 7.  Anemia.
 8.  Hepatitis C.
 9.  Hypertension.
10.  History of tuberculosis.
11.  History of abnormal liver function tests.
12.  History of gastrointestinal bleeding.
13.  History of intravenous drug abuse.
14.  Status post left below-knee amputation.

MEDICATIONS ON ADMISSION:
 1.  NPH 38 units subcutaneously q.a.m. and 4 units
subcutaneously q.p.m.
 2.  Regular insulin 5 units subcutaneously q.a.m. and 5
units subcutaneously q.p.m.
 3.  Neurontin 100 mg p.o. twice per day.
 4.  Methadone 100 mg p.o. once per day.
 5.  Diovan 160 mg p.o. once per day.
 6.  Lasix 40 mg p.o. twice per day.
 7.  Zaroxolyn 2.5 mg p.o. once per day.
 8.  Iron 325 mg p.o. twice per day.
 9.  Epogen 10,000 units every Tuesday, Thursday, and
Saturday.
10.  Metoprolol 100 mg p.o. twice per day.

ALLERGIES:

REVIEW OF SYSTEMS:  The patient denies chest pain, shortness
of breath, abdominal complaints, and diarrhea.  The patient
complains of positive right foot and ankle pain.

PHYSICAL EXAMINATION ON PRESENTATION:  On physical
examination, the patient was alert and oriented times three.
In no apparent distress.  Head and neck examination revealed
normocephalic and atraumatic.  Eyes revealed extraocular
movements were intact.  The pupils were equal, round, and
reactive to light.  The neck was nontender.  No jugular
venous distention.  No lymphadenopathy.  The lungs were clear
to auscultation bilaterally.  No wheezes, rhonchi, or rales.
Heart revealed a regular rate and rhythm.  Normal first heart
sounds and second heart sounds.  No murmurs, gallops, or
rubs.  The abdomen was soft, nontender, and nondistended.
Extremity examination revealed right ankle had a 3-cm
ulceration which probed approximately 5 cm deep to bone.
There was serosanguineous drainage present.  There was no
purulence.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Admission
laboratories revealed white blood cell count was 8.1,
hematocrit was 27.5, and platelet count was 200.  Prothrombin
time was 13.1, INR was 1.1, partial thromboplastin time was
26.3.  Differential revealed neutrophils of 70.7, lymphocytes
of 28.8, monocytes of 6.7, eosinophils of 1.6, and basophils
of 0.3.  Sodium was 142, potassium was 4.1, chloride was 111,
bicarbonate was 19, blood urea nitrogen was 64, creatinine
was 5.1, and blood glucose was 126.  ALT was 15, AST was 22,
alkaline phosphatase was 205, total bilirubin was 0.5.
Albumin was 2.1, calcium was 7.2, magnesium was 1.4, and
phosphate was 5.4.  Iron was 19, total iron-binding capacity
was 146, ferritin was 479, transferrin was 112.  A wound
culture from [**2183-3-12**] grew out gram-negative rods,
Staphylococcus coagulase-negative, beta streptococcus,
enterococcus, and carinii bacterium.

PERTINENT RADIOLOGY/IMAGING:  Electrocardiogram from [**2183-3-12**] revealed a sinus rhythm, heart rate was 102,
ventricular premature complex, left ventricular hypertrophy
with ST-T wave abnormalities.  The ST-T wave changes were
nonspecific.  Since the previous tracing on [**2183-2-5**], there were increased QRS voltage and ST-T wave changes
were still present.

A Duplex ultrasound was performed on [**2183-3-12**] to rule
out deep venous thrombosis.  The report came back as negative
for deep venous thrombosis.

A chest x-ray from [**2183-3-12**] revealed moderate left
ventricular enlargement of the heart.  The pulmonary vessels
were normal.  There was no evidence of cardiac failure.
There were no pulmonary infiltrates or pleural effusions
noted.  No acute cardiopulmonary abnormality.  Left
ventricular enlargement was noted.

HOSPITAL COURSE:   The patient was admitted to the floor,
placed on Ancef and levofloxacin, and placed on normal saline
wet-to-dry three times per day dressing changes.  A
peripherally inserted central catheter line was ordered and
placed through Interventional Radiology.

The patient went to the operating room on [**2183-3-14**] for
an incision and drainage of the right ankle.  The patient
tolerated the procedure well and without complications.  The
culture from [**3-14**] grew out gram-negative rods,
enterococcus, Staphylococcus coagulase negative, and carinii
bacterium species.  The patient was switched to vancomycin
and levofloxacin on [**2183-3-18**].

The patient developed superficial thrombophlebitis of the
right hand from intravenous infiltration on postoperative day
one.  The patient was placed on warm compresses to the right
hand which slowly resolved over the course of the next two
days.

The pathology report from the operating room was finalized on
[**2183-3-20**]; which revealed marked acute and chronic
inflammation, necrosis, and tissue formation.  The bone was
positive for acute osteomyelitis.  A repeat wound culture was
taken on [**2183-3-20**]; growing out Klebsiella pneumoniae,
heavy growth, gram-negative rods, carinii bacterium (two
strains), enterococcus and Staphylococcus coagulase-negative.
The Klebsiella was sensitive to meropenem and Zosyn.  The
patient was then switched to Zosyn and vancomycin on [**2183-3-24**].

A repeat wound culture was taken on [**2183-4-1**] which was
finalized on [**2183-4-5**]; growing Klebsiella pneumoniae;
now resistant to Zosyn.  Infectious Disease Service was
consulted.  The patient was switched to meropenem and
continued on the vancomycin which was doses according to
vancomycin levels.

Infectious Disease Service recommended a magnetic resonance
imaging to rule out any fluid collection of abscess.  A
magnetic resonance imaging was performed on [**2183-4-6**].
The magnetic resonance imaging revealed no large fluid
collection.  There was a tiny focus of fluid in the body of
the calcaneous which probably communicated with the subtalar
joint.  There was extensive low-to-moderate edema in the bone
about the ankle joint.  The nonspecific bone changes could be
compatible to both Charcot and osteomyelitis.  There was no
focal intense enhancement seen to confirm osteomyelitis, and
the multifocal edema was more suggestive of Charcot changes;
although, microscopic osteomyelitis could not be excluded.

Infectious Disease Service then recommended further
debridement in the operating room to get reliable tissue
cultures.  The patient was returned to the operating room on
[**2183-4-8**] for debridement of the right ankle.

The patient was also being followed by Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 805**] from
the Nephrology Service who was informed of the patient's
admission shortly after he was admitted for an increasing
creatinine.  The patient's creatinine on admission was 5.1
and had decreased to 4.5 on [**2183-3-24**].  One peak
creatinine to 6.1 on [**2183-4-3**] and ranged between 5.7
and 6 between [**2183-4-4**] and [**2183-4-8**].

On [**2183-4-8**], the patient underwent a right ankle
incision and drainage with washout.  Repeat wound cultures
were taken.  Postoperatively, the patient left the operating
room for the Postanesthesia Care Unit with an increased
oxygen requirement.  The patient was 92% on 15 liters face
mask.  The patient was given 40 mg of intravenous Lasix, a
Foley was placed, and the patient was given one inch of
nitroglycerin paste for a blood pressure of 195/95.  On
postoperative check, approximately three hours later, the
patient's oxygen saturation was 94% on 6 liters.  His blood
pressure was 178/82.

On [**2183-4-9**], the patient had an increased somnolence.
His potassium was at 7.  The patient was ordered Kayexalate
which he initially refused.  Regular insulin 10 units was
then given with 1 ampule of D-50 and 2 ampules of calcium
gluconate.

A Medicine Service consultation was requested.  The patient
was placed on telemetry.  Electrocardiogram revealed a heart
rate of 76 (in sinus rhythm) and anterior T wave changes
which were nonspecific.  Since last electrocardiogram, there
was no significant change.

The patient was transferred to the Medicine Service on [**2183-4-9**] under the care of Dr. [**First Name8 (NamePattern2) **] [**Name (STitle) 805**] with the
Podiatry Service to remain as a consultation for his right
foot wound.

NOTE:  Continued dictation will be provided by the Medicine
Service.





                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 101081**], M.D.  [**MD Number(1) 101082**]

Dictated By:[**Last Name (NamePattern1) 3211**]

MEDQUIST36

D:  [**2183-4-10**]  17:25
T:  [**2183-4-14**]  08:11
JOB#:  [**Job Number **]


Admission Date:  [**2183-3-12**]       Discharge Date:  [**2183-4-14**]

Date of Birth:   [**2125-5-16**]       Sex:  M

Service:

ADDENDUM:  This completes a Discharge Summary dated [**2183-4-9**] dictated by the Podiatry Service.

HISTORY OF PRESENT ILLNESS:  The patient is a 57-year-old
male with diabetes mellitus complicated by triopathy, chronic
renal insufficiency, and chronic right nonhealing foot ulcer
who was admitted to the Podiatry Service on [**2183-3-12**]
for debridement of a foot ulcer and found to have underlying
osteomyelitis.  Cultures grew enterococcus coagulase-negative
and sparse gram-negative rods, which were subsequently
identified as Klebsiella.  Thus, the patient was started on
meropenem on [**2183-4-4**].

The patient returned to the operating room on [**4-8**] for
further debridement of his wound.  On [**4-9**], the patient
was found to be lethargic.  He had a potassium of 7.  He was
treated with Lasix, insulin, D-50, and Kayexalate.  The
patient had no signs of hyperkalemic changes on his
electrocardiogram.  The patient was transferred from the
Medicine Service to the Podiatry Service for further
management at this point.

At this point, the patient complained only of pain in his
foot.  No fevers, chills, nausea, or vomiting.  He had been
having diarrhea for seven days which had slowed down.  No
abdominal pain.  No chest pain.  Occasional shortness of
breath.

PAST MEDICAL HISTORY:  As noted in the previous Discharge
Summary.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS ON TRANSFER:
 1.  Vancomycin (dosed by level).
 2.  Meropenem 500 mg intravenously twice per day.
 3.  Diltiazem 30 mg p.o. q.6h.
 4.  Lasix 60 mg p.o. q.o.d.
 5.  NPH insulin 38 units subcutaneously q.a.m. and 8 units
subcutaneously of regular q.a.m. and 8 units subcutaneously
at night and 5 units of regular with dinner.
 6.  Heparin 5000 units subcutaneously twice per day.
 7.  Calcium carbonate 1 g p.o. three times per day.
 8.  Multivitamin.
 9.  Amphojel.
10.  Epogen 10,000 units three times per week.
11.  Methadone 100 mg p.o. once per day.
12.  Percocet one to two tablets p.o. twice per day with
dressing changes.
13.  Lopressor 100 mg p.o. twice per day.
14.  Vistaril as needed.
15.  Ambien as needed.
16.  Benadryl as needed.
17.  Zofran as needed.
18.  Colace as needed.
19.  Tylenol as needed.

PHYSICAL EXAMINATION ON TRANSFER:  On transfer, the patient
had a temperature of 97.9, blood pressure was 150/80, heart
rate was 77, and oxygen saturation was 93% to 94% on 3
liters.  Generally, the patient was alert and oriented.
Jugular venous pulsation was at 7 cm.  Chest examination
revealed the patient had trace crackles at the left base;
otherwise, clear to auscultation.  Cardiovascular examination
was regular.  No murmurs.  The abdomen was obese, soft,
nontender, and nondistended.  Upper extremities had trace
pitting edema.  The lower extremities revealed the right foot
was dressed and in multipoultice boots.  The dressings were
clean, dry, and intact.  Left below-knee amputation revealed
no skin changes and was well healed.

PERTINENT RADIOLOGY/IMAGING:  Electrocardiogram revealed a
sinus rhythm at 90.  Normal axis.  Normal P-R interval, and
QRS interval, and QTc interval.  No T wave changes, and no ST
segment changes.

PERTINENT LABORATORY VALUES ON PRESENTATION:  The patient's
hematocrit was 26.4, white blood cell count was 7.3, and
platelets were 212.  Potassium was 5.  Blood urea nitrogen
and creatinine were 76 and 5.9; respectively.  The patient's
baseline for the last month had been between 5 and 6.
Calcium was 8.2, magnesium was 1.9, and phosphate was 5.9.
Notably, the patient's erythrocyte sedimentation rate and
C-reactive protein on [**4-4**] were 131 and 0.73;
respectively.  Gram stain from the previous day's debridement
showed 1+ polys, no organisms.  Blood culture was pending at
the time.  Clostridium difficile on [**4-6**] was negative.
Previous cultures revealed foot culture from the operating
room on [**4-1**] revealed Klebsiella sensitive to meropenem.
[**3-20**] operating room cultures showed Klebsiella
enterococcus, coagulase-negative Staphylococcus sensitive
only to vancomycin and carinii bacterium.

ASSESSMENT:  In short, this is a 57-year-old male with
diabetes, chronic renal insufficiency, and osteomyelitis of
his right foot with a protracted hospital course due to poor
wound healing and disposition issues surrounding the
patient's need for methadone.

HOSPITAL COURSE BY ISSUE/SYSTEM:

1.  RENAL ISSUES:  The patient's chronic renal insufficiency
remained stable with a creatinine between 5 and 6 during the
rest of his hospitalization.

The patient's potassium was treated as noted in the History
of Present Illness.  The patient's potassium returned to
baseline within 24 hours and remained around 5 for the rest
of his hospitalization.

Per the Renal Service, the patient was started back on Lasix
and Zaroxolyn which he was to continue.  The patient was
continued on his Amphojel for control of his phosphorous.
The patient was continued on his low potassium diet.

2.  INFECTIOUS DISEASE ISSUES:  The patient's operating room
cultures from [**4-8**] grew Klebsiella again; Klebsiella
which was resistant to everything except for meropenem and
Zosyn.  It also grew sparse coagulase-negative Staphylococcus
and carinii bacterium again.  Thus, the patient should be
continued on meropenem for six weeks (his course started on
[**2183-4-4**]) and vancomycin for the same period of time.
The patient should continue wet-to-dry dressing changes twice
per day and was to have Podiatry followup.

3.  DIABETES ISSUES:  The patient had low morning blood
sugars after being transferred to our service.  Thus, his
evening NPH was moved to dinner time, and his morning blood
sugars were subsequently within normal limits.

4.  HYPERTENSION ISSUES:  The patient was continued on
diltiazem and Lopressor for blood pressure control.  The
patient's target blood pressure is between 140 and 150.

5.  ANEMIA ISSUES:  The patient's hematocrit remained stable
between 26 and 29.  The patient was continued on his Epogen.
The patient received one unit of packed red blood cells while
on our service.  The patient's iron studies were sent.  They
were most consistent with anemia of chronic disease.

6.  PAIN CONTROL ISSUES:  The patient is chronically on
methadone for a history of substance abuse.  The patient
received minimal Percocet for breakthrough pain with dressing
changes.

7.  GASTROINTESTINAL ISSUES:  The patient has a history of
hepatitis C.  The patient's liver function tests were within
normal limits with the exception of his alkaline phosphatase
which was likely elevated secondary to osteomyelitis.

CONDITION AT DISCHARGE:  The patient was discharged in good
condition on [**2183-4-14**].

DISCHARGE STATUS:  The patient was to be discharged to
rehabilitation.

FINAL DISCHARGE DIAGNOSES:
 1.  Osteomyelitis of right foot.
 2.  Diabetes.
 3.  Chronic renal insufficiency.
 4.  Hypertension.
 5.  Hepatitis C.
 6.  History of substance abuse.
 7.  Anemia.
 8.  Right Charcot foot.
 9.  History of gastrointestinal bleeding in the past.
10.  History of congestive heart failure with a normal
ejection fraction.

MEDICATIONS ON DISCHARGE:
 1.  Vancomycin 1 g dosed renally for levels of less than 15;
last dose was on [**4-13**].
 2.  Metoprolol 100 mg p.o. twice per day.
 3.  Diltiazem 60 mg p.o. four times per day.
 4.  Zaroxolyn 2.5 mg p.o. twice per day.
 5.  Lasix 40 mg p.o. twice per day.
 6.  Meropenem 500 mg intravenously q.12h. (times 26 more
days).
 7.  Iron 325 mg p.o. three times per day.
 8.  Calcium carbonate 1 g three times per day with meals.
 9.  Multivitamin one tablet p.o. once per day.
10.  Heparin 5000 units subcutaneously q.12h.
11.  Reglan 25 mg intravenously q.6h. as needed.
12.  Ambien 5 mg to 10 mg p.o. q.h.s. as needed.
13.  Colace 100 mg p.o. twice per day as needed.
14.  Zofran 2 mg to 4 mg intravenously q.4-6h. as needed.
15.  Bisacodyl 10 mg q.h.s. as needed.
16.  Aluminum magnesium hydroxide 5 mL to 30 mL p.o. four
times per day.
17.  Epogen 10,000 units subcutaneously three times per week
(on Tuesday, Thursday, and Saturday).
18.  Methadone 100 mg p.o. once per day.
19.  Gabapentin 100 mg p.o. twice per day.





                            [**Name6 (MD) 251**] [**Last Name (NamePattern4) 11865**], M.D.  [**MD Number(1) 11866**]

Dictated By:[**Name8 (MD) 8330**]
MEDQUIST36

D:  [**2183-4-14**]  11:13
T:  [**2183-4-14**]  11:22
JOB#:  [**Job Number 101083**]


Name:  [**Known lastname 16230**], [**Known firstname 77**]                     Unit No:  [**Numeric Identifier 16231**]

Admission Date:  [**2156-2-23**]     Discharge Date:  [**2183-4-17**]

Date of Birth:   [**2125-5-16**]     Sex:  M

Service:

REMAINING HOSPITAL COURSE IS AS FOLLOWS:  The patient
remained hospitalized for three extra days pending insurance,
review of rehabilitation options.  There were no changes in
his clinical status.   The patient was discharged on [**2183-4-17**]
in good condition.

Discharge diagnoses and discharge medications are the same as
on previous addendum.




                          DR.[**First Name (STitle) 183**],[**First Name3 (LF) 116**] 11-692

Dictated By:[**Name8 (MD) 648**]

MEDQUIST36

D:  [**2183-4-17**]  12:36
T:  [**2183-4-17**]  12:38
JOB#:  [**Job Number 16233**]


Admission Date:  [**2183-4-17**]       Discharge Date:  [**2183-4-17**]

Date of Birth:   [**2125-5-16**]       Sex:  M

Service:  Medicine, [**Doctor Last Name **] Firm

ADDENDUM:  Hospital course from [**2183-4-17**] to [**2183-4-21**].  The remainder of the hospital course was as follows.

The patient was not discharged secondary to family concerns
over discharge plans.  The patient remained hospitalized for
four extra days pending family approval of a facility.  The
patient was initially transferred to an outside facility on
[**2183-4-19**]; however, the facility denied knowledge of his
arrival and sent him back.

The patient was then discharge on Monday when more
knowledgeable staff were available at the accepting facility.

There was no change in the patient's clinical status.  No
changes in his medications during this 4-day period.

DISCHARGE DIAGNOSES:  The same as in the two previous
Discharge Summary Addendums.

MEDICATIONS ON DISCHARGE:  The same as in the two previous
Discharge Summary Addendums.





                            [**Name6 (MD) 251**] [**Last Name (NamePattern4) 11865**], M.D.  [**MD Number(1) 11866**]

Dictated By:[**Name8 (MD) 8330**]
MEDQUIST36

D:  [**2183-5-1**]    :
T:  [**2183-5-1**]  16:26
JOB#:  [**Job Number 17947**]
{'Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Ulcer of ankle,Acute osteomyelitis, ankle and foot,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other vascular complications of medical care, not elsewhere classified,Congestive heart failure, unspecified,Chronic hepatitis C without mention of hepatic coma,Arthropathy associated with neurological disorders'}


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: 

PRESENT ILLNESS: Mr. [**Known lastname 101054**] is a 57-year-old
type 2 diabetic male with right Charcot hind foot deformity.
The patient recently developed a right lateral foot ulcer
with copious bloody drainage several days prior to admission.

MEDICAL HISTORY: 1.  Type 2 diabetes times 15 years.
 2.  Retinopathy.
 3.  Peripheral neuropathy.
 4.  Nephropathy.
 5.  Chronic renal insufficiency.
 6.  Congestive heart failure.
 7.  Anemia.
 8.  Hepatitis C.
 9.  Hypertension.
10.  History of tuberculosis.
11.  History of abnormal liver function tests.
12.  History of gastrointestinal bleeding.
13.  History of intravenous drug abuse.
14.  Status post left below-knee amputation.

MEDICATION ON ADMISSION: 1.  NPH 38 units subcutaneously q.a.m. and 4 units
subcutaneously q.p.m.
 2.  Regular insulin 5 units subcutaneously q.a.m. and 5
units subcutaneously q.p.m.
 3.  Neurontin 100 mg p.o. twice per day.
 4.  Methadone 100 mg p.o. once per day.
 5.  Diovan 160 mg p.o. once per day.
 6.  Lasix 40 mg p.o. twice per day.
 7.  Zaroxolyn 2.5 mg p.o. once per day.
 8.  Iron 325 mg p.o. twice per day.
 9.  Epogen 10,000 units every Tuesday, Thursday, and
Saturday.
10.  Metoprolol 100 mg p.o. twice per day.

ALLERGIES: REVIEW OF SYSTEMS:  The patient denies chest pain, shortness
of breath, abdominal complaints, and diarrhea.  The patient
complains of positive right foot and ankle pain.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Ulcer of ankle,Acute osteomyelitis, ankle and foot,Acute kidney failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Other vascular complications of medical care, not elsewhere classified,Congestive heart failure, unspecified,Chronic hepatitis C without mention of hepatic coma,Arthropathy associated with neurological disorders'}
