CHIEF COMPLAINT: Chest pain

PRESENT ILLNESS: 57M with a complex medical hx including HTN, CHF, DM on insulin,
ESRD (s/p AVF placement and now revision 2 weeks ago), s/p
severe Fournier's gangrene requiring an extended MICU stay and a
diverting end-sigmoid colostomy on [**2177-12-11**]. He presented to
[**Hospital6 19155**] on [**8-18**] with CP, SOB, found to have
trop of 6.8, BNP 627 and EKG c/w NSTEMI, started on heparin gtt,
given nitro which relieved his pain, transferred to [**Hospital1 18**].

MEDICAL HISTORY: MEDICAL & SURGICAL HISTORY:
1. Fournier's gangrene (requiring diverting sigmoid colostomy
and multiple washouts/testicular debridements)
2. hypoxic respiratory failure
3. CHF (LVEF 50%, on [**12/2177**])
4. MRSA tracheobronchitis
5. type 2 diabetes mellitus
6. gastroparesis
7. kidney stones
8. hypertension
9. hyperlipidemia

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]
2. Calcium Carbonate 500 mg PO TID:PRN Meals
3. Rosuvastatin Calcium 10 mg PO DAILY
4. Aspirin 325 mg PO DAILY
5. Bisacodyl 10 mg PO HS
6. Calcitriol 0.25 mcg PO 5 DAYS A WEEK
7. Vitamin D 1000 UNIT PO DAILY
8. Ferrous Sulfate 325 mg PO BID
9. Furosemide 80 mg PO BID
10. Gabapentin 300 mg PO DAILY
11. Metoprolol Tartrate 50 mg PO BID
12. Omeprazole 40 mg PO DAILY
13. Prochlorperazine 5 mg PO Q8H:PRN N/V
14. Acetaminophen 1000 mg PO Q6H:PRN Pain
Not to exceed 4 grams daily
15. Albuterol Inhaler 1 PUFF IH Q4H:PRN Wheezing
16. Glargine 60 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
17. Nephrocaps 1 CAP PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
VITALS: 98.3 153/82 97# 84
GENERAL: Well appearing in NAD
HEENT: PERRL, EOMI
NECK: no carotid bruits, mildly elevated JVD
LUNGS: Crackles in bibasilar distribution, otherwise good air
entry
HEART: RRR, normal S1 S2, no MRG
ABDOMEN: Soft, NT, NABS, no organomegaly. Ostomy without
surrounding erythema or tenderness
EXTREMITIES: 1+ edema b/l
NEUROLOGIC: A+OX3

FAMILY HISTORY: Family history of diabetes. Mother died of cancer 'in her lung
and liver'

SOCIAL HISTORY: Currently lives by himself at home. Patient is a former
policeman. Quit tobacco in [**2154**], 10 pack year history.
Occasional alcohol use; denies illicit substance use.
Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,End stage renal disease,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Awaiting organ transplant status,Suicidal ideation,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Coronary atherosclerosis of native coronary artery,Long-term (current) use of insulin,Other drugs and medicinal substances causing adverse effects in therapeutic use,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Anemia in chronic kidney disease,Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Gastroparesis,Cough,Other nonspecific findings on examination of urine,Colostomy status,Family history of malignant neoplasm of trachea, bronchus, and lung,Personal history of tobacco use
Subendo infarct, initial,Acute kidney failure NOS,End stage renal disease,CHF NOS,Hyp kid NOS w cr kid V,DMII renl nt st uncntrld,Await organ transplnt st,Suicidal ideation,Klebsiella pneumoniae,Crnry athrscl natve vssl,Long-term use of insulin,Adv eff medicinal NEC,Depressive disorder NEC,Iron defic anemia NOS,Anemia in chr kidney dis,Asthma NOS,Hyperlipidemia NEC/NOS,Gastroparesis,Cough,Abn urine findings NEC,Colostomy status,Fm hx-trach/bronchog mal,History of tobacco use
Admission Date:  [**2179-8-18**]              Discharge Date:   [**2179-9-1**]

Date of Birth:  [**2121-12-28**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 7651**]
Chief Complaint:
Chest pain

Major Surgical or Invasive Procedure:
Tunneled subclavian HD line placement
PRBC transfusion x2
Cardiac Catheterization X2 with DES to Ramus and DES to LCx/OM2


History of Present Illness:
57M with a complex medical hx including HTN, CHF, DM on insulin,
ESRD (s/p AVF placement and now revision 2 weeks ago), s/p
severe Fournier's gangrene requiring an extended MICU stay and a
diverting end-sigmoid colostomy on [**2177-12-11**]. He presented to
[**Hospital6 19155**] on [**8-18**] with CP, SOB, found to have
trop of 6.8, BNP 627 and EKG c/w NSTEMI, started on heparin gtt,
given nitro which relieved his pain, transferred to [**Hospital1 18**].

Past Medical History:
MEDICAL & SURGICAL HISTORY:
1. Fournier's gangrene (requiring diverting sigmoid colostomy
and multiple washouts/testicular debridements)
2. hypoxic respiratory failure
3. CHF (LVEF 50%, on [**12/2177**])
4. MRSA tracheobronchitis
5. type 2 diabetes mellitus
6. gastroparesis
7. kidney stones
8. hypertension
9. hyperlipidemia

Social History:
Currently lives by himself at home. Patient is a former
policeman. Quit tobacco in [**2154**], 10 pack year history.
Occasional alcohol use; denies illicit substance use.


Family History:
Family history of diabetes. Mother died of cancer 'in her lung
and liver'

Physical Exam:
ADMISSION PHYSICAL EXAM:
VITALS: 98.3 153/82 97# 84
GENERAL: Well appearing in NAD
HEENT: PERRL, EOMI
NECK: no carotid bruits, mildly elevated JVD
LUNGS: Crackles in bibasilar distribution, otherwise good air
entry
HEART: RRR, normal S1 S2, no MRG
ABDOMEN: Soft, NT, NABS, no organomegaly. Ostomy without
surrounding erythema or tenderness
EXTREMITIES: 1+ edema b/l
NEUROLOGIC: A+OX3

DISCHARGE PHYSICAL EXAM
V: Afebrile 98.6, 129/73, P-65 18 95RAL
out made 250cc urine all day yesterday
GENERAL: Middle aged male in NAD, lying in bed. 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 7 cm.
CARDIAC: RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3,
S4.
LUNGS: Resp were unlabored, no accessory muscle use. Mild
bibasilar crackles, no wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. Colostomy bag in
place and draining brown stool
EXTREMITIES: 2+ pitting edema to knees bilaterally.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ DP 2+ PT 2+
Left: Carotid 2+ DP 2+ PT 2+

Pertinent Results:
ADMISSION LABS
[**2179-8-18**] 06:00PM BLOOD WBC-9.4 RBC-2.74* Hgb-8.7* Hct-27.0*
MCV-99* MCH-31.7 MCHC-32.1 RDW-14.8 Plt Ct-195
[**2179-8-18**] 06:00PM BLOOD PT-10.9 PTT-96.4* INR(PT)-1.0
[**2179-8-18**] 06:00PM BLOOD Glucose-94 UreaN-67* Creat-5.5* Na-146*
K-4.5 Cl-113* HCO3-18* AnGap-20
[**2179-8-18**] 06:00PM BLOOD CK-MB-25* MB Indx-3.4
[**2179-8-19**] 08:20AM BLOOD Calcium-8.3* Phos-5.6* Mg-2.0

ON DISCHARGE

[**2179-8-31**] 05:45AM BLOOD WBC-11.5* RBC-2.79* Hgb-8.7* Hct-26.2*
MCV-94 MCH-31.1 MCHC-33.2 RDW-15.5 Plt Ct-204
[**2179-8-31**] 05:45AM BLOOD UreaN-30* Creat-3.8*# Na-141 K-3.9 Cl-102
HCO3-31 AnGap-12
[**2179-8-31**] 05:45AM BLOOD CK-MB-5
[**2179-8-31**] 05:45AM BLOOD Calcium-8.0* Phos-3.6 Mg-2.1

EKG [**2179-8-18**]:
Sinus rhythm. Minor non-specific lateral ST-T wave
abnormalities. Compared to
the previous tracing of [**2179-1-15**] no significant change.

CXR [**2179-8-18**]:
FINDINGS:
Cardiomegaly is noted with pulmonary edema and trace pleural
effusions, right
greater than left.  No pneumothorax.  Bony structures intact.
Degenerative AC
joint arthropathy.
IMPRESSION:
Findings compatible with congestive heart failure.

CXR [**2179-8-26**]
FINDINGS:  As compared to the previous radiograph, there is no
relevant
change.  Moderate fluid overload, combined to cardiomegaly and a
small right
pleural effusion.  Hemodialysis catheter in situ.  The
retrocardiac
atelectasis that pre-existed is less severe than on the previous
exam.  No
newly appeared focal parenchymal opacities suggesting pneumonia.


ECHO [**2179-8-19**]:
The left atrium is moderately dilated. There is moderate
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Due to suboptimal technical quality, a
focal wall motion abnormality cannot be fully excluded. Overall
left ventricular systolic function is low normal (LVEF 55%).
Tissue Doppler imaging suggests an increased left ventricular
filling pressure (PCWP>18mmHg). Right ventricular chamber size
and free wall motion are normal. The aortic valve leaflets (3)
appear structurally normal with good leaflet excursion and no
aortic stenosis or aortic regurgitation. The mitral valve
leaflets are mildly thickened. There is no mitral valve
prolapse. Mild to moderate ([**1-25**]+) mitral regurgitation is seen.
The tricuspid valve leaflets are mildly thickened. There is a
small pericardial effusion. There are no echocardiographic signs
of tamponade.
Compared with the findings of the prior study (images reviewed)
of [**2178-1-19**], the findings are similar, but the
technically suboptimal nature of both studies precludes
definitve comparison.

CARDIAC CATHETERIZATION [**2179-8-20**]
FINAL DIAGNOSIS:
1. Severe 3 vessel CAD.  CAGG not a good option given no LAD or
RCA
targets.
2. Moderate elevated right sided and moderate to severely
elevated left
sided filling pressures.
3. Preserved cardiac output.

CARDIAC CATHETERIZATION [**2179-8-30**]
COMMENTS:
1. Successful PCI of Ramus with Resolute 2.75 X 22mm stent
2. Successful PCI of LCX/OM1 with Resolute 2.75 X 26mm stent

FINAL DIAGNOSIS:
1. Severe 3 vessel CAD
2. Success PCI with DESs of Ramus (Resolute 2.75 X 22mm) and
LCX/OM2
(Resolute 2.75 X 26mm).
3. ASA 81mg indefinitely. Prefer Prasugrel 60mg load and 10mg
daily for
1 year. [**Month (only) 116**] change to Plavix 75mg daily after 6 month
uninterrupted use
of Prasugrel.
4. Risk factor reduction
5. A terumo pressure band was applied to right radial artery at
the
conclusion of procedure.


Brief Hospital Course:
57 M with complex medical hx incl ESRD, DM2, CHF, p/w NSTEMI.
Hospital course complicated by acute renal failure requiring
initiation of dialysis and staged cardiac catheterization.

# NSTEMI.

Pt admitted from OSH for unstable angina, found to have trop of
1.26 and elevated MB. ECG showed lateral ST-changes. Continued
on heparin and plavix loaded. On the floor pt denied CP, SOB. Pt
initially refused catheterization fearing it might lead to
accelerated need for hemodialysis. After several conversations
w/ attending physician, [**Name10 (NameIs) **] weighed risks and benefits of
procedure and agreed to proceed. Pt appeared overloaded prior to
procedure, and received 60 IV lasix X 2 with good urine output.
He was still mildly volume positive before catheterization,
judged to be acceptable in the setting of ESRD. He received left
heart catheterization [**8-20**], revealing signficant disease with
complicated lesions in his LAD and LCx. However, he received a
large amount of dye and his case was aborted given the desire to
avoid the need for hemodialysis given his ESRD.

The patient remained chest pain free between his diagnostic cath
[**8-20**] and therapeutic cath [**8-30**] on maximal medical regimen
including heparin gtt (48 hrs) ASA 325mg, plavix, metoprolol and
statin.

On [**8-30**], the patient had a DES to Ramus and DES to LCx/OM2. He
[**Month/Day (4) 8337**] the procedure well. He has follow-up with his
outpatient cardiologist Dr. [**Last Name (STitle) 41007**] in the coming weeks.

ESRD.

Pt had AVF placed six months prior to this admission, and
revision two weeks prior. Pt desires transplant and expressed
strong wish to postpone dialysis as long as possible. Renal
consulted for management of catheterization in setting of ESRD;
recommended simultaneous hydration and diuresis. Unfortunately
after cath [**8-20**], patient creatinine began to rise from 3.5 to
8.8, necessitating urgent dialysis. Unfortunately, the patient's
AV fistula was still too immature for use and a tunnel catheter
was placed [**8-25**]. Mr [**Known lastname **] [**Last Name (Titles) 8337**] dialysis well and went for
subsequent treatments after his second cardiac cath [**8-31**]. He has
been discharged with outpatient dialysis MWF, which he will
likely require long term. He also has outpatient follow up with
the transplant service.

Dirty UA with positive Urine culture
The patient had a dirty UA and a positive urine culture that
grew Klebsiella. The patient was asymptomatic. He completed a 7
day course of ciprofloxacin while in house.

Depression
While in house, the patient had passive suicidal ideations and a
depressed mood. He was seen by psychiatry, who recommended long
term therapy and medication. The patient refused both. The
psychiatry team spoke with the [**Hospital 228**] health care proxy and
sister in law, who felt the patient was not safe at home with a
firearm. Psych had the local police department (for whom the
patient used to work) confiscate Mr [**Known lastname **] firearm from his
home. The patient denies any homicidal or suicidal ideations at
discharge.

Anemia
The patient appeared to have anemia from iron deficiency and
chronic kidney disease. Guaiac of stools was negative. He was
kept on PO iron and also received EPO treatments at dialysis.

Past Hx of Fournier's Gangrene c/b bowel resection.
The patient had no active issues with his ostomy site.

Diabetes
The patient had 2 episodes of AM hypoglycemia. His basal insulin
dose was decreased and his bolus doses were increased to limit
post-prandial hyperglycemia.

Transitional Issues

The patient is confirmed DNR/DNI

He will continue to follow up with Nephrology at dialysis. He
also has an appointment with the transplant team. The patient's
fistula should continue to be monitored to determine when it
will be mature enough for use. Hopefully, he will not need the
tunnel catheter for a prolonged period of time.

Cardiologist Dr [**Last Name (STitle) 41007**] will monitor for symptoms of angina
post-cath. Echo in house revealed normal ejection fraction with
restrictive physiology.

Medications on Admission:
Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]
2. Calcium Carbonate 500 mg PO TID:PRN Meals
3. Rosuvastatin Calcium 10 mg PO DAILY
4. Aspirin 325 mg PO DAILY
5. Bisacodyl 10 mg PO HS
6. Calcitriol 0.25 mcg PO 5 DAYS A WEEK
7. Vitamin D 1000 UNIT PO DAILY
8. Ferrous Sulfate 325 mg PO BID
9. Furosemide 80 mg PO BID
10. Gabapentin 300 mg PO DAILY
11. Metoprolol Tartrate 50 mg PO BID
12. Omeprazole 40 mg PO DAILY
13. Prochlorperazine 5 mg PO Q8H:PRN N/V
14. Acetaminophen 1000 mg PO Q6H:PRN Pain
Not to exceed 4 grams daily
15. Albuterol Inhaler 1 PUFF IH Q4H:PRN Wheezing
16. Glargine 60 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
17. Nephrocaps 1 CAP PO DAILY


Discharge Medications:
1. Acetaminophen 1000 mg PO Q6H:PRN Pain
Not to exceed 4 grams daily
2. Bisacodyl 10 mg PO HS
3. Calcitriol 0.25 mcg PO 5 DAYS A WEEK
4. Calcium Carbonate 500 mg PO TID:PRN Meals
5. Ferrous Sulfate 325 mg PO BID
6. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]
7. Glargine 50 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
8. Rosuvastatin Calcium 20 mg PO DAILY
RX *Crestor 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet
Refills:*0
9. Vitamin D 1000 UNIT PO DAILY
10. Prasugrel 10 mg PO DAILY
RX *Effient 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet
Refills:*0
11. sevelamer CARBONATE 800 mg PO TID W/MEALS
RX *Renvela 0.8 gram 1 Powder(s) by mouth three times daily with
meals Disp #*90 Pack Refills:*0
12. Albuterol Inhaler 1 PUFF IH Q4H:PRN Wheezing
13. Omeprazole 40 mg PO DAILY
14. Prochlorperazine 5 mg PO Q8H:PRN N/V
15. Nephrocaps 1 CAP PO DAILY
RX *Nephrocaps 1 mg 1 capsule(s) by mouth daily Disp #*30 Tablet
Refills:*0
16. Aspirin 81 mg PO DAILY
RX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet
Refills:*0
17. Metoprolol Succinate XL 150 mg PO DAILY
RX *metoprolol succinate 50 mg 3 tablet(s) by mouth daily Disp
#*90 Tablet Refills:*0
18. Gabapentin 300 mg PO QHD


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: NSTEMI, ESRD on HD, DMII


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You came to the hospital with chest pain and shortness of
breath. An electrocardiogram and blood tests showed you were
having a heart attack. A cardiac catheterization revealed
extensive coronary artery disease. Due to your renal disease, no
stents were placed initially to limit the amount of contrast
injected into your body. Unfortunately, this contrast still
caused severe kidney damage that caused you to need dialysis.
Your AV fistula was not mature enough to be used and a tunneled
catheter was placed in your R chest.

You [**Hospital1 8337**] dialysis very well and you will continue to need
Dialysis as an outpatient. This will be done every Monday,
Wednesday, and Friday @3PM at [**Location (un) **] [**Location (un) 32944**] Renal Center. It
will start @230PM on [**9-3**].

 When your renal function stabilized, a second cardiac
catheterization was performed and 2 stents were placed in 2
different diseased arteries. With these stents, you must
continue to take Aspirin. You have been switched from Plavix to
Prasugrel, which is a very similar medication. Please see all of
your medication changes below

Please follow up with your PCP, [**Name10 (NameIs) **], Nephrologist, and
Kidney Transplant physicians at the appointment times listed
below.

It was a true pleasure taking care of you, Mr [**Known lastname **]

Followup Instructions:
Name: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] NP
Specialty: Primary Care
When: Tuesday [**9-7**] at 10:30am
Location: [**Hospital 46644**] MEDICAL ASSOCIATES
Address: [**Location (un) 32946**], [**Location (un) **],[**Numeric Identifier 32948**]
Phone: [**Telephone/Fax (1) 32949**]
*We rescheduled your appt with Dr.[**Last Name (STitle) 87947**] from this Friday to
Tuesday to fit around your dialysis days, you will see [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
NP

Name: [**Last Name (LF) **],[**First Name3 (LF) **] MD
Specialty:Cardiology
When: Thursday [**9-16**] at 9:45am
Location: [**Hospital 46644**] MEDICAL ASSOCIATES
Address: [**Street Address(1) **] WAY, [**Location (un) **],[**Numeric Identifier 75553**]
Phone: [**Telephone/Fax (1) 86181**]

[**Location (un) **] [**Location (un) 32944**] Renal Center
[**Doctor Last Name 56282**]
[**Location (un) 32944**], [**Numeric Identifier 87948**]
Phone: [**Telephone/Fax (1) 60552**]
Nephrologist:
Your outpatient dialysis schedule will be every Mon, Wed & Fri
at 3:00pm, you will see a Nephrologist at these visits.

Department: TRANSPLANT CENTER
When: TUESDAY [**2180-1-4**] at 10:40 AM
With: [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**], MD [**Telephone/Fax (1) 673**]
Building: LM [**Hospital Unit Name **] [**Location (un) **]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage
{"Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,End stage renal disease,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Awaiting organ transplant status,Suicidal ideation,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Coronary atherosclerosis of native coronary artery,Long-term (current) use of insulin,Other drugs and medicinal substances causing adverse effects in therapeutic use,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Anemia in chronic kidney disease,Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Gastroparesis,Cough,Other nonspecific findings on examination of urine,Colostomy status,Family history of malignant neoplasm of trachea, bronchus, and lung,Personal history of tobacco use"}


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 pain

PRESENT ILLNESS: 57M with a complex medical hx including HTN, CHF, DM on insulin,
ESRD (s/p AVF placement and now revision 2 weeks ago), s/p
severe Fournier's gangrene requiring an extended MICU stay and a
diverting end-sigmoid colostomy on [**2177-12-11**]. He presented to
[**Hospital6 19155**] on [**8-18**] with CP, SOB, found to have
trop of 6.8, BNP 627 and EKG c/w NSTEMI, started on heparin gtt,
given nitro which relieved his pain, transferred to [**Hospital1 18**].

MEDICAL HISTORY: MEDICAL & SURGICAL HISTORY:
1. Fournier's gangrene (requiring diverting sigmoid colostomy
and multiple washouts/testicular debridements)
2. hypoxic respiratory failure
3. CHF (LVEF 50%, on [**12/2177**])
4. MRSA tracheobronchitis
5. type 2 diabetes mellitus
6. gastroparesis
7. kidney stones
8. hypertension
9. hyperlipidemia

MEDICATION ON ADMISSION: Preadmission medications listed are correct and complete.
Information was obtained from PatientwebOMR.
1. Fluticasone-Salmeterol Diskus (250/50)  1 INH IH [**Hospital1 **]
2. Calcium Carbonate 500 mg PO TID:PRN Meals
3. Rosuvastatin Calcium 10 mg PO DAILY
4. Aspirin 325 mg PO DAILY
5. Bisacodyl 10 mg PO HS
6. Calcitriol 0.25 mcg PO 5 DAYS A WEEK
7. Vitamin D 1000 UNIT PO DAILY
8. Ferrous Sulfate 325 mg PO BID
9. Furosemide 80 mg PO BID
10. Gabapentin 300 mg PO DAILY
11. Metoprolol Tartrate 50 mg PO BID
12. Omeprazole 40 mg PO DAILY
13. Prochlorperazine 5 mg PO Q8H:PRN N/V
14. Acetaminophen 1000 mg PO Q6H:PRN Pain
Not to exceed 4 grams daily
15. Albuterol Inhaler 1 PUFF IH Q4H:PRN Wheezing
16. Glargine 60 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin
17. Nephrocaps 1 CAP PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
VITALS: 98.3 153/82 97# 84
GENERAL: Well appearing in NAD
HEENT: PERRL, EOMI
NECK: no carotid bruits, mildly elevated JVD
LUNGS: Crackles in bibasilar distribution, otherwise good air
entry
HEART: RRR, normal S1 S2, no MRG
ABDOMEN: Soft, NT, NABS, no organomegaly. Ostomy without
surrounding erythema or tenderness
EXTREMITIES: 1+ edema b/l
NEUROLOGIC: A+OX3

FAMILY HISTORY: Family history of diabetes. Mother died of cancer 'in her lung
and liver'

SOCIAL HISTORY: Currently lives by himself at home. Patient is a former
policeman. Quit tobacco in [**2154**], 10 pack year history.
Occasional alcohol use; denies illicit substance use. 

### Response:
{"Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,End stage renal disease,Congestive heart failure, unspecified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled,Awaiting organ transplant status,Suicidal ideation,Friedl?nder's bacillus infection in conditions classified elsewhere and of unspecified site,Coronary atherosclerosis of native coronary artery,Long-term (current) use of insulin,Other drugs and medicinal substances causing adverse effects in therapeutic use,Depressive disorder, not elsewhere classified,Iron deficiency anemia, unspecified,Anemia in chronic kidney disease,Asthma, unspecified type, unspecified,Other and unspecified hyperlipidemia,Gastroparesis,Cough,Other nonspecific findings on examination of urine,Colostomy status,Family history of malignant neoplasm of trachea, bronchus, and lung,Personal history of tobacco use"}
