CHIEF COMPLAINT: Altered Mental Status

PRESENT ILLNESS: Mr. [**Known lastname **] is a 67 yo M, discharged from [**Hospital1 18**] one day prior
to admission s/p a fall (with L rib, head injury, left
hemo/pneumo with chest tube) who was sent to BIDN after began
having AMS at NH post-discharge.  Upon discharge, patient was
alert, conversant and ambulatory with limited assistance.
Reportedly (patient is nonverbal on initial exam) patient was
noted to have increased lethargy but was alert with purposeful
movement and then became nonverbal the day of admission.  At
BIDN, T101, 62, 133/76, 20, 99%. CXR with ?pneumonia in LLL with
retrocardiac opacity and UA positive, WBC 17.2.  CT head with
new L acute SDH with beginning falcine herniation.  Given
Flagyl, Levoquin and Dilantin.  Transferred to [**Hospital1 18**] ED where
initial VS 95, 132/52, 18, 98/RA.   In ED, given Vancomycin, and
NS consulted.  Thought no indication for emergent surgergy, but
did recommend 6-pack platelets given he is on Aggrenox.

MEDICAL HISTORY: 1) Binswangers disease
2) TIA x2
3) Dyslipidemia
4) Detrussor instability
5) DJD of the cervical spine
6) Depression
7) L3 spinal lesion found on MRI during [**8-/2192**]: Pending further
work-up
8) Admitted [**10-17**] for fall down stairs with nondisplaced L
clavicle fx, L 2-4th rib fx and small hemopneumothorax s/p chest
tube placement

MEDICATION ON ADMISSION: Atorvastatin 20mg QHS
Deltrol LA 4mg Qday
Celexa 20mg Qday
Aggrenox 200mg-25mg [**Hospital1 **]
Fish oil
Folic Acid
Compazine 10mg [**Hospital1 **] PRN nausea
Colace 100mg [**Hospital1 **] PRN constipation

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 100, 81, 140/69, 17, 99/2L
Gen: Thin male with eyes slightly open, not following commands
or verbalizing
HEENT: Sclerae anicteric, PEERL; oropharynx appears dry but no
lesions, exudates, blood, or erythema
Neck: Supple, no masses, no LAD, no cervical bruits appreciated
CV: RRR, no M/R/G
Pulm: CTAB anteriorly, unable to participate in exam, no wheeze,
rale or ronchi, left shoulder with resolving eccymoses
Abd: Soft, NT, BS+, no organomegaly appreciated, grimaces to L
flank pressure c/w prior trauma
Extrem: W& WP, no C/C/E, DP pulses 2+ bilaterally, ecchymosis
over left shoulder
Neuro: Does not respond to command, PERRL, CNII-XII grossly
intact but unable to participate in exam; limbs with mild
rigidity vs volitional resistance; LE with downward going toes
b/l, 3 beat clonus on R, unable to appreciate on L

FAMILY HISTORY: No family history of CVA's.  His two children are healthy.

SOCIAL HISTORY: He is married.  He previously worked as a manufacturer's
representative but has stopped doing this job.  He has a 40 pack
year smoking history but hasn't smoked in 25 years.  He denies
any alcohol or drug use.
Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Other encephalopathy,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Presenile dementia with delusional features,Other disorders of neurohypophysis,Accidental fall on or from other stairs or steps,Late effects of cerebrovascular disease, other speech and language deficits,Personal history of tobacco use,Anemia, unspecified,Other orthopedic aftercare,Disorder of bone and cartilage, unspecified,Depressive disorder, not elsewhere classified
Subdural hem w/o coma,Encephalopathy NEC,Urin tract infection NOS,Int inf clstrdium dfcile,Presenile delusion,Neurohypophysis dis NEC,Fall on stair/step NEC,Late ef-spch/lang df NEC,History of tobacco use,Anemia NOS,Orthopedic aftercare NEC,Bone & cartilage dis NOS,Depressive disorder NEC
Admission Date:  [**2192-10-31**]              Discharge Date:   [**2192-11-14**]

Date of Birth:  [**2124-12-25**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1881**]
Chief Complaint:
Altered Mental Status

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mr. [**Known lastname **] is a 67 yo M, discharged from [**Hospital1 18**] one day prior
to admission s/p a fall (with L rib, head injury, left
hemo/pneumo with chest tube) who was sent to BIDN after began
having AMS at NH post-discharge.  Upon discharge, patient was
alert, conversant and ambulatory with limited assistance.
Reportedly (patient is nonverbal on initial exam) patient was
noted to have increased lethargy but was alert with purposeful
movement and then became nonverbal the day of admission.  At
BIDN, T101, 62, 133/76, 20, 99%. CXR with ?pneumonia in LLL with
retrocardiac opacity and UA positive, WBC 17.2.  CT head with
new L acute SDH with beginning falcine herniation.  Given
Flagyl, Levoquin and Dilantin.  Transferred to [**Hospital1 18**] ED where
initial VS 95, 132/52, 18, 98/RA.   In ED, given Vancomycin, and
NS consulted.  Thought no indication for emergent surgergy, but
did recommend 6-pack platelets given he is on Aggrenox.

ROS, unable to obtain [**2-11**] AMS and nonverbal.


Past Medical History:
1) Binswangers disease
2) TIA x2
3) Dyslipidemia
4) Detrussor instability
5) DJD of the cervical spine
6) Depression
7) L3 spinal lesion found on MRI during [**8-/2192**]: Pending further
work-up
8) Admitted [**10-17**] for fall down stairs with nondisplaced L
clavicle fx, L 2-4th rib fx and small hemopneumothorax s/p chest
tube placement

Social History:
He is married.  He previously worked as a manufacturer's
representative but has stopped doing this job.  He has a 40 pack
year smoking history but hasn't smoked in 25 years.  He denies
any alcohol or drug use.

Family History:
No family history of CVA's.  His two children are healthy.

Physical Exam:
VS: 100, 81, 140/69, 17, 99/2L
Gen: Thin male with eyes slightly open, not following commands
or verbalizing
HEENT: Sclerae anicteric, PEERL; oropharynx appears dry but no
lesions, exudates, blood, or erythema
Neck: Supple, no masses, no LAD, no cervical bruits appreciated
CV: RRR, no M/R/G
Pulm: CTAB anteriorly, unable to participate in exam, no wheeze,
rale or ronchi, left shoulder with resolving eccymoses
Abd: Soft, NT, BS+, no organomegaly appreciated, grimaces to L
flank pressure c/w prior trauma
Extrem: W& WP, no C/C/E, DP pulses 2+ bilaterally, ecchymosis
over left shoulder
Neuro: Does not respond to command, PERRL, CNII-XII grossly
intact but unable to participate in exam; limbs with mild
rigidity vs volitional resistance; LE with downward going toes
b/l, 3 beat clonus on R, unable to appreciate on L

Pertinent Results:
ADMISSION LABS:

[**2192-10-31**] 09:59PM BLOOD WBC-13.0* RBC-2.81* Hgb-8.9* Hct-27.7*
MCV-99*# MCH-31.7 MCHC-32.2 RDW-13.7 Plt Ct-456*
[**2192-10-31**] 09:59PM BLOOD Neuts-88.6* Lymphs-7.8* Monos-3.4 Eos-0.2
Baso-0.1
[**2192-10-31**] 09:59PM BLOOD PT-16.2* PTT-44.5* INR(PT)-1.4*
[**2192-10-31**] 09:59PM BLOOD Plt Ct-456*
[**2192-11-1**] 03:17AM BLOOD Glucose-110* UreaN-12 Creat-0.8 Na-133
K-3.9 Cl-102 HCO3-23 AnGap-12
[**2192-11-1**] 03:17AM BLOOD ALT-38 AST-29 AlkPhos-136* TotBili-0.5
[**2192-11-1**] 03:17AM BLOOD Calcium-8.3* Phos-3.2 Mg-2.1
[**2192-11-1**] 03:17AM BLOOD Phenyto-11.1
.
.
PERTINENT LABS:
Hct: Has ranged between 27 and 32 throughout this admission
WBC: 22.8 ([**11-9**]) -> 7.1 ([**11-14**])
Na: 132 ([**11-4**]) -> 129 ([**11-5**]) -> 130 ([**11-9**]) -> 136 ([**11-11**])
Phenytoin: 1.9 ([**11-9**]) -> 15.3 ([**11-10**])
.
Stool:
[**2192-11-9**] 11:31 am STOOL     CONSISTENCY: LOOSE      Source:
Stool.

                            **FINAL REPORT [**2192-11-10**]**

   CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2192-11-10**]):
      REPORTED BY PHONE TO [**First Name5 (NamePattern1) 8081**] [**Last Name (NamePattern1) 108828**] @ 0555 ON [**2192-11-10**].
      CLOSTRIDIUM DIFFICILE.
         FECES POSITIVE FOR C. DIFFICILE TOXIN BY EIA.
           (Reference Range-Negative).
         A positive result in a recently treated patient is of
uncertain
         significance unless the patient is currently
symptomatic
         (relapse).

RADIOLOGY
CT Head w/o Contrast ([**2192-10-17**]):
1. No acute intracranial hemorrhage.
2. Probable small calcified meningioma, stable compared to
[**2189-5-9**].
.
CT Chest, Abdomen, and Pelvis ([**2192-10-17**]):
1. Small left pneumothorax without evidence of tension.
2. Multiple left-sided rib fractures including anterior ribs
[**1-15**], and 4th and 7th posterior ribs.
3. Small left hemorrhagic pleural effusion and bilateral
scattered areas of lung contusion.
.
CT C-spine w/o Contrast ([**2192-10-17**]):
IMPRESSION: Multilevel degenerative changes as described.
Essentially stable anterolisthesis at the C4-5 level compared to

MRI of [**2192-8-10**]. No acute fracture or new subluxation
evident. However, in the setting of marked cervical kyphosis,
there is increase risk for cord injury and MRI is recommended if
there is clinical concern.
.
CT Chest w/o Contrast ([**2192-10-23**]):
1. Left lower thorax abnormality due to moderate, partially
layering nonhemorrhagic left pleural effusion and basal
subsegmental
atelectasis, both increased substantially since [**10-17**],
though stable over the past 24 hours.  New small pericardial and
right pleural effusion, are probably not significant.
2. Multiple left rib fractures, some substantially displaced.
Only one has shows instability relative to [**10-17**], and there
is no new bleeding either inside or outside the left chest.
3. Minimal right upper lobe and perihilar interstitial
infiltration, probably due to aspiration.
4. Severe coronary atherosclerotic calcification.
5. Severe cervicothoracic degenerative osteophyte formation and
scoliosis.
.
Chest Radiograph ([**2192-10-28**]):
FINDINGS: In comparison with earlier study of this date, there
has been removal of the chest tube with no evidence of
pneumothorax.
Multiple old healed rib fractures are again seen with some
volume loss in the left hemithorax.
.
CT Head [**2192-10-31**]
Per report: Acute on chronic SDH with evidence of midline shift
.
CXR [**2192-10-31**]: ? e/o L retrocardiac opacity concerning for PNA
.
CT Head ([**11-4**]): Slight increase in size of acute subdural
hematoma along the left cerebral convexity, with similar extent
of mass effect compared to the prior study.
.
MRA Head ([**11-5**]/): Normal MRA of the head.
.
Chest ([**11-6**]): The anatomic detail is obscured by respiratory
motion, but there does not appear to be any appreciable change
since [**11-1**], which showed residual atelectasis left lower
lobe and a small component of residual extrapleural hematoma
adjacent to the left upper rib fractures. Lungs are otherwise
clear.  There is no indication of new pleural effusion. Heart
size normal.
.
ECHO ([**11-7**]):  The left atrium is elongated. No thrombus/mass is
seen in the body of the left atrium. No atrial septal defect is
seen by 2D or color Doppler. Left ventricular wall thickness,
cavity size and regional/global systolic function are normal
(LVEF >55%). No masses or thrombi are seen in the left
ventricle. There is no ventricular septal defect. Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) are mildly thickened but aortic
stenosis is not present. No masses or vegetations are seen on
the aortic valve. Trace aortic regurgitation is seen. The mitral
valve appears structurally normal with trivial mitral
regurgitation. There is no mitral valve prolapse. No mass or
vegetation is seen on the mitral valve. There is borderline
pulmonary artery systolic hypertension. There is no pericardial
effusion.

CT Head ([**11-7**]): Slight increase in maximal thickness of
extra-axial collection overlying the left cerebral convexity and
extending into the tentorium and increase in associated mass
effect and now 7-mm rightward shift of septum pellucidum.
.
CT Head ([**11-9**]): Status post evacuation of left subdural
hematoma with
persistent rightward midline shift and small residual left
subdural
collection. No new hemorrhage identified.

Brief Hospital Course:
Patient is 67 yo male with h/o Binswanger's disease, s/p CVA,
who presented to the hospital on [**10-31**] with increasing lethargy
and was found to have a UTI and subdural hematoma, now s/p
drainage.
.
# Altered mental status: Patient presented with AMS in the
setting of a UTI and an evolving sub-dural hematoma.  A CT was
repeated 12 hours post-admission, which revealed a stable ICH,
thus no surgery was pursued.  He was originally treated for
hospital acquired UTI and ultimately sent to the floor on
cefpodoxime.  On [**11-7**] there was concern that Mr. [**Known lastname **] was
worsening, and a repeat CT Head revealed slight increase in
maximal thickness of extra-axial collection overlying the left
cerebral convexity and extending into the tentorium and increase
in associated mass effect and now 7-mm rightward shift of septum
pellucidum.   Neurosurgery, who was already following, decided
to evacuate the hematoma given that his MS as not improving and
there was mass effect on CT.  The patient's hematoma was
evacuated on [**11-8**].  His mental status gradually improved after
this intervention.  He remained on q4h neuro checks, and he was
placed on Dilantin for a 7-day course for seizure prophylaxis.
.
# C. Difficile:  On [**11-10**], the patient developed a leukocytosis,
fever, and increasingly watery stools.  He was started on IV
flagyl, and he defervesed.  The patient was swtiched to PO
Flagyl, and his diarrhea and leukocytosis eventually improved.
He will be continued on a 14-day course of Flagyl for C.Diff
Colitis, which should finish on [**11-24**].
.
# Hyponatremia: On admission, the patient was found to have a Na
of 126.  He was placed on fluid restrictions, and his Na
eventually increased to 136.  This hyponatremia was thought to
be secondary to SIADH and has remained stable during this
hospitalization with fluid restriction.
.
# Dysphagia:  On admission, the patient was evaluated by speech
and swallow  and was directed to have soft solids and thin
liquids when alert.  He was continued on this regimen, with
minimal PO intake secondary to decreased consciousness, until he
was reevaluated by Speech and Swallow on [**2192-11-12**].  At this time,
he was encouraged to have ground solids with nectar-thick
liquids.  He was continued on this regimen for the remained of
his hospitalization, and he did not have any acute events.
.
#. Pneumonia:  Patient had a CXR on [**10-31**] which showed a
possible lower lobe pneumonia.  When the patient was readmitted
to the MICU on [**11-8**], he was started on Vancomycin and
Levofloxacin for suspected pneumonia.  A repeat CXR was
performed, which was not worrisome for pneumonia.  The patient's
antibiotics were thus discontinued on [**11-9**] for suspected
pneumonia.  A repeat CXR on [**11-14**] showed interval improvement of
the infiltrate.
.
# Binswanger's disease/Progressive neurological deterioration:
On last admission given the patient's fall and concern for an
increased tempo of the patient's illness he was evaluated by the
inpatient neurology consult team. They recommended continuing
his outpatient regimen. Thus, the patient was continued on these
medications, and an outpatient appointment was made with
Behavioral Neurology.
.
# Lumbar mass: Patient has a lumbar mass found incidentally on
MRI L-spine to evaluate new bowel and bladder symptoms in
[**Month (only) 216**]. The etiology of this is unknown. Patient will have an LP
as outpatient, per neuro recommendations.
.
# Dyslipidemia: Patient was continued on his Atorvastatin and
Fish Oil per his outpatient regimen.
.
# Depression: The patient, at home, was taking 60 mg daily of
Citalopram.  However, on admission, he was only started on 20 mg
daily.  Thus, he was uptitrated to his home dose during this
admission.  He is currently taking 40 mg daily of Citalopram,
which he should continue until [**2192-11-17**].  He should then increase
this to 60 mg daily on [**2192-11-18**].
.
# Nutrition:  Patient was placed on ground solid with
nectar-thick liquid diet.
.
# Code:  FULL CODE confirmed by MICU with wife/HCP cell
[**Telephone/Fax (1) 108829**], work [**Telephone/Fax (1) 108830**]


Medications on Admission:
Atorvastatin 20mg QHS
Deltrol LA 4mg Qday
Celexa 20mg Qday
Aggrenox 200mg-25mg [**Hospital1 **]
Fish oil
Folic Acid
Compazine 10mg [**Hospital1 **] PRN nausea
Colace 100mg [**Hospital1 **] PRN constipation

Discharge Medications:
1. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily):
Please take 2 tablets until [**11-19**] and then increase to 3
tablets.
2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Detrol LA 4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO once a day.
4. Omega-3 Fatty Acids     Capsule Sig: One (1) Capsule PO BID
(2 times a day).
5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Olanzapine 2.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day) as needed for agitation.
Disp:*90 Tablet(s)* Refills:*1*
7. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 10 days.
Disp:*30 Tablet(s)* Refills:*0*
8. Phenytoin 100 mg/4 mL Suspension Sig: Four (4) mL PO three
times a day for 4 days.
Disp:*100 mL* Refills:*0*
9. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
10. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: [**1-11**]
Drops Ophthalmic PRN (as needed).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 459**] for the Aged - MACU

Discharge Diagnosis:
Primary:
Subdural Hematoma
C. Difficile Colitis
Hyponatremia

Secondary:
Lumbar Mass
Dyslipidemia
Depression


Discharge Condition:
Good.


Discharge Instructions:
You were admitted to the hospital because you were found to be
very confused and lethargic at your rehabilitation facility.
While you were here, we did an image of your head, which
demonstrated that your subdural hematoma had increased in size.
On [**11-8**], neurosurgery drained this hematoma and you were
transferred to the MICU.  While you were there, you developed
profuse diarrhea and you were found to have CDifficile Colitis.
We started you on an antibiotic,  Flagyl, for this infection,
and your diarrhea subsided.

While you were here, we made the following changes to your
medications:
1.  We started you on Flagyl for your C.Difficile
2.  We started you on Phenytoin for seizure prophylaxis.

Please take all medications as prescribed.

Please keep all previously scheduled appointments.

Please return to the ED or your healthcare provider if you
experience shortness of breath, chest pain, increased confusion,
lethargy, fevers, chills, or any other concerning symptoms.

Followup Instructions:
Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] (Behavioral Neurology).  Date/Time:
[**2193-2-7**] at 2PM.  Phone: [**Telephone/Fax (1) 1690**].  Location: Kurstein [**Doctor Last Name **],
[**Location (un) 551**] [**Apartment Address(1) 16806**].


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1882**] MD, [**MD Number(3) 1883**]

Completed by:[**2192-11-23**]
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Other encephalopathy,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Presenile dementia with delusional features,Other disorders of neurohypophysis,Accidental fall on or from other stairs or steps,Late effects of cerebrovascular disease, other speech and language deficits,Personal history of tobacco use,Anemia, unspecified,Other orthopedic aftercare,Disorder of bone and cartilage, unspecified,Depressive disorder, not elsewhere classified'}


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: Altered Mental Status

PRESENT ILLNESS: Mr. [**Known lastname **] is a 67 yo M, discharged from [**Hospital1 18**] one day prior
to admission s/p a fall (with L rib, head injury, left
hemo/pneumo with chest tube) who was sent to BIDN after began
having AMS at NH post-discharge.  Upon discharge, patient was
alert, conversant and ambulatory with limited assistance.
Reportedly (patient is nonverbal on initial exam) patient was
noted to have increased lethargy but was alert with purposeful
movement and then became nonverbal the day of admission.  At
BIDN, T101, 62, 133/76, 20, 99%. CXR with ?pneumonia in LLL with
retrocardiac opacity and UA positive, WBC 17.2.  CT head with
new L acute SDH with beginning falcine herniation.  Given
Flagyl, Levoquin and Dilantin.  Transferred to [**Hospital1 18**] ED where
initial VS 95, 132/52, 18, 98/RA.   In ED, given Vancomycin, and
NS consulted.  Thought no indication for emergent surgergy, but
did recommend 6-pack platelets given he is on Aggrenox.

MEDICAL HISTORY: 1) Binswangers disease
2) TIA x2
3) Dyslipidemia
4) Detrussor instability
5) DJD of the cervical spine
6) Depression
7) L3 spinal lesion found on MRI during [**8-/2192**]: Pending further
work-up
8) Admitted [**10-17**] for fall down stairs with nondisplaced L
clavicle fx, L 2-4th rib fx and small hemopneumothorax s/p chest
tube placement

MEDICATION ON ADMISSION: Atorvastatin 20mg QHS
Deltrol LA 4mg Qday
Celexa 20mg Qday
Aggrenox 200mg-25mg [**Hospital1 **]
Fish oil
Folic Acid
Compazine 10mg [**Hospital1 **] PRN nausea
Colace 100mg [**Hospital1 **] PRN constipation

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 100, 81, 140/69, 17, 99/2L
Gen: Thin male with eyes slightly open, not following commands
or verbalizing
HEENT: Sclerae anicteric, PEERL; oropharynx appears dry but no
lesions, exudates, blood, or erythema
Neck: Supple, no masses, no LAD, no cervical bruits appreciated
CV: RRR, no M/R/G
Pulm: CTAB anteriorly, unable to participate in exam, no wheeze,
rale or ronchi, left shoulder with resolving eccymoses
Abd: Soft, NT, BS+, no organomegaly appreciated, grimaces to L
flank pressure c/w prior trauma
Extrem: W& WP, no C/C/E, DP pulses 2+ bilaterally, ecchymosis
over left shoulder
Neuro: Does not respond to command, PERRL, CNII-XII grossly
intact but unable to participate in exam; limbs with mild
rigidity vs volitional resistance; LE with downward going toes
b/l, 3 beat clonus on R, unable to appreciate on L

FAMILY HISTORY: No family history of CVA's.  His two children are healthy.

SOCIAL HISTORY: He is married.  He previously worked as a manufacturer's
representative but has stopped doing this job.  He has a 40 pack
year smoking history but hasn't smoked in 25 years.  He denies
any alcohol or drug use. 

### Response:
{'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness,Other encephalopathy,Urinary tract infection, site not specified,Intestinal infection due to Clostridium difficile,Presenile dementia with delusional features,Other disorders of neurohypophysis,Accidental fall on or from other stairs or steps,Late effects of cerebrovascular disease, other speech and language deficits,Personal history of tobacco use,Anemia, unspecified,Other orthopedic aftercare,Disorder of bone and cartilage, unspecified,Depressive disorder, not elsewhere classified'}
