CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: MR. [**Known lastname 10794**] is a 52 year-old man with NICM ([**10/2195**]-LVEF 20% and
1+ MR), and type 1 diabetes mellitus who presented to ED with
SOB. Patient reports running out of lasix 4 days PTA. He further
described cough, SOB, orthopnea and slightly worse LE edema 2
days PTA. And presented to the ED on [**12-7**] with worsened SOB at
rest.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Type I Diabetes, Hyperlipidemia, HTN
2. CARDIAC HISTORY:
3. OTHER PAST MEDICAL HISTORY:
- Nonischemic dilated cardiomyopathy ([**10/2195**]-LVEF 20%, LVD 6.4

MEDICATION ON ADMISSION: - lasix 40 daily
- metoprolol succinate 100mg daily
- lisinopril 5mg daily
- lipitor 20mg daily
- aspirin 81mg daily
- seroquel 25m QHS
- insulin 40u lantus QHS, 12u novolug AM
- atrovent 250/50 [**Hospital1 **]
- ipratropium Q6 PRN SOB
- albuterol PRN SOB
- doxepin 20mg QHS (not taking)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:
VS: 115/81 119 22 92% 4L NC
GENERAL: NAD. Oriented x3. Mood, affect appropriate. Frequent
yawns.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Poor dentition
NECK: Supple with JVP of 7 cm.
CARDIAC: tachycardia, normal S1, S2. No m/r/g. No thrills,
lifts. LUNGS: No chest wall deformities, scoliosis or kyphosis.
Resp were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.

FAMILY HISTORY: - Father: pacemaker, deceased

SOCIAL HISTORY: - history of multiple incarcerations (>6 months in [**2193**])
- lives with sister
- walks w/ cane due to right sided foot drop
- Tobacco history: current smoker, 1 cig per day
- ETOH: denies
- Illicit drugs: crack cocaine three days ago
Unspecified septicemia,Acute respiratory failure,Pneumonia, organism unspecified,Acute on chronic systolic heart failure,Septic shock,Other primary cardiomyopathies,Obstructive chronic bronchitis with (acute) exacerbation,Cocaine dependence, continuous,Acute kidney failure, unspecified,Other specified episodic mood disorder,Paralytic ileus,Severe sepsis,Unspecified viral hepatitis C without hepatic coma,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled,Long-term (current) use of insulin,Tracheostomy status,Tobacco use disorder,Unspecified schizophrenia, unspecified,Other nonspecific abnormal serum enzyme levels,Personal history of noncompliance with medical treatment, presenting hazards to health
Septicemia NOS,Acute respiratry failure,Pneumonia, organism NOS,Ac on chr syst hrt fail,Septic shock,Prim cardiomyopathy NEC,Obs chr bronc w(ac) exac,Cocaine depend-contin,Acute kidney failure NOS,Episodic mood disord NEC,Paralytic ileus,Severe sepsis,Hpt C w/o hepat coma NOS,Meth resis Staph carrier,DMI wo cmp uncntrld,Long-term use of insulin,Tracheostomy status,Tobacco use disorder,Schizophrenia NOS-unspec,Abn serum enzy level NEC,Hx of past noncompliance
Admission Date:  [**2195-12-8**]              Discharge Date:   [**2195-12-16**]

Date of Birth:  [**2143-6-4**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
intubation [**Date range (3) 63639**]
right internal jugular central venous line [**Date range (3) 63640**]


History of Present Illness:
MR. [**Known lastname 10794**] is a 52 year-old man with NICM ([**10/2195**]-LVEF 20% and
1+ MR), and type 1 diabetes mellitus who presented to ED with
SOB. Patient reports running out of lasix 4 days PTA. He further
described cough, SOB, orthopnea and slightly worse LE edema 2
days PTA. And presented to the ED on [**12-7**] with worsened SOB at
rest.

In the ED, initial vitals 130/91 139 36 99% CPAP. His exam
notable for 2 sentence dyspnea, crackles to BL mid-lung fields.
Labs notable for WBC count of 11.3 w/ 85% PMNs, HCT 32.1, BNP
2361, creatinine 0.9, trop 0.02. ABG: 7.43 pCO2 34 pO2 324 on
BiPap. CXR with diffuse bilateral airspace opacities initally
though to be asymetric pulmonary edema. The patient was started
on nitro gtt and given lasix 80IV. He was then admitted to the
CCU.

In the CCU, he was continued on lasix IV in the CCU and achieved
1L liter length of stay fluid balance without significant
improvement in respirtory status. A CTA Chest was performed that
identified bilateral parenchymal opacities consistent with
multifocal PNA and inconsistent with pulmonary edema. The
patient was started on Cefepime, Azithromycin, Vancomycin and
Bactrim. The patient was febrile to 101.2 on [**12-9**] and the
decision was then made to transfer the patient to the MIUC.
Vitals on transfer were 100.0 103 82/51 96% 6L NC.

Past Medical History:
1. CARDIAC RISK FACTORS: Type I Diabetes, Hyperlipidemia, HTN
2. CARDIAC HISTORY:
3. OTHER PAST MEDICAL HISTORY:
- Nonischemic dilated cardiomyopathy ([**10/2195**]-LVEF 20%, LVD 6.4

cm, mild RV dilation, borderline function, 1+ MR)
- hepatitis C antibody positive
- MRSA pneumonia (requiring trach)
- COPD
- Substance abuse (cocaine)
- Tobacco abuse
- schizophrenia

Social History:
- history of multiple incarcerations (>6 months in [**2193**])
- lives with sister
- walks w/ cane due to right sided foot drop
- Tobacco history: current smoker, 1 cig per day
- ETOH: denies
- Illicit drugs: crack cocaine three days ago

Family History:
- Father: pacemaker, deceased

Physical Exam:
ADMISSION EXAM:
VS: 115/81 119 22 92% 4L NC
GENERAL: NAD. Oriented x3. Mood, affect appropriate. Frequent
yawns.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Poor dentition
NECK: Supple with JVP of 7 cm.
CARDIAC: tachycardia, normal S1, S2. No m/r/g. No thrills,
lifts. LUNGS: No chest wall deformities, scoliosis or kyphosis.
Resp were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.

EXTREMITIES: No c/c/e. No femoral bruits.
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.
PULSES:
Right: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Left: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ PT 2+
Neuro: strength 5/5 bilaterally UE and LE except R foot: [**2-21**]
strength in dorsiflexion. CN II-XII intact.

DISCHARGE EXAM:
VS: Tm 98 / Tc 98, BP (105-130)/(65-85), HR 75 (75-95), RR 18,
POx 97%RA FS glucose 172-300
GENERAL: NAD. Oriented to self, hospital name, year, month.
CARDIAC: S1 and S2, no murmur.
LUNGS: Clear to auscultation throughout all fields bilaterally
NEURO: chronic right-sided foot drop; gait stable with cane

Pertinent Results:
ADMISSION LABS
[**2195-12-8**] 02:35AM BLOOD WBC-11.3* RBC-3.95* Hgb-10.4* Hct-32.1*
MCV-81* MCH-26.5* MCHC-32.5 RDW-13.7 Plt Ct-286
[**2195-12-8**] 02:35AM BLOOD Neuts-85.6* Lymphs-9.5* Monos-3.4 Eos-1.2
Baso-0.4
[**2195-12-9**] 04:15AM BLOOD PT-13.8* PTT-38.7* INR(PT)-1.3*
[**2195-12-8**] 01:58AM BLOOD Glucose-256* UreaN-8 Creat-0.9 Na-139
K-3.3 Cl-105 HCO3-20* AnGap-17
[**2195-12-8**] 01:58AM BLOOD ALT-20 AST-27 LD(LDH)-299* CK(CPK)-249
AlkPhos-54 TotBili-0.2
[**2195-12-8**] 01:58AM BLOOD Calcium-8.3* Phos-4.1 Mg-1.4*
[**2195-12-8**] 02:37AM BLOOD Type-ART pO2-324* pCO2-34* pH-7.43
calTCO2-23 Base XS-0

PERTINENT LABS
[**2195-12-12**] 08:36PM BLOOD calTIBC-203* Ferritn-679* TRF-156*
[**2195-12-14**] 08:49PM BLOOD TSH-3.2
[**2195-12-9**] 04:15AM BLOOD HIV Ab-NEGATIVE
[**2195-12-8**] 02:45AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-POS amphetm-NEG mthdone-NEG

MICRO DATA
[**2195-12-8**] 02:45AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.009
[**2195-12-8**] 02:45AM URINE Blood-TR Nitrite-NEG Protein-100
Glucose-300 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG
[**2195-12-8**] 02:45AM URINE RBC-1 WBC-2 Bacteri-FEW Yeast-NONE Epi-<1
[**2195-12-8**] 02:45AM URINE CastHy-1*
[**2195-12-8**] 02:45AM URINE Mucous-RARE
[**2195-12-9**] 8:30 am BLOOD CULTURE x2
                            **FINAL REPORT [**2195-12-15**]**
   Blood Culture, Routine (Final [**2195-12-15**]):    NO GROWTH.
[**2195-12-9**] 6:55 pm BRONCHOALVEOLAR LAVAGE      LEFT UPPER BAL.
   GRAM STAIN (Final [**2195-12-9**]):
      1+    (<1 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      NO MICROORGANISMS SEEN.
   RESPIRATORY CULTURE (Final [**2195-12-11**]):    NO GROWTH, <1000
CFU/ml.
   LEGIONELLA CULTURE (Final [**2195-12-16**]):    NO LEGIONELLA
ISOLATED.
   POTASSIUM HYDROXIDE PREPARATION (Final [**2195-12-9**]):
      This is a low yield procedure based on our in-house
studies.
      if pulmonary Histoplasmosis, Coccidioidomycosis,
Blastomycosis,
      Aspergillosis or Mucormycosis is strongly suspected,
contact the
      Microbiology Laboratory (7-2306).
      NO FUNGAL ELEMENTS SEEN TEST REQUESTED PER DR.[**Known lastname **] [**Known firstname **]
[**2195-12-10**].
   Immunoflourescent test for Pneumocystis jirovecii (carinii)
(Final
      [**2195-12-10**]):
      SPECIMEN COMBINED.
      PLEASE REFER TO SPECIMEN #337-2463B [**2195-12-9**].
      PATIENT CREDITED.
   FUNGAL CULTURE (Preliminary):    NO FUNGUS ISOLATED.
   ACID FAST SMEAR (Final [**2195-12-10**]):
      NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.
   ACID FAST CULTURE (Preliminary):    NO MYCOBACTERIA ISOLATED.

   VIRAL CULTURE: R/O CYTOMEGALOVIRUS (Preliminary):
      No Cytomegalovirus (CMV) isolated.
   CYTOMEGALOVIRUS EARLY ANTIGEN TEST (SHELL VIAL METHOD) (Final
[**2195-12-14**]):
      Negative for Cytomegalovirus early antigen by
immunofluorescence.
      Refer to culture results for further information.
[**2195-12-9**] 6:55 pm Rapid Respiratory Viral Screen & Culture
BAL.
                            **FINAL REPORT [**2195-12-12**]**
   Respiratory Viral Culture (Final [**2195-12-12**]):
      No respiratory viruses isolated.
[**2195-12-10**] 5:58 am URINE      Source: Catheter.
                            **FINAL REPORT [**2195-12-11**]**
   URINE CULTURE (Final [**2195-12-11**]):    NO GROWTH.
[**2195-12-9**] 10:05PM BLOOD ASPERGILLUS GALACTOMANNAN
ANTIGEN-Negative
[**2195-12-9**] 10:05PM BLOOD B-GLUCAN-Negative

Brief Hospital Course:
Mr. [**Known lastname 10794**] is a 52y/o gentleman with nonischemic cardiomyopathy
who presented from home with progressively worsening shortness
of breath for two days and was found to be in hypoxic
respiratory distress due to multifocal PNA.  He was intubated,
stabilized in the MICU with antibiotics, and was transitioned to
the medical floor where he was weaned to room air and was
discharged home.

ACTIVE ISSUES

#. Acute respiratory failure: due to multifocal PNA.
He was intubated and at first his presentation was concerning
for CHF exacerbation.  Was initially admitted to the Cardiac ICU
and was diuresed, but when he spiked a fever and became
tachycardic in the setting of leukocytosis as well, a CTA was
performed which ruled out PE but showed multifocal PNA so
diuresis was stopped and he was started on antibiotics and
transferred to the MICU for further management (see below).

#. Multifocal pneumonia: Clinically resolved by discharge.
He has a history of MRSA pneumonia requiring tracheostomy during
prior admission to OSH in summer [**2194**].  Here, he was started on
Vanc/Cefepime/Cipro/Azithro as well as Bactrim given concern for
potential PCP (he has been in prison and has a h/o IVDU).   His
HIV test was negative.  PPD was placed and was negative.
Bronchoscopy was done and he was ruled out for TB and PCP so his
[**Name9 (PRE) **] were changed to Vanc/Cefepime/Cipro.  Was extubated without
complication.  Was transitioned to the medical floor where he
remained afebrile, hemodynamically stable, with leukocytosis
resolved.  He was weaned to room air and ambulated without
desaturating.  He completed an 8 day regimen ([**Date range (3) 63640**])
and was discharged home.

#. Non-ischemic cardiomyopathy: euvolemic.
LVEF 20%, mild RV dilation,  1+ MR.  As discussed above, he was
initially diuresed due to concern for CHF exacerbation, but he
was euvolemic.  He was transitioned back to his home dose of
lasix 40mg PO daily.  He was also continued on his home ACE
inhibitor and beta-blocker.

#. Elevated troponin: possibly represented demand ischemia.
Troponin was mildly elevated with peak of 0.05 which was thought
to be related to demand from his persistent tachycardia.  He
ruled out for MI with declining troponins.  No EKG changes.

#. Acute kidney injury: likely prerenal; resolved.
Creatinine baseline is 0.9 but peaked at 2 on [**11-19**].  Was
likely [**1-21**] to spesis and over-diuresis. Also, possibly related
to brief Rx with treatment-dose Bactrim.  His Cr then trended
down and was back to baseline at 0.9 upon discharge.

#. DM2: stable at the time of discharge.
He was initially continued on glargine and ISS. On [**12-10**] he
required insulin drip for FS persistently in the 400s despite SC
insulin, but this quickly resolved.  He was discharged on his
home dose of medications and will follow up with his PCP.

#. Schizophrenia/Depression: with depressed mood/affect and
hallucinations this admission.
After he was stabilized and extubated, he was noted to respond
to questions with single-word answers, with flat affect and poor
eye contact.  CT head was negative.  However, after a visit from
his sister and sister's boyfriend, he tearfully admitted that he
had been lonely and felt that nobody was visiting him
(especially since he had been in the ICU on [**Holiday **]).  After
this, he was alert/interactive and was fully conversant.  He
admitted that while he was in the ICU he saw a tiger in his
room.  It is unclear if this was related to intubation/sedation
or his untreated schizophrenia.  No further hallucinations.  At
the time of discharge, he denied SI/HI and desired follow-up
with a mental health provider so an appointment was made for
him.

#. Substance abuse: UTox positive for cocaine.
He was counseled on the importance of abstinence from drugs.

INACTIVE ISSUES

#. Hyperlipidemia: stable.
He was continued on home Atorvastatin.

#. COPD: stable.
He was continued on home Albuterol, Ipratropium.

TRANSITIONAL ISSUES
#. Emergency Contact: [**Name (NI) 4944**] ([**Telephone/Fax (1) 63641**])
#. Code Status: Full Code

Medications on Admission:
- lasix 40 daily
- metoprolol succinate 100mg daily
- lisinopril 5mg daily
- lipitor 20mg daily
- aspirin 81mg daily
- seroquel 25m QHS
- insulin 40u lantus QHS, 12u novolug AM
- atrovent 250/50 [**Hospital1 **]
- ipratropium Q6 PRN SOB
- albuterol PRN SOB
- doxepin 20mg QHS (not taking)

Discharge Medications:
1. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.
2. metoprolol succinate 100 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO once a day.
3. lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Lipitor 20 mg Tablet Sig: One (1) Tablet PO once a day.
5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. Seroquel 25 mg Tablet Sig: One (1) Tablet PO at bedtime.
7. Lantus 100 unit/mL Solution Sig: Forty (40) units
Subcutaneous at bedtime: please use 1/2 dose if not eating well;
call your doctor for any blood sugars less than 80.
8. Novolog 100 unit/mL Solution Sig: Twelve (12) units
Subcutaneous every morning: please use 1/2 dose if not eating
well; call your doctor for any blood sugars less than 80.
9. Advair Diskus 250-50 mcg/dose Disk with Device Sig: One (1)
puff Inhalation twice a day.
10. ipratropium bromide 17 mcg/Actuation HFA Aerosol Inhaler
Sig: 1-2 puffs Inhalation every six (6) hours as needed for
shortness of breath or wheezing.
11. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation every 4-6 hours as needed for shortness of
breath or wheezing.


Discharge Disposition:
Home

Discharge Diagnosis:
multifocal pneumonia


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 presented with shortness of breath and cough, and were
admitted to the ICU where you required intubation (breathing
tube) for pneumonia.  You were treated with antibiotics and were
able to be extubated and transferred to the medical floor to
complete your antibiotics.  Now you are stable for discharge
home with Primary Care follow-up.

While you were here, you were depressed and had a hallucination.
 You did not feel that you were a harm to yourself or others.
We made you an appointment with a mental health provider (please
see appointment below).

We did not make any changes to your medications.

Followup Instructions:
PRIMARY CARE
Department: [**Hospital1 7975**] INTERNAL MEDICINE
When: WEDNESDAY [**2195-12-23**] at 10:30 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 63642**], MD [**Telephone/Fax (1) 7976**]
Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site

PSYCHIATRY/SOCIAL WORK
Department: [**Hospital 7975**] [**Hospital **] HEALTH CENTER
When: THURSDAY [**2196-1-7**] at 10:30 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 63643**], LICSW [**Telephone/Fax (1) 7976**]
Building: [**Hospital1 7977**] ([**Location (un) 686**], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: Free Parking on Site
{'Unspecified septicemia,Acute respiratory failure,Pneumonia, organism unspecified,Acute on chronic systolic heart failure,Septic shock,Other primary cardiomyopathies,Obstructive chronic bronchitis with (acute) exacerbation,Cocaine dependence, continuous,Acute kidney failure, unspecified,Other specified episodic mood disorder,Paralytic ileus,Severe sepsis,Unspecified viral hepatitis C without hepatic coma,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled,Long-term (current) use of insulin,Tracheostomy status,Tobacco use disorder,Unspecified schizophrenia, unspecified,Other nonspecific abnormal serum enzyme levels,Personal history of noncompliance with medical treatment, presenting hazards to health'}


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: Shortness of breath

PRESENT ILLNESS: MR. [**Known lastname 10794**] is a 52 year-old man with NICM ([**10/2195**]-LVEF 20% and
1+ MR), and type 1 diabetes mellitus who presented to ED with
SOB. Patient reports running out of lasix 4 days PTA. He further
described cough, SOB, orthopnea and slightly worse LE edema 2
days PTA. And presented to the ED on [**12-7**] with worsened SOB at
rest.

MEDICAL HISTORY: 1. CARDIAC RISK FACTORS: Type I Diabetes, Hyperlipidemia, HTN
2. CARDIAC HISTORY:
3. OTHER PAST MEDICAL HISTORY:
- Nonischemic dilated cardiomyopathy ([**10/2195**]-LVEF 20%, LVD 6.4

MEDICATION ON ADMISSION: - lasix 40 daily
- metoprolol succinate 100mg daily
- lisinopril 5mg daily
- lipitor 20mg daily
- aspirin 81mg daily
- seroquel 25m QHS
- insulin 40u lantus QHS, 12u novolug AM
- atrovent 250/50 [**Hospital1 **]
- ipratropium Q6 PRN SOB
- albuterol PRN SOB
- doxepin 20mg QHS (not taking)

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:
VS: 115/81 119 22 92% 4L NC
GENERAL: NAD. Oriented x3. Mood, affect appropriate. Frequent
yawns.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.
Poor dentition
NECK: Supple with JVP of 7 cm.
CARDIAC: tachycardia, normal S1, S2. No m/r/g. No thrills,
lifts. LUNGS: No chest wall deformities, scoliosis or kyphosis.
Resp were unlabored, no accessory muscle use. CTAB, no crackles,
wheezes or rhonchi.
ABDOMEN: Soft, NTND. No HSM or tenderness. No abdominial bruits.

FAMILY HISTORY: - Father: pacemaker, deceased

SOCIAL HISTORY: - history of multiple incarcerations (>6 months in [**2193**])
- lives with sister
- walks w/ cane due to right sided foot drop
- Tobacco history: current smoker, 1 cig per day
- ETOH: denies
- Illicit drugs: crack cocaine three days ago 

### Response:
{'Unspecified septicemia,Acute respiratory failure,Pneumonia, organism unspecified,Acute on chronic systolic heart failure,Septic shock,Other primary cardiomyopathies,Obstructive chronic bronchitis with (acute) exacerbation,Cocaine dependence, continuous,Acute kidney failure, unspecified,Other specified episodic mood disorder,Paralytic ileus,Severe sepsis,Unspecified viral hepatitis C without hepatic coma,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Diabetes mellitus without mention of complication, type I [juvenile type], uncontrolled,Long-term (current) use of insulin,Tracheostomy status,Tobacco use disorder,Unspecified schizophrenia, unspecified,Other nonspecific abnormal serum enzyme levels,Personal history of noncompliance with medical treatment, presenting hazards to health'}
