CHIEF COMPLAINT: Shortness of breath

PRESENT ILLNESS: 74 yo woman with past medical history of CHF, coronary artery
disease s/p CABG in [**2190**] who presents to the hospital with 4
days of worsening shortness of breath at home. The dyspnea was
worst last night, when she was gasping for air and also had some
associated chest tightness and wheeze. She took a sublingual
nitroglycerin with some improvement in her symptoms. However, at
3 in the morning, she woke up with severe dyspnea, and when her
daughter took her vital signs, her blood pressure was elevated
(unclear to what degree), HR was 111 and her O2 saturation was
64%. The patient has O2 at home which she uses at night normally
at flow of 2L, however the daughter turned up the flow to 10L
with improvement of saturations only to 84%. At this point the
patient's daughter called EMS and she was brought to the
emergency room.
Of note, the patient reports that she is quite limited by
exertional dyspnea and shortness of breath at baseline. She has
23 steps at home, and is able to get up those stairs but only
very slowly. Her exertional dyspnea is predictable and rapidly
resolves with cessation of activites. She also had a recent
admission to [**Hospital3 **] for a CHF exacerbation in [**Month (only) 956**],
at which time she also had a cardiac catherization which per the
patient showed patency in 3 of her 4 bypass grafts. After that
admission, she was weaned off of her lasix by [**Month (only) 547**] due to drops
in blood pressure. She had a stress test in [**Month (only) 216**] which showed
possible perfusion abnormalities in the back of her heart
In the ED, she received 40mg of IV lasix and put out 300cc of
urine. Initially tachypneac to high 30s on intake, diaphoretic.
She was weaned off of the bipap and also given 1g vancomycin and
750mg of levofloxacin. Her most recent vitals where afebrile,
101 111/44 22-25, 100% on 100% non-rebreather. She reports
feeling much better since her admission and is currently chest
pain free.
.
On review of systems, she reports that she has had some recent
URI symptoms. She also has a history of DVTs x2 and had
previously been on coumadin, but has been off of coumadin for at
least 2 years. She has 3 pillow orthopnea. She denies fevers,
chills or rigors. No change in bowel habits. No symptoms of
claudication. No recent weight gain or change in eating habits.

MEDICAL HISTORY: Coronary artery disease s/p coronary artery bypass
graft in [**2190**], (stress test [**2199-8-12**] @[**Hospital3 **], under Dr.
[**First Name (STitle) 2031**] [**Telephone/Fax (1) 98231**] shows mild ischemia LV RCA distribution
consistent with old finding.)
2. Carcinoid tumor of right middle lobe s/p resection.
3. Diabetes mellitus, type 2, HbA1c=8.8 ([**6-/2198**])
4. Obesity.
5. Deep venous thrombosis, [**2176**], on Coumadin X6 months. Stopped
Coumadin, had another DVT,[**2176**] placed on Coumadin since, s/p IVC
filter, [**2197**]
6. Oxygen dependent since lung surgery and for obstructive sleep
apnea, uses 2L nasal cannula 02 at night at home. NO Bpap
7. obstructive sleep apnea.
8. restrictive lung disease
9. carpel tunnel syndrome b/l, [**2179**]
10. congestive heart failure (left atrium is mildly dilated.
LVEF 67%/[**2199**])
11.Anemia of Chronic disease, baseline Hct=30-33.0/Hb=10.
12.HTN
13.hypercholesterolemia

MEDICATION ON ADMISSION: Amlodipine 2.5mg qdaily - recently started [**8-28**]
Quinapril 20 mg Po daily
Metformin 1000mg [**Hospital1 **]
isosorbide mononitrate 30mg daily
Ferrous sulfate 325 tid
omeprazole 40mg [**Hospital1 **]
Klor-con 8meq [**Hospital1 **]
Magnesium oxide 400mg tid
Insulin 70/30 50U qam, 20U qhs
Multivitamin 1 tab daily
Calcium + vitamin D 750/400mg [**Hospital1 **]
vitamin C 500mg [**Hospital1 **]
Vitamin b12 1 tab daily

ALLERGIES: Ampicillin / Ceftin / Bactrim / Zocor / Lopressor

PHYSICAL EXAM: PHYSICAL EXAM on Admission:
GENERAL: Well appearing woman in NAD. Oriented x3. Mood, affect
appropriate.  Speaking in full sentences.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother - diabetes

SOCIAL HISTORY: -Tobacco history:  None
-ETOH:  None
-Illicit drugs:  None
Is married, lives with husband, daughter and 1 of her sons.  [**Name (NI) **]
2 other children.
She lives with her husband, adult daughter and son (38 yo) in a
Acute on chronic diastolic heart failure,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of venous thrombosis and embolism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Other dependence on machines, supplemental oxygen,Other diseases of lung, not elsewhere classified,Anemia of other chronic disease,Pure hypercholesterolemia,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Unspecified essential hypertension,Other and unspecified angina pectoris
Ac on chr diast hrt fail,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Hx-ven thrombosis/embols,DMII wo cmp nt st uncntr,Obstructive sleep apnea,Depend-supplement oxygen,Other lung disease NEC,Anemia-other chronic dis,Pure hypercholesterolem,Peptic ulcer NOS,Hypertension NOS,Angina pectoris NEC/NOS
Admission Date:  [**2203-10-23**]              Discharge Date:   [**2203-10-27**]

Date of Birth:  [**2129-3-14**]             Sex:   F

Service: MEDICINE

Allergies:
Ampicillin / Ceftin / Bactrim / Zocor / Lopressor

Attending:[**First Name3 (LF) 443**]
Chief Complaint:
Shortness of breath

Major Surgical or Invasive Procedure:
BiPAP

History of Present Illness:
74 yo woman with past medical history of CHF, coronary artery
disease s/p CABG in [**2190**] who presents to the hospital with 4
days of worsening shortness of breath at home. The dyspnea was
worst last night, when she was gasping for air and also had some
associated chest tightness and wheeze. She took a sublingual
nitroglycerin with some improvement in her symptoms. However, at
3 in the morning, she woke up with severe dyspnea, and when her
daughter took her vital signs, her blood pressure was elevated
(unclear to what degree), HR was 111 and her O2 saturation was
64%. The patient has O2 at home which she uses at night normally
at flow of 2L, however the daughter turned up the flow to 10L
with improvement of saturations only to 84%. At this point the
patient's daughter called EMS and she was brought to the
emergency room.
Of note, the patient reports that she is quite limited by
exertional dyspnea and shortness of breath at baseline. She has
23 steps at home, and is able to get up those stairs but only
very slowly. Her exertional dyspnea is predictable and rapidly
resolves with cessation of activites. She also had a recent
admission to [**Hospital3 **] for a CHF exacerbation in [**Month (only) 956**],
at which time she also had a cardiac catherization which per the
patient showed patency in 3 of her 4 bypass grafts. After that
admission, she was weaned off of her lasix by [**Month (only) 547**] due to drops
in blood pressure. She had a stress test in [**Month (only) 216**] which showed
possible perfusion abnormalities in the back of her heart
In the ED, she received 40mg of IV lasix and put out 300cc of
urine. Initially tachypneac to high 30s on intake, diaphoretic.
She was weaned off of the bipap and also given 1g vancomycin and
750mg of levofloxacin. Her most recent vitals where afebrile,
101 111/44 22-25, 100% on 100% non-rebreather. She reports
feeling much better since her admission and is currently chest
pain free.
.
On review of systems, she reports that she has had some recent
URI symptoms. She also has a history of DVTs x2 and had
previously been on coumadin, but has been off of coumadin for at
least 2 years. She has 3 pillow orthopnea. She denies fevers,
chills or rigors. No change in bowel habits. No symptoms of
claudication. No recent weight gain or change in eating habits.



Past Medical History:
 Coronary artery disease s/p coronary artery bypass
graft in [**2190**], (stress test [**2199-8-12**] @[**Hospital3 **], under Dr.
[**First Name (STitle) 2031**] [**Telephone/Fax (1) 98231**] shows mild ischemia LV RCA distribution
consistent with old finding.)
2. Carcinoid tumor of right middle lobe s/p resection.
3. Diabetes mellitus, type 2, HbA1c=8.8 ([**6-/2198**])
4. Obesity.
5. Deep venous thrombosis, [**2176**], on Coumadin X6 months. Stopped
Coumadin, had another DVT,[**2176**] placed on Coumadin since, s/p IVC
filter, [**2197**]
6. Oxygen dependent since lung surgery and for obstructive sleep
apnea, uses 2L nasal cannula 02 at night at home. NO Bpap
7. obstructive sleep apnea.
8. restrictive lung disease
9. carpel tunnel syndrome b/l, [**2179**]
10. congestive heart failure (left atrium is mildly dilated.
LVEF 67%/[**2199**])
11.Anemia of Chronic disease, baseline Hct=30-33.0/Hb=10.
12.HTN
13.hypercholesterolemia


Social History:
-Tobacco history:  None
-ETOH:  None
-Illicit drugs:  None
Is married, lives with husband, daughter and 1 of her sons.  [**Name (NI) **]
2 other children.
She lives with her husband, adult daughter and son (38 yo) in a

[**Location (un) 1773**] apartment in [**Location (un) 538**], Mass. The indicates
that she has 31 steps to climb. Her family is very supportive.
Daughter,
[**Name (NI) 98232**], is the contact @ Cell [**Telephone/Fax (1) 98233**]/Home [**Telephone/Fax (1) 98234**].
Retired office asst. Pt is a native of [**Country 5881**], where she used to
work as a nurse. [**First Name (Titles) **] [**Last Name (Titles) **] currently or in past. No Etoh
intake.


Family History:
Mother - diabetes

Physical Exam:
PHYSICAL EXAM on Admission:
GENERAL: Well appearing woman in NAD. Oriented x3. Mood, affect
appropriate.  Speaking in full sentences.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

NECK: Supple with JVP of 6 cm.  Negative hepatojuglar reflex.
CARDIAC: Slightly muffled S1.  3/6 systolic murmur radiating to
apex, possible [**2-2**] diastolic murmur.  Normal S2. No S3/S4
LUNGS: Bibasilar crackles
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not
enlarged by palpation. No abdominial bruits.
EXTREMITIES: Mild bilateral edema.  Vein harvest scar on left
leg. Warm and well perfused.
PULSES:  1+ radial pulses bilaterally.  DP and PT Pulses not
palpable.
.


Pertinent Results:
Labs on admission:

[**2203-10-23**] 02:02PM   SODIUM-137 POTASSIUM-4.7 CHLORIDE-99 TOTAL
CO2-29 ANION GAP-14
[**2203-10-23**] 02:02PM   CK(CPK)-63
[**2203-10-23**] 02:02PM   CK-MB-7 cTropnT-0.07*
[**2203-10-23**] 02:02PM   CALCIUM-8.7 PHOSPHATE-5.3* MAGNESIUM-1.8
[**2203-10-23**] 05:44AM   TYPE-ART PEEP-5 O2- PO2-263* PCO2-67*
PH-7.22* TOTAL CO2-29 BASE XS--1
[**2203-10-23**] 05:44AM   GLUCOSE-238* LACTATE-1.4 NA+-138 K+-4.2
CL--101 TCO2-27
[**2203-10-23**] 05:44AM   freeCa-1.21
[**2203-10-23**] 05:30AM   GLUCOSE-247* UREA N-15 CREAT-0.7 SODIUM-141
POTASSIUM-4.5 CHLORIDE-102 TOTAL CO2-26 ANION GAP-18
[**2203-10-23**] 05:30AM   cTropnT-<0.01
[**2203-10-23**] 05:30AM   proBNP-1443*
[**2203-10-23**] 05:30AM   WBC-17.4*# RBC-4.46 HGB-12.1 HCT-37.2 MCV-84
MCH-27.2 MCHC-32.6 RDW-16.5*
[**2203-10-23**] 05:30AM   NEUTS-84.1* LYMPHS-11.4* MONOS-3.0 EOS-1.0
BASOS-0.6
[**2203-10-23**] 05:30AM   PLT COUNT-245
[**2203-10-23**] 05:30AM   PT-12.7 PTT-23.0 INR(PT)-1.1
.
Imaging:
CXR [**10-23**]: Bilateral pleural effusions and findings consistent
with fluid overload. The presence of an underlying infection
remains a possibility.

LENI [**10-23**]: IMPRESSION: No DVT in the left lower extremity

Discharge Labs:
[**2203-10-26**] 07:35AM BLOOD WBC-9.4 RBC-4.30 Hgb-11.4* Hct-34.9*
MCV-81* MCH-26.4* MCHC-32.5 RDW-16.2* Plt Ct-218
[**2203-10-26**] 07:35AM BLOOD Plt Ct-218
[**2203-10-26**] 07:35AM BLOOD Glucose-199* UreaN-31* Creat-0.9 Na-139
K-4.3 Cl-92* HCO3-35* AnGap-16
[**2203-10-26**] 07:35AM BLOOD Calcium-9.3 Phos-4.7* Mg-1.8

Brief Hospital Course:
74 y.o woman with history of CABG and CHF, also DVT who presents
with acute onset of dyspnea and evidence of pulmonary edema,
consistent with a severe exacerbation of congestive heart
failure.
.
# Congestive heart failure: She presented with worsening
dyspnea, diaphoresis, and tachycardia consistent with a CHF
decompensation.  She she had not been on lasix due to labile
blood pressures.  She was admitted to the CCU for diruesis with
lasix and a nitroglycerin drip.  Her lower extremity dopplers
were negative for DVT.  She was transitited to PO lasix on the
floor, with the goal to take 40 mg PO lasix in the am while at
home; this was subsequently changed to 20mg PO the day prior to
discharge due orthostatic hypotension.
.
# CORONARIES:  She had a history of CABG with a recent abnormal
stress test.  Based upon her laboratory data and findings on
EKG, there is no acute evidence of ACS.   Her history is
consistent with chronic stable angina with likely anginal pain
with increased demand from congestive heart failure
exacerbation.  She was placed on a nitroglycerin drip as above,
and continued on ASA 325 mg, and Atorvastatin 80 mg.  Her home
dose of isosorbide was restarted when she was stable on the
floor.
.
# Hypertension: She was continued on her quinipril throughout
her hospital course.
.
# Diabetes Mellitus: Initially her home insulin of 70/30 was
converted to NPH, and she was maintained on NPH with 20U in
morning and 8U at night.  She was given an ISS for meal time
coverage and started on Metformin.  Prior to discharge her
glucose was labile into the 500s, prompting her to be restarted
on her home insulin regimen of insulin 70/30 50 units in the AM
and 20 with dinner with sliding scale coverage.

Medications on Admission:
Amlodipine 2.5mg qdaily - recently started [**8-28**]
Quinapril 20 mg Po daily
Metformin 1000mg [**Hospital1 **]
isosorbide mononitrate 30mg daily
Ferrous sulfate 325 tid
omeprazole 40mg [**Hospital1 **]
Klor-con 8meq [**Hospital1 **]
Magnesium oxide 400mg tid
Insulin 70/30 50U qam, 20U qhs
Multivitamin 1 tab daily
Calcium + vitamin D 750/400mg [**Hospital1 **]
vitamin C 500mg [**Hospital1 **]
Vitamin b12 1 tab daily

Discharge Medications:
1. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO twice a day.
2. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1)
Tablet PO DAILY (Daily).
3. Calcium Carbonate 200 mg (500 mg) Tablet, Chewable Sig: 1.5
Tablet, Chewables PO twice a day.
4. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed) as needed for chest pain:
take as directed.
5. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. XIBROM 0.09 % Drops Sig: One (1) drop Ophthalmic daily ().
8. Vitamin C 500 mg Tablet Sig: One (1) Tablet PO twice a day.
9. Klor-Con 8 8 mEq Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO twice a day.
10. Magnesium Oxide 400 mg Tablet Sig: One (1) Tablet PO three
times a day.
11. Vitamin B-12  Oral
12. Ferrous Sulfate 324 mg (65 mg Iron) Tablet, Delayed Release
(E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO TID (3
times a day).
13. Insulin NPH & Regular Human 100 unit/mL (70-30) Suspension
Sig: Fifty (50) units Subcutaneous once a day.
14. Insulin NPH & Regular Human 100 unit/mL (70-30) Suspension
Sig: Twenty (20) units Subcutaneous at bedtime.
15. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
16. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily): do
not take if BP top number is less than 90. .
17. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.

18. Furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
19. Quinapril 10 mg Tablet Sig: 0.5 Tablet PO once a day: do not
take if systolic blood pressure is less than 100.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Acute on chronic Diastolic congestive Heart Failure
Hypertension
Coronary Artery Disease


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 had an acute exacerbation of your congestive heart failure.
We gave you medicine to take the extra fluid off and your weight
this morning is 183 pounds. We adjusted your medicine to help
your heart work better. You will need to take your medicine
every day and weigh yourself every day to prevent another
hospitalization. Call Dr. [**First Name (STitle) 2031**] if your weight increases more
than 3 pounds in 1 day or 5 pounds in 3 days. Also call Dr.
[**First Name (STitle) 2031**] for any trouble breathing, especially at night or for any
swelling in your legs or abdomen.
Medications changes:
1. STOP taking Amlodipine
2. Start taking aspirin to prevent a heart attack
3. Decrease the Quinapril to 5 mg daily (one half a pill)
4. Start taking furosemide (lasix) 20 mg daily to prevent fluid
buildup and shortness of breath.
.
If your systolic blood pressure is less than 100, please do not
take the Quinipril. You should continue to take the furosemide
and isosorbide mononitrate unless your systolic blood pressure
is less than 90.


Followup Instructions:
Cardiology:
Name: [**Last Name (LF) **],[**First Name3 (LF) **] P.
Location: [**Hospital **] HOSPITAL
Address: [**Location (un) **], [**Location (un) **],[**Numeric Identifier 38978**]
Phone: [**Telephone/Fax (1) 77385**]
Appt: [**11-1**] at 2pm
{'Acute on chronic diastolic heart failure,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of venous thrombosis and embolism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Other dependence on machines, supplemental oxygen,Other diseases of lung, not elsewhere classified,Anemia of other chronic disease,Pure hypercholesterolemia,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Unspecified essential hypertension,Other and unspecified angina pectoris'}


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: 74 yo woman with past medical history of CHF, coronary artery
disease s/p CABG in [**2190**] who presents to the hospital with 4
days of worsening shortness of breath at home. The dyspnea was
worst last night, when she was gasping for air and also had some
associated chest tightness and wheeze. She took a sublingual
nitroglycerin with some improvement in her symptoms. However, at
3 in the morning, she woke up with severe dyspnea, and when her
daughter took her vital signs, her blood pressure was elevated
(unclear to what degree), HR was 111 and her O2 saturation was
64%. The patient has O2 at home which she uses at night normally
at flow of 2L, however the daughter turned up the flow to 10L
with improvement of saturations only to 84%. At this point the
patient's daughter called EMS and she was brought to the
emergency room.
Of note, the patient reports that she is quite limited by
exertional dyspnea and shortness of breath at baseline. She has
23 steps at home, and is able to get up those stairs but only
very slowly. Her exertional dyspnea is predictable and rapidly
resolves with cessation of activites. She also had a recent
admission to [**Hospital3 **] for a CHF exacerbation in [**Month (only) 956**],
at which time she also had a cardiac catherization which per the
patient showed patency in 3 of her 4 bypass grafts. After that
admission, she was weaned off of her lasix by [**Month (only) 547**] due to drops
in blood pressure. She had a stress test in [**Month (only) 216**] which showed
possible perfusion abnormalities in the back of her heart
In the ED, she received 40mg of IV lasix and put out 300cc of
urine. Initially tachypneac to high 30s on intake, diaphoretic.
She was weaned off of the bipap and also given 1g vancomycin and
750mg of levofloxacin. Her most recent vitals where afebrile,
101 111/44 22-25, 100% on 100% non-rebreather. She reports
feeling much better since her admission and is currently chest
pain free.
.
On review of systems, she reports that she has had some recent
URI symptoms. She also has a history of DVTs x2 and had
previously been on coumadin, but has been off of coumadin for at
least 2 years. She has 3 pillow orthopnea. She denies fevers,
chills or rigors. No change in bowel habits. No symptoms of
claudication. No recent weight gain or change in eating habits.

MEDICAL HISTORY: Coronary artery disease s/p coronary artery bypass
graft in [**2190**], (stress test [**2199-8-12**] @[**Hospital3 **], under Dr.
[**First Name (STitle) 2031**] [**Telephone/Fax (1) 98231**] shows mild ischemia LV RCA distribution
consistent with old finding.)
2. Carcinoid tumor of right middle lobe s/p resection.
3. Diabetes mellitus, type 2, HbA1c=8.8 ([**6-/2198**])
4. Obesity.
5. Deep venous thrombosis, [**2176**], on Coumadin X6 months. Stopped
Coumadin, had another DVT,[**2176**] placed on Coumadin since, s/p IVC
filter, [**2197**]
6. Oxygen dependent since lung surgery and for obstructive sleep
apnea, uses 2L nasal cannula 02 at night at home. NO Bpap
7. obstructive sleep apnea.
8. restrictive lung disease
9. carpel tunnel syndrome b/l, [**2179**]
10. congestive heart failure (left atrium is mildly dilated.
LVEF 67%/[**2199**])
11.Anemia of Chronic disease, baseline Hct=30-33.0/Hb=10.
12.HTN
13.hypercholesterolemia

MEDICATION ON ADMISSION: Amlodipine 2.5mg qdaily - recently started [**8-28**]
Quinapril 20 mg Po daily
Metformin 1000mg [**Hospital1 **]
isosorbide mononitrate 30mg daily
Ferrous sulfate 325 tid
omeprazole 40mg [**Hospital1 **]
Klor-con 8meq [**Hospital1 **]
Magnesium oxide 400mg tid
Insulin 70/30 50U qam, 20U qhs
Multivitamin 1 tab daily
Calcium + vitamin D 750/400mg [**Hospital1 **]
vitamin C 500mg [**Hospital1 **]
Vitamin b12 1 tab daily

ALLERGIES: Ampicillin / Ceftin / Bactrim / Zocor / Lopressor

PHYSICAL EXAM: PHYSICAL EXAM on Admission:
GENERAL: Well appearing woman in NAD. Oriented x3. Mood, affect
appropriate.  Speaking in full sentences.
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were
pink, no pallor or cyanosis of the oral mucosa. No xanthalesma.

FAMILY HISTORY: Mother - diabetes

SOCIAL HISTORY: -Tobacco history:  None
-ETOH:  None
-Illicit drugs:  None
Is married, lives with husband, daughter and 1 of her sons.  [**Name (NI) **]
2 other children.
She lives with her husband, adult daughter and son (38 yo) in a 

### Response:
{'Acute on chronic diastolic heart failure,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Personal history of venous thrombosis and embolism,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Obstructive sleep apnea (adult)(pediatric),Other dependence on machines, supplemental oxygen,Other diseases of lung, not elsewhere classified,Anemia of other chronic disease,Pure hypercholesterolemia,Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Unspecified essential hypertension,Other and unspecified angina pectoris'}
