Updated with your comments/suggestions – thanks!
Chief Complaint: “_”
History of Present Illness:
Abdominal constipation: besides OPQRST or OLDCARTS, the attending would want to know if there is a fever or blood (hematochezia) for an infectious process, change w. meal (for a duodenal ulcer would decrease b.c of alkali secretion vs a stomach ulcer will increase b.c of acid secretion), weight change, NSAID use (ulcer risk factor) or reflux. Managed w. _.
Allergic rhinitis: they want you to classify severity. Intermittent severity is w. symptoms <4 days/wk or <4 wks at a time, while persistent severity w. symptoms >4 days/wk or >4 wks at a time. Mild symptoms have no sleep disturbance, no impairment of activities and normal school/work while moderate-severe symptoms have sleep disturbance, impairment of activities or impaired school/work.
Asthma: attending wants to know sx severity b.c this will guide tx. InTWOmittent severity w. symptoms <2 days/wk, SABA use <2 days/wk and nighttime awakenings <2/month and. Mild persistent severity is going to be >2 days/wk but not daily, SABA use >2 days/wk but not daily and nighttime awakenings <4/month. Moderate persistent severity w. symptoms daily, SABA use daily and nighttime awakenings >4/month. And, Severe persistent severity w. symptoms throughout day, continuous SABA use and nightly awakenings.
Back/joint pain: attending would want to know if acute or chronic b.c will guide tx. Contributing factors: ; Alleviating factors: . Denies radiation. Currently managed w. _.
BPH: LUTS (lower urinary tract sx): enlarged prostate blocks stream, incomplete voiding, nighttime urination
COPD: _ pack-year, cough, sputum production, dyspnea
DM: always want to have latest A1c ready. Last A1c _/_/_ _%. Also want to know if compliant w. meds. And the microvascular complications of DM: vision change, Last eye exam _. Ulcer check _. Denies tingling. A&P below for more on secondary DM screening
Headache: Reports bilaTeral Tension-like pain, a/w photophobia or phonophobia (a phobia or sensitivity to light or sound), not N/V. Unilateral pUlsating (Migraine), a/w photophobia and phonophobia, N/V, aura. Headache log not present at this visit but pt reported trigger w. Sleep, Eat (hunger) and Life stress (SEAL), and for F: menstrual cycle. For both Tension headache or Migraine you want to ask about warning signs: so, Denies fever, stiff neck for meningitis.
HF: NYHA I: asymptomatic; II: symptomatic w. moderate exertion; III: symptomatic w. mild exertion; IV: symptomatic at rest. Ask about baseline _ b.c exacerbated at presentation
Hypertension. This will be the MC case. The attending would want to know about compliance w. meds, any adverse SEs, if well/poorly controlled on _, and, of course, the all-important Log shows _. Snoring/sleep apnea is important to start thinking about in resistant HTN for OSA. And of course, warning signs HAs, chest pain, change in vision.
Pharyngitis: began _, OPQRST _, attending also want to know about Centor criteria for Abx: fever, anterior cervical adenopathy, tonsillar swelling/exudates, absent cough
Sinusitis: attending wants to know about warning signs for Abx use: >10 d, >102F, purulent nasal d/c, facial (not just sinus) pain, double sickening (worsening)
Review of Systems
Constitutional: +fatigue, denies fever, N/V/Ha/dizziness
Eyes: denies change in vision;
Ears: denies change in hearing;
Resp: denies change in breathing, SOB
Cardio: denies chest pain, palpitations
GI: +constipation, denies diarrhea, hematochezia, change in BM
GU: denies polyuria, dysuria, hematuria
MSK: denies muscle aches, joint pain
Meds
Include OCPs & consider as etiology for HTN; try to avoid combo OCPs >35 w. thrombosis RFs smoking, HTN
Include vitamin/supplement/weight loss pills as can all have T4
Allergies
_ since _ triggers _ carries _
PMH
PSH
Social
Born/raised:
Occupation:
Lives with:
Tobacco:
–(packs/day) * (years/smoker) = e.g. 2 packs/day for 20 years = 40 pack-year
–(# cigarettes day/20) * (years/smoker) = e.g. 10 cigarettes/day for 6 years = 3 pack-year
ETOH using as standard drink: 12 oz beer = 5 oz wine = 1.5 oz shot
–during wk: _ standard drinks
–weekend: _ standard drinks
Drugs:
Diet/exercise:
Family *focus on: (1) MI/HTN (2) diabetes (3) cancer (genetic screening referral)
Father: Passed of _ at age _
Mother: Passed of _ at age _
Brother:
Sister:
Physical Exam
V/S: BP: _/_ HR: _ RR: _ Sat: _ Temp: _
General: no acute distress, well/ill appearing, obese/cachectic, calm, conversational
HEENT: Normocephalic and atraumatic. Eyes PERRLA, no conjunctivitis, no icterus. Oropharynx is clear of exudate/thrush. Tympanic membranes are clear. No LAD. No gross thyromegaly.
Neuro: CN II-XII intact; nl motor and sensation x4
Cardio: Normal S1, S2, PMI. No audible murmurs or palpable thrills.
Resp: lungs clear x4.
GI: no ascites, guarding; BS x4; soft and nontender x4; liver non-palpable
GU: deferred
MSK: warm x_ w. pulse / cold x_ w. decreased pulse, decreased hair _ concerning for PAD; no palpable clots, edema, tenderness; Straight leg raise test to asses for radiculopathy: nerve impingement was _negative
Skin: no rashes *infection, lesions *biopsy, bruising *bleeding risk, anticoagulation
Labs
baseline _
Imaging
baseline _
Contrast in CKD, age >75
MRI: implant _
A & P
1-liner +
#Abdominal
–Constipation:
-counseled to increase fiber/hydration
-laxative: osmotic/bulk: Mg [Mg Citrate/Milk of Mg, BM 0.5-3 hrs], polyethylene glycol [Miralax, BM 1-4 d], wheat dextrin [Benefiber, BM 1-2 d], psyllium [Metamucil, BM 12-72 hrs], lactulose 1 hr, GoLytely 3-4 hrs
-surfactant: H2O softens up stool: docusate [Colace, BM 1-2 d]
-prokinetic: motility: metoclopramide [Reglan]
-cathartic: combo laxative + prokinetic, thus faster onset: Senna, BM 6-12 hrs
–Diarrhea: probiotic, Loperamide [Imodium]
#Acne
–Counseled to not lean face on hand and that acne is not caused by dirt, chocolate, greasy foods
–Counseled to use salicylic a. to wash face (helps break up keratin layer, open up pores), results 6 wks
–Prescribed topical retinoids [Retinol, Retin-A, Tretinoin] for white/black-heads and counseled blast of vitamin A to help atrophy sebaceous glands, apply at evening
–Prescribed oral retinoids [Accutane] for white/black-heads
–Prescribed benzoyl peroxide for inflamed white/black-heads, pustules and counseled not abx, bacterial static, so won’t develop resistance, can wash face daily
–Prescribed topical abx (Clindamycin)
–Prescribed oral abx (Minocycline, Doxycycline) for severe
–Ordered intralesional corticosteroid injection (ICSL) to modulate immune response for severe cystic acne
#Allergies
–Counseled to use pillow/mattress covers, decrease clutter that collects dust, vacuum, close window for pollen, humidifier (if dry air), dehumidifier (if moist air)
–Flonase (fluticasone, $20) vs Nasonex (mometasone, $80) w. 2nd-gen anti-H1: loratadine [Claritin], cetirizine [Zyrtec], can use Cromolyn (mast cell stabilizer) for prevention
–if severe congestion: Afrin (Oxymetazoline, a-agonist ~dextromethorphan); SE: rebound congestion if used >5 d
#Allergic contact dermatitis
–Topical steroid
–Counseled MC are cosmetics/fragrances, not have to be new product, can develop after repeat yrs
#Alopecia, androgenic, circular/M-pattern
–OTC Minoxidil [Rogaine], counseled arteriolar dilator, initial hair shedding resolves, must wash hands after application to avoid hypotension, HA; can’t stop cold, must wean off
–Prescribed Finasteride [Propecia], counseled inhibits conversion of testosterone -> DHT, has SE of sex dysfunction, teratogenic don’t pass pill
#Anxiety: GAD 7 score _.
–Prescribed Sertraline [Zoloft], counseled med can take up to 8 wks for effect and not to worry if not at effect by next visit; also counseled to not stop SSRI cold if feeling better due to possible rebound anxiety/depression
–Ordered TSH
#Asthma exacerbation
–Counseled since intermittent severity use SABA prn
–Counsel since persistent severity, damage (unlike in smoking/COPD) is ongoing and need to limit damage w. ICS, use spacer and wash mouth to avoid thrush; episodes of exercise-induced bronchospasm is marker of inadequate control/ongoing damage, counseled to warm-up before, use face mask to limit cold air; effect on linear growth is small and poorly controlled asthma can also slow a child’s growth
–Administered in-office Duoneb (ipratropium + albuterol)
–Prescribed Dexamethasone [Decadron] 0.5 mg/kg PO qd for 1-2 d; counsel crush & mix w. pudding to help mask bitter taste
–Prescribed PPI for comorbid GERD
#Back pain: paraspinal tenderness concerning for muscle strain, midline concerning for vertebrae compression fx, radiculopathy concerning for herniated disc, relief when leaning forward concerning for spinal stenosis, worst w. rest & better w. activity concerning for inflammatory spondyloarthropathy
–Counseled most pts w. acute (<6 wks) back pain get better in a few wks, counseled to lift from squatting position and not bend over, strengthen core to strengthen lower back muscles, work on posture
–Continue icy-hot, capsaicin, CBD, Acetaminophen prn and counseled to alternate w./limit any NSAID to lowest dose, shortest time and always w. food
–Consider PT referral >6 wks
–Ordered gabapentin [Neurontin] for radiculopathy started 100 mg TID for risk of respiratory depression/drowsiness can up to next visit -> 200 -> 400 -> max 800); pregabalin [Lyrica] (more $; start 75 mg -> max 100)
#BPH: clinical history of LUTS: nocturia, frequency, hesitancy; also considered prostate ca., but less likely because symmetrically enlarged, smooth prostate
–Ordered UA for hematuria (bladder cancer, kidney stones), infection; consider PSA in symptomatic patients
–Acute: Started Tamsulosin [Flomax] 0.4 mg qd and counseled relaxes prostate muscle to increase voiding and decrease need to use bathroom
–Chronic: Started Finasteride for PSA >1.5 and counseled helps reduce prostate size, effect ~3 mos and around 6 mos can d/c Flomax, decrease PSA ~50%; SE: sex drive, ED, if preexisting prostate ca., teratogenic don’t pass pill
–Refractory: TURP referral
#COPD
–mild exacerbation: methylprednisolone [Medrol dosepak] or prednisone 40 mg x5 days
–mod-severe (fever, cough, sputum, wheeze): add Azithromycin [Z-pak]
#Cough: D/d: post-URI, postnasal drip, asthma, GERD
–OTC: dextromethorphan [Robitussin], Mucinex (no cough suppression, thins mucus)
–Prescription: Benzonatate [Tessalon], codeine
#DM/pre-DM (A1c 5.7-6.4) *app AACE algorithm
–Counseled goal A1c <7% (elderly/episodes of hypoglycemia <8%)
–Counseled of importance of weight loss in lowering A1c and to limit processed carbs, start w. breakfast high in fat, protein (eggs, peanut butter, oatmeal, buckwheat, Greek yogurt full-fat, nuts, humus), EatRight.org for registered nutritionist
–Ordered CMP ([Cr]), microalbuminuria (q 1 yr), eye exam (type I: w.in 5 yrs; II: at diagnosis + q 1 yrs), annual lipid, ulcer check
–Started Metformin 500 mg BID -> 1000 mg BID & counseled initial stomach upset when starting med (c/i CKD 4, HF)
–Started Insulin for A1c >9 %
–if N/V: consider gastroparesis -> Metoclopramide [Reglan]
#Flu
–Prescribed Tamiflu (w.in 72 hrs) or Xofluza (w.in 24 hrs)
#GERD
–Counseled to avoid food triggers: spicy foods, caffeine, chocolate, citrus, soda, mint & not lay recumbent w.in ~hrs of eating
–Ordered stool sample b.f PPI to assess for H. pylori for close family contact, high-risk country
–For mild: started Ca2+-carbonate [Tums], Maalox, Mylanta -> Ranitidine [Zantac]
–For mod-sever: started Pantoprazole [Protonix] 20 mg qd take 30 mins b.f meal to suppress acid -> 20 mg bid -> 40 mg qd / bid -> titrate off ~6 mos
Strength: Esomeprazole [Nexium] > Omeprazole [Prilosec] > Pantoprazole [Protonix]
–For M >50 w. sx for >5 yrs w. ca. RFs, alarm sx (weight loss, melena, vomiting, hematemesis, anemia, dysphagia), refractory sx, consider secondary etiology and GI referral for H pylori, d/c PPI/H2-blocker 2 wks b.f appt, endoscopy
#Gout
–Counseled to limit ETOH, red meat
–Chronic: Started allopurinol 100 mg and prophylaxis w. colchicine 0.6 mg qd q 3-6 mos urate at goal (<6)
#HA: bilaTeral pressure-like pain consistent w. Tension-type; Unilateral pUlsating consistent w. Migraine
–Counseled to start HA log and limit SEAL stressors: Sleep, Eat (hunger) and Life stress
–Abortive: naproxen [Aleve] 500 mg or Aspirin-Acetaminophen-Caffeine [Excedrin] prn and counseled to limit any NSAID to lowest dose, shortest time and always w. food
–Preventative: >9: Amitriptyline [Elavil] 10-12.5 mg qhs; increase 10-12.5 mg q 2-3 wks as tolerated and as needed for sleep, until improvement or max dose 100-125 mg qhs; Nortriptyline [Pamelor] is less sedating; Protriptyline is activating, may cause weight loss
–Abortive: Eletriptan [Relpax]; c/i in motor aura, CAD, prior stroke
–Preventative: B2 [Riboflavin] 400 mg qd, Mg-oxide 400 mg qd
–Refractory: Botox referral
#HF:
—ACE-i/ARB: enalapril 10 mg BID (PARADIGM found Entresto > enalapril alone, must d/c enalapril for Entresto); Valsartan in Heart Failure trial showed that while valsartan (an ARB) added to an ACE-I ↓ hospitalization in pts w. CHF, it did not decrease mortality. The Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) trial showed that rates of cardiovascular death and HF admissions were similar in pts w. CHF that were treated with ACE-i or ARBs
—beta-blocker: COMET trial: carvedilol [Coreg] shows ↓ mortality vs metoprolol succinate [Toprol] (tartrate is tart i.e. not as effective)
—Cardiac Defibrillator: any pt w. episode v-fib/tach or NYHA class II/III w. EF <35%
—Epelerenone (no gynecomastia) vs spironolactone: aldosterone antagonist = hyperK+ vs iso dinitrate-hydralazine [BiDil] for AA
#HIV
–Ordered lipids before and 1-3 mos after starting HAART
–PPD for latent TB when CD4 >200
#HTN/pre-HTN: >2 reads (rational: need labs (which take 1-2 wks) b.f starting anti-HTN)
–Counseled ACC/AHA guidelines: for nl BP: <120/<80 & f/u 1 yr; elevated: <130/<80 & f/u 3-6 mos; stage 1: <140/<90 ASCVD <10% & f/u 3-6 mos or ASCVD >10% start med & f/u 1 mos; stage 2: >140/90 start med & f/u 1 mos
–Counseled goal <130/80
–Counseled to go to Walmart/Amazon for Omron BP cuff and given log to record for next visit
–Counseled DASH diet
–Ordered lipid panel for baseline and ASCVD risk scoring; consider statin next visit
–Ordered A1c for DM screen for BP >135/80 (USPSTF)
–Ordered UA for hypertensive nephropathy
–Ordered BMP for renal fx, K
–Ordered TSH
–Refilled _ Nifedipine 30 -> 60 -> 90 BID (max dose 120 mg i.e. can’t do 90 BID) vs. Amlodipine 2.5 -> 5 -> 10 mg QD
–Chlorthalidone > HCTZ for CVD benefit
–F/u 1-2 wks to check K
–Resistant: consider 2/2: med rec (steroids, ETOH, OCPs, NSAIDs), OSA, CKD, underlying pain/anxiety, nephrology referral
#Joint pain
–Ordered topical diclofenac [Voltaren] and counseled not to use w. oral due to increased SEs
–Acetaminophen prn and counseled to limit any NSAID to lowest dose, shortest time and always w. food
–Counseled on conservative management, PT exercises so strong muscles help knee joint absorb shock; less strain on your knee, better chances for pain relief and further injury
–Consider steroid injection next visit
–Glucosamine supplement
#Lipids
–see Health Maintenance for who gets screened
–Ordered CMP for baseline ALT level, no preexisting muscle sx
–Started A–torn-vastatin [Lipitor] / Rosuvastatin [CRestor] for clinical ASCVD, LDL >190, 45-75 w. DM or ASCVD >7.5%
–Reorder lipid profile x1 in 1-3 mos to assess for compliance
–if SE will consider Pravastatin/Fluvastatin for lower risk of myopathy, counseled inhibitors of P450 (grapefruit juice) increase risk
#Muscle spasm
–Counseled heat pad
–Prescribed cyclobenzaprine [Flexeril]
#Obesity: BMI _
–Counseled to limit processed carbs, start w. breakfast high in fat, protein (eggs, peanut butter, oatmeal, buckwheat, Greek yogurt full-fat, nuts, humus), EatRight.org for registered nutritionist
–Discussed leptin resistant state and consider GI bypass
#Pharyngitis
–Counseled absence of Centor Criteria for Abx: fever, anterior cervical adenopathy, tonsillar swelling/exudates, absent cough
–Acetaminophen prn and counseled to limit any NSAID to lowest dose, shortest time and always w. food
#Pneumonia
–Azithromycin [Z-pak] b.c also has anti-inflammatory properties or Amoxicillin-Clavulanic a. [Augmentin] *caution quinolone/doxycycline have tendinopathy
#Pyelonephritis: clinical diagnosis (don’t need imaging): cystitis + fever, CVA tenderness, N/V
–Ciprofloxacin or Levaquin and counseled to take few hrs b.f/after milk, antacid (Ca), Fe supplement and SE risk of tendinopathy
#Seborrheic dermatitis (“cradle cap”)
–Selenium shampoo, 1% hydrocortisone cream BID to face, 0.1% fluocinolone to scalp
#Sinusitis
–Counseled absence of warning signs for Abx: >10 d, >102F, purulent nasal d/c, facial pain, double sickening (worsening); if abx: Augmentin or doxycycline for penicillin allergy
#Tinea (Athlete’s foot (pedis), jock itch (cruris), body (corporis))
–Prescribed topical antifungal clotrimazole [Lotrimin, Mycelex], ketoconazole [Nizoral] apply BID 3 cm beyond margin of lesion for 2-4 wks
–For pedis, counseled on secondary prophylaxis w. benzoyl peroxide not abx, bacterial static, so won’t develop resistance, can wash daily
#Tinea (nail (onychomycosis), face (capitis))
–Prescribed oral antifungal terbinafine 250 mg (fingernail 6 wks, toenail 12 wks, face)
#UTI: isn’t UTI until symptomatic (unless pregnant)
–Ordered UA positive for leukocyte esterase, nitrites; repeat UA for squamous cell dirty sample; culture for neg UA w. +sx
–Uncomplicated (UpToDate: “consider healthy man…as simple cystitis”): Nitrofurantoin [Macrobid] x5 days or Bactrim x3 days
–Complicated (DM, CKD, HIV) (= uncomplicated pyelo): Ciprofloxacin or Levaquin x10 d and counseled to take few hrs b.f/after milk, antacid (Ca), Fe supplement and SE risk of tendinopathy or Bactrim x2 wks
–Consider: urethritis -> penile ulcerations -> gonorrhoeae, chlamydia
–Warning: obstructive sx (dribbling, hesitancy) -> prostatitis -> DRE
#Venous insufficiency: hx of fracture / physical exam support mild venous insufficiency
–Counseled to go to medical supply store for compression stockings w. a min. of 20-30 mm Hg
Health Maintenance
#Immunizations (Cerner: patient information -> immunization schedule; Epic: chart review -> misc reports -> immunization)
–Hep A _/_/_ (travel, MSM, drug use, liver dz, clotting factor d/o, personal contact w. international adoptee)
–Hep B _/_/_ (as above + HIV, DM, high-risk setting (prison, STD clinic, sex work))
–Hib _/_/_ (asplenia, hematopoietic stem cell transplant)
–HPV _/_/_ (9-45; start by 14 -> 2 doses, 15 -> 3 doses, immunocompromised -> 3 doses)
–Influenza _/_/_ (if >6 mos and b.w 6 mos-8 yrs, for 1st time: x2 doses separated by 4 wks)
–Meningococcal _/_/_ (HIV, military/college, asplenia, complement component deficiency, Eculizumab)
–MMR _/_/_ (administer unless evidence of immunity: born b.f 1957)
–Pneumococcal mnemonic: Prevner (PCV13, new)) only given x1 & always followed by Pneumovax, whereas Pneumovax (PPSV23) can give multiple & boosted once >65
-Pneumovax _/_/_ (>65 or Big 3: Love (i.e. heart, excluding HTN)/Lung/Liver dz; smoker, ETOH, DM); once >65 -> Prevner -> once 1-yr since Prevner -> boost Pneumovax
-Prevner _/_/_ (>65 or HIV, CKD, nephrotic syndrome, asplenia, immunodeficiency, cochlear implant, CSF leak); since Prevner only given x1 & followed by Pneumovax -> Pneumovax 8 wks -> Pneumovax 5 yrs after 1st dose -> >65 Pneumovax 5 yrs after last dose
–Tdap _/_/_ (1-time 11-64 y/o (for additional pertussis protection), then boost w. Td q 10 yrs; x1 q pregnancy)
–Varicella _/_/_ (administer unless evidence of immunity: born b.f 1980)
–Zoster _/_/_ (>50 only if had chickenpox, assume had if unsure)
#ASCVD (app Guideline App ® CV risk):
–_% or pending _ (lipids)
#USPSTF (app AHRQ ePSS):
–Aspirin: 50-59 w. 10-year ASCVD >10%
–Breast: mammogram: 50-74 y/o q 2 yrs (genetic testing for high-risk: <50, bilateral, male, multiple cases, Ashkenazi)
–BMI: processed carbs, start w. breakfast high in fat, protein (eggs, peanut butter, oatmeal, buckwheat, Greek yogurt full-fat, nuts, humus), EatRight.org for registered nutritionist
–Cervix: 21-65 y/o: pap (cytology) q 3 yrs or >30: pap + HPV q 5 or HPV alone q 5 (3+ nl Paps w. no abnormal Paps in the last 10 yrs can stop screening)
–Colon: 50-75 y/o or 10 yrs b.f ca. found in family member (1) colonoscopy q 10 yrs (2) FIT-DNA (vs gFOBT (guaiac): (i) only detects human globin (ii) 3 samples) q annual (3) sigmoidoscopy q 5 yrs + FIT q 3 yrs
–Depression: >12: PHQ9
–DM: screen 40-70 and overweight/obese (BMI >25), BP >135/80; (other risk factors: 1° relative, high-risk race, CVD, HTN, HDL <35, triglyceride >250, PCOS, physical inactivity)
-random: >200 w. sxs (polyuria, polydipsia)
-fasting: 100-125 pre-DM; >125 DM
-OGTT: 140-199 pre-DM; >200 DM
-A1c: 5.7-6.4 pre-DM; >6.5 DM
–Folate: “planning or capable”: 400-800 ug
–Lipids
-M: 20-35 w. CHD risk (clinical ASCVD (MI, CVA, PAD, CS), HTN, DM, BMI >30, smoker) or >35 w.out
-F: 20-45 w. CHD risk (level B) or >45 w. CHD risk (level A)
–Osteoporosis: DEXA: F >65 or <65 w. equivalent risk of osteoporotic fx (e.g. FRAX >9.3%, parental fx): z-score compare to your age, t-score compare to 45 y/o
-Vitamin D: >65 w. risk of falls: >800 IU daily
–Smoking:
-55-85: annual noncontrast chest CT for >30 pack-year and currently smoke or quit w.in past 15 yrs; d/c screening once pt has not smoked for 15 yrs or develops health problem that limits life expectancy
-65-75: x1 US for AAA who have ever smoked
–STD:
-Chlamydia/Gonorrhea: “asymptomatic, lead to PID”: F <24 or new/>1 partner, non-monogamous, past STD, sex work
-Hep B (HBsAg): foreign-born, HIV, IV drug use, household contacts/sexual partners of persons w. HBV, MSM, dialysis, high-risk setting (prison, STD clinic, sex work)
-Hep C (anti-HCV Ab): IV drug use, blood transfusion b.f 1992, born b.w 1945-65, high-risk setting (prison, STD clinic, sex work)
-HIV: 15-65: low-risk: x1; high-risk: IV drug use, MSM, unprotected sex, past STD, high-risk setting (prison, STD clinic, sex work)
-Syphilis: MSM, high-risk setting (prison, STD clinic, sex work); USPSTF: “no evidence supports routine screening of pts diagnosed w. other STDs for syphilis infection”
–TB: >18 pts born in/former residents of countries w. prevalence, pts who lived in prisons/shelters
#Diet & Exercise
–Counseled to limit processed foods, red meat, sugary drinks (use Stevia (plant sugar) instead of Splenda)
–Counseled to 150 min of moderate aerobic PE and 2 days/wk muscle strengthening (calisthenics)
#Specialty f/u (Cerner: pt schedule; Epic: snapshot)
–Confirmed _ appt on _