CONTACTS
SUBJECTS
VA Notify Injury Hematoma Left Leg Symptoms Worsening Pain Need Crut
1403 -
1403 - ..
1404 - Summary/Objective
1405 -
140501 - Follow up ref SDS 14 0000. ref SDS 13 0000.
140502 -
140503 -
140504 -
140505 -
140506 -
140508 - ..
1406 -
1407 -
1408 - Progress
1409 -
140901 - Meeting Primary Care VA Examin Injury Right Hip
140902 -
140903 - Follow up ref SDS 14 499K.
140904 -
140905 - Met Lauren Rettberg, NP PA. She replaces Doctor Rao as primary care
140906 - provider, which was indicated during the meeting with Doctor Rao, when
140907 - she indicated that Primary Care was not a "fun" assignment, reported
140908 - on 150923 1530. ref SDS 14 7U8N
140910 - ..
140911 - Reported fall on Sunday, 160501, as related also to Doctor Simpson in
140912 - Cardiology, earlier this morning on 160504 1000. ref SDS 23 FZ7I
140913 -
140914 - 1. On 160501, after hiking usual 11 mile route in the morning,
140915 - hiked another 9 miles through mountainous terrain in
140916 - Crystal Rock Park, Walnut Creek. Suffered another fall
140917 - crossing a very shallow stream stepping across on rocks and
140918 - logs, reported in case study on 140101 0600. ref SDS 4 O85F
140920 - ..
140921 - 2. Fall in this case seems similar to falling on Half Dome hike
140922 - last year on 150916 0535. ref SDS 8 O87H
140924 - ..
140925 - 3. Both occurred from losing balance.
140927 - ..
140928 - Lauren commented similarly to Doctor Simpson that losing balance
140929 - occurs from dizziness where there is a sensation the room is spinning,
140930 - and commonly called "vertigo."
140932 - ..
140933 - Lauren used the term "BPPV" neurology condition that causes falls due
140934 - to dizziness.
140935 -
140936 - [On 160513, Lauren called and discussed again falling can
140937 - be related to BPPV neurology condition. Research at that
140938 - time found BPPV = "Benign paroxysmal positional vertigo"
140939 - and occurs when calcified crystals in either or both
140940 - vestibular chambers somehow move into the semicircular
140941 - canals that maintain balance. ref SDS 24 CV4L
140943 - ..
140944 - [On 160523 1842 reviewed the record indicating Some falls
140945 - hiking Half Dome the past few years occurred from slipping
140946 - that may be reduced with better shoes. ref SDS 27 FF6K
140948 - ..
140949 - Requested referral to investigate calcium buildup in balancing
140950 - semicircular canals (sometimes called "rings"), toward resolving
140951 - balance problems, including to reduce danger hiking Half Dome
140952 - scheduled on 160914.
140954 - ..
140955 - Lauren left her office to consult with an attending physician.
140957 - ..
140958 - She returned 10 minutes or so later.
140960 - ..
140961 - Lauren diagnosed fall on Sunday arising from dizziness commonly
140962 - associated with vertigo.
140964 - ..
140965 - Lauren performed a neurological test...
140967 - ..
140968 - Research shows....
140969 -
140970 - Wikipedia...
140971 -
140972 - https://en.wikipedia.org/wiki/Neuroimaging
140973 -
140974 - A neurological examination is the assessment of sensory neuron
140975 - and motor responses, especially reflexes, to determine whether
140976 - the nervous system is impaired. This typically includes a
140977 - physical examination and a review of the patient's medical
140978 - history,[1] but not deeper investigation such as neuroimaging.
140980 - ..
140981 - In general, a neurological examination is focused on finding
140982 - out whether there are lesions in the central and peripheral
140983 - nervous systems or there is another diffuse process that is
140984 - troubling the patient.[2] Once the patient has been thoroughly
140985 - tested, it is then the role of the physician to determine
140986 - whether these findings combine to form a recognizable medical
140987 - syndrome or neurological disorder such as Parkinson's disease
140988 - or motor neurone disease.[2] Finally, it is the role of the
140989 - physician to find the cause for why such a problem has
140990 - occurred, for example finding whether the problem is due to
140991 - inflammation or is congenital.
140993 - ..
140994 - Tests of vision, hearing, sensation, and reaction were passed.
140996 - ..
140997 - Additionally, Lauren performed Romberg's vestibular function test to
140998 - assess balance....
140999 -
141000 - https://en.wikipedia.org/wiki/Romberg%27s_test
141001 -
141002 - Romberg's test, Romberg's sign, or the Romberg maneuver is a
141003 - test used in an exam of neurological function, and also as a
141004 - test for drunken driving. The exam is based on the premise
141005 - that a person requires at least two of the three following
141006 - senses to maintain balance while standing: proprioception (the
141007 - ability to know one's body in space); vestibular function (the
141008 - ability to know one's head position in space); and vision
141009 - (which can be used to monitor [and adjust for] changes in body
141010 - position).
141012 - ..
141013 - A patient who has a problem with proprioception can still
141014 - maintain balance by using vestibular function and vision. In
141015 - the Romberg test, the standing patient is asked to close his
141016 - or her eyes. A loss of balance is interpreted as a positive
141017 - Romberg's test.
141019 - ..
141020 - Today, Lauren included Romberg's test...
141021 -
141022 - Stood with heels touching and eyes shut.
141023 -
141024 - This lasted for 30 seconds.
141026 - ..
141027 - Passed this test.
141028 -
141029 - [On 160519 0800 Romberg's test was performed again in
141030 - Physical Therapy, and seemed to pass this and more
141031 - complicated test standing on unstable surface. ref SDS 25
141032 - EQ9O
141034 - ..
141035 - She did another test...
141036 -
141037 - Walk heel to toe.
141039 - ..
141040 - Passed this test, although I would say barely. There were only 5 or 6
141041 - steps. In another 2 or 3 steps seemed like might have "crashed and
141042 - burned."
141044 - ..
141045 - Lauren was kind to say... "Excellent", but it was a struggle to
141046 - maintain a straight line after 2 or 3 steps.
141047 -
141048 - [On 160523 0830 heal-toe walking test was performed again
141049 - in Physical Therapy, initially could only walk 2 - 3 steps
141050 - before falling out of line, but further testing walked 10 -
141051 - 20 steps. ref SDS 26 HX4N
141053 - ..
141054 - The Romberg's balance test was done a few years ago on 130227, by
141055 - Doctor Abrams in Neurology, here at the VAMCSF on referral from Doctor
141056 - Stewart to evaluate for spinal stinosis. ref SDS 2 PPWW At that time
141057 - over 3 years ago, could only step heel-to-toe for 1 or 2 steps, i.e.,
141058 - much worse than today, ref SDS 2 IP5L, since Lauren reported the same
141059 - test today was "excellent."
141061 - ..
141062 - Back at home, did this test a few more times. Seem to do better by
141063 - keeping head up, rather than looking down. That would seem to
141064 - indicate that looking down can cause loss of balance.
141066 - ..
141067 - There is similar sensation when going upstairs. Balance is perfect
141068 - because looking straight ahead. However going downstairs requires
141069 - looking down. There have been no falls going downstairs, because
141070 - after looking down to verify stair step dimensions, can raise the
141071 - head. As well there are hand rails. Actually, have carried a lot
141072 - heavy things up and downstairs without balance difficulty.
141074 - ..
141075 - Lauren plans to do more research on balance issues. She scheduled
141076 - telephone call on 160513 1100, to report her findings and
141077 - recommendations.
141079 - ..
141080 - Lauren recommended...
141081 -
141082 - 1. Drink water during long hikes 11 - 15 miles
141083 -
141084 - 2. Eating before long hikes.
141085 -
141086 - 3. Taking Naproxen (Aleve) with meals.
141088 - ..
141089 - 4. Avoiding heavy reliance on juices and softdrinks.
141091 - ..
141092 - Lauren advised that softdrinks, like Doctor Pepper, has caffine that
141093 - contributes to frequent urination.
141095 - ..
141096 - Thanked Lauren for helpful meeting today. Look forward to her call on
141097 - 160513 1100, per above. ref SDS 0 N83N
141098 -
141099 -
141100 -
141101 -
141102 -
1412 -
SUBJECTS
VA Progress Notes ER General Surgery Debridement Infected Wound Hema
2103 -
210401 - ..
210402 - Progress Notes Meeting Medical Practice Examination Injury Hematoma Lower Left Leg
210403 -
210404 - Follow up ref SDS 14 YK5J.
210405 -
210406 - VA Progress Notes for meeting with health care providers are
210407 - available at...
210408 -
210409 - https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_nfto=false&_pageLabel=mhvHome
210410 -
210421 -
210422 -
210423 - 1. Date/Time: 04 May 2016 @ 0827
210424 - Note Title: MP NP RESIDENT F/U NOTE
210425 - Location: San Francisco CA VAMC
210426 - Signed By: RETTBERG,LAUREN B
210427 - Co-signed By: RETTBERG,LAUREN B
210428 - Date/Time Signed: 04 May 2016 @ 1644
210430 - ..
210431 - 2. LOCAL TITLE: MP NP RESIDENT F/U NOTE
210432 - STANDARD TITLE: PRIMARY CARE NURSE PRACTITIONER NOTE
210433 - DATE OF NOTE: MAY 04, 2016@08:27 ENTRY DATE: MAY 04, 2016@08:27:22
210434 - AUTHOR: RETTBERG,LAUREN B EXP COSIGNER: KEENE,TERRY L
210435 - URGENCY: STATUS: COMPLETED
210437 - ..
210438 - I have seen and discussed the patient with my supervising
210439 - practitioner, Terry Keene, DNP, who agrees with my assessment
210440 - and plan.
210442 - ..
210443 - 3. ID: 71yo male w h/o GERD, achalasia (s/p tx at SacramentoVA),
210444 - CAD 4v CABG in 2009, HL.
210445 - Last PCP visit 9/2015 with Dr. Rao.
210447 - ..
210448 - 4. Interim events:
210449 -
210450 - -9/2015 admission for infected hematoma and LLE cellulitis
210451 -
210452 - -10/28/15 Cards, worsening CAD off statin 2/2 SEs, mainly xs urination and
210453 - dry/cracked feet.
210454 -
210455 - -2/3/16 Cards, starting ezetimide + omep, cardiologist would prefer high-
210456 - intensity statin--taking
210458 - ..
210459 - Actually, on 151028, patient resumed Atorvastatin 10 mg and Ezetimibe
210460 - 10 mg.
210462 - ..
210463 - This section might be clairfied to report on 160203, Doctor Simpson
210464 - reduced statin drugs 50% based on CCTA showing no evidence
210465 - atherosclerosis, and patient HDL 73. 160203 1000, ref SDS 21 NR81
210467 - ..
210468 - Progress Notes continue...
210469 -
210470 - 5. CC/HPI:
210471 -
210472 - 1. Hep C: Discussed negative result and indication for screening.
210473 -
210474 - 2. Bloodwork requests: had non-VA lab corp test 4/1. Results
210475 - wnl, also had has h/o elevated bilirubin, would like to
210476 - follow moving fwd. Attributes it to SE of statin. Denies
210477 - any bowel abnormalities, RUQ pain, n/v.
210479 - ..
210480 - 3. "Balance issue": Just spoke to cards about it (note
210481 - pending), Last Sunday did a training hike. Fell Sunday, 8
210482 - stream crossings, felt tentative (abnormal per report), on
210483 - 4th stream crossing, was on the ground, no precipitating
210484 - sxs. Had hiked 11 miles. Intends to go to Yosemite in one
210485 - month. Questions around
210487 - ..
210488 - Half Dome hike in Yosemite scheduled on 160914, not next month.
210490 - ..
210491 - Progress Notes continue...
210492 -
210493 - - Recommend hiking poles, for example "brand" likes letters.
210494 -
210495 - - Doesn't drink water, drinks OJ, grape juice, dr pepper
210497 - ..
210498 - Typical liquid: orange juice, combination lemon, grape and Doctor
210499 - Pepper.
210501 - ..
210502 - Patient has since migrated to greater reliance on plain water.
210503 -
210505 - ..
210506 - Progress Notes continue...
210507 -
210508 - 4. Achalsia: Dr. Lee prescribed omeprazole GI clinic at Sacto,
210509 - april 7 f/u, last EGD 3/2016, next 3 mos. Taking maalox,
210510 - famotadine bid, ompreazole 20 mg q every other day.
210511 -
210513 - ..
210514 - 6. ROS unremarkable for f/c, n/v, cp, sob, doe. +r knee pain, bilat foot pain,
210515 - polyuria
210517 - ..
210518 - 7. Computerized Problem List is the source for the following:
210519 -
210520 - 1. History of coronary artery bypass grafting, 10/14/2015
210521 -
210522 - Onset 10/00/2009
210523 - SFVA LIMA, SVGs diag, ramus, PDA
210525 - ..
210526 - 2. Hyperlipidemia 10/14/2015
210527 - 3. Body mass index 30+ - obesity 10/14/2015
210528 - 4. Chronic ischemic heart disease 10/14/2015
210529 - 5. Esophageal Achalasia * (ICD-9-CM 530.0) 12/08/2009
210531 - ..
210532 - This list can be updated to include...
210533 -
210534 - Metatarsalgia
210535 - Urination frequency improved reduced statins and Omeprazole
210536 - Shoulder left myopathy nearly healed reduced statins
210537 - Wrist right fracture nearly healed
210538 - Knee right pain (MRI pending evaluation MCL tear)
210539 - Knee left chronic degenerative arthritis - continual pain
210540 - Feet chronic injuries
210541 - Fall sway balance problem - bruise right hip
210542 - LLG Hematoma
210543 - Cellulitis
210544 - Weight - needs more hiking recover injuries
210546 - ..
210547 - Progress Notes continue...
210548 -
210549 - 8. Active Outpatient Medications: updated 5.4.16
210550 -
210551 - 1. omprazole 20mg every other day
210552 - 2. famotadine BID
210553 - 3. ALOH/MGOH/SIMTH XTRA STRENGTH SUSP 30ml in evening
210554 - 4. atorva 10mg daily
210555 - 5. ezetimide 10mg daily
210556 - 6. COenzyme q10--maintain energy that is reduced by statin
210557 - 7. 400mg daily naproxen for hiking--for pain in knees and feet
210558 - 8. Glucosamine chondryotin
210560 - ..
210561 - This is an excellent list.
210563 - ..
210564 - Progress Notes continue...
210565 -
210566 - 9. SH: (from cards note)
210567 -
210568 - 1. lives concord
210569 - 2. single has gf
210570 - 3. wife of many years died of breast ca a few yrs ago
210571 - 4. Gets up 3-6 am often to walk, bed early am, so not much sleep. one meal a day
210572 - in evening, but healthy (fish, avocados, vegs).
210574 - ..
210575 - This "SH" section can be monitored for comprehensive assessment, shown
210576 - in daily record of exercise, diet, vitals, and medications. 140101
210577 - 0600, ref SDS 4 EF5M Doctor Rao gave helpful guidance - see for
210578 - example Progress Notes on 141024 0900. ref SDS 5 IO6J
210579 -
210581 - ..
210582 - Progress Notes continue...
210583 -
210584 - 10. ROS:
210585 -
210586 - 1. No difficulty with medications
210587 - 2. No headache, blurred vision, loss of hearing, or difficulty swallowing
210588 - 3. No DOE, cough, sputum
210589 - 4. No chest pain, syncope, palpitations
210590 - 5. No abd pain, nausea, vomiting, constipation
210591 - 6. No dysuria, increased frequency
210592 - 7. No swollen joints
210593 -
210595 - ..
210596 - 11. PE:
210597 -
210598 - 1. Vitals:
210599 - BP: 138/72 (05/04/2016 09:47)
210600 - Pulse: 69 (05/04/2016 09:47)
210601 - Temp: 97.9 F [36.6 C] (04/18/2016 14:17)
210602 - Resp: 17 (04/18/2016 14:17)
210603 - 02 Sat: 5/4/16 09:47:05 O2:98
210605 - ..
210606 - 2. Height: 64.5 in [163.8 cm] (09/23/2015 15:32)
210607 - 3. Weight: 05/04/2016@09:47 191
210608 - 4. BMI: 32.3 (Obesity Level I)
210610 - ..
210611 - 5. Gen: Robust male appears younger than stated age in NAD
210613 - ..
210614 - 6. Eyes: conjugate, no conjunctival pallor
210616 - ..
210617 - 7. Ears: TMs wnl bilat, some dried blood in L canal
210619 - ..
210620 - 8. Heart: RRR, s1, s2, no murmer, s3
210622 - ..
210623 - 9. Ext: no cyanosis, clubbing, or edema
210625 - ..
210626 - 10. Bruise 7" x 6" right hip from fall on 160501
210628 - ..
210629 - Lauren reviewed photograph during the meeting.
210631 - ..
210632 - 11. MSK: no tremors or tenderness; Nl bulk & tone
210634 - ..
210635 - 12. Neuro: MS: A&O to person/place/time/situation; CN II-XII
210636 - grossly intact
210638 - ..
210639 - 13. CN: PERRL, EOMI, sensation intact V1-V3, face symmetric,
210640 - SCM/Trap 5/5, tongue midline;
210642 - ..
210643 - 14. Motor: Strength 5/5 BUE; 5/5 BLE; neg pronator drift,-Romberg
210645 - ..
210646 - 15. Sensory: light touch and proprioception intact
210648 - ..
210649 - 16. Coordination: no dysmetria, RAMs intact bilat
210651 - ..
210652 - 17. Gait: tandem gait intact,
210654 - ..
210655 - 12. A/P:
210656 -
210657 - 1. Falls: 2 falls in last yr assoc with hiking on uneven terrain,
210658 - without precipitating sxs or LOC. Most recent 4d ago. Cause
210659 - of fall ddx broad but cardiac etiology less likely without
210660 - assoc sxs. Associated with degree of fatigue, occuring
210661 - ~11 miles into hiking, "tentative footing" which likely
210662 - correlary for fear of falling (RF for falls). Suspect
210663 - orthostatic hypotention v insufficient caloric intake v altered
210664 - gait 2/2 pods orthotics v age-related decline (though unlikely
210665 - in such an active pt--but perhaps slower reflexes, poor
210666 - vision).
210668 - ..
210669 - Reassuring that neuro exam today wnl.
210671 - ..
210672 - What does "wnl" mean?
210674 - ..
210675 - Consider adding...
210676 -
210677 - Bruise right hip 7" x 7" from fall
210678 -
210680 - ..
210681 - Progress Notes continue...
210682 -
210683 - Discussion about utility of head imaging for cochlear
210684 - crystals. Pt without vertigious sxs at this time,
210685 - discussed at length. Consider Dicks-Halpike manuever if
210686 - vertigo presents
210688 - ..
210689 - Long discussion with pt about appropriate fuel for
210690 - endurance exercise (water, well balanced snacks
210691 - cho/protein/fat).
210693 - ..
210694 - Strongly encourage hydrating prior and during activity
210696 - ..
210697 - Encourage use of lightweight collapsable hiking poles for
210698 - increased stability rough terrain (available at REI, etc)
210700 - ..
210701 - Cont ortho and pods f/u re: MSK pain which may also be
210702 - contributing
210704 - ..
210705 - Consider referral to gait and balance PT clinic if falls
210706 - persist
210708 - ..
210709 - Referral to balance professional in Neurology to evaluate sway balance
210710 - problems should occur to prevent another fall, rather than wait for
210711 - another fall.
210713 - ..
210714 - Progress Notes continue...
210715 -
210716 - 2. H/o Elev direct bilirubin: Seen in Endo 10/2014 with
210717 - management deferred to GI.
210719 - ..
210720 - Ddx at that time include Gilbert's syndrome vs. other. Not
210721 - mentioned in GI notes, will recheck value at next visit and
210722 - discuss with pt to evaluate with GI provider.
210724 - ..
210725 - Operating analysis on elevated bilirubin is correlation with liver
210726 - damage caused taking statin treatment cited by Doctor Egan in
210727 - Cardiology during meeting on 131017 1000. ref SDS 3 T24N
210729 - ..
210730 - Liver damage shown by elevated bilirubin drives frequent urination,
210731 - shown by problem subsiding when statin treatments paused.
210733 - ..
210734 - Progress Notes continue...
210735 -
210736 - 3. Liver panel, CBC
210737 -
210738 - Urinary frequency: Suspect assoc with sugary beverage consumption v enlarged
210739 - prostate or combination.
210740 -
210741 - 1. A1c, UA at next visit
210742 - 2. Discussed decreased caffeine, increase water
210743 - 3. F/u telephone 1-2 wk
210744 -
210746 - ..
210747 - 4. CAD: s/p 4V CABG 2009, followed by cards
210748 -
210749 - 1. Cont atorva 10mg, ezetimide, coenzyme q 10
210750 - 2. Pt declines ASA ppx
210751 - 3. Appreciate ongoing management by cards
210752 -
210754 - ..
210755 - 5. Knee/foot pain: Followed by ortho/pods, possible orthotics contributing to
210756 - balance disturbance on uneven surface
210757 -
210758 - 1. Encouraged f/u with specialities
210759 - 2. F/u PRN
210760 -
210762 - ..
210763 - 6. Obesity: BMI 32, would benefit from weight loss, given
210764 - excellent exercise tolerance
210766 - ..
210767 - Address at next visit.
210768 -
210770 - ..
210771 - 13. HCM
210772 -
210773 - Screening tests:
210774 -
210775 - 1. Colon Cancer Screen-
210776 - 2. PSA -(discussed r/b. Pt. elected to check PSA)
210777 - 3. HIV screen -(pt. verbally consented)
210778 - 4. HBV screen -(consider in all asian/PI pts. and if RF)
210779 - 5. HCV screen - Neg 5/2016
210780 - 6. AAA screen -(age >65, h/o tob use.) will order abd us
210781 - 7. Depression screen -
210782 -
210784 - ..
210785 - Immunizations:
210786 -
210787 - 1. Tdap -(Tdap age <65, Td age >65)
210788 - 2. Flu Vaccine -
210789 - 3. Pneumovax -
210790 - 4. Zostavax -(age >60, contra if immunocomp incl chronic steroids)
210791 -
210793 - ..
210794 - Geri:
210795 -
210796 - 1. Falls - positive
210797 - 2. osteoporosis screen -
210798 - 3. cognitive screen -(consider for all AGE >75)
210799 - 4. Elder Abuse -
210800 - 5. Home Safety -(e.g. living space/bathrooms safe to prevent falls
210801 - 6. Driving -(all pts with dementia dx should be referred to DMV for eval)
210802 - 7. Urinary Incontinence-(ddx DIAPPERS)
210803 -
210805 - ..
210806 - Other:
210807 -
210808 - 1. Seatbelts -
210809 - 2. Gun in home -
210810 - 3. Vision -
210811 - 4. Hearing -
210812 - 5. Dental -
210813 - 6. Medication Adherence- (consider pharm med teaching referral if poor)
210814 - 7. DPOA/Advanced Directive - (consider referral to AD group to complete)
210815 -
210817 - ..
210818 - 14. Follow up in 1-2 wks by phone, in clinic in person 6 mos or PRN
210820 - ..
210821 - 15. PREVISIT PLANNING:
210822 -
210823 - 1. Telephone: Prevnar? Colo?
210825 - ..
210826 - 2. HIV screen, HRB review, LUTS, calcium of head screen research, Assess vision
210827 - in person: Review Bilirubin,
210829 - ..
210830 - 3. Falls, status of GI management
210832 - ..
210833 - 4. RN: labs for next visit: ordered
210835 - ..
210836 - 5. LVN: remind pt to bring outside records
210838 - ..
210839 - Received call from Lauren's assistant OA 160511 - she asked for any
210840 - other issues to discuss with Lauren on 160513.
210842 - ..
210843 - Presented need for medication/treatment supplies to recover from lower
210844 - leg and feet injuries.
210845 -
210847 - ..
210848 - Progress Notes continue...
210849 -
210850 - 16. Time-based coding used because *more than 50 percent* of the time
210851 - below was spent counseling or coordinating care.
210853 - ..
210854 - 17. OFFICE VISITS
210855 -
210856 - Avg. minutes spent Established patient New Patient
210857 - FTF(face-to-face) code THIS VISIT code this visit
210858 - CC (couns/coord)
210859 - 5 [ ] 3[ ] 99211 [ ]
210860 - 10 [ ] 6[ ] 99212 [ ]
210861 - 15 [ ] 8[ ] 99213 [ ]
210862 - 20 [ ] 11[ ] [ ]
210863 - 25 [ ] 13[ ] 99214 [ ]
210864 - 30 [ ] 16[ ] [ ]
210865 - 40 [ ] 21[ ] 99215 [ ]
210866 - 45 [ ] 23[ ] 99204 [ ]
210867 - 60 [ ] 31[ ] 99205 [ ]
210868 -
210870 - ..
210871 - 18. Clinical Reminder Activity
210872 - MED REC-PRIMARY CARE:
210873 - Current medications reviewed with patient/caregiver and reconciliation
210874 - of medications related to today's visit completed, including non-VA
210875 - medications and discrepancies, if identified, were addressed.
210876 - Medication changes and the importance of medication management were
210877 - reviewed with the patient/caregiver today based on individual needs.
210878 - Patient/caregiver acknowledged understanding of instructions as
210879 - stated. An updated list of reconciled medications have been provided
210880 - to the patient/caregiver. The following is a complete list of active
210881 - medications, including non-VA meds. Patient does not have any non-VA
210882 - meds if none are listed.
210883 - PSO2 - Opt Rx Profile
210885 - ..
210886 - 19. Allergies: ROSUVASTATIN, SIMVASTATIN,
210887 - Adverse Reactions: ___________________ ,
210889 - ..
210890 - 20. Active and Recently Expired Outpatient Medications (including
210891 - Supplies):
210892 -
210893 - 1. Active Outpatient Medications Status
210894 - ======================================================================
210895 -
210896 - 1. AMMONIUM LACTATE 12% LOTION APPLY LOTION TOPICALLY ACTIVE
210897 - EVERY DAY TO DRY SKIN
210898 - 2. ATORVASTATIN CALCIUM 20MG TAB TAKE ONE-HALF TABLET ACTIVE
210899 - ORALLY AT BEDTIME FOR CHOLESTEROL
210900 - 3. CLOTRIMAZOLE 1% TOP CREAM APPLY CREAM TOPICALLY TWICE ACTIVE
210901 - A DAY UNDER AFFECTED TOE
210902 - 4. EZETIMIBE 10MG TAB TAKE ONE TABLET ORALLY EVERY DAY ACTIVE
210903 - 5. FAMOTIDINE 20MG TAB TAKE ONE TABLET ORALLY AT BEDTIME ACTIVE
210904 - FOR STOMACH
210905 - 6. GAUZE PAD 4IN X 4IN 12-PLY STERILE USE GAUZE AS ACTIVE
210906 - DIRECTED TO COVER WOUND PACKING.
210907 - 7. KERLIX 4.5IN STERILE USE BANDAGE AS DIRECTED TO WRAP ACTIVE
210908 - LOOSELY AROUND WOUND.
210909 - 8. TAPE,MICROPORE 2IN 3M #1530-2 USE TAPE AS DIRECTED ACTIVE
210910 -
210912 - ..
210913 - 2. Pending Outpatient Medications Status
210914 - ======================================================================
210915 -
210916 - 1. OMEPRAZOLE 20MG EC CAP TAKE ONE CAPSULE ORALLY EVERY PENDING
210917 - OTHER DAY
210919 - ..
210920 - 3. Inactive Outpatient Medications Status
210921 - ======================================================================
210922 -
210923 - 1. CLEANSING CLOTH,COMFORT SHIELD USE CLOTH TOPICALLY AS EXPIRED
210924 - DIRECTED
210925 -
210926 - 10 Total Medications
210928 - ..
210929 - 4. HDRM - REMOTE ACTIVE MEDICATIONS
210930 -
210931 - Active Medications from Remote Data
210932 -
210933 - 1. AL OH 400MG/MG OH 400MG/SIMETHICONE 40MG/5ML LIQUID(360ML)
210934 - Sig: TAKE 30 ML BY MOUTH AT BEDTIME - FOR STOMACH CONDITION
210935 - Quantity: 8 Days Supply: 90
210936 - 3 refills remaining until 12/10/16
210937 - Last filled 03/14/16 at NORTHERN CALIFORNIA HCS (Active)
210939 - ..
210940 - 2. OMEPRAZOLE 20MG CAP,EC
210941 - Sig: TAKE ONE CAPSULE BY MOUTH TWICE A DAY - 15 MINUTES BEFORE
210942 - A MEAL FOR SEVERE ACID REFLUX AND ESOPHAGEAL NARROWING.
210943 - **NOTE DOSE REDUCTION**
210944 - Quantity: 180 Days Supply: 90
210945 - 3 refills remaining until 10/16/16
210946 - Last filled 10/16/15 at NORTHERN CALIFORNIA HCS (Active)
210948 - ..
210949 - 3. FAMOTIDINE 20MG TAB
210950 - Sig: TAKE ONE TABLET BY MOUTH TWICE A DAY FOR ACID REFLUX. **REPLACES
210952 - ..
210953 - 4. RANITIDINE** TAKE IN THE MORNING AND AT BEDTIME
210954 - Quantity: 180 Days Supply: 90
210955 - 3 refills remaining until 03/16/17
210956 - Last filled 04/10/16 at NORTHERN CALIFORNIA HCS (Active)
210958 - ..
210959 - RXNV - Non VA Meds
210961 - ..
210962 - No Non-VA Meds Extracted
210964 - ..
210965 - During the meeting with Lauren, she asked for list of medications, and
210966 - the same list was presented that was discussed with Doctor Simpson
210967 - during the meeting in Cardiology, reported on 160504 1000. ref SDS 23
210968 - OV6P
210969 -
210970 -
210971 - /es/ Lauren B RETTBERG, NP Resident
210972 - San Bruno CBOC & Medical Practice, NPI 1073996773
210973 - Signed: 05/04/2016 16:44
210974 -
210975 - /es/ TERRY L KEENE, DNP, FNP-BC, ARNP
210976 - Women's Clinic, NPI# 1659359016
210977 - Cosigned: 05/05/2016 10:34
210978 -
210979 -
210980 -
210981 -
210982 -
210983 -
210984 -
210985 -
210986 -
210987 -
210988 -
210989 -
210990 -
210991 -