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Table of Contents

#Carry Over Chief Complaint
|DH_CC_VN2021|

#Carry Over Assessment/Plan
|DH_FreeTextAssessmentPlan|

#Carry Over ROS
|DH_ROSConsSymp|

#Carry Over PE
|DH_Fatigue|

#CBC
Today's WBC |LR_wbc_Today|, Hgb |LR_hgb_Today|, MCV |LR_mcv_Today|, Plts |LR_platelets_Today|0, ANC |LR_NEUT#_Today|

#PSA
|LR_psa_Value| (|LR_psa_Date|)

#CEA
|LR_CEA_Value| (|LR_CEA_Date|)

#CA-125
|LR_CA-125_Value| (|LR_CA-125_Date|)

#CA 19-9
|LR_CA19-9_Value| (|LR_CA19-9_Date|)

#CA 27-29
|LR_CA27-29_Value| (|LR_CA27-29_Date|)

#Iron Studies
Iron studies (|LR_Iron Sat Percent_Date|) showed ferritin |LR_ferritin_Value|, iron sat |LR_Iron Sat Percent_Value|%, B12 |LR_B12_Value|, folate |LR_folate_Value|

#SPEP
M-Spike |LR_MSpike_Value|, IgA |LR_IgA_Value|, IgG |LR_IgG_Value|, IgM |LR_IgM_Value|, Lambda FLC |LR_Lambda free light chain (serum)_Value|, Kappa FLC |LR_Kappa free light chain (serum)_Value|, K/L FLC ratio |LR_Kappa/Lambda Ratio, free light chain (serum)_Value|

Leukopenia HPI 

As you know, |PI_FullName| is a |PI_Age| year old |PI_Sex| with history of HTN, here for evaluation of leukopenia. Patient states low blood count was found on a routine test.

Patient denies any personal history of frequent infections such as URI, UTI, GI infections or B symptoms including fever, unintentional weight loss or night sweats.

Today, patient has no complaints.

Generic Cancer HPI 

As you know, |PI_FullName| is a |PI_Age| year old |PI_Sex| with history of HTN, here for evaluation of DX

Patient denies any personal history of easy bruising, bleeding, fevers, chills, CP, SOB, BRBPR, hemoptysis, or jaundice.

Today, patient has no complaints.

Generic Hem HPI 

As you know, |PI_FullName| is a |PI_Age| year old |PI_Sex| with history of HTN, here for evaluation of anemia. Patient states low blood count was found on a routine test.

Patient denies any personal history of easy bruising, oral-nasal mucocutaneous bleeding, fever, chills, weight loss, CP, SOB, BRBPR, hemoptysis, or jaundice.

Today, patient has no complaints.

Leukopenia 

Problem #1 Leukopenia
-Today's CBC showed decreased WBC
-Patient denies any personal history of frequent infections such as URI, UTI, GI infections or B symptoms.
-Will obtain lab work including CBC, CMP, vitamin B12, folate, ANA, RF, CRP, ESR, LDH, TSH, HIV, SPEP, hepatitis panel, flow cytometry, and blood smear.
-Neutropenic precautions was discussed with patient.
-Repeat CBC next visit
-Role of diagnostic bone marrow biopsy was discussed and will consider at next visit after reviewing results of today's workup

Thrombocytopenia 

Problem #1 Thrombocytopenia
-Reviewed outside lab results which showed
-Pt is asymptomatic; no easy bruising or bleeding.
-Will obtain lab work including CBC, CMP, vitamin B12, folate, ANA, RF, CRP, ESR, LDH, TSH, HIV, SPEP, hepatitis panel, and blood smear.
-At this time there is no indication for SDP transfusions unless plt count < 10K
-Bleeding precaution instructions as well as avoidance of unnecessary use of NSAIDS/ASA were recommended to the patient.
-Repeat CBC next visit.

Anemia 

Problem #1 Anemia
-Today's CBC showed microcytic hypochromic anemia with Hgb ; pt is unable to tolerate PO iron due to GI side effects
-There is no evidence of active bleed at this time.
-Will obtain lab work including CBC, CMP, iron studies, vitamin B12, folate, reticulocyte, EPO, TSH, SPEP
-Patient is asymptomatic and there is no indication for urgent blood product support unless Hg is less than 7.
-Repeat CBC next visit
-Will start patient on IV iron tx with Venofer

RTO as scheduled for IV iron tx

Leukocytosis 

Problem #1 Leukocytosis
-Today's CBC showed WBC
-Will obtain lab work including CBC, CMP, iron studies, vitamin B12, folate, ESR, CRP, reticulocyte, LDH, BCR/ABL FISH, MPN panel, flow cytometry, and blood smear.
-Patient is asymptomatic and without B symptoms or evidence of occult infection.
-Physical exam was overall unremarkable; no palpable lymphadenopathy or organomegaly
-Repeat CBC next visit.

Erythrocytosis 

Problem #1 Erythrocytosis
-Reviewed outside lab results which showed elevated Hgb
-Pt is asymptomatic and without B symptoms
-Physical exam was unremarkable; no palpable organomegaly
-Will obtain lab work including CBC, CMP, iron studies, vitamin B12, folic acid, epo, MPN panel
-There is no need for therapeutic phlebotomy or cytoreductive therapy (i.e. hydroxyurea) at this time
-Repeat CBC next visit

MGUS 

Problem #1 Monoclonal Gammopathy
-Patient was found with M spike on SPEP
-Will obtain lab tests including CBC, CMP, IFE/IFU, QIGG, B2M, kappa/lambda FLC
-Will schedule patient for skeletal survey to evaluate for lytic lesions
-Depending on results of today's workup, patient may need further workup with bone marrow biopsy and will consider at next visit

PE/DVT 

Problem #1 PE
-Pt was found with PE, likely provoked and started on DOAC with apixaban
-Will obtain lab work including CBC, CMP, D-dimer, MPN panel, FVL, prothrombin gene mutation
-Bleeding precaution instructions as well as avoidance of unnecessary use of NSAIDS/ASA were recommended to the patient
-Recommend patient continue AC with apixaban 5mg PO BID

New Oncology 

Problem #1
-
-I discussed with the patient regarding diagnosis, prognosis, and treatment options for the condition. During the discussion, I clarified the nature of the disease and recommended [INSERT RECOMMENDATION HERE]
-Risks and benefits of chemotherapy including but not limited to emesis, myelosuppression, fatigue, drug reaction, fever, and death was discussed in detail with the patient.
-Patient expressed understanding and asked appropriate questions regarding the treatment options.
-Obtain lab work including CBC, CMP

ROS/PE 

Constitutional: No fever. No rigors. No diaphoresis. No anorexia. No weight loss. No sleep disturbance.

Eyes: No blurred vision. No double vision. No floaters. No redness. No discharge. No decreased visual acuity

Ears, Nose, Throat: No hearing loss. No altered smell. No altered taste. No mouth sores. No dry mouth. No dysphagia.

Cardiovascular: No palpitations No dyspnea. No orthopnea. No claudication. No edema. No varicose veins.

Respiratory: No exertional dyspnea. No wheezing. No cough. No stridor. No hemoptysis.

Gastrointestinal: No nausea. No vomiting. No diarrhea. No constipation. No heartburn. No abdominal pain. No jaundice. No blood in stool.

Genitourinary: No dysuria. No nocturia. No hesitancy. No urgency. No hematuria. No incontinence.

Musculoskeletal: No bone pain. No myalgia. No arthralgia. No back pain. No limited range of motion.

Integumentary: No rash. No pruritus. No skin lesions. No breast mass. No tenderness. No nipple discharge.

Neurological: No neuropathy. No weakness. No paralysis. No numbness. No tremor. No headache. No altered consciousness.

Physical Exam
General: Patient appears well developed, well nourished and in no apparent distress.
Eyes: Conjunctiva clear, PERRLA, EOM intact
Throat: Oropharynx without lesions.
Heart: Regular rhythm and rate without murmur or gallop.
Lungs: Clear bilaterally without rhonchi, rales, or wheezes
Abdomen: Soft, non­tender, non­distended, without masses.
Skin: No rashes, ecchymosis, petechiae, or jaundice.
Extremities: Without clubbing, cyanosis or edema.