Release Of Information-Hospital Notes Report Period from 01/01/2001 thru 01/01/2006 Test Patient Date of Birth: 11/30/29 Medical Record: 123456 Patient, Test 123456-1 Discharge Summary
Confidential Report Run on: Thu Jun 18 09:18:51 CDT 2009 by
Release Of Information-Hospital Notes Report Period from 01/01/2001 thru 01/01/2006 Test Patient Date of Birth: 11/30/29 Medical Record: 123456
ADMISSION DATE: 03/23/2000 DISCHARGE DATE:
DISCHARGE DIAGNOSIS: 1. Respiratory arrest, secondary to mucus
2. Coronary artery disease, status post myocardial
3. Status post coronary artery bypass grafting
5. Insulin dependent diabetes mellitus, type 2.
8. Cerebrovascular accident, 11-93.
9. Left radical mastectomy with radiation therapy
10. Degenerative joint disease, status post L4-L5
CONSULTATIONS: 3/24/00 - Nutrition Services - to review need of feeding
tube placement. Calorie count was on 3/24/00 was 1300 calories and 55
grams of protein, and therefore, no feeding tube was replaced.
DISCHARGE MEDICATIONS: 1. Chemstrips q 4 hrs. with sliding scale insulin
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Release Of Information-Hospital Notes Report Period from 01/01/2001 thru 01/01/2006 Test Patient Date of Birth: 11/30/29 Medical Record: 123456
greater than 400 units, give 10 units and call physician.
2. Insulin NPH 18 units q.a.m. and 18 units q.p.m.
3. Regular insulin, 10 units, q.a.m., 4 units
11. Heparin 5,000 units subq. q.12 h.
12. K-Dur 20 milliequivalents p.o. q.d.
14. Flonase, one spray each nostril b.i.d.
15. Combivent inhaler 4 puffs q.4.h.
17. Laxative of choice. Laxative results recorded
on activities of daily living record.
18. Tylenol suspension 650 mg. p.o. q.4-6 h.
19. Xanax 0.25 mg. t.i.d. p.r.n., not to be given
20. Oxygen therapy per trach collar during the
day. Start at 30% to keep SATS greater than
90%. BiPAP setting 20/5 with 4 liters of O2
bleed in the night with long #6 Shiley inner
cannula with cuff inflated. While on trach
collar, we will have a short inner cannula
DISCHARGE DISPOSITION: 1. Condition on discharge: improved.
2. Immediate destination: Hillview Nursing Home
3. Activity: activity as tolerated.
4. Diet: soft dental diet with continued calorie
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Release Of Information-Hospital Notes Report Period from 01/01/2001 thru 01/01/2006 Test Patient Date of Birth: 11/30/29 Medical Record: 123456
and protein counts. Attention deficit disorder
Boost Plus to meal plans t.i.d. with meals and
b.i.d. with snacks. Dietary to work with family
to provide favorite foods at patient request.
Fluid restriction of this patient is 2,500 cc.
5. Oxygen therapy: she will receive 30% humidified
O2 per trach collar to keep saturations greater
than 90%. At night she will BiPAP with setting
of 20/5 with 4 liters of O2 bled in. A #6
Shiley inner cannula will be placed with the
cuff inflated. While on the trach collar during
the day, a shorter inner cannula will be placed
with no cuff inflated. The patient may be
placed on a Passey Muir valve during the day
while on trach collar for ability to speak.
6. Physical Therapy at the nursing home to
increase activities of daily living. Dressing
changes will be done q.d. Instructions for
dressing changes include cleanse area with
Saf-Clens solution and then pack wound with
Aquacel dressing and cover with gauze and then
cover with a large Tegaderm patch with skin prep
8. Follow up plans: Patient should follow up with
Dr. Pak's nurse practitioner in one week, with
Pulmonary in one week, and Endocrinology in one
9. DURABLE MEDICAL EQUIPMENT: BiPAP machine
10. ALLERGIES: No known drug allergies.
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Release Of Information-Hospital Notes Report Period from 01/01/2001 thru 01/01/2006 Test Patient Date of Birth: 11/30/29 Medical Record: 123456
12. Hospital Care: In the future for immediate
care she will be cared transferred to Saint
Francis per her health insurance guidelines.
SUMMARY OF ESSENTIAL FACTS OF HISTORY AND PHYSICAL: Mrs. Test Patient is a
72-year-old who is status post coronary artery bypass grafting times 2 on
September 27, 1999 with a very complicated hospital course, including
chronic respiratory insufficiency, requiring a tracheostomy and nocturnal
BiPAP. She was discharged to Hillview Nursing Home on 2-3-00 and required
re-admission to Gundersen Lutheran 2-17-00 for hypercapnic respiratory
failure. She was discharged to Hillview Nursing Home for a second time on
2-28-00 and was doing very well with physical therapy and wound healing
until March 23, 2000, when it was reported to her daughter that while she
was preparing to switch from BiPAP she had respiratory rest and cyanosis.
Paramedics were able to suction the mucus plug and ambu bag her and she was
revived quickly where she was taken to Gundersen Lutheran.
Physical exam on admission: In general, Mrs Test Patient is a well nourished
72-year-old white female, who was alert, oriented and appeared in no
apparent distress on BiPAP. Vital signs included a temperature of 36.1,
pulse 82, BP 100/35, respiratory rate of 20, with an SPO2 of 100% on BiPAP
with 4 liter bleed of O2. Head, eyes, ears, nose and throat, pupils equal,
round, reactive to light and accommodation. Extraocular movements intact.
She did have bilateral conjunctival injection, but there was no discharge
noted. Heart was regular rate and rhythm with a grade 4-6 systolic murmur.
Her lungs had diminished breath sounds with wheezing on the left. No
crackles were audible, however, her breathing was quite shallow. Abdomen
was soft, nontender, obese with good bowel sounds in all quadrants.
Extremities, radial pulses palpable at 3+, dorsalis pedis pulses were
dopplerable bilaterally. She had +3 edema to her shins on both legs.
Her admission ABG showed a pH 7.29, pCO2 of 68.9, pO2 of 119.2, and an HCO3
of 32.6. It was noted that an ABG done two weeks ago had a pCO2 of 52, and
one week ago her pCO2 was 55. INR was found to be 0.9, PTT 27.9, CPK 38,
WBC 13.7, HGB 9.5, neutrophils were elevated at 79% with segs at 68% and
bands at 14% which were slightly high. Chest x-ray showed some volume loss
in the left lung with increased vascular congestion on the right.
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Release Of Information-Hospital Notes Report Period from 01/01/2001 thru 01/01/2006 Test Patient Date of Birth: 11/30/29 Medical Record: 123456
Electrocardiogram showed no new ST depressions or T wave changes.
ADMISSION MEDICATIONS:1. Lopressor 50 mg. p.o. b.i.d.
8. Heparin 5,000 units subq. q.12 h.
11. Flonase one spray each nostril b.i.d.
15. Tylenol suspension 650 mg. p.o. q.4-6 h.
16. Xanax 0.25 mg. t.i.d. p.r.n., not to be
17. Oxygen therapy per trach collar during
the day at 30% to keep SATS greater than
90% BiPAP setting of 20/5 with 4 liters of
18. Insulin sliding scale. In addition, she
received NPH 8 units subq. at 6:30 a.m.;
NPH 8 units subq. at 12 noon; and NPH 100
units subq. at 1800; and NPH 8 units subq.
at 2400. Regular insulin, 10 units subq.
q.a.m.; regular insulin 4 units subq. 12
subq. were given at the beginning of the
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Release Of Information-Hospital Notes Report Period from 01/01/2001 thru 01/01/2006 Test Patient Date of Birth: 11/30/29 Medical Record: 123456
HOSPITAL COURSE: Mrs Test patient is a 72-year-old white female, who is a patient
of Dr. Buckley, was admitted for a respiratory arrest secondary to mucus
plugging and chronic respiratory failure. Her chest x-ray showed slight
vascular congestion, and therefore, she was diuresed initially with 40 mg.
of Lasix IV. Electrocardiogram was obtained and showed no new ST or T wave
changes. Mary had complaints lately of chest pain, but she believes that
this is due to the chest compressions that she had received at the nursing
home. Two normal CPK were obtained and the results were 34 and 38
respectively. On BiPAP overnight her ABG improved to pH 7.4, pACO2 of 55,
pAO2 of 64, bicarb of 36, pulse ox of 95%, and this was taken on 4 liter
During the respiratory arrest at the nursing home, apparently the feeding
tube was displaced and, therefore, pulled out. A Nutrition Services
consult was obtained and her calorie needs were estimated to be 1,700 to
1,950 with protein needs between 65-98 grams. We discussed replacement of
feeding tube with patient and family and they decided that a trial of oral
intake would help assess whether the feeding tube needed to be replaced.
She was placed on a mechanical soft diet and given Boost Plus with meals
t.i.d. and b.i.d. with snacks. Often times her chemstick checks were
directly after the Boost drinks, and therefore, her blood sugars ran high
throughout the hospitalization between 200-400. Extra insulin was provided
through sliding scale, and she was placed on NPH 18 units b.i.d. to try to
provide longer term coverage. Patient continued to do well and was
afebrile throughout the hospital course. She was given one dose of
ceftriaxone 1 gram IV because of her high WBC on her initial admission
labs. She remained afebrile, and there was no evidence of pulmonary
infiltrates on chest x-ray, and therefore, after the one dose the
On 3-26-00, it was noted that her weight had increased 6 kilogram since her
admission weight of 95.8 kilogram, and therefore, she was given 20 mg. of
Lasix IV. Her nutritional status improved. She was able to ambulate 50
feet in the hallways with physical therapy, and her breathing returned to
baseline and we discussed plans to return to Hillview with the Test Patient family.
Her intake remained good and her calorie count on 3-26-00 showed calories
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Release Of Information-Hospital Notes Report Period from 01/01/2001 thru 01/01/2006 Test Patient Date of Birth: 11/30/29 Medical Record: 123456
of 1600 and 61.9 grams of protein. The patient requested Resource juice
instead of Boost Plus, but it was explained to her that Resource has only
half the calories and protein of Boost Plus. She agreed to continue with
the Boost Plus with meals t.i.d. and wanted to try the Resource juice
Mrs Test patient, Mr. Test Patient, and their adult daughter discussed the plan to have
further care at Saint Mary's Test Hospital under their health plan guidelines.
They had an extension of care given until April 7th for this visit. ______________________________________________________________________________
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1. The Borel transform in Euclidean φ44, Local existence for Re ν < 4, avec E. Speer, Commun. Math. Phys. 72, 293 (1980). 2. Lieb’s correlation inequality for plane rotors, Commun. Math. Phys. 77, 1453. Renormalization in the complete Mellin representation of Feynman amplitudes,avec C. de Calan et F. David, Commun. Math. Phys. 78, 4 (1981). 4. Local existence of the Borel transform in
Havelock Infant School Inspection report Unique Reference Number Local Authority Inspect ion number Inspect ion dates Report ing inspector This inspection of the school was carried out under section 5 of the Education Act 2005. Type of school School category Age range of pupils Gender of pupils Nu mber of pupils on the school roll Appropriate authority