...Molina regarding the denyal of my request for shoe orthitics. If the notes in the report states I have pes planus (flat feet), then how do I have high arches? pes planus: people with flat feet or fallen arches either have no arch, or it is very low. My feet are flat to the ground, my left foot is severely flat and my ankle rolls inward. In the letter I recieved it states that I have high arches and hammer toe which is new to me. It also states that the notes don't show any of the problems that I have been going to the doctors for. Yes, I do believe my feet are the same size they just don't stand on the ground the same, the left one falls flat to the ground with no arch at all with the ankle rolling inwards, while the other foot has very little arch....
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...DOI: 11/28/1984. The patient is a 65 -year-old male pump installer/laborer who sustained a work-related injury to his low back after repetitive jumping off his 4-feet high truck bed. The patient is diagnosed with postlaminectomy syndrome. The patient was subsequently diagnosed with postlaminectomy syndrome, not elsewhere classified. As per office notes dated 6/1/16, the patient presents with chief complaints of low back and neck pain. The patient continues with chronic intractable low back pain as well as chronic intractable neck pain. The patient states that he has paying for methadone as an out-of-pocket expense. He notes that, “the pain would be intolerable without the medication.” The patient exhibits no aberrant behavior toward the pain medication today and denies adverse...
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...Claims Adjuster High Life Insurance Company 1000 Throughway Boulevard Chicago, IL 00000 Re: Your Insured, Anthony Stacatto Claimant: Mary Graham Claim No.: 93-8822 TX Date of Loss: January 13, 20xx Dear Mr. Salinas: As you are aware, I was injured in an automobile accident with your insured Anthony Stacatto on January 13, 20xx at the intersection of 12th Street and Loop Lane, Chicago. I was traveling east on Loop Lane, and as I entered the intersection with 12th Street, your insured came through a stop sign on 12th Street and smashed into my car just behind the driver’s seat, barely missing a direct hit on me. [NOTE: Even though a direct hit on Mary did not occur, the near miss increases the sense of emotional trauma Mary suffered.] The power of the collision spun my car all the way around and left it facing west almost all the way to the curb. [NOTE: The power of the impact shows how fast the other driver was going, which supports both how negligent he was and how seriously Mary is injured.] I have enclosed the police report, which states that I had the right of way, and a diagram that shows where your insured struck my car and the final resting place of the car. The enclosed photograph showing the severe damage to my car indicates how strong the collision was. In addition to failing to yield the right of way, your insured did not even slow down, let alone stop, at the stop sign. This was apparently due to the fact that your insured was talking on a cell phone. A witness...
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...of weather and in attics, basements, crawl spaces, and other similar places; climbing poles, ladders, and work aloft with small tools; and lifting and moving loads up to 80 pounds. A discharge summary report by Lamont Ellis, MD, dated 08/09/2017, indicated that the claimant presented to the emergency department with left-sided retrosternal chest pain radiating to his left neck and jaw with nausea, vomiting, and sweats. He had recurring symptoms prior to going to bed. His chest x-ray was unremarkable. He was admitted to the hospital to rule out acute coronary event. His blood sugar was normal. A CAT scan of the chest showed a possible early developing right lobe pneumonia. He had an elevated WBC at 13,000, but afebrile. He was discharged with home medications with Zithromax and Nexium....
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...Report noted a follow-up visit for an injury sustained on 11/03/15. The patient is 55 % better. There is decreased in pain and increase in the ROM of the neck. The patient stated that she fees that she could tolerate full duty. The treatment was followed and tolerated. He is currently on modified duty. She has completed 6 visits of Chiropractic treatment. She is tolerating her current medications. The right-sided neck pain was 3/10-scale level. She described the pain as sharp and minimal. She denies any pain in her arms. There is no numbness and tingling in the arms. The patient denies any weakness of the upper extremities. The patient...
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...Character Trait Note #1: Conniving-The character trait conniving is shown in this quote because this quote shows how Assef did something that was immoral and wrong. He did not care what the others thought and wanted to do simply because he loved seeing people in great pain. This shows how heartless Assef is and how he likes to see others in pain because he finds it amusing, which is immorally wrong. Character Trait Note #2: Assef can also be seen as the character trait of Deceitful. While at Amir’s party, Assef acts as if he is innocent and Amirs friend. He even invites Amir to his hosue so they can play volleyball but in reality instead he will do horrible things to Amir and Hassan. Another reason why he is deceitful is because of how he tries to be seen as a savior and how he is doing the right thing by getting rid of all the Hazaras. Assef wants to be like Hitler so that’s why he wants to exterminate all of the Hazaras because he feels they are inferior and should not be able to live in Afghanistan....
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...of her back, gluteal, left inguinal, and left leg pain with worsening of her gait and posture. (004) On 3/9/2015, Ms. Rodriguez was admitted at Sunrise Medical Center for elective surgery to address these concerns. The operative report by Jaswinder Grover, MD documented that the...
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...progress • Change in condition • Change Care Plan ASAP after condition change • Notification to MD and family Bladder and Bowel • Indicate status: always continent, occasionally incontinent, frequent- ly incontinent, always incontinent • Indicate if has catheter (indwell- ing or condom, intermittent), uri- nary ostomy, or no urine output • Toileting program in progress or attempted and outcome • Constipation? Which interventions used, and results? Anticoagulant Therapy Medicare Documentation • Must reflect need/reason for skilled care • Daily vital signs • Monitor for bleeding, bruises • Monitor lab values: Be sure PT/INR drawn per physician order and reported to MD • Monitor sudden dyspnea, chest pain, temp or color change in extremities ADLs • How does resident perform? – Bed mobility – Transfers – Ambulation – Dressing – Eating – Toileting...
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...Neeraj’s USMLE Step-2 CS Notes The Perfect “Encounter”: A Strategic Approach to Communication & Interpersonal skills The encounter in a USMLE CS examination is between a non-physician medical educator (SP: Standardized Patient) and an examinee, who may be a medical student or a physician. SPs are defined as "a simulated or real patient who has been taught to present a problem so accurately that the simulation cannot be detected by a skilled clinician.” (1) These SPs will seem like real patients to you and should be treated as such during the USMLE examination. With this in mind, it is important to remember that good communication and interpersonal skills are a top concern for every patient. If you have a pleasing personality, patiently hear all of their dilemmas and concerns, and have good communication skills, it will surely create and maintain long lasting and conducive relationships with your patients. Before we talk about strategies to delineate an ideal and perfect encounter with a SP, we should know a few facts about the examination. First, what is the purpose of the examination? It is very interesting that this examination is structured to test your clinical skill proficiency and not the diagnosis that you arrive at. Three components of the report score: One must pass all three components in a single test administration. These three components are as follows: ICE (Integrated Clinical Encounter): assess data gathering and data sharing ability...
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...common and start in the gland cells. Endocrine tumors are less common and are known as islet cell tumors. Here are some: gastrinomas, insulinomas, glucagonomas, somatostatinomas, vipomas,ppomas. Most of these tumors are not cancer. The outlook for these is better than that of exocrine cancers. Approximately 75% of all pancreatic cancers occur within the head of neck of the pancreas, 15-20% occur in the body of the pancreas, and 5-10% occur in the tail. Signs and Symptoms of Pancreatic Cancer Early pancreatic cancers often do not cause any signs or symptoms. Some signs: * Jaundice and related symptoms: The yellowing of the eyes and skin, which is caused by the buildup of bilirubin made by the liver. * Belly or back pain: Pain in the abdomen or in the back is a common sign of advanced pancreatic cancer. * Weight loss: Losing weight without any effort over a number of months is very common. * Digestive problems:...
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...background information (paragraph 7). . Provides a new paragraph on the use of ADTMC (paragraph 8). . Revises guidance relevant to the assignment of screeners (paragraph 9). . Simplifies training requirements (paragraph 10). . Refines supervisory requirements (paragraph 11). . Significantly revises the screeners’ performance evaluation requirements (paragraph 13). . Allows the use of other approved algorithmic systems besides the ADTMC (paragraph 18). . Deletes the use of MEDCOM Form 425-R (Internal/External Audit Form for ADTMC). . Provides changes to the narratives that accompany the following algorithms: SORE THROAT, A-1 EAR PAIN/DISCOMFORT/DRAINAGE, A-2 SINUS PROBLEMS/PAIN, A-4 RINGING IN THE EARS (TINNITUS), A-8 EXTREMITY PAIN NOT ASSOCIATED WITH A JOINT, B-3 NAUSEA/VOMITING/DIARRHEA, C-1 RECTAL PAIN/ITCHING/BLEEDING, C-3 CONSTIPATION, C-4 CHEST PAIN, D-2 DIZZINESS/FAINTNESS/BLACKOUT, F- 1 NUMBNESS/TINGLING, F-3 PARALYSIS/WEAKNESS, F-4 FATIGUE, G-1 MEDCOM Pam 40-7-21 FEVER/CHILLS, G-2 ACNE, J-2 SHAVING PROBLEM--PSEUDOFOLLICULITIS BARBAE (PFB) (INGROWN HAIRS), J-3 DANDRUFF (SCALING OF THE SCALP), J-4 HAIR LOSS, J-5 ATHLETE’S FOOT (TINEA PEDIS), J-6 JOCK ITCH (TINEA CRURIS), J-7 SCALING, DEPIGMENTED SPOTS ON THE CHEST, BACK, AND UPPER ARMS (TINEA VERSICOLOR), J-8 FEVER BLISTERS (COLD SORES), J-10 DRUG RASH, J-14 SUNBURN, K-8 . Contains changes in appendix B, List of Medications. . Adds constipation to list of terms defined in the glossary. 2 MEDCOM Pam 40-7-21 DEPARTMENT...
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...information (paragraph 7). . Provides a new paragraph on the use of ADTMC (paragraph 8). . Revises guidance relevant to the assignment of screeners (paragraph 9). . Simplifies training requirements (paragraph 10). . Refines supervisory requirements (paragraph 11). . Significantly revises the screeners’ performance evaluation requirements (paragraph 13). . Allows the use of other approved algorithmic systems besides the ADTMC (paragraph 18). . Deletes the use of MEDCOM Form 425-R (Internal/External Audit Form for ADTMC). . Provides changes to the narratives that accompany the following algorithms: SORE THROAT, A-1 EAR PAIN/DISCOMFORT/DRAINAGE, A-2 SINUS PROBLEMS/PAIN, A-4 RINGING IN THE EARS (TINNITUS), A-8 EXTREMITY PAIN NOT ASSOCIATED WITH A JOINT, B-3 NAUSEA/VOMITING/DIARRHEA, C-1 RECTAL PAIN/ITCHING/BLEEDING, C-3 CONSTIPATION, C-4 CHEST PAIN, D-2 DIZZINESS/FAINTNESS/BLACKOUT, F- 1 NUMBNESS/TINGLING, F-3 PARALYSIS/WEAKNESS, F-4 FATIGUE, G-1 MEDCOM Pam 40-7-21 FEVER/CHILLS, G-2 ACNE, J-2 SHAVING PROBLEM--PSEUDOFOLLICULITIS BARBAE (PFB) (INGROWN HAIRS), J-3 DANDRUFF (SCALING OF THE SCALP), J-4 HAIR LOSS, J-5 ATHLETE’S FOOT (TINEA PEDIS), J-6 JOCK ITCH (TINEA CRURIS), J-7 SCALING, DEPIGMENTED SPOTS ON THE CHEST, BACK, AND UPPER ARMS (TINEA VERSICOLOR), J-8 FEVER BLISTERS (COLD SORES), J-10 DRUG RASH, J-14 SUNBURN, K-8 . Contains changes in appendix B, List of Medications. . Adds constipation to list of terms defined in the glossary. 2 MEDCOM...
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...surgery. B. Medical Illnesses 4. Family History= 5. Allergies = 6. Current Meds 7. Prosthesis= Pacemaker, Hearing Aid, Dentures, False Eye, False Limb 8. ADL’S @ home….hygiene, bladder & bowel elimination, hygiene, activity level, diet habits. 9. Health Practices 10. Lifestyle Habits Vital Signs: Must be taken Height/Weight: Always take the pt’s weight on the hospital scale 1. Compare the weight with 2. Determine if See Guidelines of Wgt/Height measurement pg. 188. Before you begin your assessment, ask the pt how he/she feels? · Note any Signs & Symptoms = warning that something is wrong. A. sign= B. symptom = C. local sign= D. systemic sign = one that’s produced by the effect of disease on the whole body · Does the pt c/o any pain or discomfort? Where? · How much pain? · use Make your assessment give a mental picture of the patient: · don’t use critical or judgmental words · don’t use the words: Good or Bad, Well, or Normal · Instead describe why you think it’s normal, good, or bad! 4 Methods (Techniques) of Physical Assessment 1. Inspection = Purposeful Observation “Looking” for See Figure 12.1A; pg.186 Inspect from 2. Percussion = “striking” or tapping a part of the body & listening for the sound it makes. Mostly done See Table 12.1B; pg. 186 3. Palpation = lightly “touching” or applying pressure · See Figure 12-2 Noting the size, shape, mobility...
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...effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment, NIDDM or IDDM.Promotes incorporation of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Contraindications Hypersensitivity; severe chronic heart failure, bronchial asthma or related bronchospastic conditions; severe hepatic impairment. Adverse effects Bradycardia, AV...
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...DOI: 12/2/2015. Patient is a 41-year-old male yard helper who sustained an injury when he slipped and fell over a pipe. Per OMNI entry, he is status post L5-S1 fusion on 9/29/2016. Based on the medical report dated 12/22/16, the patient presents 3 months post operatively from a L5-S1 anterior lumbar interbody fusion. He reports that his back pain has been worse in the last 2 weeks. He is having lower back pain that is more constant and severe. The numbness on his left leg is back and it happens in the mornings when he wakes up, but as the day goes by, the numbness goes away. He is still taking Percocet and is also doing muscle relaxers. Standing and sitting for prolonged time increases his symptoms. He is still wearing his back brace. He rates his pain level at 8/10....
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